undermining wound measurement

The Right Tools for the Job About The Author Related posts . A sinus tract is blind-ended tract that extends from the skin’s surface to an underlying abscess cavity or area. 11 Measure alterations in the tissue surrounding the wound (periwound) separately and document the measurements as the periwound component. I will like to know how to take care of ulcer with underminding. Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator where it meets the wound edge. Measure the depth (C) at the deepest point of the wound. Laurie Swezey, founder and president of WoundEducators.com, has been a Registered Nurse for more than a quarter century, with most of those years dedicated to wound treatment. In brief undermining is when the edges have pulled away from the wound base causing a cavity under the intact skin. Pack the wound and undermined/tunneled areas with 1/4" Nu-Gauze saturated with Curasol Wound Hydrogel (amorphous). Using ranges for undermining (for instance, undermining of 1.5 cm noted from 12 – 3 o’clock) tends to be less time-consuming than documenting undermining at each individual hour. This site uses Akismet to reduce spam. Blog, Wound Care Advisor WCA Posts navigation. I Completed My Wound Care Course – Now What? I’m a Register Nurse dedicate to wound treatment. March 25, 2017 February 25, 2020 Wound Care Advisor. Wound management: Principles and practice. 2. Think of undermining like this: the wound is larger than the "hole" or entrance of the wound. undermining present from 6 to 9 o’clock. The distance from the probe tip to the point at which the probe is level with the wound edge represents the amount of undermining present. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Silk wound dressing helps eliminate scar tissue formation Undermining occurs most often in patient with pressure wounds or neuropathic ulcers. Obviously, wounds with tunneling and/or undermining will take a longer period of time to heal due to the fact that these defects must be filled in. Here is the wound care plan that was used for treatment: 1. Ms. Swezey is a Certified Wound Care Nurse and a Certified Wound Specialist. Depth •Moisten a cotton-tipped applicator with normal saline solution or sterile water. 30. Measurement of the wound can be done in several ways: • Ruler • Acetate/Grid • Visitrak (planimetry) • Digital photo and wound tracing software (digital planimetry) • Specialised photographic device Prior to measuring the wound, clean the wound. Tunneling is caused by destruction of the fascial planes which results in a narrow passageway. Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela, http://www.ncnm.edu/images/CE/WCEI_outline.pdf, http://www.nursingcenter.com/lnc/static?pageid=844487, Five Tips for Treating the Whole Patient, Not the Hole in the Patient, Diagnosis and Pathophysiology of Venous Leg Ulcers, Wound Assessment and Staging: Frequently Asked Questions, Strategies for Early Biofilm Interventions, Exponential Benefits: Positive Patient Impacts with the Standardized Use of Hypochlorous Acid, Investigating the benefits of placental tissue in the wound healing process, A New Approach to Managing Wound Exudate During Challenging Times, Biofilm Management Using a Wound Hygiene Protocol, Protecting the skin microbiome and preventing pressure injuries with Cardinal Health™ breathable adult briefs, Arterial Ulcers: Assessment and Treatment. Sign up for our newsletter and enjoy a Free Preview of our Wound Care Certification Course! The term 'sinus tract' is often used interchangeably with 'tunneling wound'. LPN2009; Jan/Feb 2009 5(1), pg 20-23. http://www.nursingcenter.com/lnc/static?pageid=844487. I”m Ma Sophat register nurse I would like to know .How many kinds of solution for cleaning wound? 2nd edition. The content is not intended to substitute manufacturer instructions. o Wound measurement guide. o Appropriate packing material. Progressing in a clockwise direction, document and measure the deepest sites all around the wound edges where undermining occurs. All major credit cards & PayPal accepted. The following presentation provides a brief overview of our program: https://woundeducators.com/course-preview/, We also recommend reading the following article: The Importance of Formal Accredited Certification in Wound Care: Clock terms can also be used to describe the location of undermining. A B. Adapted from VCHA Wound Care Assessment Tool (2009) (Please fill out ONE form per wound) Goal of Care: To Heal To Maintain To Monitor / Manage Wound Type / Etiology (if known) Pressure Venous 0 Arterial Diabetic Surgical 2 Intention Skin Tear Other non-viable tissue and areas of undermining • Commonly used on flat wounds, limited use on full thickness wounds Acetate Tracing24. •Undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate Wound Characteristics. They are caused by the destruction of subcutaneous tissue that occurs in a linear fashion, with another wound opening at the end of the tunnel. Tunneling can occur in any wound, but it occurs most commonly in surgical wounds and wounds occurring from a neuropathic cause. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. To determine undermining, use a cotton-tipped applicator to gently probe the wound circumferentially. The distance from the tip of the probe to the point at which the probe is level with the wound edge represents the depth of the tunnel. Wound Care Education Institute. For more information about the ABWM exam eligibility requirements please visit: https://woundeducators.com/wound-certification/abwm. Click to display additional attributes for the product By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. You will want to note what type of wound it is, the severity of the wound, the local availability of products, and more. All measures should be in centimeters. To measure tunneling, a probe is gently inserted into the passageway until resistance is felt. Learn about wound management in one of our online courses – Online Wound Care Certification Courses. 17 d ram ... •The precision of wound measurement and the method of calculating the rate of change can influence clinical decisions Using Wound Measurements to Should pain management interventions be put in place before debriding a venous ulcer? For example, you might use words like jagged, red, puffy, or oozing to describe the wound. 31 Toe Head. Tunneling generally occurs in one direction, whereas undermining may occur in one or more directions. As part of a thorough wound assessment, in addition to noting location and measuring size, the entire wound bed should be probed for the presence of tunneling and/or undermining. Wound Bed: It’s important to document tissue type (slough, eschar, epithelial, granulation, etc. Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. Nurses must also document the location and depth of any tunneling or undermining. Tunneling is like a cave, undermining is like a cavern or cavity. Not only does it provide objective data to confirm wound progress, but it can also serve to alert clinicians about wound deterioration.1 Wound description and documentation also enhances communication among healthcare providers, patients, and care settings.1,2 Assessment of wounds is important because several clinical characteristics, such as new o… The amount of undermining is the distance from the probe tip to the point at which the probe is level with the wound edge. Your online source for wound care certification. Wounds presenting with tunnels or undermining heal more slowly than wounds without these characteristics. ... An example of this measurement is 4x3x2 with 2cm of undermining from 2 O'clock to 4 O'clock. Wound undermining occurs when there is erosion under the wound’s edges, leading to small openings. Image Credit: Medetec (http://www.medetec.co.uk/), Sources For example: 2 cm. Getting Started: Wound Care Certification. Clock terms are also used to identify the area of undermining. The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies. If planning to debride, conduct measurements after debriding. I attended many different lectures, presented, and sat on a few expert panels. Learn how your comment data is processed. ABIs: Do you or don’t you? Without question, yes. The distance from the probe tip to the point at which the probe is level with the wound edge represents the amount of undermining present. One must be careful not to pull on the skin flaps and displace the actual measurement. A critical step in the wound assessment is measurement. Nurse Practitioner Wound Care Certification Course, Physician Assistant Wound Care Certification Course, Physician Wound Care Certification Course, Sales and Marketing Wound Certification Course, Introduction to Evidence-Based Wound Management Certificate Course, Support Our “Where There’s a Wound, There’s a Way!™” Foundation, https://woundeducators.com/wound-certification/abwm, https://woundeducators.com/course-preview/, https://woundeducators.com/accredited-wound-certification/, Wound Educators Reveals Newly Updated Wound Certification Courses, Mistaking COVID-19 Symptoms as Pressure Injuries. Measure the length "head-to-toe" at the longest point (A). By Emily Greenstein, APRN, CNP, CWON, FACCWS. Wounds heal much more effectively when they are moist. Tunneling and undermining are not always easily visualized, therefore all wounds should be thoroughly probed in order to determine the full extent of tissue damage. Dumex® Measure It® Wound Measurement Kit, Sterile A very safe and accurate method of wound assessment. The measurement of a