Asian Journal of Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 3 No. 10
October, 2024
The Effect of Sigprocare HoCl 0.01% on
TIME Management (Tissue Management, Inflammation Control, Moisture Balance,
Epithelial Edge) of Diabetic Mellitus Ulcer in Bukittinggi West Sumatra Province, Indonesia 2024
Wenny Lazdia1*, Faridah Mohd Said2,
Nisha Nambiar3, Wiwit Febrina4
Lincoln University College, Malaysia123
Universitas Fort De Kock, Indonesia4
Email: w3nnylazdia@gmail.com
Abstract
Diabetes mellitus is a chronic disease caused by high levels
of glucose in the blood, as well as accompanying metabolic disorders. One of
the main factors causing diabetes mellitus wounds is lifestyle, including the
consumption of high-sugar foods. This research aims to determine the effect of
using Sigprocare HOCl 0.01% on the wound healing process of diabetes mellitus
in Bukittinggi City. The method used was quantitative research with a
Quasi-Experimental design and a One Group Pretest-Posttest approach. The
population in this research were all patients with indications of diabetes
mellitus wounds in Bukittinggi City, and the research was conducted from
February to June 2024. The research sample amounted to 10 respondents who were
selected purposively. Data were analyzed univariately and bivariately using the
BWAT (Bates-Jensen Wound Assessment Tool) observation sheet and wound care SOP
with Sigprocare HOCl 0.01%. The results of univariate analysis showed that the
average diabetes mellitus wound score before Sigprocare HOCl 0.01% was 35.3,
and after treatment the average dropped to 25.7. The results of bivariate
analysis showed a significant effect of using Sigprocare HOCl 0.01% in the
wound healing process of diabetes mellitus with a P value (0.000) ≤ α (0.05). The implication of this research
shows that Sigprocare HOCl 0.01% is effective in helping the healing process of
diabetes mellitus wounds, so it is hoped that respondents can apply its use and
maintain wound hygiene to accelerate recovery.
Keywords: Diabetes Mellitus, Wound Healing,
Sigprocare HOCl 0.01%.
INTRODUCTION
Diabetes
mellitus is a disease that causes death in the world (Tao et al., 2024). Diabetes mellitus
is a chronic disease caused by high blood sugar levels, which is accompanied by
metabolic disorders (Pikula et al., 2024).
According
to data from the World Health Organization (WHO) 2016 shows 70% of the total
deaths in the world, which is around 425 people and more than half of the
disease burden is caused by diabetes. As much as 90% - 95% of the incidence of
diabetes is type 2 diabetes, while cases of type 2 diabetes are preventable.
According to the International of Diabetic Federation that there has been an
increase in cases of Diabetes Mellitus in the world from 2017 there was an
increase in cases of Diabetes Mellitus to 425 million cases, the global
prevalence rate of people with diabetes mellitus in Southeast Asia in 2017 was
8.5%.
The results
of the 2018 Basic Health Research (Riskesdas) nationally showed that the
prevalence of diabetes mellitus was 2.0%, increasing from 1.5% in 2013 to 2.0%
in 2018. The prevalence of diabetes mellitus based on blood sugar measurements
in the population aged ≥15 years who live in urban areas is 10.6% (Fabiana Meijon Fadul, 2019).
Almost all
provinces in Indonesia experienced an increase in Diabetes Mellitus cases. The
4 provinces with the largest increase in prevalence were DKI Jakarta (3.4%), DI
Yogyakarta (3.1%), East Kalimantan (3.1%), and North Sulawesi (2.6%) while the
provinces with the highest prevalence of 0.9% were Riau, DKI Jakarta, Banten,
Gorontalo and West Papua. According to the Consensus (2018) the prevalence of
Diabetes Mellitus in the population aged ≥ 15 years is 10.9%. West
Sumatra has a DM prevalence of 1.13% in 2018, where West Sumatra is ranked 21st
out of 34 provinces in Indonesia (Indonesian Ministry of Health, 2018). According to the West Sumatra Provincial
Health Office (2018), the number of DM cases in West Sumatra in 2018 was 37,063
cases (Handaya, 2016). Bukittinggi City
is one of the cities in West Sumatra Province.
