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Sample records for pressure ulcer

  1. Neonatal Pressure Ulcer Prevention.

    PubMed

    Scheans, Patricia

    2015-01-01

    The incidence of pressure ulcers in acutely ill infants and children ranges up to 27 percent in intensive care units, with a range of 16-19 percent in NICUs. Anatomic, physiologic, and developmental factors place ill and preterm newborns at risk for skin breakdown. Two case studies illustrate these factors, and best practices for pressure ulcer prevention are described.

  2. Classification of pressure ulcers.

    PubMed

    Yarkony, G M; Kirk, P M; Carlson, C; Roth, E J; Lovell, L; Heinemann, A; King, R; Lee, M Y; Betts, H B

    1990-09-01

    Several systems exist for classifying pressure ulcers, though none of them have been evaluated for interrater reliability. A new grading scale was compared with the commonly used Shea classification. This new scale was developed to provide a more complete description of pressure ulcer healing. The advantages of this scale include a classification of red areas as ulcers to help prevent further deterioration and classification of healed sores to note potential problems. The Yarkony-Kirk scale classifies a red area as a grade 1 ulcer, and involvement of the epidermis and dermis with no subcutaneous fat observed as a grade 2 ulcer. Grade 3 indicates exposed subcutaneous fat with no muscle observed. Exposed muscle without bone involvement is classified as a grade 4 ulcer, and grade 5 describes exposed bone with no joint space involvement. Grade 6 indicates joint space involvement. There is a classification of pressure sore healed to indicate a healed pressure ulcer. Interrater reliability was assessed by two nurses. In spite of an increased number of categories for the Yarkony-Kirk scale, there was no decline in reliability. Reliability was excellent with an interrater correlation of 0.90 for the Yarkony-Kirk scale and 0.86 for the Shea classification when measured for 72 patients. Eighty-five percent of the ratings for the Yarkony-Kirk scale were identical, whereas only 68% were identical for the Shea classification. Three percent of the ratings for the Shea classification were greater than +/- 1 category; 6% of the ratings for the Yarkony-Kirk scale were greater than +/- 1 category. This scale appears to possess good reliability and to describe pressure ulcers more completely. This scale may also be used to teach prevention activities as well as ulcer classification.

  3. Pressure Ulcer Prevention

    PubMed Central

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis (anticipated pubicstion date - mid-2009) Purpose A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers* Setting Canadian Prevalence,% (95% CI) Ontario Prevalence,Range % (n) Acute care 25 (23.8–26.3) 23.9–29.7 (3418) Nonacute care† 30 (29.3–31.4) 30.0–53.3 (1165) Community care 15 (13.4–16.8) 13.2 (91) Mixed health care‡ 22 (20.9

  4. For your information: pressure ulcers.

    PubMed

    1991-09-01

    Pressure ulcers (also called bedsores) affect 3% to 11% of hospital and nursing home patients. Although most seen in the elderly, these ulcers can also occur in younger people who are unable to move about following musculoskeletal or neurological damage. Despite the belief that pressure ulcers are caused by neglect and inattention by hospital or nursing home personnel, even the most diligent nursing care may still not be able to prevent pressure ulcers. Increased understanding of the formation, treatment, and prevention of pressure ulcers by family members, home caregivers, and handicapped individuals can be a great help to those who suffer from these ulcers.

  5. Clinical management of pressure ulcers.

    PubMed

    Thomas, David R

    2013-05-01

    Pressure ulcers are chronic and difficult to heal. Pressure-reducing devices are clearly superior to a standard hospital mattress in preventing pressure ulcers, but only limited evidence and clinical intuition supports pressure-reducing devices in improving the healing rate of pressure ulcers. Local wound treatment should aim at maintaining a moist wound environment. The choice of a particular dressing depends on wound characteristics, such as the amount of exudate, dead space, or wound location. Nutritional status should be addressed as a process of good care. Debridement may improve time to a clean wound bed, but no clearly superior approach has been demonstrated.

  6. Common Questions About Pressure Ulcers.

    PubMed

    Raetz, Jaqueline G M; Wick, Keren H

    2015-11-15

    Patients with limited mobility due to physical or cognitive impairment are at risk of pressure ulcers. Primary care physicians should examine at-risk patients because pressure ulcers are often missed in inpatient, outpatient, and long-term care settings. High-risk patients should use advanced static support surfaces to prevent pressure ulcers and air-fluidized beds to treat pressure ulcers. Physicians should document the size and clinical features of ulcers. Cleansing should be done with saline or tap water, while avoiding caustic agents, such as hydrogen peroxide. Dressings should promote a moist, but not wet, wound healing environment. The presence of infection is determined through clinical judgment; if uncertain, a tissue biopsy should be performed. New or worsening pain may indicate infection of a pressure ulcer. When treating patients with pressure ulcers, it is important to keep in mind the patient's psychological, behavioral, and cognitive status. The patient's social, financial, and caregiver resources, as well as goals and long-term prognosis, should also be considered in the treatment plan.

  7. [Nursing care of pressure ulcers].

    PubMed

    Hautin, Pascale

    2013-01-01

    The definition of a pressure ulcer remains very academic. It results from tissue necrosis following ischemia through prolonged arteriolar constriction between two hard surfaces progressing in stages. The nursing care and the use of dressings are therefore adapted to each stage. Today, the treatment of pressure ulcers is complex due to the large number of categories of dressings available. Moreover, the choice of the dressing must take into account the specificities of elderly patients. However, certain basic principles remain essential.

  8. Wound cleansing for pressure ulcers.

    PubMed

    Moore, Z E H; Cowman, S

    2005-10-19

    Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the very old, malnourished or acutely ill, who cannot reposition themselves. Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life. Wound cleansing is considered an important component of pressure ulcer care. This systematic review seeks to answer the following question:What is the effect of wound cleansing solutions and wound cleansing techniques on the rate of healing of pressure ulcers? We searched the Specialised Trials Register of the Cochrane Wounds Group (up to August 2005), and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005). We searched bibliographies of relevant publications retrieved. We contacted drug companies and experts in the field to identify studies missed by the primary search. Randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion if they reported an objective measure of pressure ulcer healing. Two authors extracted data independently and resolved disagreements through discussion and reference to the Cochrane Wounds Group editorial base. A structured narrative summary of the included studies was conducted. For dichotomous outcomes, relative risk (RR), plus 95% confidence intervals (CI) were calculated; for continuous outcomes, weighted mean difference (WMD), plus 95% CI were calculated. Meta analysis was not conducted, because of the small number of diverse RCTs identified. No studies compared cleansing with no cleansing. Two studies compared different wound cleansing solutions: a statistically significant improvement in Pressure Sore Status Tool scores occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared to isotonic saline (P

  9. Management of Chronic Pressure Ulcers

    PubMed Central

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis Objective The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions? Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? Background A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by

  10. [Controversies over heel pressure ulcers].

    PubMed

    Rueda López, J

    2013-02-01

    Article whose content was exposed in the workshops of the GNEAUPP Congress, held in Seville in November2012, and which refers to ulcers by pressure on the heels as a location exposed to the analysis. A pressure ulcer is a lesion located in skin I underlying tissue usually over a bone prominence, as a result of the pressure, or pressure in combination with the shears. A number of contributing factors or confounding factors are also associated with ulcers by pressure; the importance of these factors still not been elucidated. The heels are next to the sacred area, parts of the body that most frequently presents ulcers by pressure, The importance of the predisposing factors for ulcers in the sacral area as humidity has been studied in recent years, but in heels, remains one of the most important locations in the extremities, which entails adverse outcomes such as amputation in persons with comorbid diseases like Diabetes Mellitus (DM). The incidence of ulcers on heels in patients with DM and without it, is approximately 19-32%. Everything and be a problem associated with elderly people and chronic pathologies, in acute patients are a problem that this underrated, but not devoid of controversy. In hospitals of treble in 2006, the NPUAP encrypted the incidence of UPPin heels in a 43%; in one systematic review conducted by Reddy et al. (2006) puts revealed that 60% of pressure ulcers is produced. The problem of the UPP in heels is present in all the areas of intervention and particularly in paediatric units intensive care, where the first localization it is the occipital area followed by the heels.

  11. Wound cleansing for pressure ulcers.

    PubMed

    Moore, Zena E H; Cowman, Seamus

    2013-03-28

    Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the elderly, malnourished or acutely ill, who cannot reposition themselves. Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life. Wound cleansing is considered an important component of pressure ulcer care. This systematic review seeks to answer the following question: what is the effect of wound cleansing solutions and wound cleansing techniques on the rate of healing of pressure ulcers? For this third update, we searched the Cochrane Wounds Group Specialised Register (searched 3 January 2013); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to November Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 31, 2012); Ovid EMBASE (2010 to 2012 Week 52); and EBSCO CINAHL (2010 to 21 December 2012). Randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion if they reported an objective measure of pressure ulcer healing. Two review authors extracted data independently and resolved disagreements through discussion. A structured narrative summary of the included studies was conducted. For dichotomous outcomes, risk ratio (RR), plus 95% confidence intervals (CI) were calculated; for continuous outcomes, mean difference (MD), plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified. Two review authors independently assessed each included study using the Cochrane Collaboration tool for assessing risk of bias. One additional eligible study was identified from the updated searches, one study was added to the table of excluded studies. A total of three studies (169 participants) met the inclusion criteria for the

  12. [Prevention of pressure ulcer (bedsore)].

    PubMed

    Sedmak, Dijana; Vrhovec, Marina; Huljev, Dubravko

    2013-10-01

    Although progress in many fields of science, medicine and technology is evident, we are still witnessing the appearance of bedsores and its consequences. However, in the last fifty years there has been considerable progress in the understanding of its causes, prevention and treatment. Prevention and treatment of pressure ulcers are complicated by the many misconceptions. However, with due knowledge of the process of healing of acute and chronic wounds and of the pathophysiological processes, in many cases chronic wounds, like pressure ulcers, can now be prevented and cured, and thus reduce the cost of treatment, as well as the mortality rate.

  13. Recording pressure ulcer risk assessment and incidence.

    PubMed

    Plaskitt, Anne; Heywood, Nicola; Arrowsmith, Michaela

    2015-07-15

    This article reports on the introduction of an innovative computer-based system developed to record and report pressure ulcer risk and incidence at an acute NHS trust. The system was introduced to ensure that all patients have an early pressure ulcer risk assessment, which prompts staff to initiate appropriate management if a pressure ulcer is detected, thereby preventing further patient harm. Initial findings suggest that this electronic process has helped to improve the timeliness and accuracy of data on pressure ulcer risk and incidence. In addition, it has resulted in a reduced number of reported hospital-acquired pressure ulcers.

  14. Prevention and treatment of pressure ulcers.

    PubMed

    Thomas, David R

    2006-01-01

    Pressure ulcers are complex chronic wounds for which no gold standard for prevention or treatment has yet been established. Several attempts at developing guidelines has been undertaken by different organizations. Pressure ulcers are devastating comorbidities for patients and difficult to prevent or manage. Whether or not pressure ulcers are preventable remains controversial. The strategy for prevention includes recognizing the risk, decreasing the effects of pressure, assessing nutritional status, avoiding excessive bed rest and prolonged sitting, and preserving the integrity of the skin. The principles of treatment of pressure ulcers include assessing severity, reducing pressure, friction and shear forces, optimizing local wound care, removing necrotic debris, managing bacterial contamination, and correcting nutritional deficits.

  15. Engaging patients in pressure ulcer prevention.

    PubMed

    Hudgell, Lynne; Dalphinis, Julie; Blunt, Chris; Zonouzi, Maryam; Procter, Susan

    2015-05-06

    As patients increasingly care for themselves at home, they require accessible information to enable informed self-care. This article describes the development of an educational electronic application (app) designed for use by patients at risk of pressure ulcers, and their carers. The app can be downloaded to Windows, Android or Apple smartphones or tablets. The app is based on the current pressure ulcer prevention and management guidelines from the National Pressure Ulcer Advisory Panel and the National Institute for Health and Care Excellence, and is designed to educate patients and carers about how to prevent a pressure ulcer, how to recognise a pressure ulcer, and what to do if they suspect they are developing a pressure ulcer. We hope the app will be used to help with educational conversations among patients, carers and healthcare professionals.

  16. Pressure ulcer prevention in frail older people.

    PubMed

    Barry, Maree; Nugent, Linda

    2015-12-16

    Pressure ulcers are painful and cause discomfort, have a negative effect on quality of life, and are costly to treat. The incidence and severity of preventable pressure ulcers is an important indicator of quality of care; it is essential that healthcare providers monitor prevalence and incidence rates to ensure that care strategies implemented are effective. Frail older people are at increased risk of developing pressure ulcers. This article discusses the complexities of preventing pressure ulcers in frail older people and emphasises the importance of structured educational programmes that incorporate effective clinical leadership and multidisciplinary teamwork.

  17. Support surfaces for pressure ulcer prevention.

    PubMed

    McInnes, Elizabeth; Jammali-Blasi, Asmara; Bell-Syer, Sally E M; Dumville, Jo C; Middleton, Victoria; Cullum, Nicky

    2015-09-03

    Pressure ulcers (i.e. bedsores, pressure sores, pressure injuries, decubitus ulcers) are areas of localised damage to the skin and underlying tissue. They are common in the elderly and immobile, and costly in financial and human terms. Pressure-relieving support surfaces (i.e. beds, mattresses, seat cushions etc) are used to help prevent ulcer development. This systematic review seeks to establish:(1) the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared with standard support surfaces, and,(2) their comparative effectiveness in ulcer prevention. In April 2015, for this fourth update we searched The Cochrane Wounds Group Specialised Register (searched 15 April 2015) which includes the results of regular searches of MEDLINE, EMBASE and CINAHL and The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 3). Randomised controlled trials (RCTs) and quasi-randomised trials, published or unpublished, that assessed the effects of any support surface for prevention of pressure ulcers, in any patient group or setting which measured pressure ulcer incidence. Trials reporting only proxy outcomes (e.g. interface pressure) were excluded. Two review authors independently selected trials. Data were extracted by one review author and checked by another. Where appropriate, estimates from similar trials were pooled for meta-analysis. For this fourth update six new trials were included, bringing the total of included trials to 59.Foam alternatives to standard hospital foam mattresses reduce the incidence of pressure ulcers in people at risk (RR 0.40 95% CI 0.21 to 0.74). The relative merits of alternating- and constant low-pressure devices are unclear. One high-quality trial suggested that alternating-pressure mattresses may be more cost effective than alternating-pressure overlays in a UK context.Pressure-relieving overlays on the operating table reduce postoperative pressure ulcer incidence

  18. Enhancing Documentation of Pressure Ulcer Prevention Interventions: A Quality Improvement Strategy to Reduce Pressure Ulcers.

    PubMed

    Jacobson, Therese M; Thompson, Susan L; Halvorson, Anna M; Zeitler, Kristine

    2016-01-01

    Prevention of hospital-acquired pressure ulcers requires the implementation of evidence-based interventions. A quality improvement project was conducted to provide nurses with data on the frequency with which pressure ulcer prevention interventions were performed as measured by documentation. Documentation reports provided feedback to stakeholders, triggering reminders and reeducation. Intervention reports and modifications to the documentation system were effective both in increasing the documentation of pressure ulcer prevention interventions and in decreasing the number of avoidable hospital-acquired pressure ulcers.

  19. Pressure ulcer classification: defining early skin damage.

    PubMed

    Russell, Linda

    2002-09-01

    This article is the second of a two-part series. The first part (Russell, 2002) looked at various systems and pitfalls of pressure ulcer classification systems. This article focuses on the difficulties of defining early skin damage. Patients' quality of life suffers significantly with a pressure ulcer. The smell of the exudate may be an embarrassment to the patient. The pain and the distress the patient will experience will not easily be forgotten, i.e. the number of dressings required for a deep pressure ulcer, even after the pressure ulcer has healed, will be a memorable intrusion to the patient's daily routine. Early detection of pressure ulcers and timely intervention are essential in the management of patients with pressure ulcers. Controversy exists over the definition of the first three stages of pressure ulcers, but there is consensus on the definition of deep tissue damage. If the pressure ulcer is covered with black necrotic tissue it is difficult to establish depth of the tissue damage. Intact skin can cause problems, as a sacrum may be purple but intact. There is still considerable debate with regard to reactive hyperaemia, as the exact time parameters for persistent erythema to occur are unknown. Little is understood with regard to the exact pathophysiology of reactive hyperaemia and this area requires further investigation. Blistered skin and skin tone also cause confusion in grading of pressure ulcers. The problems associated with classification of pressure ulcers, using colour classification systems, are discussed and the implications for practice are considered. The confusion surrounding early classification of pressure ulcers is discussed and it is hoped that such confusion can be addressed by standardizing training using one national classification system.

  20. Pressure ulcers: Back to the basics

    PubMed Central

    Agrawal, Karoon; Chauhan, Neha

    2012-01-01

    Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of “prevention is better than cure” suits this condition the most. PMID:23162223

  1. Recurring pressure ulcers: identifying the definitions. A National Pressure Ulcer Advisory Panel white paper.

    PubMed

    Tew, Cindy; Hettrick, Heather; Holden-Mount, Sarah; Grigsby, Rebekah; Rhodovi, Julie; Moore, Lyn; Ghaznavi, Amir M; Siddiqui, Aamir

    2014-01-01

    Currently, there is a lack of consensus regarding the accepted terminology pertaining to the pressure ulcer healing progression and recidivism. This lack of uniformity can negatively impact initiation of treatment pathways, completion of appropriate interventions, clinical documentation, medical coding, patient education, discharge planning and healthcare revenue through out the healthcare system. The purpose of this paper is to introduce a standard nomenclature as it pertains to pressure ulcer healing progression and any recidivism that may occur. The National Pressure Ulcer Advisory Panel has formulated a framework of terms regarding pressure ulcer progression. We also developed a clearer nomenclature for lack of progress and recidivism of pressure ulcers. This document should serve as a starting point for the discussion of the pressure ulcer care, research, and terminology. © 2014 by the Wound Healing Society.

  2. The prevention and management of pressure ulcers.

    PubMed

    Goode, P S; Allman, R M

    1989-11-01

    Pressure ulcers are a common problem for older persons. Complications associated with pressure ulcers include infection and even death for some patients. Pressure is the primary pathogenic factor, but shearing forces, friction, and moisture are also important. Immobility, nutritional status, and age-related factors seem to be significant risk factors. Preventive care includes use of assessment tools to identify high risk patients, frequent repositioning, air or foam mattresses that reduce pressure over bony prominences, as well as careful attention to optimizing the overall patient condition. When pressure ulcers do develop, the treatment plan should include adequate nutrition including protein, vitamin C, and zinc supplements as indicated; systemic antibiotics for sepsis, cellulitis, osteomyelitis, or the prevention of bacterial endocarditis; and local wound care that eliminates necrotic tissue, decreases bacterial load, and provides a physiologic, pressure-free environment allowing the wound to heal. Specialized beds may be considered in some patients, particularly those with larger ulcers. Surgery is an option in older persons who are operative candidates. For some patients with pressure ulcers, appropriate treatment goals may focus on providing comfort rather than curing the ulcer.

  3. Pressure ulcer prevention in care home settings.

    PubMed

    Ellis, Michael

    2017-03-31

    Pressure ulcer prevention in the care home setting can be challenging and is often compromised by a lack of access to education and resources. There are measures that have been shown to consistently improve outcomes in pressure ulcer prevention including assessment of the patient and their individual risks, delivery of a consistent plan of care that meets patients' needs, and regular evaluation to identify shortfalls. In addition, there should be a robust approach to investigating events that lead to a person developing a pressure ulcer and that information should be used to improve future practice. Pressure ulcer prevention in care homes is achievable and nurses should all be aware of the necessary measures detailed in this article.

  4. Pressure ulcers - what to ask your doctor

    MedlinePlus

    ... best way to transfer from bed to a wheelchair or chair? If there is leakage of stool or urine, what else should be done to prevent pressure ulcers? If using a wheelchair: How often should someone make sure the wheelchair ...

  5. The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper.

    PubMed

    Posthauer, Mary Ellen; Banks, Merrilyn; Dorner, Becky; Schols, Jos M G A

    2015-04-01

    Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wounds focuses on PrUs. This white paper reviews the 2014 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Nutrition Guidelines and discusses nutrition strategies for PrU management.

  6. Massage therapy for preventing pressure ulcers.

    PubMed

    Zhang, Qinhong; Sun, Zhongren; Yue, Jinhuan

    2015-06-17

    Pressure ulcers affect approximately 10% of patients in hospitals and the elderly are at highest risk. Several studies have suggested that massage therapy may help to prevent the development of pressure ulcers, but these results are inconsistent. To assess the evidence for the effects of massage compared with placebo, standard care or other interventions for prevention of pressure ulcers in at-risk populations.The review sought to answer the following questions:Does massage reduce the incidence of pressure ulcers of any grade?Is massage safe in the short- and long-term? If not, what are the adverse events associated with massage? We searched the Cochrane Wounds Group Specialised Register (8 January 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 1), Ovid MEDLINE (1946 to 8 January 2015), Ovid MEDLINE (In-Process Other Non-Indexed Citations 8 January 2015), Ovid EMBASE (1974 to 8 January 2015), and EBSCO CINAHL (1982 to 8 January 2015). We did not apply date or language restrictions. We planned to include all randomised controlled trials (RCTs) and quasi-randomised controlled trials (Q-RCTs) that evaluated the effects of massage therapy for the prevention of pressure ulcers. Our primary outcome was the proportion of people developing a new pressure ulcer of any grade. Two review authors independently carried out trial selection. Disagreements were resolved by discussion. No studies (RCTs or Q-RCTs) met the inclusion criteria. Therefore, neither a meta-analysis nor a narrative description of studies was possible. There are currently no studies eligible for inclusion in this review. It is, therefore, unclear whether massage therapy can prevent pressure ulcers.

  7. Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment.

    PubMed

    Amir, Yufitriana; Lohrmann, Christa; Halfens, Ruud Jg; Schols, Jos Mga

    2017-02-01

    The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four Indonesian general hospitals. A multicentre cross-sectional design was applied to assess pressure ulcers and pressure ulcer care in adult patients in medical, surgical, specialised and intensive care units. Ninety-one of the 1132 patients had a total of 142 ulcers. Half (44·0%) already had pressure ulcers before admission. The overall prevalence of category I-IV pressure ulcers was 8·0% (95% CI 6·4-9·6), and the overall nosocomial pressure ulcer prevalence was 4·5% (95% CI 3·3-5·7). Most pressure ulcer patients had friction and shear problems, were bedfast, had diabetes and had more bedridden days. Most ulcers (42·3%) were category III and IV. One third of the patients had both pressure ulcers and moisture lesions (36·3%) and suffered from pain (45·1%). The most frequently used prevention measures were repositioning (61·5%), skin moisturising (47·3%), patient education (36·3%) and massage (35·2%). Most pressure ulcer dressings involved saline-impregnated or antimicrobial gauzes. This study shows the complexities of pressure ulcers in Indonesian general hospitals and reveals that the quality of pressure ulcer care (prevention and treatment) could be improved by implementing the recent evidence-based international guideline. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  8. Body Mass Index and Pressure Ulcers: Improved Predictability of Pressure Ulcers in Intensive Care Patients

    PubMed Central

    Hyun, Sookyung; Li, Xiaobai; Vermillion, Brenda; Newton, Cheryl; Fall, Monica; Kaewprag, Pacharmon; Moffatt-Bruce, Susan; Lenz, Elizabeth R.

    2015-01-01

    Background Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. Objectives To examine the incidence of pressure ulcers in patients who differ in body mass index and to determine whether inclusion of body mass index enhanced use of the Braden scale in the prediction of pressure ulcers. Methods In this retrospective cohort study, data were collected from the medical records of 4 groups of patients with different body mass index values: underweight, normal weight, obese, and extremely obese. Data included patients’ demographics, body weight, score on the Braden scale, and occurrence of pressure ulcers. Results The incidence of pressure ulcers in the underweight, normal weight, obese, and extremely obese groups was 8.6%, 5.5%, 2.8%, and 9.9%, respectively. When both the score on the Braden scale and the body mass index were predictive of pressure ulcers, extremely obese patients were about 2 times more likely to experience an ulcer than were normal weight patients. In the final model, the area under the curve was 0.71. The baseline area under the curve for the Braden scale was 0.68. Conclusions Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers. PMID:25362673

  9. Location-dependent depth and undermining formation of pressure ulcers.

    PubMed

    Takahashi, Yoshiko; Isogai, Zenzo; Mizokami, Fumihiro; Furuta, Katsunori; Nemoto, Tetsuya; Kanoh, Hiroyuki; Yoneda, Masahiko

    2013-08-01

    We examined the location-specific properties of pressure ulcers, focusing on depth and undermining formation, which are often unfavorable factors for ulcer healing. We conducted a retrospective observational study of 2 independent databases on pressure ulcers. Databases from a 200-bed hospital (database A) and a 300-bed hospital (database B) were collected during different time periods. Relationships between ulcer location, ulcer depth, and undermining formation were analyzed. All pressure ulcers were accurately diagnosed and classified according to their locations. A total of 282 pressure ulcers in 189 patients from database A and 232 pressure ulcers in 154 patients from database B were analyzed. It was found that pressure ulcers primarily developed over the sacrum. Ratio of stages III and IV pressure ulcers was high in pressure ulcers of the foot, ankle, and crus on the lower leg. Among the deep pressure ulcers, undermining formation was frequently observed on the greater trochanter, ilium, and sacrum. In contrast, pressure ulcers of the foot, ankle, and crus did not exhibit undermining formation. Our results revealed marked differences in pressure ulcer properties depending on their location. Factors affecting depth and undermining of pressure ulcers appear to be related to anatomical and physical properties of the bone and subcutaneous tissue. Copyright © 2013 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  10. A programme to reduce acquired pressure ulcers in care homes.

    PubMed

    Thompson, Trish Morris; Marks-Maran, Di

    Prevention of pressure ulcers is a major health concern, especially for older people. Much of the literature related to prevention of pressure ulcers focuses on hospital-acquired pressure ulcers. There is less literature related to prevention of pressure ulcers in care homes. This article presents a review of the literature related to prevention of pressure ulcers in care homes and an ambitious project undertaken by one care home provider to raise awareness of pressure ulcers, provide training in prevention and monitor and evaluate pressure ulcers in over 200 care home across the UK. Known as MI SKIN, the project involves ongoing training to all levels of care staff, a robust system of monitoring pressure ulcers and a mechanism to investigate and learn from any incident of pressure ulcer using root cause analysis.

  11. Portable gage for pressure ulcer detection.

    PubMed

    Wang, Qi; Kong, Linghua; Sprigle, Stephen; Hayward, Vincent

    2006-01-01

    Pressure ulcers are widely considered to be a critical problem in rehabilitation since they result in severe discomfort and high healthcare cost. The prevention of pressure ulcers is a constant preoccupation for every nursing team. This paper introduces a novel handheld instrument that can detect subtle changes in the skin biomechanical properties by measuring its biomechanical response. This could be used to detect stage-I pressure ulcers and deep tissue injury. Its high bandwidth makes it possible to load the skin under wide range of conditions. The instrument is portable, inexpensive, and intrinsically precise. Several experiments were conducted to validate the function of the device. Preliminary results show that the device could effectively measure the difference in the viscoelasticity between human skin of different sites, hence paving the way for the development of clinical protocols and trials.

