A Wound Care “View” to Promote Health Equity: Using Long Wave Infrared Thermography (LWIT)

Introduction: Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.1 The objective was to provide wound ostomy and continence (WOC) nurse assessments and education at a health fair for the inner-city community’s homeless, indigent, and non-English-speaking population.Methods:Physicians, nurses, and interpreters were volunteers. The WOC nurse station used a Doppler pulse and LWIT during assessments. The LWIT device provided a visual and thermal image for relative temperature differential (RTD) to assess metabolic activity below the skin; warm indicates inflammation/infection, and coolness indicates decreased perfusion. Scheduled 5 hours after a Spanish-speaking mass and before a free hot meal.  Stations were set up for initial screening, vitals, glucose testing, and miscellaneous exams.  The WOC nurse attended to clients with diabetes, edema, or skin/wound issues identified during screening.  Consent was obtained before imaging, and immediate education was provided.Results:Several health concerns were identified, including: Case A: 65-year-old male with COPD, no treatment for diabetes.  LWIT shows inflammation on the planter foot; previous research states asymmetrical temperatures over 2.2 ˚C may indicate a risk of diabetic foot ulcer (DFU)2. Educated on possible pressure leading to ulceration, proper shoes, offloading, foot inspection, and care.  Case B: A diabetic patient with a history of stroke and toe amputation is planning bunion surgery due to ill-fitting shoes. The Doppler and LWIT revealed decreased perfusion; he was educated on the significance of blood flow for healing and advised to discuss options with his physician before surgery. Case C: A 59-year-old male in a wheelchair with diabetes (359 glucose) wearing loose-fitting slippers; LWIT image discovered poor toe perfusion. Educated on the importance of protecting feet and toes to avoid injury, followed by healing challenges. Case D: A 60-year-old female with a blood clot disorder and back pain; ankle inflammation on the LWIT image confirmed known arthritis.  The client asked, “Could this be the reason for my numb leg?”  She was cautioned about the risk of all injuries and advised to discuss numbness with her physician.     Discussion: LIWT did visualize unknown health concerns, followed by education.References:1. What is Health Equity? Center for Disease Control and Prevention. Found online at https://www.cdc.gov/healthequity/whatis/index.html 2. Armstrong D, Holtz-Neiderer K, Wendel C, Mohler J, Kimbriel H, Lavery L. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am J Med. 2007;120(12):1042–1046.