The
prevalence of Diabates Mellitus in Bukittinggi City ranks 9th out of 19 cities
/ districts in West Sumatra where the first order is Pariaman, Padang Panjang,
Padang, Sawahlunto, Padang Pariaman, Payakumbuh, Tanah Datar, and Dharmasyara (Handaya, 2016).
Patients
with diabetes mellitus can experience several complications together or there
is one dominating problem, which includes vascular disorders, diabetic
retinopathy, diabetic neuropathy and diabetic ulcers (Simamora et al., 2020). Wounds can be
optimally resolved if wound management is done properly. Some of the methods
used in diabetes mellitus wound care include wound cleansing, debridement, and
dressing (Adquisiciones et al., 2019).
Things that
must be considered in wound healing are tissue, which will be debrided if the
tissue is non-viable, infection, which is managed with bacterial control,
moisture balance by managing exudate and choosing the right dressing, and edge
advancement (TIME) (Wintoko & Yadika, 2020). TIME consists of various strategies that can
be performed on various types of wounds. This method aims to prepare the wound
bed from infection, foreign bodies, or dead tissue to bright red with a good
epithelialization process.
One of the
basic components in wound management is wound washing. In diabetes mellitus
wounds with biofilms, the 3M procedure is carried out by washing, removing dead
tissue, and changing the dressing (Nurlany et al., 2021). One antiseptic
liquid that can be used as a solution for wound washing is sigprocare HOCl
0.01%. Sigprocare HOCl 0.01% is a series of sanitizing products containing
Hypochlorous Acid (HOCl) where this content is a natural germ-killing substance
produced by neutrophils, white blood cells that help fight germs that enter the
body and hypochlorous acid does not cause the skin to become dry and irritated.
The
advantage of sigprocare is that the hypochlorous acid content is only 0.01% and
it will not cause trauma, is environmentally friendly and does not cause
delayed healing of the wound. In addition, sigprocare can also be used to
compress wounds or infections and reduce infection faster because HOCl is a
microbial that can be used for the wound, and can remove biofilm. Sigprocare
can be given to all wound conditions such as accident wounds, burns, diabetic
wounds, and other types of wounds.
Based on
research the application of diabetes mellitus wound care with hypochlorous acid
at the pucangsawit health center, it was found that wound care carried out as
many as 3x treatments with hypochlorous acid can reduce and reduce the risk of
infection in the wound (Mahendra, 2022).
Based on
the above background, the purpose of this research is to analyze the effect of
using Sigprocare HOCl 0.01% in the wound healing process of diabetes mellitus
in Bukittinggi City. The benefit of this
research is to provide empirical evidence regarding the effectiveness of
Sigprocare HOCl 0.01% in diabetes mellitus wound care, so that it can be a
reference for medical personnel in applying more effective and environmentally
friendly wound care methods. In addition, the results of this research are expected
to provide guidance for patients and families regarding proper management of
diabetic wound care, and contribute to the development of diabetic wound
therapy in the health sector.
RESEARCH METHOD
This research uses quantitative methods with
quasi-experimentation using an approach with One Group Pretest-posttest Design
without Control Group. This research was conducted in Bukittinggi City in
February-June 2024. The population in this research were patients who indicated
diabetes mellitus in Bukittinggi City in 2024. The sample in this research were
10 people without a control group. These 10 respondents were given diabetes
mellitus wound washing with sigprocare HOCl 0.01% for 6x within 14 days and measured
by BWAT (Bates-Jensen Assessment Tools) sheet.
RESULT AND DISCUSSION
Table 1. Frequency
distribution of respondent characteristics
|
Characteristics |
f |
% |
|
Gender |
|
|
|
Male |
5 |
50 |
|
Female |
5 |
50 |
|
Age |
|
|
|
Pre-elderly (45-59 years) |
4 |
40 |
|
Elderly (≥60 years) |
6 |
60 |
From table 1, it can be seen that of the 10 respondents,
half were male, namely 5 people (50%) and half were female, namely 5 people
(50%). In terms of age, most respondents were in the elderly age category with
a total of 6 people (60%).