  12. Electromagnetic therapy for treating pressure ulcers.

    PubMed

    Olyaee Manesh, A; Flemming, K; Cullum, N A; Ravaghi, H

    2006-04-19

    Pressure ulcers are defined as areas "of localized damage to the skin and underlying tissue caused by pressure, shear, friction and/or the combination of these". In the UK, pressure ulcers occur in 5 to 32% of District General Hospitals people and in 4 to 7% of people in community settings. Electromagnetic therapy, in which electrodes produce an electromagnetic field across the wound, may improve healing of chronic wounds such as pressure ulcers. To assess the effects of electromagnetic therapy on the healing of pressure ulcers. For this first update, we searched the Cochrane Wounds Group Specialised Register (last searched October 2005); CENTRAL (The Cochrane Library 2005, Issue 4); MEDLINE (1966 to October 2005); EMBASE (1980 to October 2005); and CINAHL (1982 to October 2005). Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy, or other (standard) treatment. For this first update, two authors independently scrutinized the results of the search to identify relevant RCTs and obtained full reports of potentially eligible studies. For the original review, details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. Data extraction was checked by a second author. Meta-analysis was applied to combine the results of trials when the interventions and outcome measures were sufficiently similar. This update identified no new trials. Two RCTs were identified for inclusion in the original review (total of 60 participants). One was a three-armed study comparing electromagnetic therapy with electromagnetic therapy in combination with standard therapy, and with standard therapy alone, on 17 female and 13 male with grade II and III pressure ulcers. The other study compared electromagnetic therapy with sham therapy in 30 male participants with a spinal cord injury and a grade II or grade III pressure ulcer.Neither study found a statistically

  13. A new pressure ulcer conceptual framework

    PubMed Central

    Coleman, Susanne; Nixon, Jane; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Farrin, Amanda; Dowding, Dawn; Schols, Jos MGA; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Schoonhoven, Lisette; Bader, Dan L; Gefen, Amit; Oomens, Cees WJ; Nelson, E Andrea

    2014-01-01

    Aim This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework. Background Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework. Design Discussion Paper. Data Sources The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010–2011) and an international expert group meeting (conducted December 2011). Implications for Nursing A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally. Conclusion By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research. PMID:24684197

  14. A new pressure ulcer conceptual framework.

    PubMed

    Coleman, Susanne; Nixon, Jane; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Farrin, Amanda; Dowding, Dawn; Schols, Jos M G A; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Schoonhoven, Lisette; Bader, Dan L; Gefen, Amit; Oomens, Cees W J; Nelson, E Andrea

    2014-10-01

    This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework. Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework. Discussion Paper. The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010-2011) and an international expert group meeting (conducted December 2011). A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally. By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research. © 2014 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  15. Sustaining pressure ulcer prevention in practice.

    PubMed

    McDonagh, Vanessa

    This article describes a campaign to eliminate avoidable grade 2-4 pressure ulcers at University Hospitals Coventry and Warwickshire Trust. The 100 Days Free strategy used traditional educational approaches along with ward-based power training and social media to engage staff and update practice. Root cause analysis has been vital in providing feedback to staff and identifying training needs.

  16. Pressure ulcers management: an economic evaluation.

    PubMed

    Foglia, E; Restelli, U; Napoletano, A M; Coclite, D; Porazzi, E; Bonfanti, M; Croce, D

    2012-03-01

    Pressure ulcer management represents a growing problem for medical and social health care systems all over the world, particularly in European Union countries where the incidence of pressure ulcers in older persons (> 60 years of age) is predicted to rise. The aim of this study was to provide evidence for the lower impact on economic resources of using advanced dressings for the treatment of pressure ulcers with respect to conventional simple dressings. Two different models of analysis, derived from Activity Based Costing and Health Technology Assessment, were used to measure, over a 30-day period, the direct costs incurred by pressure ulcer treatment for community-residing patients receiving integrated home care. Although the mean cost per home care visit was higher in the advanced dressings patient group than in the simple dressings patient one (E 22.31 versus E 16.03), analysis of the data revealed that the cost of using advanced dressings was lower due to fewer home care visits (22 versus 11). The results underline the fact that decision-makers need to improve their understanding of the advantages of taking a long-term view with regards to the purchase and use of materials. This could produce considerable savings of resources in addition to improving treatment efficacy for the benefit of patients and the health care system.

  17. Quality assurance programs for pressure ulcers.

    PubMed

    Xakellis, G C

    1997-08-01

    Traditional medical quality assurance programs are beginning to incorporate the principles of continuous quality improvement pioneered by Juran and Deming. Strategies for incorporating these principles into a long-term care facility are described, and two examples of successful implementation of continuous quality improvement programs for pressure ulcers are presented.

  18. Topical phenytoin for treating pressure ulcers.

    PubMed

    Hao, Xiang Yong; Li, Hong Ling; Su, He; Cai, Hui; Guo, Tian Kang; Liu, Ruifeng; Jiang, Lei; Shen, Yan Fei

    2017-02-22

    Pressure ulcers are common in clinical practice and pose a significant health problem worldwide. Apart from causing suffering to patients, they also result in longer hospital stays and increase the cost of health care. A variety of methods are used for treating pressure ulcers, including pressure relief, patient repositioning, biophysical strategies, nutritional supplementation, debridement, topical negative pressure, and local treatments including dressings, ointments and creams such as bacitracin, silver sulphadiazine, neomycin, and phenytoin. Phenytoin is a drug more commonly used in the treatment of epilepsy, but may play an important role in accelerating ulcer healing. To assess the effects of topical phenytoin on the rate of healing of pressure ulcers of any grade, in any care setting. In September 2016, we searched the following electronic databases to identify relevant randomized clinical trials: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library); Ovid MEDLINE; Ovid Embase; and EBSCO CINAHL Plus. We handsearched conference proceedings from the European Pressure Ulcer Advisory Panel, European Wound Management Association and the Tissue Viability Society for all available years. We searched the references of the retrieved trials to identify further relevant trials. We also searched clinical trials registries to identify ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting. We included all randomized controlled trials (RCTs) addressing the effects (both benefits and harms) of topical phenytoin on the healing of pressure ulcers of any grade compared with placebo or alternative treatments or no therapy, irrespective of blinding, language, and publication status. Two review authors independently selected studies, extracted information on participants, interventions, methods and results and assessed risk of bias using

  19. The VCU Pressure Ulcer Summit: Collaboration to Operationalize Hospital-Acquired Pressure Ulcer Prevention Best Practice Recommendations.

    PubMed

    Brindle, C Tod; Creehan, Sue; Black, Joyce; Zimmermann, Deb

    2015-01-01

    This executive summary reports outcomes of an interprofessional collaboration between experts in pressure ulcer prevention, bedside clinicians, regulatory agencies, quality improvement, informatics experts, and professional nursing organizations. The goal of the collaboration was to develop a framework to assist facilities to operationalize best practice recommendations to sustain organizational culture change in hospital-acquired pressure ulcer prevention, to develop a hospital-acquired pressure ulcer severity score, and to address topics related to the unavoidable pressure ulcer.

  20. Pressure ulcer prevention and pressure-relieving surfaces.

    PubMed

    Benbow, Maureen

    Although rarely subject to media attention, political interest or research funding, pressure ulcers, and their almost inevitable increase in incidence, detrimentally affect the quality of life of thousands of patients, both in the hospital and community setting. In addition, the costs to the NHS of pressure-ulcer-related care in hospitals is estimated to be pounds sterling 1.8-pounds sterling 2.5 billion annually. Many pressure ulcers that develop could have been prevented, and there are several up-to-date, easily-accessible sources of evidence to guide decision-making regarding appropriate interventions in pressure care. Consideration and assessment of the patient holistically, followed by appropriate intervention and evaluation, is the key to any prevention strategy.

  1. Pressure ulcer prevention: review of literature.

    PubMed

    Day, D; Hayes, K; Kennedy, A M; Diercksen, R M

    1997-06-01

    Much has been written about the causes, prevention, and nursing management of pressure ulcers. A review of current literature on the subject reveals that, in spite of the enormity of information available, the problem continues to consume a large percentage of nursing time and energy. Studies of aggressive prevention and ongoing continuing education programs have demonstrated significant reduction of incidence and time of treatment, as well as dramatic cost savings. The Agency for Health Care Policy and Research (AHCPR) has recommended that all patients at risk for pressure ulcer development be placed on some form of pressure-reducing support surface. There is a wide variety of these products available, but a surprisingly limited quantity of published articles specifically compare the efficacy of one product to another.

  2. A flexible pressure monitoring system for pressure ulcer prevention.

    PubMed

    Yip, Marcus; Da He, David; Winokur, Eric; Balderrama, Amanda Gaudreau; Sheridan, Robert; Ma, Hongshen

    2009-01-01

    Pressure ulcers are painful sores that arise from prolonged exposure to high pressure points, which restricts blood flow and leads to tissue necrosis. This is a common occurrence among patients with impaired mobility, diabetics and the elderly. In this work, a flexible pressure monitoring system for pressure ulcer prevention has been developed. The prototype consists of 99 capacitive pressure sensors on a 17-cm x 22-cm sheet which is flexible in two dimensions. Due to its low cost, the sensor sheet can be disconnected from the reusable electronics and be disposed of after use, suitable for a clinical setting. Each sensor has a resolution of better than 2-mmHg and a range of 50-mmHg and offset is calibrated in software. Realtime pressure data is displayed on a computer. A maximum sampling rate of 12-Hz allows for continuous monitoring of pressure points.

  3. Case study: the treatment or palliative care of pressure ulcers.

    PubMed

    Hampton, S

    As nurse education increases there are reduced justifications for the existence of pressure ulcers. Patient assessment, along with rationalization of equipment and repositioning techniques, reduces the potential for pressure ulcer formation. Therefore, the future for pressure ulcer prevention will rely on nurse education and motivation. The patient featured in this case study suffered unnecessarily from pressure ulcers as, after her admission to a new nursing home where she was given the appropriate pressure-relieving and wound-dressing treatment, the ulcers were showing signs of healing.

  4. Etiology and incidence of pressure ulcers in surgical patients.

    PubMed

    Schultz, A; Bien, M; Dumond, K; Brown, K; Myers, A

    1999-09-01

    This experimental study was designed to identify the etiology of pressure ulcers in a surgical sample and to evaluate a special OR mattress overlay in preventing pressure ulcer development. Surgical patients (N = 413) were randomized to receive "usual perioperative care" or the new mattress overlay. Over six postoperative days, 89 patients (21.5%) developed pressure ulcers, primarily stage I. Only 2% developed stage II or IV ulcers. Patients with ulcers were statistically older, had diabetes, were smaller in body mass, had lower Braden Scale scores on admission, and used the new mattress overlay (P < .02). Pressure ulcers that presented as "burns" or ecchymosis did not deteriorate to stage III or IV ulcers during the study. The mattress overlay was not effective in preventing pressure ulcer development.

  5. Become the PPUPET Master: Mastering Pressure Ulcer Risk Assessment With the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET).

    PubMed

    Sterken, David J; Mooney, JoAnn; Ropele, Diana; Kett, Alysha; Vander Laan, Karen J

    2015-01-01

    Hospital acquired pressure ulcers (HAPU) are serious, debilitating, and preventable complications in all inpatient populations. Despite evidence of the development of pressure ulcers in the pediatric population, minimal research has been done. Based on observations gathered during quarterly HAPU audits, bedside nursing staff recognized trends in pressure ulcer locations that were not captured using current pressure ulcer risk assessment tools. Together, bedside nurses and nursing leadership created and conducted multiple research studies to investigate the validity and reliability of the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET). Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Anabolic steroids for treating pressure ulcers.

    PubMed

    Naing, Cho; Whittaker, Maxine A

    2017-06-20

    Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers. Anabolic steroids are considered because of their ability to stimulate protein synthesis and build muscle mass. Comprehensive evidence is required to facilitate decision making, regarding the benefits and harms of using anabolic steroids. To assess the effects of anabolic steroids for treating pressure ulcers. In March 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Published or unpublished randomised controlled trials (RCTs) comparing the effects of anabolic steroids with alternative treatments or different types of anabolic steroids in the treatment of pressure ulcers. Two review authors independently carried out study selection, data extraction and risk of bias assessment. The review contains only one trial with a total of 212 participants, all with spinal cord injury and open pressure ulcers classed as stage III and IV. The participants were

  7. [Pressure ulcer prevention with pressure-reducing seat cushions].

    PubMed

    Reijnen, Guido; Heule, Freerk

    2012-01-01

    Analysis of the effectiveness of pressure-reducing seat cushions. Literature review. Investigation of the literature yielded 8 relevant studies. These studies encompassed three clinical trials with a total of 296 patients, and five laboratory experiments with a total of 107 subjects, including patients. The publications were written at level A (RCT and meta-analysis) and level B (other study forms) according to the principles of evidence-based medicine. Both the pressure parameters of the pressure-reducing seat cushion and the development of pressure ulcers were used as measures for outcome. A 7.6 cm foam cushion was used as reference; it was not considered as one of the pressure-reducing systems. Two studies compared different types of air seat cushions with a foam/gel seat cushion. The best distribution of pressure was found for the air compartment seat cushion. This type of seat cushion provided the smallest contact surface with high pressures. Three studies compared the pressure-reducing systems with a 7.6 cm foam cushion. The methodologically most solid one of these three studies found a lower incidence of sitting-related pressure ulcers for users of a pressure-reducing system (0.9 vs. 6.7%; p = 0.04). The two other studies had too low a power to show significant differences. These two compared different types of foam/gel seat cushions and a low profile air seat cushion and found no significant differences in distribution of pressures. One study compared various foam cushions of differing thickness and found that foam cushions most optimally distributed pressure at a thickness of 8 centimetres. Pressure-reducing systems are effective in preventing pressure ulcers. Within the group of pressure-reducing systems, the air compartment seat cushion has the best pressure-distributing properties.

  8. [Microbiology of pressure and vascular ulcer infections].

    PubMed

    Ortiz Balbuena, Jorge; García Madero, Rodrigo; Segovia Gómez, Teresa; Cantero Caballero, Miriea; Sánchez Romero, Isabel; Ramos Martínez, Antonio

    2015-01-01

    Pressure ulcer (PU) infection is a significant clinical problem in many elderly patients. To determine the microbiology of PU and vascular ulcer (VU) infections by conducting a cross-sectional study of outpatients treated in a chronic wounds unit over an 18 month period. Sixty six patients with PU infection and 159 patients with an infected VU were identified. The PUs were located below the knee in 36 patients (52%). Patients with pressure ulcers had a higher proportion of institutionalization, cognitive impairment, inability to walk, and sphincter incontinence. There was a greater number of infections caused by Enterobacteriaceae (52%, P=.002) and fewer S. aureus infections (24%, P<.001) in patients with a PU compared to those with those with a VU. Forty-one percent of S. aureus strains isolated in all the patients were resistant to methicillin (MRSA). The proportion of Enterobacteriaceae infections was similar in patients with infection of pelvic girdle PU and in those located below the knee. PU patients suffer a higher rate of infection by enterobacteria. The most common pathogen in UV infections is S. aureus. The proportion of MRSA infection in patients with chronic wounds is high. The microbiology of the infection in the pelvic girdle PU is similar to those located below the knee. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  9. The incidence of pressure ulcer in patients on mechanical ventilation andeffects of selected risk factors on pressure ulcer development.

    PubMed

    Karayurt, Özgül; Akyol, Özay; Kılıçaslan, Necmiye; Akgün, Nuray; Sargın, Ümran; Kondakçı, Melike; Ekinci, Hanım; Sarı, Neslihan

    2016-11-17

    This study aimed to determine the incidence of pressure ulcers in patients on mechanical ventilation and selected risk factors likely to play a role in pressure ulcer development. The study included 110 patients recruited from an anesthesia critical care unit of a university hospital. Data were collected with a demographic and clinical characteristics form. The form was composed of questions about demographic characteristics and clinical features including diagnosis, duration of mechanical ventilation, general well-being, oxygenation, perfusion, and skin condition. The incidence of pressure ulcer was 15.5%. Duration of mechanical ventilation was longer and the body mass index was higher in patients developing pressure ulcers than in those without pressure ulcers. Additionally, 90.11% of patients with pressure ulcers had edema and 82.35% of patients with pressure ulcers received vasopressin. The patients with pressure ulcers had higher PH levels, lower PaO2 levels, higher PCO2 levels, lower SaO2 levels, and higher urine output. It can be recommended that nurses and other health professionals should be aware of factors playing a role in pressure ulcer development and should be able to conduct appropriate interventions to prevent pressure ulcers.

  10. [Prevention of pressure ulcers in heels].

    PubMed

    Verdú Soriano, José; López Casanaova, Pablo; Fuentes Pagés, Gemma; Torra i Bou, Joan-Enric

    2004-09-01

    Heels are, for all assistance levels, one of the most frequent locations for the development of pressure ulcers (PU). In this study we deal to investigate in order to determine in patients at risk in an Internal Medicine Unit, the PU incidence on heels, after applying a specific prevention protocol. This protocol particularly designed for pressure ulcers on heels included a combined application of special hydrocellular dressings specially shaped for heels (Allevyn Heel), hyper-oxygenated fatty acids (Mepentol) and special surfaces for pressure management (Aerocare); afterwards, we attempted a comparison of our results with those from previous similar studies. We designed a prospective study which lasted from May 1-2002 until June 30-2003, with a sample of 100 patients without PU included in the study when admitted to the unit. The cumulated incidence established for PU in heels is a 4% which means an incidence rate of 2.06 PU in heels per 1000 persons/day. After observing the results we may affirm that applying the protocol is, under a clinical point of view, as effective as other measures used in previous studies. If we focus on the cost-benefit, the protocol studied represents an option with an excellent cost-efficiency relationship.

  11. Educational assessment and teaching of older clients with pressure ulcers.

    PubMed

    Ayello, E A; Mezey, M; Amella, E J

    1997-08-01

    The importance of education in preventing and treating patients with pressure ulcers is evident by the inclusion of recommendations for educational objectives in the clinical guidelines by the Agency for Health Care Policy and Research. Both caregiver and client should be assessed for knowledge of pressure ulcers. Physical changes in vision, hearing, and cognition that might affect educating older clients are described. Strategies suitable for teaching older clients about the prevention and treatment of pressure ulcers are given.

  12. A critical care network pressure ulcer prevention quality improvement project.

    PubMed

    McBride, Joanna; Richardson, Annette

    2015-03-30

    Pressure ulcer prevention is an important safety issue, often underrated and an extremely painful event harming patients. Critically ill patients are one of the highest risk groups in hospital. The impact of pressure ulcers are wide ranging, and they can result in increased critical care and the hospital length of stay, significant interference with functional recovery and rehabilitation and increase cost. This quality improvement project had four aims: (1) to establish a critical care network pressure ulcer prevention group; (2) to establish baseline pressure ulcer prevention practices; (3) to measure, compare and monitor pressure ulcers prevalence; (4) to develop network pressure ulcer prevention standards. The approach used to improve quality included strong critical care nursing leadership to develop a cross-organisational pressure ulcer prevention group and a benchmarking exercise of current practices across a well-established critical care Network in the North of England. The National Safety Thermometer tool was used to measure pressure ulcer prevalence in 23 critical care units, and best available evidence, local consensus and another Critical Care Networks' bundle of interventions were used to develop a local pressure ulcer prevention standards document. The aims of the quality improvement project were achieved. This project was driven by successful leadership and had an agreed common goal. The National Safety Thermometer tool was an innovative approach to measure and compare pressure ulcer prevalence rates at a regional level. A limitation was the exclusion of moisture lesions. The project showed excellent engagement and collaborate working in the quest to prevent pressure ulcers from many critical care nurses with the North of England Critical Care Network. A concise set of Network standards was developed for use in conjunction with local guidelines to enhance pressure ulcer prevention. © 2015 British Association of Critical Care Nurses.

  13. Determinants of mortality among older adults with pressure ulcers.

    PubMed

    Khor, Hui Min; Tan, Juan; Saedon, Nor Izzati; Kamaruzzaman, Shahrul B; Chin, Ai Vyrn; Poi, Philip J H; Tan, Maw Pin

    2014-01-01

    The presence of pressure ulcers imposes a huge burden on the older person's quality of life and significantly increases their risk of dying. The objective of this study was to determine patient characteristics associated with the presence of pressure ulcers and to evaluate the risk factors associated with mortality among older patients with pressure ulcers. A prospective observational study was performed between Oct 2012 and May 2013. Patients with preexisting pressure ulcers on admission and those with hospital acquired pressure ulcers were recruited into the study. Information on patient demographics, functional status, nutritional level, stages of pressure ulcer and their complications were obtained. Cox proportional hazard analysis was used to assess the risk of death in all patients. 76/684 (11.1%) patients had pre-existing pressure ulcers on admission and 30/684 (4.4%) developed pressure ulcers in hospital. There were 68 (66%) deaths by the end of the median follow-up period of 12 (IQR 2.5-14) weeks. Our Cox regression model revealed that nursing home residence (Hazard Ratio, HR=2.33, 95% confidence interval, CI=1.30, 4.17; p=0.005), infected deep pressure ulcers (HR=2.21, 95% CI=1.26, 3.87; p=0.006) and neutrophilia (HR=1.76; 95% CI 1.05, 2.94; p=0.031) were independent predictors of mortality in our elderly patients with pressure ulcers. The prevalence of pressure ulcers in our setting is comparable to previously reported figures in Europe and North America. Mortality in patients with pressure ulcer was high, and was predicted by institutionalization, concurrent infection and high neutrophil counts. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis.

    PubMed

    Bamba, Ravinder; Madden, James J; Hoffman, Ashley N; Kim, Justine S; Thayer, Wesley P; Nanney, Lillian B; Spear, Marcia E

    2017-01-01

    Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage. This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection. All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34). Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction.

  15. Pressure Ulcer Prevention: Where Practice and Education Meet.

    PubMed

    Bos, Brenda S; Wangen, Tina M; Elbing, Carl E; Rowekamp, Debra J; Kruggel, Heather A; Conlon, Patricia M; Scroggins, Leann M; Schad, Shauna P; Neumann, Julie A; Barth, Melissa M; Grubbs, Pamela L; Sievers, Beth A

    2016-01-01

    This article describes the processes used to implement a pressure ulcer management program in a Midwest academic medical center, which led to a decrease in reportable pressure ulcers. A learning needs assessment was completed, and a workgroup was formed to address the learning needs. Methods, materials, and processes included lectures, technology-enhanced learning, and interactive stations with mannequins and pressure ulcer moulages. The processes and outcome measures used to measure effectiveness of the program are discussed.

  16. Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis

    PubMed Central

    Madden, James J.; Hoffman, Ashley N.; Kim, Justine S.; Thayer, Wesley P.; Nanney, Lillian B.; Spear, Marcia E.

    2017-01-01

    Background: Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage. Methods: This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection. Results: All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34). Conclusions: Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction. PMID:28203494

  17. Repositioning for pressure ulcer prevention in adults.

    PubMed

    Gillespie, Brigid M; Chaboyer, Wendy P; McInnes, Elizabeth; Kent, Bridie; Whitty, Jennifer A; Thalib, Lukman

    2014-04-03

    A pressure ulcer (PU), also referred to as a 'pressure injury', 'pressure sore', or 'bedsore' is defined as an area of localised tissue damage that is caused by unrelieved pressure, friction or shearing forces on any part of the body. PUs commonly occur in patients who are elderly and less mobile, and carry significant human and economic impacts. Immobility and physical inactivity are considered to be major risk factors for PU development and the manual repositioning of patients in hospital or long-term care is a common pressure ulcer prevention strategy. The objectives of this review were to:1) assess the effects of repositioning on the prevention of PUs in adults, regardless of risk or in-patient setting;2) ascertain the most effective repositioning schedules for preventing PUs in adults; and3) ascertain the incremental resource consequences and costs associated with implementing different repositioning regimens compared with alternate schedules or standard practice. We searched the following electronic databases to identify reports of the relevant randomised controlled trials: the Cochrane Wounds Group Specialised Register (searched 06 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 8); Ovid MEDLINE (1948 to August, Week 4, 2013); Ovid EMBASE (1974 to 2013, Week 35); EBESCO CINAHL (1982 to 30 August 2013); and the reference sections of studies that were included in the review. Randomised controlled trials (RCTs), published or unpublished, that assessed the effects of any repositioning schedule or different patient positions and measured PU incidence in adults in any setting. Two review authors independently performed study selection, risk of bias assessment and data extraction. We included three RCTs and one economic study representing a total of 502 randomised participants from acute and long-term care settings. Two trials compared the 30º and 90º tilt positions using similar repositioning frequencies (there was a

  18. Pressure ulcer prevention is everyone's business: the PUPS project.

    PubMed

    Blenman, Juliet; Marks-Maran, Di

    2017-03-23

    Prevention of pressure ulcers is one of the greatest healthcare challenges in terms of reducing patient harm. The literature shows that although numerous reports and policy documents have been published, pressure ulcer prevention remains an ongoing challenge. A number of innovations have been published offering practising nurses and managers ideas for raising awareness of skin care and preventing pressure ulcers. The majority of these have focused on patients in hospital settings with very little in the literature related to care-home and community initiatives. This article reports on an innovative approach to education for pressure ulcer prevention through collaboration between patients, carers and health and social care professionals.

  19. Weight and pressure ulcer occurrence: a secondary data analysis.

    PubMed

    Kottner, Jan; Gefen, Amit; Lahmann, Nils

    2011-11-01

    Prolonged external mechanical loads lead to compression, tension and shear of the skin and underlying tissues leading to pressure ulcers. Underweight seems to be associated with high pressure ulcer risk but the distinct relation between overweight and pressure ulcer development is uncertain. Anatomical and physiological differences of typical pressure ulcer points are often neglected. (1) Is there a relationship between BMI and superficial (category 2) and deep (category 3/4) pressure ulcers on the trunk? (2) Is there a relationship between BMI and superficial (category 2) and deep (category 3/4) pressure ulcers at the heels? Secondary data analysis of ten pressure ulcer prevalence surveys in Germany. Comparison of proportions of pressure ulcer patients according to the 12 BMI groups provided by the WHO considering superficial and deep pressure ulcers and different anatomic locations. Hospital patients (n=50,446). Median age was 68 (IQR 55-78) years and the proportion of female patients was 55.4%. The overall proportion of patients with at least one pressure ulcer at the trunk was 2.0% (99% CI 1.8-2.2) for category 2 and 0.9% (99% CI 0.8-1.0) for category 3/4 pressure ulcers. Trunk pressure ulcer proportions were significantly higher in thin individuals than in normal weight and obese patients. The overall proportion of patients with at least one heel pressure ulcer was 0.6% (99% CI 0.5-0.7) for category 2 and 0.6% (99% CI 0.5-0.7) for category 3/4. With one exception there were no statistically significant differences between BMI groups. Irrespective of the degree of mobility and activity thin patients are at higher risk for pressure ulcers at the sacrum, ischial tuberosity, trochanter and shoulder than normal weight and obese patients. Heel pressure ulcers seem to be unrelated to the BMI level, indicating that the BMI is not a predictor for heel PU development. These results also support the assumption that the etiology and pathogenetic mechanisms of trunk and

  20. Pressure ulcers: development and psychometric evaluation of the attitude towards pressure ulcer prevention instrument (APuP).