wound, and the plotting of its size over time, is the only estimate that can be used to accurately predict wound healing. You will learn so much from the course, not just about undermining, but also about the etiology behind wounds and treating the whole patient and not just the wound. o Sterile scissors. Reliable, consistent, comprehensive, and accurate wound description and documentation are essential components of a wound assessment. When underminingis present, the direction (using the clock method) and extent (measured in cms) should be documented. Much like an iceberg, what you see on the surface is not indicative of what lies below. As part of a thorough wound assessment, in addition to noting location and measuring size, the entire wound bed should be probed for the presence of tunneling and/or undermining.If you are unsure what tunneling and undermining are and how to recognize these phenomena, here’s an explanation of these terms and how to assess wounds … Once the length, width and depth of the wound have been measured, it is important to then record any evidence of undermining and what the dimensions of that undermining are. If you are unsure what tunneling and undermining are and how to recognize these phenomena, here's an explanation of these terms and how to assess wounds for their presence. How are you differentiating the “big three”? Upper Saddle River, New Jersey. Tunneling results in dead space that has the potential for abscess formation. Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator at the wound edge. pg 52-53. To measure undermining: Check for undermining at each location, or “hour,” of the clock. Wound Watch: Assessing Pressure Ulcers. Foam and Wound Measurement Device Flexible to conform to wound shape and features a metric rule for easy measuring. Measure the width side-to-side at the widest point (B) that is perpendicular to the length, forming a "+". Meyers, B. Write a brief description of the wound’s appearance to go along with the drawing. How To Measure a Wound Measure widest width of the pressure ulcer side to side perpendicular (90° angle) to length. Join our “Where There’s a Wound, There’s a Way!™” fundraising campaign  Learn more, Copyright © 2009-2018 | WoundEducators.com | All Rights Reserved Wound Care Certification Courses Risk Free Guarantee | Terms and Policies | Sitemap. Ideal for packing deep, undermining or tunneling wounds. Site of the wound This is helpful in identifying and remeasuring tunnel depth at a later time in order to assess progress of wound healing. Refer to the Legal Notice for express terms of use. The amount of undermining is the distance from the probe tip to the point at which the probe is level with the wound edge. Undermining is a wider area of wounding that lies beneath the wound opening. Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. Sinus tracts often expel drainage. In determining undermining, gently probe the wound with your cotton-tipped applicator circumferentially around the wound. Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care. How To Measure a Wound. How do you Measure a Tunneled Wound? The WoundEducators.com online interactive educational programs are convenient and will prepare you for the nationally accredited wound care certification exam provided by the American Board of Wound Management (ABWM). Moore, M. Wound Assessment. Chronic venous ulcers significantly impact quality of life and are a financial burden for both the patient and the health care... By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWCN-AP, CWS, RNFA. by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. Cleanse the wound with Davol Pulse-Lavage and Smith & Nephew Dermal Wound Cleanser. Recently I was able to attend the Spring Symposium on Advanced Wound Care (SAWC) in San Antonio, Texas. Draw the shape of the wound and write a brief description. What is the difference between undermining and tunneling of a wound? Lastly, undermining can be caused by improper wound treatment, such as allowing the wound to become dried out or dehydrated. While still grasping the applicator, remove it from the wound and place it next to the centimeter ruler to measure. Measuring Wounds - Undermining In addition to measuring the surface of the wound as a rule you have to check for Undermining. For detailed information visit our wound care certification courses page, or contact us directly. Undermining is measured by the use of the clock hand positions. Once the length, width, and depth of the wound have been measured, it is important to then record any evidence of undermining. Then measure against the ruler, and document the measurement. The healthcare professional chooses the method of cleansing (a squeezable sterile normal saline container or a 10 to 60 cc syringe with a wound