1. Implementing a Validated Peristomal
Skin Assessment Instrument into
Clinical Practice to Facilitate the
Provision of Optimal Ostomy Care
Mario Antonini, MS, ET
Rehabilitation Center for Ostomy and Wound Care - San Giuseppe Hospital
Empoli, Italy
SC-000238-IT
Symposium and speaker sponsored by ConvaTec

3. The rehabilitation of people
living with an ostomy depends
mainly on the integrity of their
peristomal skin.
Maintaining a healthy
peristomal skin is therefore,
the main objective of any
healthcare professional that
manages ostomates.

4. STOMATHERAPY IN ITALY: Panoramic
THE STOMATHERAPY IN ITALY
• N. of ostomy patients: 60.000 (Source:
FAIS - Italian Ostomy Patients Association)
• New Procedures/year: 16.000 – 17.000
• N. of ET Centers: 120
• N. of ET Nurses : 300
Ostomy patients in Italy
44,87%
Nord Italia
33,78%
Centro Italia
21,35%
Sud Italia

5. THE SACS STUDY: Review of the Literature
Need for a shared
Peer-to-Peer and recognized
discussion classification
Review of
the
Literature
Peristomal
Lesions
(Dermatologist)

6. THE SACS STUDY: Review of the Literature
The literature often classifies peristomal
skin complications by early or late
presentations.
Among those, what is described as “skin
irritation” has the higher incidence rate.
According to Colwell et al. the incidence
rate is between 18% and 55%.

7. THE SACS STUDY: Review of the Literature
Type of Ostomy
According to my
esperience,
33% approximately 1/3 of
67% Colostomates and 2/3
of Ileo-Urostomates
suffer from at least
one peristomal lesion.
Colostomy Ileo-Urostomy

8. THE SACS STUDY: Review of the Literature
1. Number of participants in
each phase of the analysis.
Incidence of complications
of the stoma and peristomal 2. Different length of the
skin among individuals with studies.
colostomy, ileostomy, and
urostomy: a systematic
review. Salvadalena G.
Journal Wound Ostomy 3. No definitions of skin
Continence Nurs. 2008 Nov- disorders.
Dec;35(6):596-607; quiz 608-9.
4. No description of the
assessment of the skin
lesions.

9. THE SACS STUDY: Review of the Literature
RECOMMENDATION 9
Assess the stoma immediately post-operatively and the
stoma/peristomal skin condition with each appliance change
using a validated classification tool to monitor for
complications.
Level of Evidence = IV
RECOMMENDATION 10
Identify risk factors that influence stomal and peristomal
complications.
Level of Evidence = III
RECOMMENDATION 17
Assessment and follow-up by an Enterostomal Therapy Nurse
(ETN) are recommended for the client and family after ostomy
surgery to decrease psychological distress, promote optimal
quality of life and prevent complications.
Level of Evidence = IIb
RECOMMENDATION 18
Educate client and family members to recognize
complications affecting the stoma and peristomal skin.
Level of Evidence = IV

10. THE SACS STUDY: Objectives
DEFINITION OF THE
OBJECTIVE N.1: Assess and PARAMETERS FOR
classify peristomal skin disorders. THE RESEARCH:
The Study group agreed
on not taking into
consideration:
OBJECTIVE N.2: Evaluate the - The etiology of the
correlation between blood peristomal skin
chemistry and severity of disorders
peristomal lesions. - the therapeutical
treatment
OBJECTIVE N.3: Diagnosis and
treatment of peristomal skin FUTURE STEPS
disorders.

11. End of
the
SACS
Study
OSTOMY CLASSIFICATION
CENTERS OF THE
• Rome PERISTOMAL
SKIN DISORDERS
• Catania
• Messina February 2006
• Turin 2005
2004
December OSTOMY June/July
2003 CENTERS 2006
• Bozen
Beginning of • Prato
the SACS • Empoli
Study

12. Ostomy Patient
ENROLLMENT
2* END POINT of the
S.A.C.S. SACS Study
Study
Group 1 Group 2
< 1 year > 1 year
ASSESSMENT
• General Evaluation
Time frames • Blood Chemistry
(0, 4, 12, 24 weeks) • Pictures
REGISTRATION
Consensus Data Analysis with SPSS
Conference software
Classification of Peristomal Skin Disorders

13. THE SACS STUDY: Results
656 PATIENTS ENROLLED
• 380 (group 1 < 1 yr)
• 276 (group 2 > 1 yr))

14. THE SACS STUDY: Results

15. THE SACS STUDY: Definitions
PERISTOMAL AREA:
The term “peristomal” is
meant to include the
whole skin around the
stoma (within 7,5 cm,
which is the maximum
size of the skin barriers
available in the market),
7,5 cm 7,5 cm
even if it is not directly
linked with the stoma.