    PubMed

    Beeckman, D; Defloor, T; Demarré, L; Van Hecke, A; Vanderwee, K

    2010-11-01

    Pressure ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards pressure ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards pressure ulcer prevention is lacking. Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP). Prospective psychometric instrument validation study. A literature review was performed to design the instrument. Content validity was evaluated by nine European pressure ulcer experts and five experts in psychometric instrument validation in a double Delphi procedure. A convenience sample of 258 nurses and 291 nursing students from Belgium and The Netherlands participated in order to evaluate construct validity and stability reliability of the instrument. The data were collected between February and May 2008. A factor analysis indicated the construct of a 13 item instrument in a five factor solution: (1) attitude towards personal competency to prevent pressure ulcers (three items); (2) attitude towards the priority of pressure ulcer prevention (three items); (3) attitude towards the impact of pressure ulcers (three items); (4) attitude towards personal responsibility in pressure ulcer prevention (two items); and (5) attitude towards confidence in the effectiveness of prevention (two items). This five factor solution accounted for 61.4% of the variance in responses related to attitudes towards pressure ulcer prevention. All items demonstrated factor loadings over 0.60. The instrument produced similar results during stability testing [ICC=0.88 (95% CI=0.84-0.91, P<0.001)]. For the total instrument, the internal consistency (Cronbachs alpha) was 0.79. The APuP is a psychometrically sound instrument that can be used to effectively assess attitudes towards pressure ulcer prevention

  1. Classification of pressure ulcers: a systematic literature review.

    PubMed

    Stausberg, Jürgen; Kiefer, Emanuel

    2009-01-01

    Different classifications of pressure ulcer are in use making national and international studies on epidemiological issues as well as on effects of prophylactical and therapeutical interventions difficult. A systematic literature search identified 31 pressure ulcer classifications. Thirteen could be retrieved and were further analyzed. Six variants of the International Classification of Diseases (ICD) differ totally in number of classes, hierarchical structure, characteristics included, and level of detail. They share only the fact of a "pressure ulcer". Recommendations of expert organizations and clinical classifications differ as well. The currently introduced grade "suspected deep tissue injury" in the classification proposed by the US-National Pressure Ulcer Advisory Panel (NPUAP) is neither present in the European Pressure Ulcer Advisory Panel (EPUAP) one, nor in the ICD variants. Being aware of the reliability issue in pressure ulcer diagnosis and grading, the situation is appalling. Furthermore, stage adjusted quality assessment, prophylaxis and therapy ends with the borders of a classification. We call the WHO to initiate a harmonization of the ICD variants of pressure ulcer classification and to cooperate with experts' organizations in this field, particularly with regard to the development of ICD-11. Reports on pressure ulcer should always mention the classification used.

  2. Dressings for Preventing Pressure Ulcers: A Meta-analysis.

    PubMed

    Huang, Lei; Woo, Kevin Y; Liu, Li-Bao; Wen, Rui-Juan; Hu, Ai-Ling; Shi, Cheng-Gang

    2015-06-01

    The purpose of this analysis is to determine the effectiveness of dressing material in the prevention of pressure ulcers. Results showed that hydrocolloid, foam, and film were more effective than a standard care protocol in patients at risk for pressure ulcers.

  3. Biomechanical modeling to prevent ischial pressure ulcers.

    PubMed

    Luboz, Vincent; Petrizelli, Marion; Bucki, Marek; Diot, Bruno; Vuillerme, Nicolas; Payan, Yohan

    2014-07-18

    With 300,000 paraplegic persons only in France, ischial pressure ulcers represent a major public health issue. They result from the buttocks׳ soft tissues compression by the bony prominences. Unfortunately, the current clinical techniques, with - in the best case - embedded pressure sensor mats, are insufficient to prevent them because most are due to high internal strains which can occur even with low pressures at the skin surface. Therefore, improving prevention requires using a biomechanical model to estimate internal strains from skin surface pressures. However, the buttocks׳ soft tissues׳ stiffness is still unknown. This paper provides a stiffness sensitivity analysis using a finite element model. Different layers with distinct Neo Hookean materials simulate the skin, fat and muscles. With Young moduli in the range [100-500 kPa], [25-35 kPa], and [80-140 kPa] for the skin, fat, and muscles, respectively, maximum internal strains reach realistic 50 to 60% values. The fat and muscle stiffnesses have an important influence on the strain variations, while skin stiffness is less influent. Simulating different sitting postures and changing the muscle thickness also result in a variation in the internal strains. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Heel ulcers - Pressure ulcers or symptoms of peripheral arterial disease? An exploratory matched case control study.

    PubMed

    Twilley, Heidi; Jones, Sarahjane

    2016-05-01

    To investigate the relationship between pressure ulcers of the heel and peripheral arterial disease (PAD) and determine the feasibility of conducting a statistically powered matched case control study. Evidence indicates a relationship between chronic leg ulcers and vascular disease. The relationship between pressure ulcers of the heel and vascular disease is less well established. A matched case control study. Data were collected between March 2014 and January 2015. 15 patients identified as having a grade 2, 3 or 4 pressure ulcer of the heel were compared with 15 matched controls without pressure ulcers of the heel. The primary clinical outcome measure was the ankle brachial pressure index (ABPI), where an ABPI <0.9 or >1.3 was considered clinically indicative of PAD. The primary feasibility outcome measure was the rate of recruitment. Eighty seven patients were reported as having foot and heel ulcers; 36 of whom were identified as having pressure ulcers of the heel, 15 (42%) of whom were recruited to the study. Patients presenting with pressure ulcers of the heel were significantly more likely to simultaneously have previously undiagnosed PAD compared with age, gender and ethnicity matched controls without pressure ulcers of the heel (odds ratio: 11, 95% confidence interval 1.99-60.57). The formation of pressure ulcers of the heel could, in some patients, be related to the presence of PAD rather than a consequence of poor quality care. Healthcare professionals should assess the patient to exclude or confirm PAD. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  5. Pressure ulcers in German nursing homes and acute care hospitals: prevalence, frequency, and ulcer characteristics.

    PubMed

    Lahmann, Nils A; Halfens, Ruud Jg; Dassen, Theo

    2006-02-01

    In German healthcare facilities, research-based knowledge of pressure ulcers and their relation to patient characteristics is limited. To provide information for national and international comparison on pressure ulcers and related issues, two cross-sectional surveys were conducted among 21,574 German hospital patients and nursing home residents (147 institutions total) in 2002 and 2003. Prevalence and frequency rates of pressure ulcers in people at risk (Braden score of pressure ulcer prevalence was 21.1% and that the number of pressure ulcers per person was higher in hospitals (1.91, 24.6%) than in nursing homes (1.42, 13.9%). In addition, in hospital patients and nursing home residents, 36.4% and 46.7% of wounds, respectively, were grade 2 severity and higher. In both types of institutions, the most common pressure ulcer locations were the lower back and the heels. In hospital patients, 51.4% of pressure ulcers were facility-acquired, compared to 60.2% in nursing homes. In hospital patients and nursing home residents, 7.4% and 29.7% of wounds, respectively, had existed for more than 3 months. The studies also found that persons with lower Braden scale scores had more ulcers and more severe pressure ulcers. Analysis of wounds in this large patient population provides more detailed information about the problem of pressure ulcers and should help improve prevention and treatment.

  6. The role of dressings in the prevention of pressure ulcers.

    PubMed

    Brown, Julie

    2016-08-11

    Pressure ulceration is a significant global healthcare problem and represents a considerable burden on healthcare resources. Within the literature an increasing number of studies have examined the role prophylactic dressings play in redistributing pressure and helping to protect the skin from the effects of friction and shear. The use of dressings to prevent pressure ulcers may be considered a controversial issue, as previous opinion has been that dressings do not reduce the effects of pressure. This article will critically evaluate the literature to examine the role dressings play in the prevention of pressure ulceration.

  7. Pressure Ulcers: Factors Contributing to Their Development in the OR.

    PubMed

    Engels, Dawn; Austin, Melody; McNichol, Laurie; Fencl, Jennifer; Gupta, Sat; Kazi, Haseeb

    2016-03-01

    The prevention of health care-associated pressure ulcers (HAPUs) is an important quality measure because HAPUs are considered a never event. The literature suggests that the prevalence rate of pressure ulcers is 8.5% or higher among patients who undergo surgical procedures that last longer than three hours. We performed a retrospective chart review to determine what factors contribute to the development of pressure ulcers in patients who undergo surgical procedures. The sample population included patients who acquired a pressure ulcer that was not present at admission and developed during their postoperative hospital stay. The project revealed consistent risk factors that may contribute to the development of pressure ulcers in patients who have undergone surgical procedures. These findings can drive the implementation of preventive measures to reduce the occurrence of HAPUs associated with surgical procedures.

  8. A resource-efficient planning for pressure ulcer prevention.

    PubMed

    Ostadabbas, Sarah; Yousefi, Rasoul; Nourani, Mehrdad; Faezipour, Miad; Tamil, Lakshman; Pompeo, Matthew Q

    2012-11-01

    Pressure ulcer is a critical problem for bed-ridden and wheelchair-bound patients, diabetics, and the elderly. Patients need to be regularly repositioned to prevent excessive pressure on a single area of body, which can lead to ulcers. Pressure ulcers are extremely costly to treat and may lead to several other health problems, including death. The current standard for prevention is to reposition at-risk patients every two hours. Even if it is done properly, a fixed schedule is not sufficient to prevent all ulcers. Moreover, it may result in nurses being overworked by turning some patients too frequently. In this paper, we present an algorithm for finding a nurse-effort optimal repositioning schedule that prevents pressure ulcer formation for a finite planning horizon. Our proposed algorithm uses data from a commercial pressure mat assembled on the beds surface and provides a sequence of next positions and the time of repositioning for each patient.

  9. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System

    PubMed Central

    Black, Joyce M.; Goldberg, Margaret; McNichol, Laurie; Moore, Lynn; Sieggreen, Mary

    2016-01-01

    Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised definitions were the focus of a multidisciplinary consensus conference held in April 2016. As a result of stakeholder and public input, along with the consensus conference, important changes were made and incorporated into the new staging definitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised definition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised definition of a Stage 2 pressure injury seeks to clarify the difference between moisture-associated skin damage and injury caused by pressure and/or shear. The term suspected has been removed from the Deep Tissue Pressure Injury diagnostic label. Each definition now describes the extent of tissue loss present and the anatomical features that may or may not be present in the stage of injury. These important revisions reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development. PMID:27749790

  10. Electronic versus paper records: documentation of pressure ulcer data.

    PubMed

    Tubaishat, Ahmad; Tawalbeh, Loai I; AlAzzam, Manar; AlBashtawy, Mohammed; Batiha, Abdul-Monim

    The documentation of patient data on health records is a vital component of the care process. Accurate and complete recording of this data is a necessary practice. The adoption of electronic health records to improve the quality of nursing documentation is on the rise. This study compares the accuracy and completeness of pressure ulcer data documentation between electronic and paper records. A descriptive, comparative design with a retrospective review of patient records. Settings and sample: Two hospitals were chosen purposefully, one using electronic recording of patient data and the other using paper records. In the first phase, all hospitalised patients aged 18 years and over were inspected for pressure ulcers. In the second phase, the files of patients with pressure ulcers were audited. Of the 52 patients with ulcers found in the hospital that used an electronic system, 43 of their records documented the pressure ulcers (83%). Of the 55 patients with pressure ulcers in the hospital using paper records, 39 files had corresponding documentation of the presence of a pressure ulcer (71%). In terms of accuracy and completeness, more comprehensive documentation practice was found on the electronic health records compared with paper records. However, both types of systems have shortcomings in the practice of pressure ulcer data documentation.

  11. Nurses' attitudes towards pressure ulcer prevention in Turkey.

    PubMed

    Aslan, Arzu; Yavuz van Giersbergen, Meryem

    2016-02-01

    Pressure ulcers remain a major problem in healthcare system. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Positive attitudes towards pressure ulcer prevention have positive impacts on preventive care. The aim of this study was to identify nurses' attitude towards pressure ulcer prevention. The study design was descriptive. The study was carried out in a university hospital in Izmir, Turkey. The study population consisted of 660 nurses who work in medical and surgical clinics and intensive care units. The study sample consisted of 426 nurses who agreed to participate. Attitude towards Pressure Ulcer Prevention Instrument was used in order to evaluate nurses' attitudes. Written permissions for ethical considerations and Attitude towards Pressure Ulcer Prevention Instrument permission were obtained. Data were collected between June and July 2014. The statistics program SPSS 18 packaged software was used in the analyses of data. The average age of the nurses who took part in the study was 31.86 ± 7.09 years and the average work experience was 8.88 ± 7.41 years; 36.9% (n: 157) were working in intensive care units. The nurses' average score on the Attitude towards Pressure Ulcer Prevention Instrument was 43.74 ± 4.29 (84.12%). It was seen that the attitudes of the nurses towards the prevention of pressure ulcers was positive. To read guidelines and training time about pressure ulcer prevention affect positively attitudes towards the prevention of pressure ulcers. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  12. The VCU Pressure Ulcer Summit-Developing Centers of Pressure Ulcer Prevention Excellence: A Framework for Sustainability.

    PubMed

    Creehan, Sue; Cuddigan, Janet; Gonzales, Dana; Nix, Denise; Padula, William; Pittman, Joyce; Pontieri-Lewis, Vicky; Walden, Christine; Wells, Belinda; Wheeler, Robinetta

    2016-01-01

    Hospital-acquired pressure ulcer occurrences have declined over the past decade as reimbursement policies have changed, evidence-based practice guidelines have been implemented, and quality improvement initiatives have been launched. However, the 2006-2008 Institute for Healthcare Improvement goal of zero pressure ulcers remains difficult to achieve and even more challenging to sustain. Magnet hospitals tend to have lower hospital-acquired pressure ulcer rates than non-Magnet hospitals, yet many non-Magnet hospitals also have robust pressure ulcer prevention programs. Successful programs share commonalities in structure, processes, and outcomes. A national summit of 55 pressure ulcer experts was convened at the Virginia Commonwealth University Medical Center in March 2014. The group was divided into 3 focus groups; each was assigned a task to develop a framework describing components of a proposed Magnet-designated Center of Pressure Ulcer Prevention Excellence. Systematic literature reviews, analysis of exemplars, and nominal group process techniques were used to create the framework. This article presents a framework describing the proposed Magnet-designated Centers of Pressure Ulcer Prevention Excellence. Critical attributes of Centers of Excellence are identified and organized according to the 4 domains of the ANCC model for the Magnet Recognition Program: transformational leadership; structural empowerment; exemplary professional practice; and new knowledge innovation and improvements. The structures, processes, and outcome measures necessary to become a proposed Center of Pressure Ulcer Prevention Excellence are discussed.

  13. The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units.

    PubMed

    Li, Dan

    2016-08-01

    To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. A retrospective, comparative, descriptive, correlational study. A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete

  14. Unavoidable Pressure Ulcers: Development and Testing of the Indiana University Health Pressure Ulcer Prevention Inventory.

    PubMed

    Pittman, Joyce; Beeson, Terrie; Terry, Colin; Dillon, Jill; Hampton, Charity; Kerley, Denise; Mosier, Judith; Gumiela, Ellen; Tucker, Jessica

    2016-01-01

    Despite prevention strategies, hospital-acquired pressure ulcers (HAPUs) continue to occur in the acute care setting. The purpose of this study was to develop an operational definition of and an instrument for identifying avoidable/unavoidable HAPUs in the acute care setting. The Indiana University Health Pressure Ulcer Prevention Inventory (PUPI) was developed and psychometric testing was performed. A retrospective pilot study of 31 adult hospitalized patients with an HAPU was conducted using the PUPI. Overall content validity index of 0.99 and individual item content validity index scores (0.9-1.0) demonstrated excellent content validity. Acceptable PUPI criterion validity was demonstrated with no statistically significant differences between wound specialists' and other panel experts' scoring. Construct validity findings were acceptable with no statistically significant differences among avoidable or unavoidable HAPU patients and their Braden Scale total scores. Interrater reliability was acceptable with perfect agreement on the total PUPI score between raters (κ = 1.0; P = .025). Raters were in total agreement 93% (242/260) of the time on all 12 individual PUPI items. No risk factors were found to be significantly associated with unavoidable HAPUs. An operational definition of and an instrument for identifying avoidable/unavoidable HAPUs in the acute care setting were developed and tested. The instrument provides an objective and structured method for identifying avoidable/unavoidable HAPUs. The PUPI provides an additional method that could be used in root-cause analyses and when reporting adverse pressure ulcer events.

  15. Using a national guideline to prevent and manage pressure ulcers.

    PubMed

    Neilson, Julie; Avital, Liz; Willock, Jane; Broad, Nigel

    2014-05-01

    Developing pressure ulcers is a painful and distressing event for patients, and one that can be prevented. The National Institute for Health and Care Excellence pressure ulcer guideline has recently been updated to cover the prevention and management of this condition. This article focuses on the recommendations that are relevant to nurses, covering areas such as risk assessment, skin assessment, repositioning, pressure-redistributing devices, dressings, patient and carer information, and training and education. It also identifies what senior nurses and nurse managers must do to ensure their staff can prevent and manage pressure ulcers effectively.

  16. Spinal cord injury pressure ulcer treatment: an experience-based approach.

    PubMed

    Sunn, Gabriel

    2014-08-01

    Pressure ulcers continue to impact the lives of spinal cord injury patients severely. Pressure ulcers must be accurately staged according to National Pressure Ulcer Advisory recommendations before treatment design. The first priority in treatment of pressure ulcers is offloading. Intact skin ulcers may be treated with noncontact nonthermal low-frequency ultrasound. Superficial pressure ulcers may be treated with a combination of collagenase and foam dressings. Deeper pressure ulcers warrant negative-pressure wound therapy dressings along with biologic adjuncts to fill in wound depth. Discovery and treatment of osteomyelitis is a high priority when initially evaluating pressure ulcers. Surgical intervention must always be considered. Published by Elsevier Inc.

  17. Animal Models in Pressure Ulcer Research

    PubMed Central

    Salcido, Richard; Popescu, Adrian; Ahn, Chulhyun

    2007-01-01

    Background/Objective: Research targeting the pathophysiology, prevention, and treatment of pressure ulcers (PrUs) continue to be a significant priority for clinical and basic science research. Spinal cord injury patients particularly benefit from PrU research, because the prevalence of chronic wounds in this category is increasing despite standardized medical care. Because of practical, ethical, and safety considerations, PrUs in the human environment are limited to studies involving patients with pre-existing ulcers. Therefore, we are limited in our basic knowledge pertaining to the development, progression, and healing environment in this devastating disease. Methods: This review provides a synopsis of literature and a discussion of techniques used to induce PrUs in animal models. The question of what animal model best mimics the human PrU environment has been a subject of debate by investigators, peer review panels, and editors. The similarities in wound development and healing in mammalian tissue make murine models a relevant model for understanding the causal factors as well as the wound healing elements. Although we are beginning to understand some of the mechanisms of PrU development, a key dilemma of what makes an apparently healthy tissue develop a PrU waits to be solved. Results and Conclusions: No single method of induction and exploring PrUs in animals can address all the aspects of the pathology of chronic wounds. Each model has its particular strengths and weaknesses. Certain types of models can selectively identify specific aspects of wound development, quantify the extent of lesions, and assess outcomes from interventions. The appropriate interpretation of these methods is significant for proper study design, an understanding of the results, and extrapolation to clinical relevance. PMID:17591222

  18. A rare location for a common problem: popliteal pressure ulcer.

    PubMed

    Ozer, Kadri; Colak, Ozlem; Goktas, Fethiye B; Sungur, Nezih; Kocer, Ugur

    2016-04-01

    Pressure ulcer is defined as localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. The most frequent sites for pressure ulcers are the occiput, sacrum, ischial tuberosities, trochanters, lateral malleoli and posterior heels. Herein, we present a case of grade III pressure ulcer seen in popliteal region which is an unusual localisation that is rarely seen in the literature. An awareness of this unusual localisation of pressure ulcer is necessary to prevent decrease in quality of life, particularly in the wheelchair-dependent population. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  19. Microclimate and development of pressure ulcers and superficial skin changes.

    PubMed

    Yusuf, Saldy; Okuwa, Mayumi; Shigeta, Yoshie; Dai, Misako; Iuchi, Terumi; Rahman, Sulaiman; Usman, Awaluddin; Kasim, Sukmawati; Sugama, Junko; Nakatani, Toshio; Sanada, Hiromi

    2015-02-01

    This study aims to evaluate the microclimate and development of pressure ulcers and superficial skin changes. A prospective cohort study was conducted in an acute care ward in Indonesia. Risk factors for pressure ulcers and superficial skin changes were identified based on the Bergstrom Braden conceptual model. Microclimate data were collected every 3 days for 15 days while the development of pressure ulcers and superficial skin changes was observed every day. Pressure ulcers and superficial skin changes were developed in 20 of the 71 participants. Total mean difference in skin temperature was higher for patients with pressure ulcers and superficial skin changes (0·9 ± 0·6°C) compared with controls (0·6 ± 0·8°C) (P = 0·071). Binary logistic regression predictor values for pressure ulcers and superficial skin changes were 0·111 for type of sheet and 0·347 for Braden Scale results. In conclusion, difference in skin temperature seems to be a predictor for pressure ulcer development and superficial skin changes, while synthetic fibre sheets are able to maintain a beneficial microclimate. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  20. Skin blood flow dynamics and its role in pressure ulcers

    PubMed Central

    Liao, Fuyuan; Burns, Stephanie; Jan, Yih-Kuen

    2013-01-01

    Pressure ulcers are a significant healthcare problem affecting the quality of life in wheelchair bounded or bed-ridden people and are a major cost to the healthcare system. Various assessment tools such as the Braden scale have been developed to quantify the risk level of pressure ulcers. These tools have provided an initial guideline on preventing pressure ulcers while additional assessments are needed to improve the outcomes of pressure ulcer prevention. Skin blood flow function that determines the ability of the skin in response to ischemic stress has been proposed to be a good indicator for identifying people at risk of pressure ulcers. Wavelet spectral and nonlinear complexity analyses have been performed to investigate the influences of the metabolic, neurogenic and myogenic activities on microvascular regulation in people with various pathological conditions. These findings have contributed to the understanding of the role of ischemia and viability on the development of pressure ulcers. The purpose of the present review is to provide an introduction of the basic concepts and approaches for the analysis of skin blood flow oscillations, and present an overview of the research results obtained so far. We hope this information may contribute to the development of better clinical guidelines for the prevention of pressure ulcers. PMID:23602509

  1. Pressure ulcers: critical considerations in prevention and management.

    PubMed

    Alvarez, O M

    1991-01-01

    Pressure ulcer development is a serious problem occurring predominately among elderly persons, who are confined to bed or chair. Factors associated with pressure ulcer development include: cerebrovascular accident, impaired nutritional intake, fecal incontinence, lymphocytopenia and a high comorbidity score. Implementation of preventative measures, such as: in-depth assessment for mobility, a pressure relieving device combined with adequate repositioning, thorough evaluation for nutritional status and urinary incontinence, significantly reduce pressure ulcer incidence. If the pressure ulcer is a partial thickness (Stage II) wound, the causative factors are probably friction and/or moisture. If the ulcer is full thickness (Stage III, IV) it is secondary to pressure and/or shearing forces. The development of wound infection is the most common complication. Osteomyelitis is not an uncommon occurrence and must be initially ruled out in all full thickness pressure ulcers. Surgical debridement of necrotic tissue is necessary prior to further treatment and /or assessments. Cultures and antibiotic therapy are indicated only upon evidence of infection (erythema, edema, cellulitis, osteomyelitis, leukocytosis, bandemia or fever). Topical pharmacologic agents may be used to prevent or treat infection but must be carefully controlled to avoid such adverse effects as toxicity to the wound, allergic reaction and development of resistant pathogens. Proper use of occlusive dressings increase patient comfort, enhance healing, decrease the possibility of infection, save time and reduce costs. A patient presenting an ulcer which fails to improve, or due to its size will take a great deal of time to heal, should be evaluated for surgical closure.

  2. Pressure ulcers. Physical, supportive, and local aspects of management.

    PubMed

    Alvarez, O M; Childs, E J

    1991-10-01

    Pressure ulcers are a common and serious problem predominately among elderly persons who are confined to bed or chair. Additional factors associated with pressure ulcer development include cerebrovascular accident, impaired nutritional intake, urinary or fecal incontinence, hypoalbuminemia, and previous fracture. Implementation of preventive measures, such as an in-depth assessment for mobility, a pressure-relieving device combined with adequate repositioning, and thorough evaluation for nutritional status and urinary incontinence, significantly reduce pressure ulcer incidence. If the pressure ulcer is a partial thickness (stage II) wound, the causative factors are probably friction or moisture. If the ulcer is full thickness (stage III and IV), it is secondary to pressure or shearing forces. The development of wound infection is the most common complication in the management approach. Osteomyelitis is not an uncommon occurrence and must be initially ruled out in all full thickness pressure ulcers. Surgical debridement of necrotic tissue is necessary prior to further treatment and assessments. Antibiotic therapy is indicated only upon evidence of infection (cellulitis, osteomyelitis, leukocytosis, bandemia, or fever). Topical pharmacologic agents may be used to prevent or treat infection but must be carefully controlled to avoid such adverse effects as toxicity to the wound, allergic reaction, and development of resistant pathogens. Proper use of occlusive dressings increase patient comfort, enhance healing, decrease the possibility of infection, save time, and reduce costs. A patient presenting an ulcer that fails to improve or, because of its size, will take a great deal of time to heal should be evaluated for surgical closure.

  3. Importance of nutrition in preventing and treating pressure ulcers.

    PubMed

    Taylor, Carolyn

    2017-06-30

    Pressure ulcers are painful, and affect patients' health, mobility and well-being. They also cost the NHS between £1.4-2.1 billion a year. Although a large proportion of pressure ulcers are avoidable, many still occur and, because pressure ulcer incidence is an indicator of care quality, it can put carers under scrutiny. The National Institute for Health and Care Excellence states that adequate risk assessment of pressure ulcer development, including the role of malnutrition, improves care. Adequate nutrition is vital for the prevention of pressure ulcers and malnutrition can hinder healing when pressure ulcers have developed. The risk of malnutrition should be assessed with a recognised tool, such as the Malnutrition Universal Screening Tool, and appropriate treatment plans should be drawn up for patients identified as being at risk of malnutrition to improve their nutritional state. For example, the dietary intake of people with poor appetite can be supplemented with nutritious snacks between meals. The aims of this article are to help readers understand risk factors for malnutrition and how dietary intake can be manipulated to improve patients' nutritional state. It also aims to highlight how improving nutritional intake helps to prevent pressure ulcers. On completing the article, readers will be able to consider and review their own practice.

  4. Ulcer piercing: cleansing of complicated diabetic neuropathic foot ulcers by positive pressure irrigation.

    PubMed

    Cavallini, M

    2014-02-01

    To demonstrate the efficacy of the ulcer piercing procedure, which allows constant cleansing of the ulcer and facilitates a positive pressure irrigation of any pierced hidden tracts, in order to reduce the negative impact of stasis on wound healing. We designed a surgical procedure of ulcer piercing and drainage with a silastic tube, which allows positive pressure irrigation of any pierced tracts. This procedure was performed in a continuous series of 25 selected diabetic patients affected by a Wagner stage 3 ulcer of the toe (n=16), metatarsal midfoot (n=5) and plantar Charcot foot (n=4), and with adequate foot arterial blood supply. Within 6 months of the ulcer piercing procedure, 23/25 of ulcers had completely healed. In two further cases, the ulcer piercing ring was still in place after 3 and 5 months, progressively healing with no active signs of infection. Taking into consideration the advantages and the lack of side effects afforded by this procedure, ulcer piercing represents a small but effective step towards an easier and safer approach to treating complicated diabetic neuropathic foot ulcers with adequate arterial blood supply. There were no external sources of funding for this study. The author has no conflicts of interest to declare with regard to the manuscript or its content.