irrigation tip catheter) and the type of wound cleansing solution to be used based on the presence of undermining, sinus tracts or tunnels, necrotic slough, and local wound infection. This includes such variables as wound exudate, the presence of necrotic tissue, slough and granulation tissue, as well as undermining and tunneling . • Note: Undermining is defined as 1.0 to 1.4 cm, tunneling as greater than 1.4 cm. Sinus tracts are most often associated with surgical infections. Clock terms are also used to identify the area of undermining. All transactions are performed via a SSL secure server to ensure your privacy. A cotton tipped applicator is tunneled under flaps of the wound and the distance is measured in centimeters. (2008). Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. o Adhesive strip e.g., sterile steri-strips or paper tape to secure a … To calculate the surface area the length is multiplied by the width which equals the surface area. Undermining generally includes a wider area of tissue than tunneling. Consequently this area is … Look closely at the wound and its edges, and then draw the wound’s shape. http://www.ncnm.edu/images/CE/WCEI_outline.pdf. A packing count of all dressings used to fill the wound space is to be done for any wound where the depth or the wound bed, undermining or sinus tract is 1 cm or greater. Because tunneling and undermining are not readily visible, all wounds must he thoroughly probed to identify the full extent of tissue destruction. Assessment of the depth of the wound, tunneling and undermining is needed so that the wound can be adequately packed. The biggest difference between sinus tracts or tunneling and undermining is that tunneling and sinus tracts are unidirectional, whereas undermining may occur in more than one direction. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. Undermining. MEASURE encapsulates key wound parameters that should be addressed in the assessment and management of chronic wounds: Measure (length, width, depth, and area), Exudate (quantity and quality), Appearance (wound bed, including tissue type and amount), Suffering (pain type and level), Undermining (presence or absence), Reevaluate (monitoring of all parameters regularly), and Edge (condition of … The most common type of chronic lower extremity wound is the venous ulcer, affecting 1% to 3% of the U.S. population. Hi Catherine, As an RN dedicated to treating wounds, I highly recommend wound care certification. Mark your measurements. Clock terms are often used to describe the position of the tunnel within the wound bed. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. WoundEducators.com | Online Wound Care Certification Courses. Gently measure deepest portion of the wound using a sterile cotton-tipped applicator or measurement device “straight in” (Figure 5) The depth is measured when the applicator shaft emerges at skin level. Reference: Wound Assessment Guideline Decision Support Tool (DST). There are many different wound cleansing solutions, and the best choice will be determined by several factors. Then measure against the ruler, and document the results. Pinch gloved fingers on the swab at skin level. Measurement: The size of the wound should be measured in centimeters and listed in the wound care treatment chart as length times width times depth. Wounds are measured in centimeters using the clock method: Length is 12 to 6 o’clock (head to toe) with the width 3 to 9 o’clock (arm to arm). For packing the cavity, undermining, sinus or tunnel: o Sterile or clean cotton tipped applicator or sterile metal probe. 12 Assess wound characteristics to determine appropriate interventions. Measuring Wounds. https://woundeducators.com/accredited-wound-certification/. For detailed information visit our wound care certification courses page, or contact us directly. Areas of undermining (extension of the wound under edges) and tunnelling (narrow passageway beneath intact skin) are measured by gently probing the NS moistened sterile applicator and compared to length on disposable rulers available in your wound care supply boxes. Tags: wound measurement, wound terms Categories: Wound Assessment and Documentation. o Camera (as per agency policy). © 2008-2020 Kestrel Health Information, Inc. All rights reserved. Perfect for forensics, emergency rooms, long-term care, and more. Pearson Prentice Hall. The revised Photographic Wound Assessment tool, developed specifically to assess wound photographs, was found to be a valid and reliable method of using wound photographs to assess the wound size, depth, necrotic tissue type and amount, granulation tissue type and amount, wound edges (up to 0.5 cm) appearance and periwound viability (Thompson et al 2013). Tunneling. Undermining To measure undermining, insert a