"Pressure vs. Moisture - Wounds that Fall Between the Cracks"

Accurate identification of wound etiology is of utmost importance in both clinical practice and research. Given the Centers for Medicare and Medicaid Services’ directive to identify and track Stage III and Stage IV pressure ulcers upon admission to health care agencies, all levels of healthcare need to identify and classify wounds accurately and consistently.

One of the most controversial lesions is the linear lesion that develops between the buttocks. The linear lesion starts as a slit or fissure along the inter gluteal cleft. The lesion width ranges from 0.1cm to 1.0cm and the length and depth varies.  After surveying our colleagues, we found there is no consensus regarding the etiology of this wound.  Is the wound due to moisture, friction and shear, or pressure? If the lesion is due to a combination of factors and the wound is located over a bony prominence, is it classified as a pressure ulcer?

To validate the problem, a basic survey using ten photos and four response choices was developed and placed on the website Survey Monkey. The four response choices were: pressure, moisture, skin tear, and incontinence associated dermatitis. A message was sent via the Wound Ostomy Continence (WOC) Wound Forum and the WOC Iowa Affiliate email system requesting input from WOC colleagues.

In summary, the survey revealed the inconsistent classification of these lesions. The European Pressure Ulcer Advisory Panel has made a statement to distinguish the difference between a pressure ulcer and moisture lesion. The National Pressure Ulcer Advisory Panel does not differentiate a lesion caused by moisture. The purpose of this poster is to recognize the controversy of lesion etiology and to propose action to address the classification system quandary.