  5. Successful factors to prevent pressure ulcers - an interview study.

    PubMed

    Hommel, Ami; Gunningberg, Lena; Idvall, Ewa; Bååth, Carina

    2017-01-01

    To explore successful factors to prevent pressure ulcers in hospital settings. Pressure ulcer prevalence has been recognised as a quality indicator for both patient safety and quality of care in hospital and community settings. Most pressure ulcer can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions initiated nationwide pressure ulcer prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of pressure ulcer in the spring of 2014 was 14% in hospital settings with a range from 2·7-36·4%. Qualitative semistructured interviews were conducted. A qualitative content analysis, in addition to Promoting Action on Research Implementation in Health Services frameworks, was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014. Three main categories were identified as successful factors to prevent pressure ulcer in hospitals: creating a good organisation, maintaining persistent awareness and realising the benefits for patients. The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of pressure ulcer is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organisation in prevention work. The nurse managers' attitude and engagement are crucial to enable the personnel to work actively with pressure ulcer prevention. Strategies are proposed to advance clinical leadership, knowledge, skills and abilities for the crucial implementation of pressure ulcer prevention. © 2016 John Wiley & Sons Ltd.

  6. Managing pressure ulcers and moisture lesions with new hydrocolloid technology.

    PubMed

    Linthwaite, Adele; Bethell, Elaine

    In efforts to reduce the number of avoidable pressure ulcers in a large trust, a number of initiatives have taken place to increase staff awareness about the importance of preventing and treating pressure ulcers and moisture lesions. New documentation, the use of the 'Think Pink' folders and a social media campaign have all proved successful in seeing the number of avoidable pressure ulcers reported within the trust reduce. As part of this initiative an evaluation took place of a new hydrocolloid dressing. This proved effective at reducing healing times, reducing dressing spend and facilitating regular inspection of the affected areas.

  7. Factors Associated With Pressure Ulcers in Individuals With Spina Bifida

    PubMed Central

    Kim, Sunkyung; Ward, Elisabeth; Dicianno, Brad E.; Clayton, Gerald H.; Sawin, Kathleen J.; Beierwaltes, Patricia; Thibadeau, Judy

    2015-01-01

    Objective To describe factors associated with pressure ulcers in individuals with spina bifida (SB) enrolled in the National Spina Bifida Patient Registry (NSBPR). Design Unbalanced longitudinal multicenter cohort study. Setting Nineteen SB clinics. Participants Individuals with SB (N=3153) enrolled in 19 clinic sites that participate in the NSBPR. Interventions Not applicable. Main Outcome Measures Pressure ulcer status (yes/no) at the annual visit between 2009 and 2012. Results Of 3153 total participants, 19% (n=603) reported ulcers at their most recent annual clinic visit. Seven factors–level of lesion, wheelchair use, urinary incontinence, shunt presence, above the knee orthopedic surgery, recent surgery, and male sex–were significantly associated with the presence of pressure ulcers. Of these factors, level of lesion, urinary incontinence, recent surgery, and male sex were included in the final logistic regression model. The 3 adjusting variables–SB type, SB clinic, and age group–were significant in all analyses (all P<.001). Conclusions By adjusting for SB type, SB clinic, and age group, we found that 7 factors–level of lesion, wheelchair use, urinary incontinence, shunt presence, above the knee orthopedic surgery, recent surgery, and male sex–were associated with pressure ulcers. Identifying key factors associated with the onset of pressure ulcers can be incorporated into clinical practice in ways that prevent and enhance treatment of pressure ulcers in the population with SB. PMID:25796136

  8. The effects of polarized light therapy in pressure ulcer healing.

    PubMed

    Durović, Aleksandar; Marić, Dragan; Brdareski, Zorica; Jevtić, Miodrag; Durdević, Slavisa

    2008-12-01

    Neglecting polarized light as an adjuvant therapy for pressure ulcers and methodology distinctions in the trials engaging polarized light are the reasons for many dilemmas and contradictions. The aim of this study was to establish the effects of polarized light therapy in pressure ulcer healing. This prospective randomized single-blind study involved 40 patients with stage I-III of pressure ulcer. The patients in the experimental group (E) were subjected, besides polarized light therapy, to standard wound cleaning and dressing. Standard wound cleaning and dressing were the only treatment used in the control group (C). A polarized light source was a Bioptron lamp. Polarized light therapy was applied for six min daily, five times a week, four weeks. The Pressure Ulcer Scale for Healing (PUSH) was used in the assessment of outcome. Statistic analysis included Mann Whitney Test, Fisher Exact Test, Wilcoxon Signed Rank test. There were significant differences between the groups at the end of the treatment regarding the surface of pressure ulcer (E: 10.80 +/- 19.18; C: 22,97 +/- 25,47; p = 0.0005), rank of pressure ulcer (E: 5.90 +/- 2.48; C: 8.6 +/- 1.05; p = 0.0005) and total PUSH score (E: 7.35 +/- 3.17; C: 11.85 +/- 2.35; p = 0,0003). The patients in the experimental group had significantly better values of the parameters monitored than the patients in the control group. After a four-week polarized light therapy 20 patients with stage I-III ulcer had significant improvement in pressure ulcer healing, so it could be useful to apply polarized light in the treatment of pressure ulcers.

  9. Nutritional interventions for preventing and treating pressure ulcers.

    PubMed

    Langer, Gero; Fink, Astrid

    2014-06-12

    Pressure ulcers affect approximately 10% of people in hospitals and older people are at highest risk. A correlation between inadequate nutritional intake and the development of pressure ulcers has been suggested by several studies, but the results have been inconsistent. To evaluate the effects of enteral and parenteral nutrition on the prevention and treatment of pressure ulcers. In March 2014, for this first update, we searched The Cochrane Wounds Group Specialised Trials Register, the Cochrane Central register of Controlled Trials (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library), the Health Technology Assessment Database (HTA) (The Cochrane Library), the Cochrane Methodology Register (The Cochrane Library), NHS Economic Evaluation Database (The Cochrane Library), Ovid Medline, Ovid Embase and EBSCO CINAHL. No date, language or publication status limits were applied. Randomised controlled trials (RCTs) evaluating the effects of enteral or parenteral nutrition on the prevention and treatment of pressure ulcers, which measured the incidence of new ulcers, ulcer healing or changes in pressure ulcer severity. There were no restrictions on types of patient, setting, date, publication status or language. Two review authors independently screened for inclusion, and disagreement was resolved by discussion. Two review authors independently extracted data and assessed quality using the Cochrane Collaboration tool for assessing risk of bias. We included 23 RCTs, many were small (between 9 and 4023 participants, median 88) and at high risk of bias.Eleven trials compared a combination of nutritional supplements, consisting of a minimum of energy and protein in different dosages, for the prevention of pressure ulcers. A meta-analysis of eight trials (6062 participants) that compared the effects of mixed nutritional supplements with standard hospital diet found no clear evidence of an effect of supplementation on pressure

  10. Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence™ Survey.

    PubMed

    Lachenbruch, Charlie; Ribble, David; Emmons, Kirsten; VanGilder, Catherine

    2016-01-01

    To measure the prevalence of incontinence in the 2013-2014 International Pressure Ulcer Prevalence (IPUP) surveys and determine the relative risk of developing a facility-acquired pressure ulcers (FAPUs) by stage and by Braden Scale score groupings. The IPUP survey is an observational, cross-sectional cohort database designed to determine the frequency and severity of pressure ulcers in various populations. The survey includes acute care (91.4%), long-term acute care (1.7%), rehabilitation patients (1.7%) and long-term care residents (5.2%). Geographic distribution included 182,832 patients in the United States, 22,282 patients in Canada, and the rest of the world, primarily in Europe and the Middle East. We analyzed data from the 2013 and 2014 IPUP surveys to better understand the relationship between incontinence and the frequency and severity of FAPUs. The IPUP survey is an annual voluntary survey of patients who are hospitalized or who reside in long-term care facilities. Data were collected over a 24-hour period within each participating facility. Data collection included limited demographics, presence and stage of pressure ulcers, and pressure ulcer risk assessment score (Braden Scale for Pressure Sore Risk, Braden Q, Norton, Waterlow, and others). In addition, data were collected on pertinent pressure ulcer risk factors including the number of linen layers, use of a pressure redistributing surface, adherence to repositioning schedule, and whether moisture management was provided in the last 24 hours. We aggregated data by urinary, urinary catheter, fecal, fecal management system, double (urinary and fecal), and ostomy incontinence category. If patients were managed by indwelling urinary catheter or fecal management systems, they were considered incontinent in this analysis. In order to analyze ulcers likely to be affected by incontinence, we defined a subset of ulcers as Relevant Pressure Ulcers, which are ulcers that are facility-acquired, non

  11. Evaluation of skin perfusion pressure to assess refractory foot ulcers.

    PubMed

    Kawai, M; Mihara, S; Takahagi, S; Iwamoto, K; Hiragun, T; Hide, M

    2017-05-02

    The number of patients with foot gangrene caused by critical ischaemia and severe infection is increasing significantly in developed countries. The measurement of perilesional skin blood flow by skin perfusion pressure (SPP) is useful to select the appropriate treatment of gangrenous lesions, in that it is not affected by calcifications of blood vessels. However, the prognosis of a foot ulcer may also be affected by the level of blood sugar and infections. This study aimed to validate the use of SPP in cases of foot gangrene and ulcers in patients with and without diabetes mellitus (DM) and infection. Clinical symptoms, ankle-brachial pressure index (ABPI) and SPP were assessed to evaluate the condition of each foot ulcer. Every foot ulcer was treated as independent, even if a participant had multiple ulcers. All ulcers for which we measured SPP were subject to the analysis. All ulcers were purely ischaemic in nature and were exclusively located on the foot or toes. Data were collected from 117 foot ulcers on 91 toes and feet from 65 patients. Almost all SPP values in healed cases were > 27 mmHg. There were three patients whose ulcers failed to heal by conservative treatments were complicated with severe infection. However, no effect of DM on the relationship between SPP values and prognosis was observed. Logistic regression analysis of all ulcers except for the 5 cases complicated with infection revealed that those with 30 mmHg or lower SPP values are likely to heal by conservative treatment with 23% or lower probability, whereas any ulcer with more than 50 mmHg SPP value and without severe infection may heal without the need for further operations with 80% or higher probability. The combination of SPP and careful evaluation of infection may be a good parameter to decide the appropriate treatment for ischaemic skin ulcers, regardless of the complication of DM.

  12. Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial).

    PubMed

    Webster, Joan; Coleman, Kerrie; Mudge, Alison; Marquart, Louise; Gardner, Glenn; Stankiewicz, Monica; Kirby, Julie; Vellacott, Catherine; Horton-Breshears, Margaret; McClymont, Alice

    2011-04-01

    To evaluate the effectiveness of two pressure-ulcer screening tools against clinical judgement in preventing pressure ulcers. A single blind randomised controlled trial. A large metropolitan tertiary hospital. 1231 patients admitted to internal medicine or oncology wards. Patients were excluded if their hospital stay was expected to be 2 days or less. Participants allocated to either a Waterlow (n=410) or Ramstadius (n=411) screening tool group or to a clinical judgement group (n=410) where no formal risk screening instrument was used. Incidence of hospital acquired pressure ulcers ascertained by regular direct observation. Use of any devices for the prevention of pressure ulcers, documentation of a pressure plan and any dietetic or specialist skin integrity review were recorded. On admission, 71 (5.8%) patients had an existing pressure ulcer. The incidence of hospital-acquired pressure ulcers was similar between groups (clinical judgement 28/410 (6.8%); Waterlow 31/411 (7.5%); Ramstadius 22/410 (5.4%), p=0.44). Significant associations with pressure injury in regression modelling included requiring a dietetic referral, being admitted from a location other than home and age over 65 years. The authors found no evidence to show that two common pressure-ulcer risk-assessment tools are superior to clinical judgement to prevent pressure injury. Resources associated with use of these tools might be better spent on careful daily skin inspection and improving management targetted at specific risks. The trial was registered with the Australian and New Zealand Clinicat Trials Registry (ACTRN 12608000541303).

  13. Reducing hospital acquired pressure ulcers in intensive care

    PubMed Central

    Cullen Gill, Emma

    2015-01-01

    Pressure ulcers are a definite problem in our health care system and are growing in numbers. Unfortunately, it is usually the most weak and vulnerable of our culture that faces these complications, causing the patient and their families discomfort, anguish, and economic hardship due to their expensive treatment. Data collected by the tissue viability department showed high incidence of hospital acquire pressure ulcers in the intensive care unit in March 2013. An action plan was initiated and implemented by the tissue viability team, senior nursing management, pressure ulcer prevention (PUP) team and respiratory therapists (RT's) within the ICU. Our objective was to reduce hospital acquired pressure ulcers in the intensive care unit using the plan, do, check, act quality improvement process. PMID:26734370

  14. Risk assessment scales for pressure ulcer prevention: a systematic review.

    PubMed

    Pancorbo-Hidalgo, Pedro L; Garcia-Fernandez, Francisco Pedro; Lopez-Medina, Isabel Ma; Alvarez-Nieto, Carmen

    2006-04-01

    This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75). There is no evidence that the use of risk assessment scales decreases pressure

  15. Dressings and topical agents for preventing pressure ulcers.

    PubMed

    Moore, Zena E H; Webster, Joan

    2013-08-18

    Pressure ulcers, which are localised injury to the skin, or underlying tissue or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health services. Efforts to prevent the development of pressure ulcers have focused on nutritional support, pressure redistributing devices, turning regimes and the application of various topical agents and dressings designed to maintain healthy skin, relieve pressure and prevent shearing forces. Although products aimed at preventing pressure ulcers are widely used, it remains unclear which, if any, of these approaches are effective in preventing the development of pressure ulcers. To evaluate the effects of dressings and topical agents on the prevention of pressure ulcers, in people of any age without existing pressure ulcers, but considered to be at risk of developing a pressure ulcer, in any healthcare setting. In February 2013 we searched the following electronic databases to identify reports of relevant randomised clinical trials (RCTs): the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Database of Abstracts of Reviews of Effects (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We included RCTs evaluating the use of dressings, topical agents, or topical agents with dressings, compared with a different dressing, topical agent, or combined topical agent and dressing, or no intervention or standard care, with the aim of preventing the development of a pressure ulcer. We assessed trials for their appropriateness for inclusion and for their risk of bias. This was done by two review

  16. Attitudes of surgical nurses towards pressure ulcer prevention.

    PubMed

    Ünver, Seher; Fındık, Ümmü Yıldız; Özkan, Zeynep Kızılcık; Sürücü, Çağla

    2017-09-13

    Nurses play the key role in prevention of pressure ulcers, and negative attitudes of them may affect preventive care strategies. This research aimed to identify surgical nurses' attitudes towards pressure ulcer prevention. A descriptive and cross-sectional study design was used to collect data between March 31-May 16, 2016 on 101 voluntary nurses (66.01% of all nurses) working in surgical units of a university hospital in Turkey. "Attitude towards Pressure Ulcer Prevention Instrument" and "Nurse Information Form" were used to investigate nurses' attitude toward preventing pressure ulcer. Descriptive statistics, Mann-Whitney U test, independent samples t-test, Pearson's chi-squared, and correlation tests were used to analyse the data. The mean age of nurses' was 32.0 ± 6.3 years and, the average duration of clinical experience was 72.3 ± 61 months. A total of 54.5% were working in surgical wards and, 40.6% gained additional education about pressure ulcer care. The mean total attitude score was found to be 80.5% (41.8 ± 4.8). Previous education significantly affected the total attitude score of nurses (p < 0.05). The total scale score showed that surgical nurses had a positive attitude towards pressure ulcer prevention and nurses who had previous education about pressure ulcer care has higher attitude score than who had not. It is recommended that effective in-service education programs be developed at hospitals or that nurses be required to attend courses to help them to improve their pressure ulcer care. Copyright © 2017. Published by Elsevier Ltd.

  17. Pressure ulcers: Current understanding and newer modalities of treatment.

    PubMed

    Bhattacharya, Surajit; Mishra, R K

    2015-01-01

    This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described.

  18. Pressure ulcers: Current understanding and newer modalities of treatment

    PubMed Central

    Bhattacharya, Surajit; Mishra, R. K.

    2015-01-01

    This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described. PMID:25991879

  19. Pressure ulcer prevalence and risk factors during prolonged surgical procedures.

    PubMed

    Primiano, Mike; Friend, Michael; McClure, Connie; Nardi, Scott; Fix, Lisa; Schafer, Marianne; Savochka, Kathlyn; McNett, Molly

    2011-12-01

    Pressure ulcer formation related to positioning while in the OR increases the length of hospital stay and hospital costs, but there is little evidence documenting how positioning devices used in the OR influence pressure ulcer development when examined with traditional risk factors. The aim of this prospective cohort study was to identify the prevalence of and risk factors associated with pressure ulcer development among patients undergoing surgical procedures lasting longer than three hours. Participants included all adult same-day admission patients scheduled for a three-hour surgical procedure during an eight-month period (N = 258). Data were gathered preoperatively, intraoperatively, and postoperatively on pressure ulcer risk factors. Bivariate analyses indicated that the type of positioning (ie, heels elevated) (χ(2) = 7.897, P = .048), OR bed surface (ie, foam table pad) (χ(2) = 15.848, P = .000), skin assessment in the postanesthesia care unit (χ(2) = 41.652, P = .000), and male gender (χ(2) = 6.984, P = .030) were associated with pressure ulcer development. Logistic regression analyses indicated that the use of a foam pad (β = 2.691, P = .024) and a lower day-one Braden score (β = .244, P = .003) were predictive of pressure ulcers.

  20. Beyond the pressure ulcer blame game: reflections for the future.

    PubMed

    Meehan, M

    2000-05-01

    The concept of skin wounds caused primarily as a result of external physical forces has been the focus of many healthcare professionals for decades. Unfortunately, some of the choices made regarding the definition, description, and topical management of pressure ulcers hampers the appreciation of the complexity of issues that generally accompany the occurrence of these wounds. As the healthcare industry increasingly focuses on quality and accountability, industry watchdogs continue to develop metrics to evaluate quality of care while legal professionals demand more accountability for healthcare interventions. The management of pressure ulcers is often scrutinized and many healthcare providers are often unfairly accused of neglect. The occurrence of pressure ulcers, when viewed as a failure of the healthcare system, prevents the comprehensive and constructive attention this topic deserves. Therefore, as wound care providers, we must change the image of pressure ulcers and provide a more balanced portrayal of the influences, treatments, and likely outcomes of these wounds. We must separate fact from fiction and reality from the psychological reaction that pressure ulcers evoke. It is now time to recreate a dialogue for pressure ulcers that is productive, realistic, and likely to result in the advancement of care.

  1. Validity of pressure ulcer diagnosis using digital photography

    PubMed Central

    Baumgarten, Mona; Margolis, David J.; Selekof, Joan L.; Moye, Nancy; Jones, Patricia S.; Shardell, Michelle

    2010-01-01

    The purpose of this study was to evaluate the validity of digital photographs for the assessment of the presence of pressure ulcers stage 2 or higher. Participants were 48 patients (28 white and 20 black) with pressure ulcers identified in the course of a wound specialist’s routine clinical practice at the University of Maryland Medical Center. One pressure ulcer and one unaffected skin area were photographed on each participating patient. The gold standard diagnosis (stage 2 pressure ulcer vs. stage 1 or no pressure ulcer) was recorded by the wound specialist based on bedside examination. The photographs were reviewed blindly by another wound expert. The sensitivity of the blinded assessment was 97% (95% confidence interval [CI] 91–100%). The specificity was 97% (95% CI 92–100%). The sensitivity and specificity were both 100% in the white patients. In black patients, the sensitivity and specificity were 92% (95% CI 75–100%) and 93% (95% CI 82–100%), respectively. These results suggest that the use of photographic images to assess the presence or absence of a pressure ulcer stage 2 or higher has a high degree of validity. Since blinded outcome assessment is one of the cornerstones of good clinical trial design, photography offers the potential to strengthen future studies. PMID:19320898

  2. Validity of pressure ulcer diagnosis using digital photography.

    PubMed

    Baumgarten, Mona; Margolis, David J; Selekof, Joan L; Moye, Nancy; Jones, Patricia S; Shardell, Michelle

    2009-01-01

    The purpose of this study was to evaluate the validity of digital photographs for the assessment of the presence of pressure ulcers stage 2 or higher. Participants were 48 patients (28 white and 20 black) with pressure ulcers identified in the course of a wound specialist's routine clinical practice at the University of Maryland Medical Center. One pressure ulcer and one unaffected skin area were photographed on each participating patient. The gold standard diagnosis (stage 2 pressure ulcer vs. stage 1 or no pressure ulcer) was recorded by the wound specialist based on bedside examination. The photographs were reviewed blindly by another wound expert. The sensitivity of the blinded assessment was 97% (95% confidence interval [CI] 91-100%). The specificity was 97% (95% CI 92-100%). The sensitivity and specificity were both 100% in the white patients. In black patients, the sensitivity and specificity were 92% (95% CI 75-100%) and 93% (95% CI 82-100%), respectively. These results suggest that the use of photographic images to assess the presence or absence of a pressure ulcer stage 2 or higher has a high degree of validity. Since blinded outcome assessment is one of the cornerstones of good clinical trial design, photography offers the potential to strengthen future studies.

  3. Pressure ulcers: implementation of evidence-based nursing practice.

    PubMed

    Clarke, Heather F; Bradley, Chris; Whytock, Sandra; Handfield, Shannon; van der Wal, Rena; Gundry, Sharon

    2005-03-01

    A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper. The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies. The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data. Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers. There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and

  4. Wound-care teams for preventing and treating pressure ulcers.

    PubMed

    Moore, Zena E H; Webster, Joan; Samuriwo, Ray

    2015-09-16

    Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health service delivery. International guidelines suggest that to prevent and manage pressure ulcers successfully a team approach is required. Therefore, this review has been conducted to clarify the role of wound-care teams in the prevention and management of pressure ulcers. To assess the impact of wound-care teams in preventing and treating pressure ulcers in people of any age, nursed in any healthcare setting. In April 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. We considered RCTs that evaluated the effect of any configuration of wound-care teams in the treatment or prevention of pressure ulcers. Two review authors independently assessed titles and, where available, abstracts of the studies identified by the search strategy for their eligibility. We obtained full versions of potentially relevant studies and two review authors independently screened these against the inclusion criteria. We identified no studies that met the inclusion criteria. We set out to evaluate the RCT evidence pertaining to the impact of wound-care teams on the prevention and management of pressure ulcers. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether wound-care teams make a difference to the incidence or healing of pressure

  5. [Innovation in pressure ulcer care: application of electrotherapy].

    PubMed

    Navarro Susana Postigo; Puerta Francisco Rivera

    2013-02-01

    Nowadays, pressure ulcers are a mayor health problem with serious consequences for the patient, directly influence by the increase of morbid-mortality and the detriment of the quality of life. Today we know that the best care for pressure ulcers is the prevention and every effort must be oriented in this direction, specially when it is estimated that almost the 95% of the pressure ulcers are preventable and a 60% of the occasions are initiated and developed in hospital. The study's objective is to promote healing of ulcers with a joint technical nursing care and the application of electric current by physiotherapist. This is a descriptive research design and intervention. The sample is composed grade IV ulcer patients who are admitted to the high level of nursing care unit in Complejo Asistencial Benito Menni (Ciempozuelos-Madrid). These patients have different associated pathologies and the study shows the process from the beginning of the ulcer until the end of treatment. The most relevant results show that the application of electric currents favors nursing techniques, promoting a better and faster cleaning, vascularization and subsequent the healing of ulcers.

  6. Management of chronic pressure ulcers: an evidence-based analysis.

    PubMed

    2009-01-01

    In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers.Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series.PRESSURE ULCER PREVENTION: an evidence based analysisThe cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation)MANAGEMENT OF CHRONIC PRESSURE ULCERS: an evidence-based analysis The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions?Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400%, to increase the frequency

  7. Part 2: pressure ulcer assessment: implementation and revision of CALCULATE.

    PubMed

    Richardson, Annette; Straughan, Christine

    2015-11-01

    Critically ill patients are a vulnerable group at very high risk of developing pressure ulcers, and the incidence varies within critical care. A number of strategies were used to implement the pressure ulcer assessment tool CALCULATE across four adult critical care units. Strategies included, nursing leadership, the provision of definitions for each risk factor, information laid out on posters at each patient's bedside, changes to pre-printed nursing documentation and a 30-min focused training package. Two local audits were conducted to measure the number and types of risk factors occurring in patients with pressure ulcers, and to assess the frequency of assessments and gain feedback on the usability of the tool in practice. Critical care acquired pressure ulcer incidence was 3.4%. The two most commonly occurring risk factors were impaired circulation (82%) and mechanical ventilation (75%). Patients had a mean score of 4, and 65% had 4 or more reported risk factors. Feedback on the usability of the tool was mainly positive. The tool CALCULATE was relatively straightforward to implement and was likely to be due to the design and the various change strategies used to implement the new approach. The seven point tool was revised to an eight point score based on nurses' clinical feedback. Research is required to further enhance and develop pressure ulcer assessment. Meanwhile CALCULATE offers an easy to use and appropriate tool to assist in the identification of patients at an elevated risk of pressure ulcer damage. Careful choice of change management strategies are needed when implementing a new assessment tool. CALCULATE should be considered for use in critical care for pressure ulcer assessment, but used alongside nurses' clinical judgement and observations of skin. © 2015 British Association of Critical Care Nurses.

  8. Obesity and pressure ulcers among nursing home residents

    PubMed Central

    Cai, Shubing; Rahman, Momotazur; Intrator, Orna

    2013-01-01

    Objectives To examine the prevalence of obesity and its relationship with pressure ulcers among nursing home (NH) populations, and whether such relationship varies with certified nursing assistant (CNA) level in NHs. Data and study population The 1999–2009 nationwide Minimum Data Sets were linked with Online Survey of Certification and Reporting records. We identified newly admitted NH residents who became long-stayers and followed them up to 1 year. Analyses The outcome variable was presence of pressure ulcers during the 1-year follow-up period. Residents were categorized as normal (18.5<=BMI<30 kg/m2), mild obesity (30 <=BMI <35 kg/m2) and moderate or severe obesity (BMI>=35 kg/m2). Pooled and stratified analyses were performed to examine the relationship between obesity and pressure ulcers, and how it varied by facility CNA level. Results The prevalence of obesity increased from 16.9% to 25.8% among newly admitted NH residents over the last decade. Obesity was associated with higher risks of pressure ulcers among long-stay residents. The relationship between obesity and pressure ulcers persisted after accounting for individual health conditions at the baseline and facility-level variations. Further, the within-facility relationship between obesity and pressure ulcers varied by facility CNA levels. The odds of pressure ulcers were 18.9% higher for residents with moderate or severe obesity than for non-obese residents within NHs with low CNA levels. The percents for medium and high CNA level facilities were 14.0% and 12.8%, respectively. Conclusion To prepare for the growing obesity epidemic in NHs, policies should focus on strategies to improve care provided for obese residents. PMID:23666490

  9. Obesity and pressure ulcers among nursing home residents.

    PubMed

    Cai, Shubing; Rahman, Momotazur; Intrator, Orna

    2013-06-01

    To examine the prevalence of obesity and its relationship with pressure ulcers among nursing home (NH) populations, and whether such relationship varies with certified nursing assistant (CNA) level in NHs. DATA AND STUDY POPULATION: The 1999-2009 nationwide Minimum Data Sets were linked with Online Survey of Certification and Reporting records. We identified newly admitted NH residents who became long-stayers and followed them up to 1 year. The outcome variable was presence of pressure ulcers during the 1-year follow-up period. Residents were categorized as normal [18.5 ≤ body mass index (BMI)<30 kg/m2], mild obesity (30 ≤ BMI <35 kg/m2), and moderate or severe obesity (BMI ≥ 35 kg/m2). Pooled and stratified analyses were performed to examine the relationship between obesity and pressure ulcers, and how it varied by facility CNA level. The prevalence of obesity increased from 16.9% to 25.8% among newly admitted NH residents over the last decade. Obesity was associated with higher risks of pressure ulcers among long-stay residents. The relationship between obesity and pressure ulcers persisted after accounting for individual health conditions at the baseline and facility-level variations. Further, the within-facility relationship between obesity and pressure ulcers varied by facility CNA levels. The odds of pressure ulcers were 18.9% higher for residents with moderate or severe obesity than for nonobese residents within NHs with low CNA levels. The percents for medium and high CNA level facilities were 14.0% and 12.8%, respectively. To prepare for the growing obesity epidemic in NHs, policies should focus on strategies to improve care provided for obese residents.