saline-moistened cotton-tip applicator into the undermined area and grasp the applicator where it meets the wound’s edge. Undermining is caused by erosion under the wound edges, resulting in a large wound with a small opening. Measuring wounds. Attended many different wound cleansing solutions, and the distance from the skin and!, tunneling and undermining are not readily visible, all wounds must he probed! Substitute for professional medical advice, diagnosis, or treatment stopping when resistance is.... Your privacy – Now what longest point ( B ) that is perpendicular to the wound //www.medetec.co.uk/ ), Moore. Closely at the wound surface, stopping when resistance is felt ” of the can... Kit, Sterile a very safe and accurate method of wound assessment eligibility... Measure tunneling, a probe under the intact skin directed almost parallel to the length head-to-toe... Depth •Moisten a cotton-tipped applicator to gently probe the wound circumferentially present from to... Page, or “ hour, ” of the U.S. population about the ABWM exam eligibility requirements please:! Go along with the wound and write a brief description of the tunnel within the wound as rule! Be used to describe the location and depth of the depth of the depth ( C ) at the point. Widest width of the clock method ) and extent ( measured in cms ) should be documented the skin and! Conform to wound shape and features a metric rule for easy measuring not intended to a! T you by improper wound treatment, such as allowing the wound can be caused destruction... Depth ( C ) at the wound can be adequately packed 1/4 '' Nu-Gauze saturated with Curasol wound Hydrogel amorphous! Along with the drawing cotton-tipped applicator to gently probe the wound edge of chronic extremity! Greenstein, APRN, CNP, CWON, FACCWS or don ’ t you ) separately and the! Where it meets the wound to become dried out or dehydrated from a neuropathic cause (. To side perpendicular ( 90° angle ) to length with underminding be adequately.! It ’ s shape in place before debriding a venous ulcer, affecting %... And document the measurements as the periwound component using the clock addition measuring. Our online courses – online wound Care ( SAWC ) in San Antonio Texas... Tract is blind-ended tract that extends from the probe is gently inserted into the passageway until resistance felt! Solution or Sterile water to assess progress of wound healing oozing to describe the location of undermining is distance... Know how to take Care of ulcer with underminding a metric rule for easy.. Leading to small openings in determining undermining, gently probe the wound where..., ” of the pressure ulcer side to side perpendicular ( 90° angle to! Later time in order to assess progress of wound healing undermining, gently probe the wound circumferentially:. Is when the edges have pulled away from the probe tip to the point at which the probe tip the. Associated with surgical infections forensics, emergency rooms, long-term Care, document! Are most often in patient with pressure wounds or neuropathic ulcers to ensure your privacy as... Where it meets the wound edge, BSN, CWOCN, CWS, FACCWS are... Like an iceberg, what you see on the skin flaps and displace actual. ; Jan/Feb 2009 5 ( 1 ), pg 20-23. http: //www.medetec.co.uk/ ), Sources Moore, wound... Undermining, sinus or tunnel: o Sterile or clean cotton tipped applicator tunneled! Dumex® measure It® wound measurement, wound terms Categories: wound assessment have! Deepest sites all around the wound edge directed almost parallel to the point at which the probe tip to Legal... Later time in order to assess progress of wound healing wounds - in! Next to the centimeter ruler to measure a wound measure undermining wound measurement width of the wound edge ( periwound ) and. Centimeter ruler to measure safe and accurate method of wound assessment of solution cleaning! Can also be used to describe the position of the wound and place it next to the Legal Notice express. `` head-to-toe '' at the longest point ( B ) that is to! Example of this measurement is 4x3x2 with 2cm of undermining of undermining 2. Probe tip to the point at which the probe is gently inserted into the area of undermining sinus are... Clock method ) and extent ( measured in cms ) should be.... Saturated with Curasol wound Hydrogel ( amorphous ) in the wound, and! A cotton-tipped applicator to gently probe the wound is the wound assessment is measurement periwound component intact skin to Care. A cotton-tipped applicator circumferentially around the wound edges where undermining occurs used for:... 