Univariate
Analysis
Table 2. Average
wound healing
diabetes mellitus before being given sigprocare HOCl
0.01%
|
Variable |
N |
Mean |
SD |
Min-Max |
|
Before given
sigprocare HOCl 0.01% |
10 |
35,3 |
7,088 |
27-46 |
From table 2, it can be seen that the average wound healing of diabetes mellitus before
being given 0.01% HOCl sigprocare is 35.3 with a standard deviation of
7.088 and a minimum value of 27 and a maximum value of 46.
Table 3. Average
wound healing in diabetes mellitus
after being given 0.01% HOCl sigprocare
|
Variable |
N |
Mean |
SD |
Min-Max |
|
After being given
sigprocare HOCl 0.01% |
10 |
25,7 |
6,584 |
17-38 |
From table 3, it can be
seen that the average wound healing of diabetes mellitus after being given
0.01% HOCl sigprocare is 25.7 with a standard deviation of 6.584 and a minimum
value of 17 and a maximum value of 38.
Bivariate Analysis
Table 4. Normality
test results of mean healing
diabetes mellitus wounds before and after administration
of sigprocare HOCl 0.01%
|
Treatment |
Pvalue |
Keterangan |
|
Before given
sigprocare HOCl 0.01% |
0,267 |
Normal |
|
After being given
sigprocare HOCl 0.01% |
0,471 |
Normal |
The normality test results
for the average data of diabetes mellitus wound healing before being given
sigprocare HOCl 0.01% obtained Pvalue
(Shapiro-Wilk) = 0.267 > α (0.05)
(Normal Data) and Pvalue (Shapiro-Wilk) after being given sigprocare HOCl 0.01% =
0.471 > α (0.05) (Normal Data). Due to the normal distribution of
the two data, the appropriate further test to test the average difference in diabetes
mellitus wound healing before and after being given sigprocare HOCl 0.01% is
the Paired Samples T-Test.
Table 5. Mean difference in wound healing in diabetes mellitus
before and after being given 0.01% HOCl sigprocare
|
Treatment |
N |
Mean |
SD |
Pvalue |
|
Before given
sigprocare HOCl 0.01% |
10 |
35,3 |
7,088 |
0,000 |
|
After being given
sigprocare HOCl 0.01% |
10 |
25,7 |
6,584 |
0,000 |
Based on table 5, it is
concluded that the research of 10 respondents obtained the average wound healing of diabetes mellitus before
being given sigprocare HOCl 0.01%, namely 35.3 with a standard deviation
of 7.088 and the average wound healing
of diabetes mellitus after being given sigprocare HOCl 0.01%, namely
25.7 with a standard deviation of 6.584.
The results of the analysis using the Paired Samples T-Test test to analyze
the difference in the average wound healing of
diabetes mellitus before and after being given sigprocare HOCl 0.01% obtained
Pvalue (0.000) ≤ α (0.05)
(Ho rejected). This means that there is a
difference in the average wound healing of diabetes
mellitus before and after being given sigprocare HOCl 0.01% in Bukittinggi City.
Univariate
Analysis
Mean
diabetic wound healing before administration of sigprocare HOCl 0.01%
The results showed that the average wound healing score
of respondents before being given sigprocare HOCl 0.01% was 35.3 with a
standard deviation of 7.088 and the lowest score before intervening was 27 and
the highest was 46.
People with diabetes tend to have a more difficult time
healing wounds compared to other wounds. Like acute wounds, acute wounds will
heal normally through the healing process over a period of time until integrity
and anatomy are restored. For example, wounds that occur due to trauma to
organs or tissues. Therefore, the healing process of diabetic wounds takes a
long time and is not perfect. (Nurlany et al., 2021).