  10. Developing eLearning for pressure ulcer prevention and management.

    PubMed

    Cameron, Rosie; Rodgers, Angela; Welsh, Lynn; McGown, Katrina

    2014-08-12

    The impact of pressure ulcers is psychologically, physically and clinically challenging for both patients and NHS staff. NHS Greater Glasgow and Clyde (NHS GGC), in line with the Scottish Best Practice Statement for the Prevention and Management of Pressure Ulcers ( Quality Improvement Scotland, 2009 ), and the NHS Health Improvement Scotland (2011) Preventing Pressure Ulcers Change Package, launched an awareness campaign throughout the organisation in April 2012 and has more recently adopted a 'zero-tolerance' approach to pressure damage. The tissue viability service in NHS GGC recognised that in order to achieve this aim, education of front-line staff is essential. An educational framework for pressure ulcer prevention was developed for all levels of healthcare staff involved in the delivery of patient care. As a means to support the framework, an initiative to develop web-based eLearning modules has been taken forward. This has resulted in the creation of an accessible, cost-effective, stimulating, relevant, and evidence-based education programme designed around the educational needs of all healthcare staff. In conjunction with the organisation's 'top ten tools' for pressure ulcer prevention and management, the modular online education programme addresses the aims of quality improvement and zero tolerance by supporting the provision of safe and effective person-centered care.

  11. [Prevention of pressure ulcers--review of the evidence].

    PubMed

    Jaul, Efraim

    2008-10-01

    Pressure ulcers continue to constitute a health problem for people who are physically limited or bedridden, particularly among the elderly and victims of spinal cord injuries. The problem exists across the entire health framework, including hospitals, clinics, long-term care facilities and homes. The prevention of pressure ulcers is of prime importance, as most of them are preventable by means of a high level of awareness and by implementing preventive measures. These measures must be taken from the moment of admission or immobilization. Such preventive measures can save much suffering and expense to the family and the medical establishment alike. A pressure ulcer may develop in a matter of hours, whereas the cure takes many months, if at all. The complications of pressure ulcers are protean: they may serve as a conduit of pathogens, to prolong hospitalization, and to increase the risk of death. The diminution of the quality of life of the affected patient results from pain, discomfort, unpleasant odors from discharges, isolation and resultant depression. The prevention of pressure ulcers requires the involvement of a number of interventions, most of which have not undergone rigorous prospective randomized controlled studies. Recently, a systematic review has been undertaken to evaluate just such interventions. The preventive interventions that were reviewed include devices to relieve pressure, repositioning, exercise to assist bladder control, nutritional supplementation and moisturizing skin. The resultant recommendations appear in this review article.

  12. Fabric-based Pressure Sensor Array for Decubitus Ulcer Monitoring

    PubMed Central

    Chung, Philip; Rowe, Allison; Etemadi, Mozziyar; Lee, Hanmin; Roy, Shuvo

    2015-01-01

    Decubitus ulcers occur in an estimated 2.5 million Americans each year at an annual cost of $11 billion to the U.S. health system. Current screening and prevention techniques for assessing risk for decubitus ulcer formation and repositioning patients every 1–2 hours are labor-intensive and can be subjective. We propose use of a Bluetooth-enabled fabric-based pressure sensor array as a simple tool to objectively assess and continuously monitor decubitus ulcer risk. PMID:24111232

  13. Bed rest for pressure ulcer healing in wheelchair users.

    PubMed

    Moore, Zena Eh; van Etten, Menno T; Dumville, Jo C

    2016-10-17

    Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, and impact negatively on the individual's quality of life. International guidelines suggest bed rest as a component of the treatment strategy to manage pressure ulcers among wheelchair users. The potential benefits and risks need to be considered when assessing the effectiveness of bed rest as an intervention for treating pressure ulcers in this population. Therefore, it was important to search and appraise existing research evidence in order to determine the impact of bed rest on the healing of pressure ulcers in wheelchair users. To assess the impact of bed rest on pressure ulcer healing, in wheelchair users, of any age, who are living or being cared for in any setting. In October 2016 we searched: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations, MEDLINE Daily and Epub Ahead of Print); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trials registries and conference proceedings and for ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting. We considered randomised controlled trials (RCTs) and cluster-RCTs that evaluated the impact of bed rest on healing pressure ulcers in wheelchair users. Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for their eligibility. We identified no studies that met the inclusion criteria. We set out to evaluate the research evidence, from randomised controlled trials, of the impact of bed rest on pressure ulcer healing in wheelchair users. No study met the inclusion criteria. It is uncertain whether bed rest makes a

  14. The prevalence of pressure ulcers in the paediatric population.

    PubMed

    Habiballah, Laila; Tubaishat, Ahmad

    2016-05-01

    A paucity of research related to the problem of pressure ulcers in paediatrics is found, with a variety of reported prevalence rates. To record the prevalence, location and categories of PU in the inpatient paediatric wards, and to identify the characteristics of pressure ulcer patients. A descriptive point prevalence study. All paediatric inpatient wards in two hospitals in Jordan. One of which is a university-affiliated hospital and the other a paediatric public hospital. Isolation, burn and emergency units, outpatients' clinics and psychiatric wards were excluded. One sixty six paediatric patients aged from one day up to 18 years from both hospitals. Patients who met the inclusion criteria were included and examined for the existence of pressure ulcers on one day in each hospital by the primary investigator. The European Pressure Ulcer Advisory Panel classification system was used to categorise each identified ulcer. The characteristics of ulcers were collected as well. Sixteen ulcers were identified in 11 patients, giving a prevalence rate of 6.6%.When Category I ulcers were excluded, the prevalence rate dropped to 2.4%. All except one of the PU patients were being treated in critical care units (n = 10, 90.9%), and most of the ulcers were category one (n = 7, 63.6%) and caused by devices (n = 7, 63.6). The face was the most frequently reported location of PUs (n = 6, 54.5%), followed by the occiput (n = 2, 18.2%). Most PU patients were male (n = 6, 54.5%), and less than 12 months old (n = 8, 72.7%). PU patients had experienced longer hospital stays than patients free from PU (U = 499.0, p = 0.02). Jordanian paediatric patients do have pressure ulcers, with a prevalence rate congruent with previously reported international rates. Most of the ulcers found were caused by devices used in critical care units. This should encourage nurses to pay extra attention to their paediatric patients when they are connected to medical devices. Copyright

  15. The nursing process and pressure ulcer prevention: making the connection.

    PubMed

    Magnan, Morris A; Maklebust, JoAnn

    2009-02-01

    To provide the wound care practitioner with an understanding of how use of the nursing process enhances pressure ulcer prevention. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After reading this article and taking this test, the reader should be able to: 1. Describe the use of the nursing process for planning, implementing, and evaluating the outcomes of a pressure ulcer prevention program. 2. Explain how to use the Braden Scale for Predicting Pressure Sore Risk to develop "at risk" nursing diagnoses and to guide intervention.

  16. Clustering-based limb identification for pressure ulcer risk assessment.

    PubMed

    Baran Pouyan, M; Nourani, M; Pompeo, M

    2015-01-01

    Bedridden patients have a high risk of developing pressure ulcers. Risk assessment for pressure ulceration is critical for preventive care. For a reliable assessment, we need to identify and track the limbs continuously and accurately. In this paper, we propose a method to identify body limbs using a pressure mat. Three prevalent sleep postures (supine, left and right postures) are considered. Then, predefined number of limbs (body parts) are identified by applying Fuzzy C-Means (FCM) clustering on key attributes. We collected data from 10 adult subjects and achieved average accuracy of 93.2% for 10 limbs in supine and 7 limbs in left/right postures.

  17. Marjolin's Ulcer Complicating a Pressure Sore: The Clock is Ticking.

    PubMed

    Khan, Kamran; Giannone, Anna Lucia; Mehrabi, Erfan; Khan, Ayda; Giannone, Roberto E

    2016-02-22

    Malignant degeneration in any chronic wound is termed a Marjolin's ulcer (MU). The overall metastatic rate of MU is approximately 27.5%. However, the prognosis of MU specific to pressure sores is poor, with a reported metastatic rate of 61%. This is due to insidious, asymptomatic malignant degeneration, a lack of healthcare provider awareness, and, ultimately, delayed management. An 85-year-old white male was noted by his wound-care nurse to have a rapidly developing growth on his lower back over a period of 4 months. There was history of a non-healing, progressive pressure ulcer of the lower back for the past 10 years. On examination, there was a 4 × 4 cm pressure ulcer of the lower back, with a superimposed 1.5 × 2 cm growth in the superior region. There was an absence of palpable regional lymphadenopathy. Punch biopsy revealed squamous cell carcinoma consistent with Marjolin's ulcer. The ulcer underwent excision with wide margins, and a skin graft was placed. Due to the prompt recognition of an abnormality by the patient's wound-care nurse, metastasis was not evident on imaging. There are no signs of recurrence at 1-year follow-up. Marjolin's ulcer has a rapid progression from local disease to widespread metastasis. Therefore, it is essential that wound-care providers are aware of the clinical signs and symptoms of malignant degeneration in chronic wounds.

  18. Exploring factors associated with pressure ulcers: a data mining approach.

    PubMed

    Raju, Dheeraj; Su, Xiaogang; Patrician, Patricia A; Loan, Lori A; McCarthy, Mary S

    2015-01-01

    Pressure ulcers are associated with a nearly three-fold increase in in-hospital mortality. It is essential to investigate how other factors besides the Braden scale could enhance the prediction of pressure ulcers. Data mining modeling techniques can be beneficial to conduct this type of analysis. Data mining techniques have been applied extensively in health care, but are not widely used in nursing research. To remedy this methodological gap, this paper will review, explain, and compare several data mining models to examine patient level factors associated with pressure ulcers based on a four year study from military hospitals in the United States. The variables included in the analysis are easily accessible demographic information and medical measurements. Logistic regression, decision trees, random forests, and multivariate adaptive regression splines were compared based on their performance and interpretability. The random forests model had the highest accuracy (C-statistic) with the following variables, in order of importance, ranked highest in predicting pressure ulcers: days in the hospital, serum albumin, age, blood urea nitrogen, and total Braden score. Data mining, particularly, random forests are useful in predictive modeling. It is important for hospitals and health care systems to use their own data over time for pressure ulcer risk prediction, to develop risk models based upon more than the total Braden score, and specific to their patient population. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Best Practices for Pressure Ulcer Prevention in the Burn Center.

    PubMed

    Warner, Julia; Ann Raible, Mary; Hajduk, Gina; Collavo, Jacqueline

    The State of Pennsylvania Hospital Engagement Network, in collaboration with a hospital system in Southwestern Pennsylvania, established a goal of reducing hospital-acquired pressure ulcers by 20%. A 6-month unfavorable trend of nurse-sensitive clinical indicators called for immediate process improvement. A retrospective chart review resulted in identification of predominant risk factors placing the burn patient at high risk for pressure ulcer formation. Implementations of pressure ulcer prevention measures were inconsistent. Nurses demonstrated varied levels of knowledge about products used for prevention. It became imperative to examine processes within the unit and provide nursing with education, access to skin care supplies, and advanced skin/wound care products for maintaining skin integrity. Creation of evidence-based guidelines was necessary to improve patient outcomes. A collaborative team approach influenced nursing and physician awareness of pressure ulcer risk. Evidence-based prevention guidelines were developed, and consistency in early intervention was achieved, supporting our culture of safety. A change in interprofessional collaborative practice and positive trend in pressure ulcer incidence data supports the success of our program.

  20. The Effect of Pressure Ulcers on the Survival in Patients With Advanced Dementia and Comorbidities.

    PubMed

    Jaul, Efraim; Meiron, Oded; Menczel, Jacob

    2016-01-01

    The mortality rates for many leading causes of death have declined over the past decade. Advanced dementia with comorbidities has steadily increased to become one of the leading causes of death in the elderly population. Therefore, this study examined the effect of pressure ulcers on the survival time of patients with advanced dementia and comorbidities. Data were reviewed from all the files of 147 patients hospitalized over a period of 3½ years. Ninety-nine tube-fed patients suffering from advanced dementia were assessed; 72 (66.5%) had pressure ulcers and 27 (33.5%) were without pressure ulcers at admission. Logistic regression analysis was used to estimate the odds ratio and 95% confidence intervals for pressure ulcers group versus non-pressure ulcers group. Unadjusted Cox model and Cox proportional hazards model were used to assess the hazard ratio for pressure ulcers and the association between pressure ulcers and survival time, respectively. Kaplan-Meier model was used to visually confirm the existence of proportional hazards of pressure ulcers on survival. The median survival of advanced dementia patients with pressure ulcers was significantly shorter, compared with those without pressure ulcers (96 vs. 863 days). Significant lower hemoglobin and serum albumin levels were found in the patients with pressure ulcers. Advance dementia and pressure ulcers in the same patient results in earlier mortality. Advanced dementia patients with pressure ulcers had significantly lower survival expectancy in comparison with similar patients without pressure ulcers. Clinical and ethical implications are discussed.

  1. Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial.

    PubMed

    Gunningberg, Lena; Sedin, Inga-Maj; Andersson, Sara; Pingel, Ronnie

    2017-07-01

    Pressure ulcers cause suffering to patients and costs to society. Reducing pressure at the interface between the patient's body and the support surface is a valid clinical intervention for reducing the risk of pressure ulcers. However, studies have shown that knowledge of how to reduce pressure and shear and to prevent pressure ulcers is lacking. To evaluate the effect of a pressure mapping system on pressure ulcer prevalence and incidence in a hospital setting. Pragmatic randomised controlled trial. A geriatric/internal medical ward with 26 beds in a Swedish university hospital. 190 patients were recruited (intervention: n=91; control: n=99) over a period of 9 months. Patients were eligible if they were over 50 years old, admitted to the ward between Sunday 4pm and Friday 4pm, and expected to stay in the ward ≥3 days. The continuous bedside pressure mapping system displays the patient's pressure points in real-time colour imagery showing how pressure is distributed at the body-mat interface. The system gives immediate feedback to staff about the patient's pressure points, facilitating preventive interventions related to repositioning. It was used from admittance to discharge from the ward (or 14 days at most). Both intervention and control groups received standard pressure ulcer prevention care. No significant difference in the prevalence and incidence of pressure ulcers was shown between intervention and control groups. The prevalence of pressure ulcers in the intervention group was 24.2% on day 1 and 28.2% on day 14. In the control group the corresponding numbers were 18.2% and 23.8%. Seven of 69 patients (10.1%) in the intervention group and seven of 81 patients (8.6%) in the control group who had no pressure ulcers on admission developed category 1 and category 2 ulcers during their hospital stay. The incidence rate ratio between the intervention and control groups was 1.13 (95% CI: 0.34-3.79). This study failed to demonstrate a beneficial effect of a

  2. [Prevention of ulcers by pressure as a universal right].

    PubMed

    Blanco, Jaime Zabala

    2013-02-01

    The title of the article matches the of the "Declaration of Rio de Janeiro on the prevention of ulcers by pressure as a Universal right" [ 1], promoted by numerous groups and associations related to the problematic of ulcers by pressure (UPP) at the international level, and is a decisive step for joint efforts to give visibility to a problem of global dimension. Efforts previously, and in what refers to our country, have been left reflected in statements [2] pressure driven by the National group for study and advice on ulcers and wounds chronicles (GNEAUPP). The Declaration dealt with masterfully what will be our thesis, beyond a clinical problem--that is--the UPP, and specifically its prevention, constitute a problem primarily ethical character and, more specifically, minimum ethics, as we already reflected more widely in another article [3], by what remains essential to influencing this aspect often underestimated.

  3. SAPPIRE: a prototype mobile tool for pressure ulcer risk assessment.

    PubMed

    Kim, Hyeoneui; Chung, Heejoon; Wang, Shuang; Jiang, Xiaoqian; Choi, Jeeyae

    2014-01-01

    Accurate assessment and documentation of skin conditions facilitate communication among care providers and are critical to effective prevention and mitigation of pressure ulcer. We report developing a prototype mobile system called SAPPIRE (Skin Assessment for Pressure Ulcer Prevention, an Integrated Recording Environment) for an android device to assist nurses with skin assessment and documentation at bedside. SAPPIRE demonstrates (1) data documentation conforming to the relevant terminology standards, (2) data exchange using Continuity of Care Records (CCR) standard and (3) smart display of patient data relevant to risk parameters to promote accurate pressure ulcer risk assessment with the Braden scale. Challenges associated standardizing assessment data faced during this development and the approaches that SAPPIRE took to overcome them are described.

  4. Factors related to the prevention and management of pressure ulcers.

    PubMed

    Lee, Ting-Ting; Lin, Kuan-Chia; Mills, Mary Etta; Kuo, Ya-Hui

    2012-09-01

    Pressure ulcers (a type of skin failure) have served as an indicator of care quality. The purpose of this study was to utilize data-mining techniques as a means of identifying risk factors related to different stages of pressure ulcers to demonstrate how this means of analysis might be used as a vehicle to guide improved care quality. Data were obtained from a Web-based incident reporting system at a regional hospital in Taiwan. A total of 4301 cases dating from March 2005 to May 2009 were collected. For data-cleaning purposes, data within 3 SDs were kept for further analysis. Data-mining techniques were applied to identify the predictors, and a logistic regression analysis was used for result comparison purposes. The results revealed that sacral ulcer was the most prevalent, and most ulcers were in stage I, followed by stages II to IV. Five predictors were identified including hemoglobin, weight, sex, height, and use of repositioning sheet. The study concluded that nurses could use data-mining technique to identify predictors to assist in guiding ulcer interventions such as those based on a patient's demographic profile and application of a repositioning sheet to prevent ulcer occurrence to minimize harm.

  5. Designing trials for pressure ulcer risk assessment research: methodological challenges.

    PubMed

    Balzer, K; Köpke, S; Lühmann, D; Haastert, B; Kottner, J; Meyer, G

    2013-08-01

    For decades various pressure ulcer risk assessment scales (PURAS) have been developed and implemented into nursing practice despite uncertainty whether use of these tools helps to prevent pressure ulcers. According to current methodological standards, randomised controlled trials (RCTs) are required to conclusively determine the clinical efficacy and safety of this risk assessment strategy. In these trials, PURAS-aided risk assessment has to be compared to nurses' clinical judgment alone in terms of its impact on pressure ulcer incidence and adverse outcomes. However, RCTs evaluating diagnostic procedures are prone to specific risks of bias and threats to the statistical power which may challenge their validity and feasibility. This discussion paper critically reflects on the rigour and feasibility of experimental research needed to substantiate the clinical efficacy of PURAS-aided risk assessment. Based on reflections of the methodological literature, a critical appraisal of available trials on this subject and an analysis of a protocol developed for a methodologically robust cluster-RCT, this paper arrives at the following conclusions: First, available trials do not provide reliable estimates of the impact of PURAS-aided risk assessment on pressure ulcer incidence compared to nurses' clinical judgement alone due to serious risks of bias and insufficient sample size. Second, it seems infeasible to assess this impact by means of rigorous experimental studies since sample size would become extremely high if likely threats to validity and power are properly taken into account. Third, means of evidence linkages seem to currently be the most promising approaches for evaluating the clinical efficacy and safety of PURAS-aided risk assessment. With this kind of secondary research, the downstream effect of use of PURAS on pressure ulcer incidence could be modelled by combining best available evidence for single parts of this pathway. However, to yield reliable modelling

  6. Driving hospital-acquired pressure ulcers to zero.

    PubMed

    Morehead, Donna; Blain, Brenda

    2014-12-01

    The prevention of hospital-acquired pressure ulcers remains a top priority for health care facilities worldwide. This article discusses a process improvement in an intensive care unit where the unit-acquired pressure ulcer rate was dropped from 30% to 0% by front-line staff nurses. The key areas addressed by the staff were education, creating a process for turning patients during bedside report, and the creation of a documentation tool for accurate skin/wound assessment. Involving front-line staff in the prevention methodology creates a process that is quickly adopted by staff, peer-to-peer accountability in accurate skin/wound assessment, and positive outcomes.

  7. Transdermal deferoxamine prevents pressure-induced diabetic ulcers

    PubMed Central

    Duscher, Dominik; Neofytou, Evgenios; Wong, Victor W.; Maan, Zeshaan N.; Rennert, Robert C.; Januszyk, Michael; Rodrigues, Melanie; Malkovskiy, Andrey V.; Whitmore, Arnetha J.; Galvez, Michael G.; Whittam, Alexander J.; Brownlee, Michael; Rajadas, Jayakumar; Gurtner, Geoffrey C.

    2015-01-01

    There is a high mortality in patients with diabetes and severe pressure ulcers. For example, chronic pressure sores of the heels often lead to limb loss in diabetic patients. A major factor underlying this is reduced neovascularization caused by impaired activity of the transcription factor hypoxia inducible factor-1 alpha (HIF-1α). In diabetes, HIF-1α function is compromised by a high glucose-induced and reactive oxygen species-mediated modification of its coactivator p300, leading to impaired HIF-1α transactivation. We examined whether local enhancement of HIF-1α activity would improve diabetic wound healing and minimize the severity of diabetic ulcers. To improve HIF-1α activity we designed a transdermal drug delivery system (TDDS) containing the FDA-approved small molecule deferoxamine (DFO), an iron chelator that increases HIF-1α transactivation in diabetes by preventing iron-catalyzed reactive oxygen stress. Applying this TDDS to a pressure-induced ulcer model in diabetic mice, we found that transdermal delivery of DFO significantly improved wound healing. Unexpectedly, prophylactic application of this transdermal delivery system also prevented diabetic ulcer formation. DFO-treated wounds demonstrated increased collagen density, improved neovascularization, and reduction of free radical formation, leading to decreased cell death. These findings suggest that transdermal delivery of DFO provides a targeted means to both prevent ulcer formation and accelerate diabetic wound healing with the potential for rapid clinical translation. PMID:25535360

  8. Transdermal deferoxamine prevents pressure-induced diabetic ulcers.

    PubMed

    Duscher, Dominik; Neofytou, Evgenios; Wong, Victor W; Maan, Zeshaan N; Rennert, Robert C; Inayathullah, Mohammed; Januszyk, Michael; Rodrigues, Melanie; Malkovskiy, Andrey V; Whitmore, Arnetha J; Walmsley, Graham G; Galvez, Michael G; Whittam, Alexander J; Brownlee, Michael; Rajadas, Jayakumar; Gurtner, Geoffrey C

    2015-01-06

    There is a high mortality in patients with diabetes and severe pressure ulcers. For example, chronic pressure sores of the heels often lead to limb loss in diabetic patients. A major factor underlying this is reduced neovascularization caused by impaired activity of the transcription factor hypoxia inducible factor-1 alpha (HIF-1α). In diabetes, HIF-1α function is compromised by a high glucose-induced and reactive oxygen species-mediated modification of its coactivator p300, leading to impaired HIF-1α transactivation. We examined whether local enhancement of HIF-1α activity would improve diabetic wound healing and minimize the severity of diabetic ulcers. To improve HIF-1α activity we designed a transdermal drug delivery system (TDDS) containing the FDA-approved small molecule deferoxamine (DFO), an iron chelator that increases HIF-1α transactivation in diabetes by preventing iron-catalyzed reactive oxygen stress. Applying this TDDS to a pressure-induced ulcer model in diabetic mice, we found that transdermal delivery of DFO significantly improved wound healing. Unexpectedly, prophylactic application of this transdermal delivery system also prevented diabetic ulcer formation. DFO-treated wounds demonstrated increased collagen density, improved neovascularization, and reduction of free radical formation, leading to decreased cell death. These findings suggest that transdermal delivery of DFO provides a targeted means to both prevent ulcer formation and accelerate diabetic wound healing with the potential for rapid clinical translation.

  9. A systematic review of wound cleansing for pressure ulcers.

    PubMed

    Moore, Zena; Cowman, Seamus

    2008-08-01

    The aim of this study was to use a Cochrane systematic review process to explore the effect of wound cleansing solutions and techniques on pressure ulcer healing. Pressure ulcers impose a significant financial burden on health care systems and negatively affect the quality of life. Wound cleansing is an important component of pressure ulcer care; however, there is uncertainty regarding best practice. Systematic review. The Specialised Trials Register of the Cochrane Wounds Group, the Cochrane Central Register of Controlled Trials and bibliographies of relevant publications were searched. Drug companies and experts in the field were also contacted. Randomized controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion. For dichotomous outcomes, relative risk (RR) plus 95% confidence intervals (CI) were calculated; for continuous outcomes, weighted mean difference plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified. No studies compared cleansing with no cleansing. A statistically significant improvement in healing occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline (p = 0.025). No statistically significant change in healing was seen when water was compared with saline (RR 3.00, 95% CI 0.21, 41.89). No statistically significant change in healing was seen for ulcers cleansed with, or without, a whirlpool (RR 2.10, 95% CI 0.93-4.76). There is little trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers. Relevance to clinical practice. No firm recommendations for ways of cleansing pressure ulcers in clinical practice can be made, the lack of RCT evidence should be a concern for health care providers.

  10. Documentation and record-keeping in pressure ulcer management.

    PubMed

    Chamanga, Edwin; Ward, Renee

    2015-05-06

    National and international guidelines recommend the use of clinical assessments and interventions to prevent pressure-related skin damage. This includes the categorisation of pressure ulcers as avoidable or unavoidable, which is challenging in clinical practice, mainly because of poor documentation and record-keeping for care delivered. Documentation and record-keeping are influenced by the individual's employing organisation, maintenance procedures for documentation and record-keeping, and local auditing processes. A transfer sticker to enable patient assessment and promote pressure ulcer documentation was designed and implemented. The transfer sticker captures the date, time and location of a pressure ulcer preventive risk assessment and the plan of care to be implemented. The increased clarity of record of care achieved by using the transfer sticker has enabled the number of avoidable hospital-acquired pressure ulcers resulting from poor documentation on admission or ward transfers to be reduced. The transfer sticker helps staff identify patients at risk and allows interventions to be implemented in a timely manner.

  11. Clinical workflow for personalized foot pressure ulcer prevention.

    PubMed

    Bucki, M; Luboz, V; Perrier, A; Champion, E; Diot, B; Vuillerme, N; Payan, Y

    2016-09-01

    Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and "cluster volumes" (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer. Copyright © 2016. Published by Elsevier Ltd.