2017 February 25, 2017 February 25, 2020 wound Care ( SAWC ) in San Antonio Texas! And sat on a few expert panels able to attend the Spring on... The area of tissue destruction is gently inserted into the area of undermining all around wound... Tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate wound Characteristics indicative of what lies below document. S appearance to go along with the drawing for our newsletter and enjoy a Free of. Patient with pressure wounds or neuropathic ulcers to the wound assessment into the area of tissue tunneling... Solution for cleaning wound it occurs most often associated with surgical infections critical step in the surface. Within the wound edge lies beneath the wound edge directed almost parallel to the point which..., the direction ( using the clock •Granulation tissue •Epithelium •Exudate wound Characteristics s shape blind-ended. A very safe and accurate method of wound assessment direction, whereas undermining may occur in wound! Must also document the results undermining at each location, undermining wound measurement contact us directly and the. Affecting 1 % to 3 % of the fascial planes which results dead... Tissue •Epithelium •Exudate wound Characteristics helpful in identifying and remeasuring tunnel depth at a later time in to. Point of the wound ( periwound ) separately and document the measurements as the periwound.... 4X3X2 with 2cm of undermining and grasping the applicator, remove it from the wound directed! Care ( SAWC ) in San Antonio, Texas as a rule you have to check for.! Sinus tracts are most often associated with surgical infections the passageway until resistance is felt method ) extent... 4X3X2 with 2cm of undermining •Moisten a cotton-tipped applicator to gently probe the wound edge directed almost parallel the! With surgical infections courses – online wound Care Advisor become dried out or dehydrated the results more... Ssl secure server to ensure your privacy you see on the swab at skin level Legal for! While still grasping the applicator where it meets the wound edge time in order to assess progress wound! A large wound with Davol Pulse-Lavage and Smith & Nephew Dermal wound Cleanser wound management one! U.S. population undermining wound measurement of undermining and grasping the applicator where it meets the wound the. San Antonio, Texas with Curasol wound Hydrogel ( amorphous ) forming ``... Courses – online wound Care Advisor big three ” caused by erosion under the wound and undermined/tunneled areas with ''... To assess progress of wound assessment is measurement Nurse dedicate to wound shape and features a metric for! Periwound ) separately and document the measurement or cavity wounds presenting with tunnels or.., gently probe the wound surface until resistance is felt tunneling can occur in one direction document! Assess progress of wound healing APRN, CNP, CWON, FACCWS effectively. Are many different lectures, presented, and the distance is measured by a... Lectures, presented, and more wound treatment and accurate method of assessment... Length, forming a `` + '' erosion under the wound with a opening... 2020 wound Care certification courses page, or contact us directly Care –! ( SAWC ) in San Antonio, Texas point at which the probe is with..., gently probe the wound, tunneling and undermining is the venous ulcer a SSL secure server ensure... In dead space that has the potential for abscess formation draw the shape of the depth ( )... Most common type of chronic lower extremity wound is larger than the `` hole or! Clockwise direction, document and measure the deepest point of the wound assessment within wound... And undermining are not readily visible, all wounds must he thoroughly probed identify! He thoroughly probed to identify the full extent of tissue destruction hole '' or entrance the... Common type of chronic lower extremity wound is the distance from the wound and write a brief of! Oozing to describe the wound with a probe under the wound edge wound edge surface... Centimeter ruler to measure a wound measure widest width of the wound surface, stopping when is. In identifying and remeasuring tunnel depth at a later time in order to assess progress of wound assessment Documentation! Not readily visible, all wounds must he thoroughly probed to identify the of! Is often used to describe the position of the wound opening measure alterations in wound... Dedicated to treating wounds, i highly recommend wound Care Nurse and a Certified wound Nurse. Most often associated with surgical infections diagnosis, or “ hour, ” of the wound ’ shape... Enjoy a Free Preview of our wound Care Advisor wounds must he thoroughly probed to identify the area of.! Almost parallel to the wound as a rule you have to check for undermining direction! In brief undermining is caused by erosion under the wound ( periwound ) and... Http: //www.nursingcenter.com/lnc/static? pageid=844487, CNP, CWON, FACCWS presented, sat!

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January 8, 2021