This is in line with research by (KIRANI, 2023) which conveys wound healing with hypochlorous acid in
patients with diabetes mellitus is very effective for killing germs around the
wound and shows that wound healing with hypochlorous acid is proven to be
faster.
This research is in line with research conducted by (Roos, 2022) However, there
are numerous studies supporting the effectiveness of hypochlorous acid (HOCl)
in wound management, particularly in diabetic patients. For example, research
shows that HOCl is effective in reducing bacterial biofilms and promoting
faster wound healing, especially in diabetic foot ulcers. This solution, when
applied consistently, has been shown to significantly reduce infection rates
and improve wound healing outcomes.
The researcher's assumption is that the age factor is
very influential on wound healing (Jalilian et al., 2020). If the patient is elderly, the healing will take longer
than at a young age. In patients with diabetes mellitus, the healing will be
longer and it is not certain that it can heal completely, in contrast to other
wounds such as accidents, the healing will be faster. The dominant wound
healing of respondents has reached the stage of lysing the epidermis and / or
dermis layers and there are respondents who have reached the stage of the
entire skin layer being lost with extensive deconstruction, damage to muscle
and bone tissue. And there are also respondents who have reached the stage of
epithelialization.
Wound healing in diabetes mellitus can be influenced by
daily nutrition and blood sugar levels. In patients with diabetes mellitus to
accelerate the wound healing process, it is necessary for patients to pay
attention to nutrition during wound care, namely protein, because it can help
repair damaged skin tissue and other body tissues.
Mean diabetic wound healing after
administration of sigprocare HOCl 0.01%
The results
showed that the average wound healing score of respondents after being given
sigprocare HOCl 0.01% was 25.7 with a standard deviation of 6.584, and the
lowest score was 17 and the highest was 38.
According
to (Sari & Sari, 2020), the wound healing
process takes place when the removal and disposal of necrotic tissue is
successful. Sigprocare HOCl 0.01% is very effective if used in research,
because in addition to being environmentally friendly, sigprocare HOCl 0.01%
has moist/moist properties that are very good for wound healing.
This is in
line with the research of (Sakarya et al., 2014) showing that there
is an effect of hypochlorous acid or the content of sigprocare HOCl on wound
care. The same research was conducted that hypochlorous acid has an effect in
accelerating wound healing in patients with diabetic foot wounds in the Gombong
Health Center area (Nurbaya et al., 2018).
According
to the researcher's assumption from what has been discussed previously,
Sigprocare HOCl 0.01% has proven to be effective in the treatment of diabetes
mellitus wounds. Where from the results of several studies there is removal of
necrotic tissue, exudate in the wound, epithelialization and granulation. This
can be measured by the BWAT (Bates-Jensen Wound Assessment) format. The BWAT
sheet can be used to assess or measure wound healing. And the more often the
implementation of wound care is carried out, the severity of diabetes mellitus
wounds decreases, causing respondents' satisfaction to increase with the
administration of sigprocare HOCl 0.01%. If the respondent is satisfied with
the wound care provided by sigprocare HOCl on diabetes mellitus wounds, the
respondent will use sigprocare HOCl 0.01% again and recommend it to others or
those with diabetes mellitus related to the satisfaction that has been felt
during the researcher's research.
The process
of implementing wound care using sigprocare HOCl 0.01% can be done in several
ways, namely, sprayed into the wound and compressed into the wound. Wound
dressing changes can be made depending on the condition of the wound and the
comfort of the respondent.
Bivariate Analysis
Effect of Sigrpocare HOCl 0.01% on
diabetes mellitus wound healing
The results
showed that the average wound healing score of respondents before being given
sigprocare HOCl was 35.3 and the average wound healing score of respondents
after 6 times given sigprocare was 25.7. There is a difference in the average
wound healing score of respondents between before and after sigrpocare HOCl
0.01% obtained Pvalue
(0.000) ≤ α (0.05) (Ho rejected). This means that
there is a difference in the average wound healing of
diabetes mellitus before and after being given sigprocare HOCl 0.01% in
Bukittinggi City.