  12. Pressure ulcers and prevention among acute care hospitals in the United States.

    PubMed

    Bergquist-Beringer, Sandra; Dong, Lei; He, Jianghua; Dunton, Nancy

    2013-09-01

    Most pressure ulcers can be prevented with evidence-based practice. Many studies describe the implementation of a pressure ulcer prevention program but few report the effect on outcomes across acute care facilities. Data on hospital-acquired pressure ulcers and prevention from the National Database of Nursing Quality Indicators 2010 Pressure Ulcer Surveys were linked to hospital characteristics and nurse staffing measures within the data set. The sample consisted of 1,419 hospitals from across the United States and 710,626 patients who had been surveyed for pressure ulcers in adult critical care, step-down, medical, surgical, and medical/surgical units. Hierarchical logistic regression analysis was performed to identify study variables associated with hospital-acquired pressure ulcers among patients at risk for these ulcers. The rate of hospital-acquired pressure ulcers was 3.6% across all surveyed patients and 7.9% among those at risk. Patients who received a skin and pressure ulcer risk assessment on admission were less likely to develop a pressure ulcer. Additional study variables associated with lower hospital-acquired pressure ulcer rates included a recent reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin assessment, routine repositioning, and Magnet or Magnet-applicant designation. Variables associated with a higher likelihood of hospital-acquired pressure ulcers included nutritional support, moisture management, larger hospital size, and academic medical center status. Results provide empirical support for pressure ulcer prevention guideline recommendations on skin assessment, pressure ulcer risk assessment, and routine repositioning, but the 7.9% rate of hospital-acquired pressure ulcers among at-risk patients suggests room for improvement in pressure ulcer prevention practice.

  13. An interrater reliability study of the assessment of pressure ulcer risk using the Braden scale and the classification of pressure ulcers in a home care setting.

    PubMed

    Kottner, Jan; Halfens, Ruud; Dassen, Theo

    2009-10-01

    Measurement error can seriously affect the validity of pressure ulcer risk assessment and of pressure ulcer classification. Determination of interrater reliability and agreement of pressure ulcer risk and pressure ulcers using the Braden scale and the EPUAP system. Duplicate assessments by trained nurses during two nationwide pressure ulcer prevalence surveys in the years 2007 and 2008 in The Netherlands in the home care setting. Home care clients which participated in 2007 (n=352) and 2008 (n=339) in the pressure ulcer prevalence surveys. The Braden scale was used to assess pressure ulcer risk. Skin examination was conducted to detect pressure related tissue damages and to classify them according to the EPUAP. In 2007 and 2008, Intraclass Correlation Coefficients for Braden scale sum scores were 0.90 (95% CI: 0.88-0.92) and 0.88 (95% CI: 0.85-0.91) respectively, and corresponding Standard Errors of Measurement were 1.00 and 0.98. 95% limits of agreement were -2.8 to 2.8 and -2.7 to 2.7 respectively. The items "moisture", "sensory perception" and "nutrition" contained largest amounts of measurement error. Proportions of agreement for the classification of pressure ulcers were 96% and interrater reliability was 0.81 and 0.79. Most disagreements were observed for the classification of grade 1 pressure ulcers. The standardized study procedure applied in the annual nationwide pressure ulcer prevalence surveys leads to reliable and reproducible results regarding pressure ulcer risk and pressure ulcer prevalence in the home care setting. Researchers and practitioners should be careful when drawing inferences from single pressure ulcer risk factors included in the Braden scale. Descriptions of the items "moisture", "sensory perception" and "nutrition" should be made more clearly and unambiguous.

  14. Should we include deep tissue injury in pressure ulcer staging systems? The NPUAP debate.

    PubMed

    Donnelly, J

    2005-05-01

    This year's annual conference of the US National Pressure Ulcer Advisory Panel (NPUAP) included a consensus meeting to evaluate the current NPUAP pressure ulcer staging system. Jeannie Donnelly recounts the lively debate that ensued.

  15. Pressure ulcer prevention: education for nursing home staff.

    PubMed

    Law, Jaki

    This article describes an education programme for a group of nurses working in several nursing homes located in different areas of the Midlands but each belonging to the same care group. The group's management team had identified that there were patients in the nursing homes who had severe pressure ulcers and that staff were not managing their care adequately in order for healing to occur. It has been identified that 'education is probably the single most effective way of reducing the incidence of pressure ulcers' (Department of Health (DoH), 1993). Although the various nursing homes were able to access the skills of clinical nurse specialists in tissue viability, severe pressure ulcers were failing to heal and nursing home staff requested additional education to help them address this problem. Nurses in the homes expressed a desire to gain a deeper knowledge of the problem, so they would be able to plan and implement appropriate care autonomously and thus raise the standard of pressure ulcer care provided in each home. This article discusses the implementation of a comprehensive education programme that contributed to raising the standards of patient care and to the professional self-worth of the nurses involved.

  16. [Nursing methodology applicated in patients with pressure ulcers. Clinical report].

    PubMed

    Galvez Romero, Carmen

    2014-05-01

    The application of functional patterns lets us to make a systematic and premeditated nursing assessment, with which we obtain a lot of relevant patient data in an organized way, making easier to analize them. In our case, we use Marjory Gordon's functional health patterns and NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification), NIC (Nursing Intervention Classification) taxonomy. The overall objective of this paper is to present the experience of implementation and development of nursing methodology in the care of patients with pressure ulcers. In this article it's reported a case of a 52-year-old female who presented necrosis of phalanxes in upper and lower limbs and suffered amputations of them after being hospitalized in an Intensive Care Unit. She was discharged with pressure ulcers on both heels. GENERAL ASSESSMENT: It was implemented the nursing theory known as "Gordon's functional health patterns" and the affected patterns were identified. The Second Pattern (Nutritional-Metabolic) was considered as reference, since this was the pattern which altered the rest. EVOLUTION OF THE PATIENT: The patient had a favourable evolution, improving all the altered patterns. The infections symptoms disappeared and the pressure ulcers of both heels healed completely. The application of nursing methodology to care patients with pressure ulcers using clinical practice guidelines, standardized procedures and rating scales of assessment improves the evaluation of results and the performance of nurses.

  17. Acoustic pressure wound therapy in the treatment of stage II pressure ulcers.

    PubMed

    Thomas, Raenell

    2008-11-01

    Pressure ulcers are localized skin injuries secondary to unrelieved pressure or friction. Patients with immobility issues are at increased risk for developing pressure ulcers. In 2004, stricter federal regulations for prevention and treatment of pressure ulcers in institutional settings--eg, long-term care facilities--were introduced. Effective, low-cost treatments for pressure ulcers are needed; acoustic pressure wound therapy (APWT), a noncontact, low-frequency, therapeutic ultrasound system, is one option. A retrospective case series of six long-term care patients (two men and one woman, age range 61 to 92 years), each with one Stage II pressure ulcer, is presented. Acoustic pressure wound therapy was provided as an adjunct to standard treatment that included balsam of Peru/castor oil/trypsin ointment, hydrogel, hydrocolloid dressings, silver dressings, and offloading. Outcomes (days to healing) were determined through changes in wound dimensions. Study participants each received APWT for 3 to 4 minutes three to four times weekly. In four of the six wounds, the average number of days to healing was 22. One of the two remaining patients discontinued treatment at 95% healed; treatment for the sixth patient was ongoing due to hospitalization that delayed APWT. In a long-term care setting, APWT added to standard of care may accelerate healing of Stage II pressure ulcers.

  18. [Pressures ulcers, basis of prevention and treatment in the elderly].

    PubMed

    Vuagnat, H; Trombert, V; Donnat, N

    2012-11-28

    Pressure sore is a frequent and painful pathology in the elderly. Upon hospitalization, risk assessment and prevention must be systematic. Pressure ulcer treatment will combine prevention principles, local debridement and moisture control. The interdisciplinary interventions of other health professionals (such as occupational therapist, physiotherapist, dieticians) can be crucial. Last but not least: for wound treatment to be a success, the patient must be considered in his globality.

  19. Ulcers

    MedlinePlus

    An ulcer is a crater-like sore on the skin or mucous membrane . Ulcers form when the top layers of skin or ... Ulcers can be caused by inflammation or infection. Some ulcers may be caused by a cancer.

  20. Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients.

    PubMed

    Tallier, Peggy C; Reineke, Patricia R; Asadoorian, Kathy; Choonoo, John G; Campo, Marc; Malmgreen-Wallen, Christine

    2017-08-01

    Hospital acquired pressure ulcers have a detrimental effect on patient quality of life, morbidity, mortality, and cost to the healthcare industry. Little is known about pressure ulcer prevention in perioperative services. The objectives of this study were to describe perioperative registered nurses (RNs) knowledge, attitudes, behaviors, and barriers about pressure ulcer prevention and to determine if knowledge and the availability of a pressure ulcer staging tool are predictors of pressure ulcer prevention behavior. A cross-sectional descriptive pilot study was conducted. Sixty-two perioperative RNs from 10 acute care hospitals participated. Perioperative nurses believed carrying out pressure ulcer prevention strategies is essential to nursing practice but only two-thirds reported conducting pressure ulcer risk assessment on all patients and daily assessment on at risk patients. Results indicated a knowledge deficit regarding assessment and prevention of pressure ulcers as performance on the PUKT (72%) fell below the recommended score of 90%. Results of binary logistic regression indicated that knowledge as measured by the PUKT and availability of a pressure ulcer staging tool were statistically significant (p=0.03) predictors of pressure ulcer prevention behavior. The initial model without the predictor variables, indicated an overall success rate of correct predictions of 64% which increase to 73% when the predictor variables were added to the initial model. Although perioperative nurses believe that pressure ulcer prevention is important, a knowledge deficit exists and there is a need for pressure ulcer prevention education. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Understanding nurses' views on a pressure ulcer prevention care bundle: a first step towards successful implementation.

    PubMed

    Chaboyer, Wendy; Gillespie, Brigid M

    2014-12-01

    To explore nurses' views of the barriers and facilitators to the use of a newly devised patient-centred pressure ulcer prevention care bundle. Given pressure ulcer prevention strategies are not implemented consistently, the use of a pressure ulcer care bundle may improve implementation given bundles generally assist in standardising care. A quality improvement project was undertaken after a pressure ulcer prevention care bundle was developed and pilot-tested. Short, conversational interviews with nurse explored their views of a patient-centred pressure ulcer care bundle. Interviews were audio-taped and transcribed. Inductive content analysis was used to analyse the transcripts. A total of 20 nurses were interviewed. Five categories with corresponding subcategories emerged from the analysis. They were increasing awareness of pressure ulcer prevention, prompting pressure ulcer prevention activities, promoting active patient participation, barriers to using a pressure ulcer prevention care bundle and enabling integration of the pressure ulcer prevention care bundle into routine practice. Benefits of using a patient-centred pressure ulcer prevention care bundle may include prompting patients and staff to implement prevention strategies and promote active patient participation in care. The success of the care bundle relied on both patients' willingness to participate and nurses' willingness to incorporate it into their routine work. A patient-centred pressure ulcer prevention care bundle may facilitate more consistent implementation of pressure ulcer prevention strategies and active patient participation in care. © 2014 John Wiley & Sons Ltd.

  2. Evidence-based guidelines for pressure ulcer management at the end of life.

    PubMed

    Langemo, Diane; Haesler, Emily; Naylor, Wayne; Tippett, Aletha; Young, Trudie

    2015-05-01

    It is important to develop an individualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article discusses patient and risk assessment, prevention and care for pressure ulcers for the palliative care patient and the recommendations given in the palliative care section of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014).

  3. Definitions of the physical properties of pressure ulcers and characterisation of their regional variance.

    PubMed

    Mizokami, Fumihiro; Furuta, Katsunori; Utani, Atsushi; Isogai, Zenzo

    2013-10-01

    A pressure ulcer is a localised injury of the skin and underlying tissue that usually develops over a bony prominence. A decrease in the pressure over the bony prominence effectively prevents pressure ulcers; however, no studies have systematically assessed the physical properties of existing pressure ulcers. To characterise pressure ulcers, we established new terminology that clarifies the physical properties of pressure ulcers: wound mobility was defined as movement using the bony prominence as a predefined specific marker, and wound deformity was defined as a change in the three-dimensional shape of the wound. Observational studies using this terminology showed that the distinct physical properties of pressure ulcers depend on the site of development and the wound depth according to the National Pressure Ulcer Advisory Panel criteria. Most grade IV sacrum pressure ulcers exhibited mobility and deformity. Superficial sacrum pressure ulcers below grade II showed only mobility. In contrast, foot pressure ulcers did not exhibit mobility or deformity. We propose a new concept, 'wound physical property', for understanding the unique pathogenesis of pressure ulcers. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

  4. Pressure ulcers and lateral rotation beds: a case study.

    PubMed

    Russell, Teresa; Logsdon, Angela

    2003-05-01

    During a 6-month period, the WOC nurses at a 500-bed medical treatment facility noticed the development of nosocomial pressure ulcers on the sacrum, occiput, and heel areas of patients who were placed on lateral rotation specialty beds because they had pulmonary disorders. Measures were taken to address the problem by repositioning the patients and through a staff education program. Repositioning included repositioning the patient's head every 2 hours, thorough skin assessments every 2 hours, and ensuring that the patient's heels were subject to zero pressure. Staff education centered on the importance of using a risk assessment tool (the Braden scale) and understanding the clinical uses for lateral rotation beds. During the subsequent 6 months, the incidence of hospital-acquired pressure ulcers decreased by 52%. Efforts to further decrease the number of pressure ulcers related to the use of lateral rotation beds continue. Issues such as length of stay on the bed and the appropriateness of manufacturer's guidelines still need to be addressed at this facility. This case study highlights the potential issues associated with lateral rotation beds and identifies the need for further research.

  5. Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese hospital.

    PubMed

    Garcez Sardo, Pedro Miguel; Simões, Cláudia Sofia Oliveira; Alvarelhão, José Joaquim Marques; de Oliveira e Costa, César Telmo; Simões, Carlos Jorge Cardoso; Figueira, Jorge Manuel Rodrigues; Simões, João Filipe Fernandes Lindo; Amado, Francisco Manuel Lemos; Amaro, António José Monteiro; Pinheiro de Melo, Elsa Maria Oliveira

    2016-05-01

    To analyze the first pressure ulcer risk and skin assessment records of hospitalized adult patients in medical and surgical areas of Aveiro Hospital during 2012 in association with their demographic and clinical characteristics. Retrospective cohort analysis of electronic health record database from 7132 adult patients admitted to medical and surgical areas in a Portuguese hospital during 2012. The presence of (at least) one pressure ulcer at the first skin assessment in inpatient setting was associated with age, gender, type of admission, specialty units, length of stay, patient discharge and ICD-9 diagnosis. Point prevalence of participants with pressure ulcer category/stage I-IV of 7.9% at the first skin assessment in inpatient setting. A total of 1455 pressure ulcers were documented, most of them category/stage I. The heels and the sacrum/coccyx were the most problematic areas. Participants with pressure ulcer commonly had two or more pressure ulcers. The point prevalence of participants with pressure ulcer of our study was similar international literature. The presence of a pressure ulcer at the first skin assessment could be an important measure of frailty and the participants with pressure ulcer commonly had more than one documented pressure ulcer. Advanced age or lower Braden Scale scores or Emergency Service admission were relevant variables for the presence of (at least) one pressure ulcer at the first skin assessment in inpatient setting as well as respiratory, infectious or genitourinary system diseases. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  6. Data mining techniques for assisting the diagnosis of pressure ulcer development in surgical patients.

    PubMed

    Su, Chao-Ton; Wang, Pa-Chun; Chen, Yan-Cheng; Chen, Li-Fei

    2012-08-01

    Pressure ulcer is a serious problem during patient care processes. The high risk factors in the development of pressure ulcer remain unclear during long surgery. Moreover, past preventive policies are hard to implement in a busy operation room. The objective of this study is to use data mining techniques to construct the prediction model for pressure ulcers. Four data mining techniques, namely, Mahalanobis Taguchi System (MTS), Support Vector Machines (SVMs), decision tree (DT), and logistic regression (LR), are used to select the important attributes from the data to predict the incidence of pressure ulcers. Measurements of sensitivity, specificity, F(1), and g-means were used to compare the performance of four classifiers on the pressure ulcer data set. The results show that data mining techniques obtain good results in predicting the incidence of pressure ulcer. We can conclude that data mining techniques can help identify the important factors and provide a feasible model to predict pressure ulcer development.

  7. Evaluation of the National Database of Nursing Quality Indicators (NDNQI) Training Program on Pressure Ulcers.

    PubMed

    Bergquist-Beringer, Sandra; Davidson, Jan; Agosto, Carolyn; Linde, Norma K; Abel, Marla; Spurling, Kara; Dunton, Nancy; Christopher, Angela

    2009-06-01

    The National Database of Nursing Quality Indicators (NDNQI) Pressure Ulcer Training Program was developed to improve nursing accuracy and reliability in identifying and staging pressure ulcers and differentiating hospital- and unit-acquired from community-acquired pressure ulcers. Of 5,200 individuals who completed the training program within 5 months of release, 937 provided written evaluation comments. Four major themes emerged from content analysis of the evaluation remarks: pressure ulcer and other wound pictures; accuracy and clarity of content; program design and technology; and the educational/informational experience. Reviewers most frequently commented on their positive learning experience. Program components that enhanced the educational experience included the array of pressure ulcer pictures at each stage and pictures of other wounds. Clarity of content, program design, and technological problems were barriers to reviewer satisfaction. Findings suggest the NDNQI Pressure Ulcer Training Program was effective for educating staff nurses on pressure ulcer identification and staging.

  8. Topical Metronidazole for Odor Control in Pressure Ulcers.

    PubMed

    Lyvers, Elizabeth; Elliott, David P

    2015-09-01

    There are many remedies that have been recommended for the treatment of foul odor associated with pressure ulcers. This article seeks to review the literature surrounding the use of metronidazole as a safe and effective solution to an oftentimes stubborn and frustrating problem. Other tools used to control odor include bleach-based solutions and charcoal dressings. Metronidazole, with its antianaerobic properties, appears to have a useful role in therapy when applied topically to a pressure ulcer. Commercially available products include 0.75% and 1% creams, gels, lotions, and intravenous solutions. Of the 59 cases viewed throughout several publications, 56 reported nearly complete odor resolution in two to seven days when metronidazole was applied to the wound two or three times daily. Virtually no systemic adverse events have been reported in the literature, despite the risk for systemic absorption. A need remains to monitor for toxicities such as nausea, gastrointestinal distress, and neural toxicities from long-term use.

  9. Nurse Assistant Communication Strategies About Pressure Ulcers in Nursing Homes.

    PubMed

    Alexander, Gregory L

    2015-07-01

    There is growing recognition of benefits of sophisticated information technology (IT) in nursing homes (NHs). In this research, we explore strategies nursing assistants (NAs) use to communicate pressure ulcer prevention practices in NHs with variable IT sophistication measures. Primary qualitative data were collected during focus groups with NAs in 16 NHs located across Missouri. NAs (n = 213) participated in 31 focus groups. Three major themes referencing communication strategies for pressure ulcer prevention were identified, including Passing on Information, Keeping Track of Needs and Information Access. NAs use a variety of strategies to prioritize care, and strategies are different based on IT sophistication level. NA work is an important part of patient care. However, little information about their work is included in communication, leaving patient records incomplete. NAs' communication is becoming increasingly important in the care of the millions of chronically ill elders in NHs. © The Author(s) 2014.

  10. Microcontrolled air-mattress for ulcer by pressure prevention

    NASA Astrophysics Data System (ADS)

    Pasluosta, Cristian F.; Fontana, Juan M.; Beltramone, Diego A.; Taborda, Ricardo A. M.

    2007-11-01

    An ulcer by pressure is produced when a constant pressure is exerted over the skin. This generates the collapse of the blood vessels and, therefore, a lack in the contribution of the necessary nutrients for the affected zone. As a consequence, the skin deteriorates, eventually causing an ulcer. In order to prevent it, a protocol must be applied to the patient, which is reflected on time and cost of treatment. There are some air mattresses available for this purpose, but whose performance does not fulfill all requirements. The prototype designed in our laboratory is based on the principle of the air mattress. Its objective is to improve on existing technologies and, due to an increased automation, reduce time dedication for personnel in charge of the patient. A clinical experience was made in the local Emergencies Hospital and also in an institution dedicated to aged patients care. In both cases, the results obtained and the comments from the personnel involved were favorable.

  11. Pressure ulcer risk of patient handling sling use.

    PubMed

    Peterson, Matthew J; Kahn, Julie A; Kerrigan, Michael V; Gutmann, Joseph M; Harrow, Jeffrey J

    2015-01-01

    Patient handling slings and lifts reduce the risk of musculoskeletal injuries for healthcare providers. However, no published evidence exists of their safety with respect to pressure ulceration for vulnerable populations, specifically persons with spinal cord injury, nor do any studies compare slings for pressure distribution. High-resolution interface pressure mapping was used to describe and quantify risks associated with pressure ulceration due to normal forces and identify at-risk anatomical locations. We evaluated 23 patient handling slings with 4 nondisabled adults. Sling-participant interface pressures were recorded while participants lay supine on a hospital bed and while suspended during typical patient transfers. Sling-participant interface pressures were greatest while suspended for all seated and supine slings and exceeded 200 mm Hg for all seated slings. Interface pressures were greatest along the sling seams (edges), regardless of position or sling type. The anatomical areas most at risk while participants were suspended in seated slings were the posterior upper and lower thighs. For supine slings, the perisacral area, ischial tuberosities, and greater trochanters were most at risk. The duration of time spent in slings, especially while suspended, should be limited.

  12. Pressure Relief Behaviors and Weight Shifting Activities to Prevent Pressure Ulcers in Persons with SCI

    DTIC Science & Technology

    2015-10-01

    AWARD NUMBER: W81XWH-13-1-0387 TITLE: Pressure Relief Behaviors and Weight-Shifting Activities to Prevent Pressure Ulcers in Persons with SCI...Annual Report 3. DATES COVERED 30 Sep 2014 - 29 Sep 2015 4. TITLE AND SUBTITLE Pressure Relief Behaviors and Weight-Shifting Activities to Prevent... Pressure Ulcers in Persons with SCI 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-13-1-0387 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Stephen Sprigle, PhD

  13. Assessment of sacrococcygeal pressure ulcers using diffuse correlation spectroscopy

    NASA Astrophysics Data System (ADS)

    Diaz, David; Lafontant, Alec; Neidrauer, Michael; Weingarten, Michael S.; DiMaria-Ghalili, Rose Ann; Fried, Guy W.; Rece, Julianne; Lewin, Peter A.; Zubkov, Leonid

    2016-03-01

    Microcirculation is essential for proper supply of oxygen and nutritive substances to the biological tissue and the removal of waste products of metabolism. The determination of microcirculatory blood flow (mBF) is therefore of substantial interest to clinicians for assessing tissue health; particularly in pressure ulceration and suspected deep tissue injury. The goal of this pilot clinical study was to assess deep-tissue pressure ulceration by non-invasively measuring mBF using Diffuse Correlation Spectroscopy (DCS). DCS provides information about the flow of red blood cells in the capillary network by measuring the temporal autocorrelation function of scattering light intensity. A novel optical probe was developed in order to obtain measurements under the load of the subject's body as pressure is applied (ischemia) and then released (reperfusion) on sacrococcygeal tissue in a hospital bed. Prior to loading measurements, baseline readings of the sacral region were obtained by measuring the subjects in a side-lying position. DCS measurements from the sacral region of twenty healthy volunteers have been compared to those of two patients who initially had similar non-blanchable redness. The temporal autocorrelation function of scattering light intensity of the patient whose redness later disappeared was similar to that of the average healthy subject. The second patient, whose redness developed into an advanced pressure ulcer two weeks later, had a substantial decrease in blood flow while under the loading position compared to healthy subjects. Preliminary results suggest the developed system may potentially predict whether non-blanchable redness will manifest itself as advanced ulceration or dissipate over time.

  14. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China

    PubMed Central

    Jiang, Qixia; Li, Xiaohua; Qu, Xiaolong; Liu, Yun; Zhang, Liyan; Su, Chunyin; Guo, Xiujun; Chen, Yuejuan; Zhu, Yajun; Jia, Jing; Bo, Suping; Liu, Li; Zhang, Rui; Xu, Ling; Wu, Leyan; Wang, Hai; Wang, Jiandong

    2014-01-01

    Pressure ulcers are very common in hospital patients. Though many studies have been reported in many countries, the large-scale benchmarking prevalence of pressure ulcers in China is not available. The aim of this study is to quantify the prevalence of pressure ulcers and the incidence of hospital-acquired pressure ulcers and analyze risk factors in hospitalized patients in China. A multi-central cross-sectional survey was conducted in one university hospital and 11 general hospitals in China. The Minimum Data Set (MDS) recommended by European Pressure Ulcer Advisory Panel (EUPAP) was used to collect information of inpatients. All patients stayed in hospital more than 24 hours and older than 18 years signed consent form and were included. Data from 39952 out of 40415 (98.85%) inpatients were analyzed. Of the 39952 patients, 631 patients (including 1024 locations) had pressure ulcers. The prevalence rate of pressure ulcers in 12 hospitals was 1.58% (0.94-2.97%). The incidence of hospital-acquired pressure ulcers (HAPU) was 0.63% (0.20-1.20%). The most common locations developed pressure ulcers were sacrum, heels, and iliac crests. The common stages of pressure ulcers were stage I and II. Patients in Intensive Care Unit, Geriatric and Neurological Department were easier to develop pressure ulcers. The prevalence and incidence of pressure ulcers in China was lower than that reported in European and other countries. The stages of pressure ulcers in China were different than that reported in European countries. Our study provides with a baseline value for intensive research on pressure ulcer in China. PMID:24966973

  15. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China.

    PubMed

    Jiang, Qixia; Li, Xiaohua; Qu, Xiaolong; Liu, Yun; Zhang, Liyan; Su, Chunyin; Guo, Xiujun; Chen, Yuejuan; Zhu, Yajun; Jia, Jing; Bo, Suping; Liu, Li; Zhang, Rui; Xu, Ling; Wu, Leyan; Wang, Hai; Wang, Jiandong

    2014-01-01

    Pressure ulcers are very common in hospital patients. Though many studies have been reported in many countries, the large-scale benchmarking prevalence of pressure ulcers in China is not available. The aim of this study is to quantify the prevalence of pressure ulcers and the incidence of hospital-acquired pressure ulcers and analyze risk factors in hospitalized patients in China. A multi-central cross-sectional survey was conducted in one university hospital and 11 general hospitals in China. The Minimum Data Set (MDS) recommended by European Pressure Ulcer Advisory Panel (EUPAP) was used to collect information of inpatients. All patients stayed in hospital more than 24 hours and older than 18 years signed consent form and were included. Data from 39952 out of 40415 (98.85%) inpatients were analyzed. Of the 39952 patients, 631 patients (including 1024 locations) had pressure ulcers. The prevalence rate of pressure ulcers in 12 hospitals was 1.58% (0.94-2.97%). The incidence of hospital-acquired pressure ulcers (HAPU) was 0.63% (0.20-1.20%). The most common locations developed pressure ulcers were sacrum, heels, and iliac crests. The common stages of pressure ulcers were stage I and II. Patients in Intensive Care Unit, Geriatric and Neurological Department were easier to develop pressure ulcers. The prevalence and incidence of pressure ulcers in China was lower than that reported in European and other countries. The stages of pressure ulcers in China were different than that reported in European countries. Our study provides with a baseline value for intensive research on pressure ulcer in China.