16. THE SACS STUDY: Definitions
THE PREDOMINANT SIGN:
It was decided that the
classification should always
refer to the most sever
lesion first. Additional
lesser lesions can also be
classified as an option to
conform to local practice.
In general, the
classification should
include only one “L” and
one or more “T”.

17. THE SACS STUDY: Classification
LESION (L) SACS CLASSIFICATION
L1
HYPEREMIC LESION
Peristomal redness with
intact skin.

18. THE SACS STUDY: Classification
LESION (L) SACS CLASSIFICATION
L2
EROSIVE LESION
Open lesion NOT extending
into subcutaneous tissue;
partial thickness skin loss.

19. THE SACS STUDY: Classification
LESION (L) SACS CLASSIFICATION
L3
ULCERATIVE LESION
Open lesion extending into
subcutaneous tissue and
below; full thickness skin
loss.

20. THE SACS STUDY: Classification
LESION (L) SACS CLASSIFICATION
L4
ULCERATIVE LESION
Full thickness skin loss with
non-viable, dead tissue
(necrotic, fibrinous).

21. THE SACS STUDY: Classification
LESION (L) SACS CLASSIFICATION
LX
PROLIFERATIVE LESION
Abnormal growths present
(i.e. hyperplasia,
granulomas, neoplasms)

22. THE SACS STUDY: Topography
TOPOGRAPHY (T)
Patient standing in front of the HCP
- I = Upper Left Quadrant
- II = Upper Right Quadrant
-III = Lower Right Quadrant
- IV = Lower Left Quadrant
- V = All the Quadrants
Perspective of the HCP
The order of the quadrants around the stoma
starts in the Upper Left corner (TI) and ends in the
Lower Left corner (TIV) clockwise.

23. THE SACS STUDY: One Instrument, two approaches
TI TII TIV TI
TV TV
TIV TIII TIII TII

24. THE SACS STUDY: Example Of Classification
MOST SEVERE LESION
L3
Open lesion extending into
subcutaneous tissue
TOPOGRAPHY
TIII - IV
(Quadrants III and IV)
CLASSIFICATION
L3, TIII-IV

25. THE SACS STUDY: In Europe
Requests of further info
about the study
Requests of partecipation
in the study
Translation in many other
languages

26. THE SACS STUDY: In Italy
• Nursing Management of Peristomal Lesions
Education & Training for Nurses • Tissue Repair and Ostomy Training Sessions
• University Training Courses
Insertion in Hospital Protocols • ET Centers involved
• Hospitals in Central & Northern Italy
• ConvaBase
Tools to facilitate the use of the Classification • Brochure & Ruler

27. THE SACS STUDY: San Giuseppe Hospital –
Empoli (Italy)

28. THE SACS STUDY: Useful Tools
BROCHURE
RULER
SOFTWARE
(CONVABASE)
BADGE

29. "Helm, full ahead," she orders. "Let's see what's on the other
side." Like another explorer centuries before her, who stood on the
brink of an equal adventure, her eyes blur with tears even as she
laughs, the reason for either response a mystery to her, rooted deep
in that which makes her human.
For even here, even now, the adventure is still just beginning ....
JUDITH AND GARFIELD REEVES-STEVENS
“Timone avanti tutta,” ordina. “Vediamo cosa c’è dall’altra parte.”
Come un altro esploratore vissuto secoli prima della sua epoca,
all’inizio di una identica avventura, I suoi occhi si velano di lacrime
mentre ride; la ragione di entrambe quelle reazioni rimane un
mistero per lei, per quanto sia radicata in profondità in ciò che la
rende umana.
Poichè perfino qui, perfino adesso, l’avventura non è che
all’inizio…
JUDITH AND GARFIELD REEVES-STEVENS

30. Authors:
• Mario Antonini
• Giovanna Bosio
• Luigi Lucibello
• Francesco Pisani
• Antonino Fonti
• M. Assunta Scrocca
• Gaetano Militello
• Christa Morandell GRAZIE per
• Laura Anselmi
• Stefano Gasperini l’attenzione!
• Diego Mastronicola