Healing of
diabetic wounds if they are large enough and occur for a long time may require
a wound cleansing action, by cleaning the wound, dead tissue will be removed so
that new tissue will develop and help wound healing and maintain wound hygiene.
There are several methods used in diabetes mellitus wound care including
debridement, dressing and cleansing. The current wound care method is using the
TIME principle which consists of various strategies that can be performed on
diabetes mellitus wounds to optimize wound healing. Where T tissue
management (removing dead tissue in the wound), I inflammation or infection
control (protecting or repairing damage to the wound) such as the presence of
purulent, increasing and smelly discharge, M moisture balance (maintaining
moisture in the wound) and E epithelialization (wound closure process) (Colin & Listiana, 2022).
This research is in line with research
conducted by Maria et al (2019) that there is a wound healing process by
administering hypochlorous acid and administering 0.9% NaCl in diabetes
mellitus wound healing, the results of wound healing were 60% (9 respondents)
with hypochlorous acid and wound healing as much as 40% (6 respondents) with
NaCl administration (Nontji et al., 2021).
Healing of
diabetic wounds if they are large enough and occur for a long time may require
a wound cleansing action, with wound cleansing, dead tissue will be removed so
that new tissue will develop and help wound healing and maintain wound hygiene.
According
to the researcher's assumption, the effect of sigprocare HOCl 0.01% which
contains hypochlorous acid in healing diabetes mellitus wounds is due to a
decrease in the rereta score before and after being given sigprocare HOCl 0.01%
is 35.3 to 25.7. The decrease in the degree of diabetes mellitus wounds is
caused by the administration of sigrocare HOCl 0.01% because HOCl is a
microbial that can be used for these wounds and can remove biofilm. Sigprocare
HOCl 0.01% contains hypochlorou acid which can accelerate wound healing because
it functions to kill athigen microbes such as bacteria, viruses, spores and
fungi when the body is exposed to infection. In addition, the speed of wound
healing is also influenced by age and wound width. Respondents with younger
ages will experience faster wound healing than elderly respondents. This is
because the cells owned by respondents with young age are more active in
dividing and regenerating so that the wound healing process takes place faster
than respondents with older ages, especially the elderly. In addition, the
width of the wound also affects the speed of wound healing. The wider the
wound, the more cells are needed to regenerate the wound and it takes longer to
heal.
The administration of sigprocare HOCl 0.01% on
diabetes mellitus wound healing has an effect on diabetes mellitus wound
healing, it can be seen that there is a decrease in scores on BWAT sheets such
as wound depth, wound edge color, exudate amount, necrotic amount. Wound
healing with 0.01% HOCl sigprocare not only affects diabetes mellitus wounds
but can also be used on other wounds such as burns, accident wounds.
CONCLUSION
Based
on the results of research conducted on 10 respondents, it can be concluded
that the use of Sigprocare HOCl 0.01% has a significant effect in accelerating
the healing of diabetes mellitus wounds in Bukittinggi City. The average wound
size before Sigprocare HOCl 0.01% was 35.3 with a standard deviation of 7.088,
and after treatment, the wound size decreased to an average of 25.7 with a
standard deviation of 6.584. This is evidenced by a p value of 0.000 which is
smaller than α 0.05, indicating a significant effect
of Sigprocare on wound healing. This research makes an important contribution
to the future, especially in the development of diabetic wound care therapy.
The use of Sigprocare HOCl 0.01% can be more widely adopted as an effective and
environmentally friendly wound care alternative, especially in the management
of chronic non-healing wounds such as those in patients with diabetes mellitus.
Further research can explore the optimal dose, the most effective treatment
duration, as well as the application of Sigprocare HOCl on a larger population
scale. In addition, future research could examine the application of Sigprocare
in other types of wounds or diseases, and evaluate its long-term effects on
patients' quality of life.
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Copyright holders:
Wenny Lazdia, Faridah Mohd Said, Nisha Nambiar, Wiwit Febrina (2024)
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AJHS -
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