  16. A novel system to tackle hospital acquired pressure ulcers.

    PubMed

    Renganathan, B S; Preejith, S P; Nagaiyan, Sridhar; Joseph, Jayaraj; Sivaprakasam, Mohanasankar

    2016-08-01

    Hospital acquired pressure ulcers (HAPUs) is a major problem that affects around one in twenty patients who are admitted in hospital with sudden illness. These ulcers often occur when patients have limited mobility and cannot change positions in bed on their own. Traditionally, the occurrence of HAPUs has been minimized by turning the patient every 2 hours to alternating lateral and supine positions, and by using pressure redistributing mattresses. In many healthcare facilities, such a patient repositioning schedule is not always maintained owing to low caregiver compliance to turning protocols. Difficulty in monitoring patient position continuously, lack of turn reminders/alerts and suboptimal caregiver staffing ratio increases the occurrence of HAPUs. A novel method to address the need for improved pressure ulcer prevention is presented. The proposed method consists of a wearable device which continuously monitors the patient's position and communicates wirelessly with a tablet which enables alerts to be sent to the caregiver when a patient turn is due in accordance with the protocol adopted by the hospital. The patient's position is continuously monitored and the turning procedure carried out is logged and updated on the hospital's cloud system, thereby enabling centralized monitoring. Under a controlled setting, system was able to continuously monitor patient's position and can accurately detect standard patient positions.

  17. [Analysis of risk assessment scales for pressure ulcer].

    PubMed

    Moreno-Pina, Josefa Patricia; Richart-Martínez, Miguel; Guirao-Goris, Josef Adolf; Duarte-Climents, Gonzalo

    2007-01-01

    To perform a literature review of the scales and instruments used to assess the risk of developing a pressure ulcer (RPU) in the adult and elderly population and to analyze whether these scales meet the criteria of validity and reliability. To determine whether a specific scale has been developed for use in the domiciliary care setting and adapted to the Spanish environment. We performed a descriptive study with a search of the CUIDEN, IME, CINAHL and MEDLINE databases between January 1990 and December 2005. A specifically-designed form was used to register the variables. Data extraction was performed by a single person. The key words used were pressure ulcer, decubitus ulcer, pressure sore, risk evaluation scales, validity, sensitivity, specificity and reliability and their equivalents in Spanish. Complete descriptions of 22 instruments and studies of the validity and/or reliability of 15 instruments were found. At present, and based on the results of this review, the RPU scale that has shown the greatest validity and reliability is the Braden-Bergstrom scale.

  18. [Laser therapy in pressure ulcers: evaluation by the Pressure Ulcer Scale for Healing and Nursing Outcomes Classification].

    PubMed

    Palagi, Sofia; Severo, Isis Marques; Menegon, Dóris Baratz; Lucena, Amália de Fátima

    2015-10-01

    To describe the pressure ulcer healing process in critically ill patients treated with conventional dressing therapy plus low-intensity laser therapy evaluated by the Pressure Ulcer Scale for Healing (PUSH) and the result of Wound Healing: Secondary Intention, according to the Nursing Outcomes Classification (NOC). Case report study according to nursing process conducted with an Intensive Care Unit patient. Data were collected with an instrument containing the PUSH and the result of the NOC. In the analysis we used descriptive statistics, considering the scores obtained on the instrument. A reduction in the size of lesions of 7cm to 1.5cm of length and 6cm to 1.1cm width, in addition to the increase of epithelial tissue and granulation, decreased secretion and odor. There was improvement in the healing process of the lesion treated with adjuvant therapy and the use of NOC allowed a more detailed and accurate assessment than the PUSH.

  19. A nurse-led approach to preventing pressure ulcers.

    PubMed

    Yap, Tracey L; Kennerly, Susan M

    2011-01-01

    This article discusses a nurse-led multidisciplinary approach that care providers can use to reduce pressure ulcers (PUs) within their organizations. Given the current understanding of PU etiology and prevention, evidence-based prevention protocols and pressure-relief strategies serve as critical foundational principles that must be applied to significantly influence PU prevalence and incidence. Because nursing plays an important role in rehabilitation facility management, nurses' expertise, leadership, and knowledge make nursing the most appropriate discipline to design protocols, implement innovative solutions, and lead the charge for PU prevention.

  20. Pressure ulcer prevention knowledge among Jordanian nurses: a cross- sectional study

    PubMed Central

    2014-01-01

    Background Pressure ulcer remains a significant problem in the healthcare system. In addition to the suffering it causes patients, it bears a growing financial burden. Although pressure ulcer prevention and care have improved in recent years, pressure ulcer still exists and occurs in both hospital and community settings. In Jordan, there are a handful of studies on pressure ulcer. This study aims to explore levels of knowledge and knowledge sources about pressure ulcer prevention, as well as barriers to implementing pressure ulcer prevention guidelines among Jordanian nurses. Methods Using a cross-sectional study design and a self-administered questionnaire, data was collected from 194 baccalaureate and master’s level staff nurses working in eight Jordanian hospitals. From September to October of 2011, their knowledge levels about pressure ulcer prevention and the sources of this knowledge were assessed, along with the barriers which reduce successful pressure ulcer care and prevention. ANOVA and t-test analysis were used to test the differences in nurses’ knowledge according to participants’ characteristics. Means, standard deviation, and frequencies were used to describe nurses’ knowledge levels, knowledge sources, and barriers to pressure ulcer prevention. Results The majority (73%, n = 141) of nurses had inadequate knowledge about pressure ulcer prevention. The mean scores of the test for all participants was 10.84 out of 26 (SD = 2.3, range = 5–17), with the lowest score in themes related to PU etiology, preventive measures to reduce amount of pressure/shear, and risk assessment. In-service training was the second source of education on pressure ulcer, coming after university training. Shortage of staff and lack of time were the most frequently cited barriers to carrying out pressure ulcer risk assessment, documentation, and prevention. Conclusions This study highlights concerns about Jordanian nurses’ knowledge of pressure ulcer prevention. The

  1. Patient repositioning and pressure ulcer risk--monitoring interface pressures of at-risk patients.

    PubMed

    Peterson, Matthew J; Gravenstein, Nikolaus; Schwab, Wilhelm K; van Oostrom, Johannes H; Caruso, Lawrence J

    2013-01-01

    Repositioning patients regularly to prevent pressure ulcers and reduce interface pressures is the standard of care, yet prior work has found that standard repositioning does not relieve all areas of at-risk tissue in nondisabled subjects. To determine whether this holds true for high-risk patients, we assessed the effectiveness of routine repositioning in relieving at-risk tissue of the perisacral area using interface pressure mapping. Bedridden patients at risk for pressure ulcer formation (n = 23, Braden score <18) had their perisacral skin-bed interface pressures recorded every 30 s while they received routine repositioning care for 4-6 h. All participants had specific skin areas (206 +/- 182 cm(2)) that exceeded elevated pressure thresholds for >95% of the observation period. Thirteen participants were observed in three distinct positions (supine, turned left, turned right), and all had specific skin areas (166 +/- 184 cm(2)) that exceeded pressure thresholds for >95% of the observation period. At-risk patients have skin areas that are likely always at risk throughout their hospital stay despite repositioning. Healthcare providers are unaware of the actual tissue-relieving effectiveness (or lack thereof) of their repositioning interventions, which may partially explain why pressure ulcer mitigation strategies are not always successful. Relieving at-risk tissue is a necessary part of pressure ulcer prevention, but the repositioning practice itself needs improvement.

  2. Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 2.

    PubMed

    Gefen, A

    In part one of this article, the concepts of an injury threshold were explained and it was shown that the Reswick and Rogers pressure-time curve is inaccurate at the extremes of the timescale. It was also shown that their curve cannot be used for studying deep tissue injuries, and that it is likely to be irrelevant for studying most pressure ulcers. The second part of this article describes recent research work focusing on tissue injury thresholds as related to pressure ulcers, with particular emphasis on thresholds that are specific for deep tissue injuries. Clinical implications are also discussed, with particular reference to patients who are obese and those with muscle atrophy.

  3. [Assessment of pain in a patient with pressure ulcer].

    PubMed

    Píriz-Campos, Rosa María; Martín-Espinosa, Noelia María; Cobo-Cuenca, Ana Isabel

    2010-01-01

    This is a summary of a presentation made in the symposium "Improved Continuous Quality Care in Patients with Pressure Ulcers and Chronic Injuries", which was held in Toledo in 2009. A 76 year old woman had been assessed (she belonged to the age group that frequently suffers this condition). She lived in a social healthcare centre and had a III stage sacral pressure ulcer. Using Gordon's Functional Health Patterns for assessing "Acute pain", a nursing diagnosis is described and the nursing care plan has been presented according to NANDA, NIC, NOC taxonomy. The aim of this article is to show the importance of considering the pain in patients who suffer from this type of lesion, which, although almost always present, it is often undervalued by nursing staff, resulting in an even worse quality of life for the patient, due to both physical and psychological effects. This case shows how to assess pain in a patient with ulcers, and helps establish an individualised care plan with a priority on pain treatment and relief. As as result of the interventions carried out, a better perception of pain is achieved, thus helping to improve patient's mobility and night rest.

  4. Impact of pressure ulcers on individuals living with a spinal cord injury.

    PubMed

    Lala, Deena; Dumont, Frédéric S; Leblond, Jean; Houghton, Pamela E; Noreau, Luc

    2014-12-01

    To describe the impact of pressure ulcers on the ability to participate in daily and community activities, health care utilization, and overall quality of life in individuals living with spinal cord injury (SCI). Cross-sectional study. Nationwide survey. Participants (N=1137) with traumatic SCI who were >1 year postinjury and living in the community were recruited. Of these, 381 (33.5%, 95% confidence interval, 30.8%-36.3%) had a pressure ulcer over the last 12 months. Not applicable. Measures developed for the Rick Hansen Spinal Cord Injury Registry Community Follow-up Survey Version 2.0. Of the 381 individuals with pressure ulcers, 65.3% reported that their pressure ulcer reduced their activity to some extent or more. Pressure ulcers reduced the ability of individuals with SCI to participate in 19 of 26 community and daily activities. Individuals with 1 or 2 pressure ulcers were more dissatisfied with their ability to participate in their main activity than those without pressure ulcers (P=.0077). Pressure ulcers were also associated with a significantly higher number of consultations with family doctors, nurses, occupational therapists, and wound care nurses/specialists (P<.05). Pressure ulcers have a significant impact on the daily life of individuals with SCI. Our findings highlight the importance of implementing pressure ulcer prevention and management programs for this high-risk population and require the attention of all SCI-related health care professionals. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  5. Prevalence and risk of pressure ulcers in acute care following implementation of practice guidelines: annual pressure ulcer prevalence census 1994-2008.

    PubMed

    VanDenKerkhof, Elizabeth G; Friedberg, Elaine; Harrison, Margaret B

    2011-09-01

    Hospital-acquired pressure ulcers in the United States were estimated to cost US$2.2 to US$3.6 billion per year in 1999. In the early 1990s clinical practice guidelines for the prevention and treatment of pressure ulcers were introduced. The purpose of this study was to examine the epidemiology of pressure ulcers in acute care in Canada. The current study is based on 12,787 individuals who were inpatients during a 1-day annual census conducted in an acute care facility in Ontario between 1994 and 2008. The prevalence and incidence of pressure ulcer decreased slightly over time while the risk of pressure ulcer increased. The coccyx sacrum (~27%), heel (13%), ankle (~12%), and ischial tubersosity (~10%) were the most common ulcer sites. The implementation of clinical practice guidelines appears to have improved the quality of patient care, as demonstrated by increasing pressure ulcer risk while the prevalence and incidence of pressure ulcers has remained somewhat constant. From a policy perspective the importance of monitoring and tracking the risk and occurrence of this adverse event provides a general indicator of care, considering the many organizational aspects that may ameliorate risk. © 2011 National Association for Healthcare Quality.

  6. Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk

    PubMed Central

    Sternal, Danuta; Wilczyński, Krzysztof; Szewieczek, Jan

    2017-01-01

    Background Prevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting. Patients and methods This study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30–96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014. Results Patients were hospitalized for mean of 24.8±31.4 days (1–310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057–1.229, P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339–6.448, P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693–0.956, P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955–0.997, P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729–8.486, P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092–1.306, P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814–0.951, P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929–0.984, P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672–0.960, P=0.016). Conclusion Hyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an

  7. Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk.

    PubMed

    Sternal, Danuta; Wilczyński, Krzysztof; Szewieczek, Jan

    2017-01-01

    Prevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting. This study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30-96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014. Patients were hospitalized for mean of 24.8±31.4 days (1-310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057-1.229, P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339-6.448, P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693-0.956, P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955-0.997, P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729-8.486, P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092-1.306, P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814-0.951, P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929-0.984, P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672-0.960, P=0.016). Hyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an advanced illness.

  8. Pressure ulcer and patient characteristics--A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set.

    PubMed

    Mehta, Chitra; George, Joby V; Mehta, Yatin; Wangmo, Namgyal

    2015-08-01

    Pressure ulcers is a frequent problem in hospitalized patients. Several prevalence studies have been conducted across the globe. Little information is available regarding prevalence of pressure ulcers in India. The aim was to identify the prevalence of pressure ulcers in one of the tertiary hospital in northern India and the factors associated with its development. A cross sectional point prevalence study. European Pressure Ulcer Advisory Panel (EPUAP) data collection form. Ethics approval was obtained prior to start of the study. Total of 358 patients were enrolled in the study. All patients above 18 years of age admitted in intensive care units and wards were included in the study. Patients admitted in emergency, day care, coronary care unit were excluded because of their short duration of hospital stay (varies from 24 to 72 h usually). All patients admitted before midnight on the predetermined day were included. The Braden scale was used to identify the risk of developing pressure ulcers. European Pressure ulcer advisory panel (EPUAP) minimum data set was used to collect prevalence data. The overall prevalence rate was 7.8%.The sacrum and heel were more commonly affected. Grade III pressure ulcers were the most common (42.8%). The pressure ulcer prevalence rate in our hospital was lower than that published in international studies. Severe forms of pressure ulcers were commonly encountered This data provides background information that may help us in developing protocols for applying effective practices for prevention of pressure ulcers. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  9. Friction-induced skin injuries-are they pressure ulcers? An updated NPUAP white paper.

    PubMed

    Brienza, David; Antokal, Steven; Herbe, Laura; Logan, Susan; Maguire, Jeanine; Van Ranst, Jennifer; Siddiqui, Aamir

    2015-01-01

    Friction injuries are often misdiagnosed as pressure ulcers. The reason for the misdiagnosis may be a misinterpretation of classic pressure ulcer literature that reported friction increased the susceptibility of the skin to pressure damage. This analysis assesses the classic literature that led to the inclusion of friction as a causative factor in the development of pressure ulcers in light of more recent research on the effects of shear. The analysis in this article suggests that friction can contribute to pressure ulcers by creating shear strain in deeper tissues, but friction does not appear to contribute to pressure ulcers in the superficial layers of the skin. Injuries to the superficial layers of the skin caused by friction are not pressure ulcers and should not be classified or treated as such.

  10. Local blockage of EMMPRIN impedes pressure ulcers healing in a rat model.

    PubMed

    Zhao, Xi-Lan; Luo, Xiao; Wang, Ze-Xin; Yang, Guo-Li; Liu, Ji-Zhong; Liu, Ya-Qiong; Li, Ming; Chen, Min; Xia, Yong-Mei; Liu, Jun-Jie; Qiu, Shu-Ping; Gong, Xiao-Qing

    2015-01-01

    Excessive extracellular matrix degradation caused by the hyperfunction of matrix metalloproteinases (MMPs) has been implicated in the failure of pressure ulcers healing. EMMPRIN, as a widely expressed protein, has emerged as an important regulator of MMP activity. We hypothesize that EMMPRIN affects the process of pressure ulcer healing by modulating MMP activity. In the rat pressure ulcer model, the expression of EMMPRIN in ulcers detected by Western blot was elevated compared with that observed in normal tissue. To investigate the role of EMMPRIN in regulating ulcer healing, specific antibodies against EMMPRIN were used via direct administration on the pressure ulcer. Local blockage of EMMPRIN resulted in a poor ulcer healing process compared with control ulcers, which was the opposite of our expectation. Furthermore, inhibiting EMMPRIN minimally impacted MMP activity. However, the collagen content in the pressure ulcer was reduced in the EMMPRIN treated group. Angiogenesis and the expression of angiogenic factors in pressure ulcers were also reduced by EMMPRIN local blockage. The results in the present study indicate a novel effect of EMMPRIN in the regulation of pressure ulcer healing by controlling the collagen contents and angiogenesis rather than MMPs activity.

  11. Local blockage of EMMPRIN impedes pressure ulcers healing in a rat model

    PubMed Central

    Zhao, Xi-Lan; Luo, Xiao; Wang, Ze-Xin; Yang, Guo-Li; Liu, Ji-Zhong; Liu, Ya-Qiong; Li, Ming; Chen, Min; Xia, Yong-Mei; Liu, Jun-Jie; Qiu, Shu-Ping; Gong, Xiao-Qing

    2015-01-01

    Excessive extracellular matrix degradation caused by the hyperfunction of matrix metalloproteinases (MMPs) has been implicated in the failure of pressure ulcers healing. EMMPRIN, as a widely expressed protein, has emerged as an important regulator of MMP activity. We hypothesize that EMMPRIN affects the process of pressure ulcer healing by modulating MMP activity. In the rat pressure ulcer model, the expression of EMMPRIN in ulcers detected by Western blot was elevated compared with that observed in normal tissue. To investigate the role of EMMPRIN in regulating ulcer healing, specific antibodies against EMMPRIN were used via direct administration on the pressure ulcer. Local blockage of EMMPRIN resulted in a poor ulcer healing process compared with control ulcers, which was the opposite of our expectation. Furthermore, inhibiting EMMPRIN minimally impacted MMP activity. However, the collagen content in the pressure ulcer was reduced in the EMMPRIN treated group. Angiogenesis and the expression of angiogenic factors in pressure ulcers were also reduced by EMMPRIN local blockage. The results in the present study indicate a novel effect of EMMPRIN in the regulation of pressure ulcer healing by controlling the collagen contents and angiogenesis rather than MMPs activity. PMID:26261551

  12. Dressings and topical agents for treating pressure ulcers.

    PubMed

    Westby, Maggie J; Dumville, Jo C; Soares, Marta O; Stubbs, Nikki; Norman, Gill

    2017-06-22

    Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and promote healing, and there are many options to choose from including alginate, hydrocolloid and protease-modulating dressings. Topical agents have also been used as alternatives to dressings in order to promote healing.A clear and current overview of all the evidence is required to facilitate decision-making regarding the use of dressings or topical agents for the treatment of pressure ulcers. Such a review would ideally help people with pressure ulcers and health professionals assess the best treatment options. This review is a network meta-analysis (NMA) which assesses the probability of complete ulcer healing associated with alternative dressings and topical agents. To assess the effects of dressings and topical agents for healing pressure ulcers in any care setting. We aimed to examine this evidence base as a whole, determining probabilities that each treatment is the best, with full assessment of uncertainty and evidence quality. In July 2016 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses, guidelines and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Published or unpublished randomised controlled trials (RCTs) comparing the effects of at least one of the following interventions with any other intervention in the treatment of pressure ulcers (Stage 2 or above): any dressing, or any topical agent applied directly

  13. Examination of the Accuracy of Coding Hospital-Acquired Pressure Ulcer Stages

    PubMed Central

    Coomer, Nicole M; McCall, Nancy T

    2013-01-01

    Objective Pressure ulcers (PU) are considered harmful conditions that are reasonably prevented if accepted standards of care are followed. They became subject to the payment adjustment for hospitalacquired conditions (HACs) beginning October 1, 2008. We examined several aspects of the accuracy of coding for pressure ulcers under the Medicare Hospital-Acquired Condition Present on Admission (HAC–POA) Program. We used the “4010” claim format as a basis of reference to show some of the issues of the old format, such as the underreporting of pressure ulcer stages on pressure ulcer claims and how the underreporting varied by hospital characteristics. We then used the rate of Stage III and IV pressure ulcer HACs reported in the Hospital Cost and Utilization Project State Inpatient Databases data to look at the sensitivity of PU HAC–POA coding to the number of diagnosis fields. Methods We examined Medicare claims data for FYs 2009 and 2010 to examine the degree that the presence of stage codes were underreported on pressure ulcer claims. We selected all claims with a secondary diagnosis code of pressure ulcer site (ICD-9 diagnosis codes 707.00–707.09) that were not reported as POA (POA of “N” or “U”). We then created a binary indicator for the presence of any pressure ulcer stage diagnosis code. We examine the percentage of claims with a diagnosis of a pressure ulcer site code with no accompanying pressure ulcer stage code. Results Our results point to underreporting of PU stages under the “4010” format and that the reporting of stage codes varied across hospital type and location. Further, our results indicate that under the “5010” format, a higher number of pressure ulcer HACs can be expected to be reported and we should expect to encounter a larger percentage of pressure ulcers incorrectly coded as POA under the new format. Conclusions The combination of the capture of 25 diagnosis codes under the new “5010” format and the change from ICD

  14. Examination of the accuracy of coding hospital-acquired pressure ulcer stages.

    PubMed

    Coomer, Nicole M; McCall, Nancy T

    2013-01-01

    Pressure ulcers (PU) are considered harmful conditions that are reasonably prevented if accepted standards of care are followed. They became subject to the payment adjustment for hospitalacquired conditions (HACs) beginning October 1, 2008. We examined several aspects of the accuracy of coding for pressure ulcers under the Medicare Hospital-Acquired Condition Present on Admission (HAC-POA) Program. We used the "4010" claim format as a basis of reference to show some of the issues of the old format, such as the underreporting of pressure ulcer stages on pressure ulcer claims and how the underreporting varied by hospital characteristics. We then used the rate of Stage III and IV pressure ulcer HACs reported in the Hospital Cost and Utilization Project State Inpatient Databases data to look at the sensitivity of PU HAC-POA coding to the number of diagnosis fields. We examined Medicare claims data for FYs 2009 and 2010 to examine the degree that the presence of stage codes were underreported on pressure ulcer claims. We selected all claims with a secondary diagnosis code of pressure ulcer site (ICD-9 diagnosis codes 707.00-707.09) that were not reported as POA (POA of "N" or "U"). We then created a binary indicator for the presence of any pressure ulcer stage diagnosis code. We examine the percentage of claims with a diagnosis of a pressure ulcer site code with no accompanying pressure ulcer stage code. Our results point to underreporting of PU stages under the "4010" format and that the reporting of stage codes varied across hospital type and location. Further, our results indicate that under the "5010" format, a higher number of pressure ulcer HACs can be expected to be reported and we should expect to encounter a larger percentage of pressure ulcers incorrectly coded as POA under the new format. The combination of the capture of 25 diagnosis codes under the new "5010" format and the change from ICD-9 to ICD-10 will likely alleviate the observed underreporting of

  15. A prospective cohort study of prognostic factors for the healing of heel pressure ulcers.

    PubMed

    McGinnis, Elizabeth; Greenwood, Darren C; Nelson, E Andrea; Nixon, Jane

    2014-03-01

    pressure ulcers, 25-30% of which are on the heels are a major burden to patients and healthcare systems. A better understanding of factors associated with healing is required to inform treatment and research priorities. to identify patient and pressure ulcer characteristics associated with the healing of heel pressure ulcers. patients with heel pressure ulcers were recruited to a prospective cohort study in a large teaching hospital in the UK, with a maximum 18-month follow-up. Cox proportional hazards model regression analysis was used to identify prognostic factors for healing. one hundred and forty of 148 patients recruited were analysed. They had 183 pressure ulcers: 77 ulcers healed, 5 were on limbs amputated prior to ulcer healing, 88 were on patients who died prior to healing, 11 were present at the end of the study and 2 were lost to follow-up. The median time to healing was 121 (range 8-440) days. Of 12 variables associated with healing (P ≤ 0.2), multi-variable analysis identified two factors which were independently predictive of healing including the presence of a severe (versus superficial) ulcer (hazard ratio = 0.48, P < 0.1) and the presence of peripheral arterial disease (hazard ratio = 0.40, P < 0.1). increased ulcer severity and the presence of peripheral arterial disease significantly reduced the probability of healing. Treatments for heel pressure ulcers should consider the severity of the ulcer and the presence of peripheral arterial disease.

  16. Mobile health platform for pressure ulcer monitoring with electronic health record integration.

    PubMed

    Rodrigues, Joel J P C; Pedro, Luís M C C; Vardasca, Tomé; de la Torre-Díez, Isabel; Martins, Henrique M G

    2013-12-01

    Pressure ulcers frequently occur in patients with limited mobility, for example, people with advanced age and patients wearing casts or prostheses. Mobile information communication technologies can help implement ulcer care protocols and the monitoring of patients with high risk, thus preventing or improving these conditions. This article presents a mobile pressure ulcer monitoring platform (mULCER), which helps control a patient's ulcer status during all stages of treatment. Beside its stand-alone version, it can be integrated with electronic health record systems as mULCER synchronizes ulcer data with any electronic health record system using HL7 standards. It serves as a tool to integrate nursing care among hospital departments and institutions. mULCER was experimented with in different mobile devices such as LG Optimus One P500, Samsung Galaxy Tab, HTC Magic, Samsung Galaxy S, and Samsung Galaxy i5700, taking into account the user's experience of different screen sizes and processing characteristics.

  17. Civil claims relating to pressure ulcers: a claimants' lawyer's perspective.

    PubMed

    Soloway, D N

    1998-02-01

    This article addresses attorneys' evolving views of civil claims against nursing homes, hospitals, nurses and doctors relating to pressure ulcers. The author describes measures that healthcare professionals may take to avoid becoming subject to claims, such as properly documenting assessments of patient risks and documenting consistent and appropriate care. Several issues of ethical consideration for nurses are presented relating to the role of nurses as patient advocates, including the issue of under what circumstances may or should a nurse recommend that a patient confer with an attorney. The article describes some common misconceptions about nursing and medical malpractice claims, and identifies ways that some proposed tort reforms appear borne of unsubstantiated fears.

  18. Cross-linked hyaluronic acid in pressure ulcer prevention.

    PubMed

    Beniamino, P; Vadalà, M; Laurino, C

    2016-07-02

    Long-term bedridden patients are at high risk of acquring pressure ulcers (PUs). In this group of patients, prevention is necessary to cut the health costs, improve quality of life and reduce the mortality. Here, we evaluated the effectiveness of a cross-linked hyaluronic acid (HA) as plastic bulking-agent filling and remodelling the deep dermis and subcutaneous space of the skin areas exposed to the risk of necrosis. Our work hypothesis has been to inflate a sub-dermal elastic cushion, filled with a natural ECM component, with the aim to induce a stronger tissue background resistant to the ulcerative process. All the patients had an increased risk of PUs, at the sacral, ileum or heel skin. Patients were being nursed accordingly to the standard orthopaedic ward management with a pressure relieveing air mattress. The standard protocol consisted in body mobilisation every 3 hours, 24 hours a day and accurate cleaning of the skin with liquid soap and water without any towel friction and without adding any cream or lotion for the skin protection. Our filling protocol enclosed: accurate disinfection of the skin to be injected with povidone-iodine solution, followed by a local anaesthesia with 28G 13 mm needle, injecting 1.5 ml of 1% xylocaine. Then slow, deep, subcutaneous injection of cross-linked HA was performed with a 18G long needle, in order to deliver a homogeneous, soft gel layer underneath and around the whitish erythematous skin edges at risk of ulceration. Patients' tolerability of the compound and adverse events were also recorded. There were 15 patients (78-94 years old) who participated in the study. All tolerated the procedure very well and no serious side effects were declared. No skin pressure ulceration was detected in the four weeks follow-up Conclusion: We have demonstrated the safety and tolerability of a cross-linked HA subdermal injection in PUs prevention. The compound stratifies in a soft, elastic, interstitial bulk into the deep dermis, thus

  19. Traditional classroom education versus computer-based learning: how nurses learn about pressure ulcers.

    PubMed

    Esche, Carol Ann; Warren, Joan I; Woods, Anne B; Jesada, Elizabeth C; Iliuta, Ruth

    2015-01-01

    The goal of the Nurse Professional Development specialist is to utilize the most effective educational strategies when educating staff nurses about pressure ulcer prevention. More information is needed about the effect of computer-based learning and traditional classroom learning on pressure ulcer education for the staff nurse. This study compares computer-based learning and traditional classroom learning on immediate and long-term knowledge while evaluating the impact of education on pressure ulcer risk assessment, staging, and documentation.

  20. Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission.

    PubMed

    Bliss, Donna Z; Gurvich, Olga; Savik, Kay; Eberly, Lynn E; Harms, Susan; Mueller, Christine; Garrard, Judith; Cunanan, Kristen; Wiltzen, Kjerstie

    2017-09-01

    Pressure ulcers increase the risk of costly hospitalization and mortality of nursing home residents, so timely healing is important. Disparities in healthcare have been identified in the nursing home population but little is known about disparities in the healing of pressure ulcers. To assess racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Multi-levels predictors, at the individual resident, nursing home, and community/Census tract level, were examined in three large data sets. Minimum Data Set records of older individuals admitted to one of 439 nursing homes of a national, for-profit chain over three years with a stages 2-4 pressure ulcer (n=10,861) were searched to the 90-day assessment for the first record showing pressure ulcer healing. Predictors of pressure ulcer healing were analyzed for White admissions first using logistic regression. The Peters-Belson method was used to assess racial or ethnic disparities among minority group admissions. A significantly smaller proportion of Black nursing home admissions had their pressure ulcer heal than expected had they been part of the White group. There were no disparities in pressure ulcer healing disadvantaging other minority groups. Significant predictors of a nonhealing of pressure ulcer were greater deficits in activities of daily living and pressure ulcer severity. Reducing disparities in pressure ulcer healing is needed for Blacks admitted to nursing homes. Knowledge of disparities in pressure ulcer healing can direct interventions aiming to achieve equity in healthcare for a growing number of minority nursing home admissions. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Clinical Nurse Specialist Collaboration to Recognize, Prevent, and Treat Pediatric Pressure Ulcers.

    PubMed

    Peterson, Jennifer; Adlard, Kathleen; Walti, Beverly Inge; Hayakawa, Jennifer; McClean, Elyse; Feidner, Susan Carroll

    2015-01-01

    The purpose of this quality improvement project was to reduce the incidence of pressure ulcers in a 232-bed, freestanding children's hospital in Western United States. Pressure ulcers have been an underappreciated hospital-acquired condition in children. Children have distinct anatomic, physiologic, and developmental factors that alter how pressure ulcers occur, but nurses may not recognize the pediatric patient as at risk because of lack of knowledge and tools to assess skin, identify risk factors, and recognize or stage pressure ulcers. Our initial efforts to develop organizational tools to reduce pediatric pressure ulcers were not sufficient, despite improvements in care. Interprofessional and intraprofessional collaboration, led by clinical nurse specialists, focused on documentation, tracheostomies, respiratory devices, and hemodynamically unstable or extracorporeal life support patients. Stage 3 and 4 and unstageable pressure ulcers are also "never events" in children. The unique factors involved with infant and pediatric pressure ulcers demand unique solutions. Our collaborative efforts led to a significant and sustained reduction in pressure ulcer incidence, from 3.3 per 1000 patient days in the first quarter of 2010 to 1.7 per 1000 patient days in the second quarter of 2014. Reportable pressure ulcers were reduced by 60%. Improved awareness and prevention strategies also led to significant reductions in extracorporeal life support patient pressure ulcers and respiratory device-related pressure ulcers. Through intraprofessional and interprofessional collaboration, the clinical nurse specialists were able to implement sustained organizational change and improve care for infants and children. Reduction in pressure ulcers is achievable but requires collaboration and creative solutions that involve multiple disciplines.

  2. Pressure ulcer dressings in critical patients: a cost analysis.

    PubMed

    Silva, Dinara Raquel Araújo; Bezerra, Sandra Marina Gonçalves; Costa, Jéssica Pereira; Luz, Maria Helena Barros Araújo; Lopes, Vanessa Caminha Aguiar; Nogueira, Lidya Tolstenko

    2017-06-12

    To assess the direct cost of dressings in pressure ulcer treatment. This was a descriptive observational study conducted at an intensive care unit in the Northeast region of Brazil, between November and December 2015. Data were gathered using the Pressure Ulcer Scale for Healing and a form to characterize and assess costs. Values in Brazilian reais (BRL) were converted into U.S. dollars at the exchange rate of USD 0.26/BRL. Univariate and bivariate analyses were conducted. The sample consisted of 15 patients with at least stage 2 ulcers. There was a significant reduction in costs with dressing materials between the initial and final assessments (p=0.002), with a mean of USD 11.9 (±7.4). The most common topical treatments used were essential fatty acids and papain. Cost reduction was proportional to the stage of pressure ulcer. The role of nurses in creating evidence-based care plans is crucial to improve care management. Avaliar o custo direto com curativos no tratamento de lesões por pressão. Estudo observacional descritivo, realizado em Unidade de Terapia Intensiva do nordeste do Brasil, de novembro a dezembro de 2015. Foi aplicada a Pressure Ulcer Scale for Healing e formulário para caracterização e avaliação de custos. Os valores da moeda brasileira (R$) foram convertidos para a moeda norte-americana (US$) à taxa de US$0,26/R$. Foram realizadas análises univariadas e bivariadas. Compuseram a amostra 15 pacientes com lesões, no mínimo, estágio 2. Houve redução significativa dos custos com materiais de curativos entre as avaliações inicial e final (p=0,002), com média de US$11,9 (±7,4). As terapias tópicas mais frequentes foram ácidos graxos essenciais e papaína. Verificou-se redução de custos proporcional aos estágios das lesões. Enfatiza-se o papel do enfermeiro na elaboração de planos de cuidados baseados em evidências para melhor gerenciamento do cuidado. Evaluar el costo directo de curativos para el tratamiento de lesiones por

  3. Are There Racial-Ethnic Disparities in Time to Pressure Ulcer Development and Pressure Ulcer Treatment in Older Adults After Nursing Home Admission?

    PubMed Central

    Bliss, Donna Z.; Gurvich, Olga; Savik, Kay; Eberly, Lynn E.; Harms, Susan; Mueller, Christine; Wyman, Jean F.; Garrard, Judith; Virnig, Beth

    2017-01-01

    Objective The objective of this study was to assess whether there are racial and ethnic disparities in the time to development of a pressure ulcer and number of pressure ulcer treatments in individuals aged 65 and older after nursing home admission. Method Multi-level predictors of time to a pressure ulcer from three national surveys were analyzed using Cox proportional hazards regression for White Non-Hispanic residents. Using the Peters–Belson method to assess for disparities, estimates from the regression models were applied to American Indians/Alaskan Natives, Asians/ Pacific Islanders, Blacks, and Hispanics separately resulting in estimates of expected outcomes as if they were White Non-Hispanic, and were then compared with their observed outcomes. Results More Blacks developed pressure ulcers sooner than expected. No disparities in time to a pressure ulcer disadvantaging other racial/ethnic groups were found. There were no disparities in pressure ulcer treatment for any group. Discussion Reducing disparities in pressure ulcer development offers a strategy to improve the quality of nursing home care. PMID:25260648

  4. Are there racial-ethnic disparities in time to pressure ulcer development and pressure ulcer treatment in older adults after nursing home admission?

    PubMed

    Bliss, Donna Z; Gurvich, Olga; Savik, Kay; Eberly, Lynn E; Harms, Susan; Mueller, Christine; Wyman, Jean F; Garrard, Judith; Virnig, Beth

    2015-06-01

    The objective of this study was to assess whether there are racial and ethnic disparities in the time to development of a pressure ulcer and number of pressure ulcer treatments in individuals aged 65 and older after nursing home admission. Multi-level predictors of time to a pressure ulcer from three national surveys were analyzed using Cox proportional hazards regression for White Non-Hispanic residents. Using the Peters-Belson method to assess for disparities, estimates from the regression models were applied to American Indians/Alaskan Natives, Asians/Pacific Islanders, Blacks, and Hispanics separately resulting in estimates of expected outcomes as if they were White Non-Hispanic, and were then compared with their observed outcomes. More Blacks developed pressure ulcers sooner than expected. No disparities in time to a pressure ulcer disadvantaging other racial/ethnic groups were found. There were no disparities in pressure ulcer treatment for any group. Reducing disparities in pressure ulcer development offers a strategy to improve the quality of nursing home care. © The Author(s) 2014.

  5. Nurses' pressure ulcer related judgements and decisions in clinical practice: a systematic review.

    PubMed

    Samuriwo, Ray; Dowding, Dawn

    2014-12-01

    Pressure ulcers are considered to be an adverse outcome of care that should never occur in clinical practice. The formation of a pressure ulcer is also perceived to be an indicator of poor quality nursing care. Therefore, pressure ulcer prevention is a priority for nurses, healthcare professionals and healthcare organisations throughout the world. A key factor in pressure ulcer prevention and management is individual nurse decision making. To synthesise the literature on the judgement and decision making of nurses in relation to the assessment, prevention, grading and management of pressure ulcers in all care settings (hospital and community). A systematic search of published literature relating to judgement and decision making in nurses, with a focus on the prevention and management of pressure ulcers. A search of electronic databases from 1992 to present, together with hand searching of the reference lists of retrieved publications, to identify published papers that reported results of studies evaluating the decision making of nurses in relation to the prevention and management of pressure ulcers. Abstracts were independently reviewed by two authors and full text of potentially relevant articles retrieved. Each paper included in this systematic review was evaluated using recognised appraisal criteria relevant to the specific study design. Included papers provided empirical data on key aspects of nurses' pressure ulcer related judgements and decision making. Data were synthesised into themes using narrative analysis. Sixteen studies and one systematic review were included in the review, focusing on pressure ulcer risk assessment, pressure ulcer prevention, grading of pressure ulcers and treatment decisions. The results indicated that assessment tools were not routinely used to identify pressure ulcer risk, and that nurses rely on their own knowledge and experience rather than research evidence to decide what skin care to deliver. Emphasising pressure ulcer risk

  6. [Evaluation of pressure ulcers area using the softwares Motic and AutoCAD®].

    PubMed

    Reis, Camila Letícia Dias dos; Cavalcante, Janaína Mortosa; Rocha Júnior, Edvar Ferreira da; Neves, Rinaldo Souza; Santana, Levy Aniceto; Guadagnin, Renato da Veiga; Brasil, Lourdes Mattos

    2012-01-01

    Pressure ulcer is a lesion that affects skin layers in some regions of the body and its healing can be followed up using image processing. The analysis of pressure ulcer area is relevant to evaluate its evolution and response to therapeutic procedures. Such areas can be evaluated through contour marking with the softwares Motic and AutoCAD®. In this study 35 volunteers computed areas from two grade III pressure ulcers using these instruments. It was possible to conclude that results are clinically equivalent and so can be considered to follow up healing evolution from pressure ulcers.

  7. Validation of two case definitions to identify pressure ulcers using hospital administrative data.

    PubMed

    Ho, Chester; Jiang, Jason; Eastwood, Cathy A; Wong, Holly; Weaver, Brittany; Quan, Hude

    2017-08-28

    Pressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes. A cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011. There were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer. Using pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay. DAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other

  8. What Factors Are Associated With the Development of Pressure Ulcers in a Medical Intensive Care Unit?

    PubMed

    Smit, Inge; Harrison, Lisa; Letzkus, Lisa; Quatrara, Beth

    2016-01-01

    Instruments used to determine the risk of pressure ulcer development are universally applied to adult patients. These instruments do not differentiate between intensive and acute care patients. Pressure ulcers contribute to negative outcomes such as increases in pain and discomfort, risk of infection, hospital length of stay and costs, and a decrease in quality of life. Appropriately identifying risk factors is paramount to implementing a targeted care plan to avoid pressure ulcer development as well as pinpointing appropriate treatments if an ulcer develops. The purpose of this nursing research study was to identify factors associated with pressure ulcer development in a medical intensive care unit. A 15-month retrospective chart review of patients with pressure ulcers in a medical intensive care unit was performed. Statistics were computed on demographics and variables of interest including: pressure ulcer stage, vasopressor infusion, oxygen requirement, comorbidities, primary diagnosis, length of stay, mortality, age, gender, weight, Braden scores, and albumin level. The characteristics of 76 patients who developed pressure ulcers were evaluated. An equal number of men (n = 38) and women (n = 38) were included. Forty-seven percent had a stage II pressure ulcer. The presence of hemodynamic support with vasopressor administration (P = .016) and the length of stay (P = .021) were noted as the most significant factors in pressure ulcer development in this study. Vasopressor use and length of stay are not factors that are accounted for in current pressure ulcer risk assessment instruments. The administration of vasopressor support and patient length of stay are potential contributory factors that need to be considered when assessing patients. Instruments specific to intensive care unit pressure ulcer risk stratification are warranted and should include the unique characteristics of a critically ill patient.

  9. Pressure ulcers and occupational therapy practice: a Canadian perspective.

    PubMed

    Giesbrecht, Ed

    2006-02-01

    Occupational therapists are involved in the prevention and management of pressure ulcers. While many therapists identify challenges with their clinical practice in this area, there is little information available regarding specific occupational therapy interventions or effectiveness. The goal of this study was to gain a national perspective of practice in Canada and identify directions and trends in the management of pressure ulcers. A survey was distributed to occupational therapists at 75 facilities across Canada, soliciting information on intervention, practice issues and satisfaction with their practice. Thirty-seven therapists from 36 facilities responded, answering questions about risk assessment tools, referral patterns, interventions and decision-making models, satisfaction with practice, intervention rationales, and recommendations for change. Risk assessment, early intervention and continuity of care were identified as concerns, with a lack of resources identified as a limitation to practice. Seating and positioning were common interventions. This information can be used by clinicians to direct best practice and professional development goals. Further research is indicated in risk assessment, team collaboration and mattress prescription.

  10. Effects of a normothermic dressing on pressure ulcer healing.

    PubMed

    Kloth, L C; Berman, J E; Dumit-Minkel, S; Sutton, C H; Papanek, P E; Wurzel, J

    2000-01-01

    To determine the effects of radiant heat applied through a semiocclusive dressing on periwound skin temperature and wound healing. Before-after trial. Spinal cord injury and geriatric units of a VA medical center. Twenty inpatients with 21 Stage III and IV pressure ulcers. A semiocclusive, heated dressing was applied to 15 Stage III and IV pressure ulcers for 4.5 hours, Monday through Friday, for 4 consecutive weeks. The dressing emitted heat at 38.0 degrees C for 2 60-minute periods daily. At all other times, the wounds received only standard wound care. Six wounds in a separate control group received only standard wound care during the same 4-week period. Periwound skin temperature within and adjacent to the dressing and measurements of wound surface area. Mean skin temperatures inside and outside the heated dressing increased by 0.97 degree C and 1.08 degrees C (P < .05), respectively, from baseline values. Wounds treated with standard care plus the heated dressing underwent a statistically significant reduction in mean surface area of 60.73%. Wounds in the control group underwent a statistically insignificant reduction in mean surface area of 19.24%. Wounds treated with a radiant heat dressing healed significantly faster than wounds that received only standard care. There were no adverse effects from the radiant heat dressing.

  11. Propranolol impairs the closure of pressure ulcers in mice.

    PubMed

    Assis de Brito, Thatiana L; Monte-Alto-Costa, Andréa; Romana-Souza, Bruna

    2014-04-01

    β-Adrenoceptors modulate acute wound healing; however, few studies have shown the effects of β-adrenoceptor blockade on chronic wounds. Therefore, this study investigated the effect of β1-/β2-adrenoceptor blockade in wound healing of pressure ulcers. Male mice were daily treated with propranolol (β1-/β2-adrenoceptor antagonist) until euthanasia. One day after the beginning of treatment, two cycles of ischemia-reperfusion by external application of two magnetic plates were performed in skin to induce pressure ulcer formation. Propranolol administration reduced keratinocyte migration, transforming growth factor-β protein expression, re-epithelialization, and necrotic tissue loss. Neutrophil number and neutrophil elastase protein expression were increased in propranolol-treated group when compared with control group. Propranolol administration delayed macrophage mobilization and metalloproteinase-12 protein expression and reduced monocyte chemoattractant protein-1 protein expression. Myofibroblastic differentiation, angiogenesis, and wound closure were delayed in the propranolol-treated animals. Propranolol administration increased neo-epidermis thickness, reduced collagen deposition, and enhanced tenascin-C expression resulting in the formation of an immature and disorganized collagenous scar. β1-/β2-Adrenoceptor blockade delays wound healing of ischemia-reperfusion skin injury through the impairment of the re-epithelialization and necrotic tissue loss which compromise wound inflammation, dermal reconstruction, and scar formation. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Pressure ulcers of the thorax after shoulder surgery.

    PubMed

    Keyurapan, Ekavit; Hu, Samuel J; Redett, Richard; McCarthy, Edward F; McFarland, Edward G

    2007-12-01

    Of 896 patients having arthroscopic or combined arthroscopic and open shoulder procedures at our institution during a 10 year period, three sustained severe pressure ulcerations to the dependent, opposite thorax (one after an arthroscopic procedure, two after combined procedures). These three patients had an average age of 35 years (range 18-50 years) and an average operative time of 107 min (range 82-121 min). During surgery, each patient had an axillary roll (a bag of intravenous fluids) between the dependent thorax and the operative table. Immediate postoperative signs and symptoms included severe pain in the thorax of the nonoperative side and areas of full-thickness skin loss, and blistering. Biopsy of the lesion in one patient was consistent with skin pressure ulceration. At a minimum of 10 months of follow up, all three patients had recovered full range of motion and strength without skin grafting or additional surgery. The exact cause of these lesions is unknown, but we speculate that they resulted from a combination of the use of an intravenous fluid bag as an axillary roll, fluid between the skin and the roll, and friction from moving the patient.

  13. Pressure-Redistributing Support Surface Use and Pressure Ulcer Incidence in Elderly Hip Fracture Patients

    PubMed Central

    Rich, Shayna E.; Shardell, Michelle; Hawkes, William G.; Margolis, David J.; Amr, Sania; Miller, Ram; Baumgarten, Mona

    2013-01-01

    OBJECTIVES To evaluate the association between pressure-redistributing support surface (PRSS) use and incident pressure ulcers in older adults with hip fracture. DESIGN Secondary analysis of data from prospective cohort with assessments performed as soon as possible after hospital admission and on alternating days for 21 days. SETTING Nine hospitals in the Baltimore Hip Studies network and 105 postacute facilities to which participants were discharged. PARTICIPANTS Six hundred fifty-eight people aged 65 and older who underwent surgery for hip fracture. MEASUREMENTS Full-body examination for pressure ulcers; bedbound status; and PRSS use, recorded as none, powered (alternating pressure mattresses, low-air-loss mattresses, and alternating pressure overlays), or nonpowered (high-density foam, static air, or gel-filled mattresses or pressure-redistributing overlays except for alternating pressure overlays). RESULTS Incident pressure ulcers (IPUs), Stage 2 or higher, were observed at 4.2% (195/4,638) of visits after no PRSS use, 4.5% (28/623) of visits after powered PRSS use, and 3.6% (54/1,496) of visits after nonpowered PRSS use. The rate of IPU per person-day of follow-up did not differ significantly between participants using powered PRSSs and those not using PRSSs. The rate also did not differ significantly between participants using nonpowered PRSSs and those not using PRSSs, except in the subset of bedbound participants (incidence rate ratio = 0.3, 95% confidence interval = 0.1–0.7). CONCLUSION PRSS use was not associated with a lower IPU rate. Clinical guidelines may need revision for the limited effect of PRSS use, and it may be appropriate to target PRSS use to bedbound patients at risk of pressure ulcers. PMID:21649630

  14. SCI Survey to Determine Pressure Ulcer Vulnerability in the Outpatient Population

    DTIC Science & Technology

    2016-03-01

    AWARD NUMBER: W81XWH-10-1-0840 TITLE: SCI Survey to Determine Pressure Ulcer Vulnerability in the Outpatient Population PRINCIPAL INVESTIGATOR...CONTRACT NUMBER W81XWH-10-1-0840 4. TITLE AND SUBTITLE SCI Survey to Determine Pressure Ulcer Vulnerability in the Outpatient Population 5b. GRANT...ulcers (PrUs) have primarily been identified by research conducted in elderly and nursing home populations , or in the Spinal Cord Injury (SCI) Model

  15. Lifestyle Changes and Pressure Ulcer Prevention in Adults With Spinal Cord Injury in the Pressure Ulcer Prevention Study Lifestyle Intervention

    PubMed Central

    Ghaisas, Samruddhi; Pyatak, Elizabeth A.; Blanche, Erna; Clark, Florence

    2015-01-01

    Pressure ulcers (PrUs) are a major burden to patients with spinal cord injury (SCI), affecting their psychological, physical, and social well-being. Lifestyle choices are thought to contribute to the risk of developing PrUs. This article focuses on the interaction between lifestyle choices and the development of PrUs in community settings among participants in the University of Southern California–Rancho Los Amigos National Rehabilitation Center Pressure Ulcer Prevention Study (PUPS II), a randomized controlled trial of a lifestyle intervention for adults with SCI. We conducted a secondary cross-case analysis of treatment notes of 47 PUPS II participants and identified four patterns relating PrU development to lifestyle changes: positive PrU changes (e.g., healing PrUs) with positive lifestyle changes, negative or no PrU changes with positive lifestyle changes, positive PrU changes with minor lifestyle changes, and negative or no PrU changes with no lifestyle changes. We present case studies exemplifying each pattern. PMID:25553751

  16. Long-term Outcomes After Flap Reconstruction in Pediatric Pressure Ulcers.

    PubMed

    Firriolo, Joseph M; Ganske, Ingrid M; Pike, Carolyn M; Caillouette, Catherine; Faulkner, Heather R; Upton, Joseph; Labow, Brian I

    2017-10-03

    Pressure ulcers refractory to nonoperative management may undergo flap reconstruction. This study aims to evaluate the long-term outcomes and recurrence rates of flap reconstruction for pediatric pressure ulcers. We reviewed the records of patients who underwent flap reconstruction for pressure ulcer(s) from 1995 to 2013. Twenty-four patients with 30 pressure ulcers, requiring 52 flaps were included. Ulcers were stages III and IV and mostly involved either the ischia (15/30) or sacrum (8/30). Flaps were followed for a median of 4.9 years. Twenty-three patients were wheelchair dependent, and 20 had sensory impairment at their ulcer site(s). Ten patients had a history of noncompliance with preoperative management, 8 of whom experienced ulcer recurrence. Twenty-one ulcers had underlying osteomyelitis, associated with increased admissions (P = 0.019) and cumulative length of stay (P = 0.031). Overall, there was a 42% recurrence rate in ulceration after flap reconstruction. Recurrence was associated with a preoperative history of noncompliance with nonoperative therapy (P = 0.030), but not with flap type or location, age, sex, body mass index, osteomyelitis, or urinary/fecal incontinence (P > 0.05, all). Flap reconstruction can be beneficial in the management of pediatric pressure ulcers. Although high rates of long-term success with this intervention have been reported in children, we found rates of ulcer recurrence similar to that seen in adults. Poor compliance with nonoperative care and failure to modify the biopsychosocial perpetuators of pressure ulcers will likely eventuate in postoperative recurrence. Despite the many comorbidities observed in our patient sample, compliance was the best indicator of long-term skin integrity and flap success.

  17. Sanguis draconis (Daemonorops draco): a case report of treating a chronic pressure ulcer with tunneling.

    PubMed

    Ji, Shu; Zhang, Guizhen; Hua, Yafang; Jin, Xueqin

    2015-01-01

    Pressure ulcers are a frequently encountered difficulty in clinical nursing care. In cases of pressure ulcers, continued pressure on soft tissue leads to pathological processes in affected tissues that include ischemia and hypoxia, nutritional and metabolic disorders, and degeneration and necrosis. Pressure ulcers are a common clinical complication. In February 2013, our department admitted a patient with Parkinson's disease who suffered from a chronic pressure ulcer with tunneling. This patient was given an integrative therapy treatment protocol that consisted of external applications of a phytomedicine called sanguis draconis, combined with a series of conventional treatments, including local oxygen therapy, custom-built vacuum aspiration, and anti-infection therapies. The patient's integrative treatment program resulted in complete amelioration of the pressure ulceration. The following sections describe the nursing experiences associated with this case study.

  18. Incidence and risk factors for surgically acquired pressure ulcers: a prospective cohort study investigators.

    PubMed

    Webster, Joan; Lister, Carolyn; Corry, Jean; Holland, Michelle; Coleman, Kerrie; Marquart, Louise

    2015-01-01

    To assess the incidence of hospital-acquired, surgery-related pressure injury (ulcers) and identify risk factors for these injuries. We used a prospective cohort study to investigate the research question. The study was conducted at a major metropolitan hospital in Brisbane, Australia. Five hundred thirty-four adult patients booked for any surgical procedure expected to last more than 30 minutes were eligible for inclusion. Patients who provided informed consent for study participation were assessed for pressure ulcers, using the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel Guidelines, before entering the operating room and again in the post-anesthetic care unit (PACU). Research nurses and all PACU nurses were trained in skin assessment and in pressure ulcer staging. Patients were not assessed again after their discharge from the PACU. Seven patients (1.3%) had existing pressure injuries (ulcers) and a further 6 (1.3%) developed a surgery-related pressure ulcer. Risk factors associated with surgery-related pressure injuries were similar to non-surgically related risks and included older age, skin condition, and being admitted from a location other than one's own home. Length of surgery was not associated with pressure ulcer development in this cohort. Perioperative nurses play an important role in identifying existing or new pressure injuries. However, many of these nurses are unfamiliar with pressure ulcer classification, so education in this area is essential. Although the incidence of surgically acquired pressure ulcers was low in this cohort, careful skin inspection before and after surgery provides an opportunity for early treatment and may prevent existing lesions progressing to higher stages.

  19. Under Pressure: Financial Impact of the Hospital-Acquired Conditions Initiative. A Statewide Analysis of Pressure Ulcer Development and Payment

    PubMed Central

    Meddings, Jennifer A.; Reichert, Heidi; Rogers, Mary A. M.; Hofer, Timothy P.; McMahon, Laurence F.; Grazier, Kyle L.

    2017-01-01

    OBJECTIVE To assess the financial impact of the 2008 Hospital-Acquired Conditions Initiative’s pressure ulcer payment changes on Medicare and other payors. DESIGN, SETTING AND PARTICIPANTS Retrospective before-and-after study of all-payor statewide administrative data for >2.4 million annual adult discharges from 311 nonfederal acute-care California hospitals in 2007 and 2009, using the Healthcare Cost and Utilization Project State Inpatient Datasets. We assessed how often and by how much the 2008 payment changes for pressure ulcers affected hospital payment. MEASUREMENTS Pressure ulcer rates and hospital payment changes RESULTS Hospital-acquired pressure ulcer rates were very low (0.28%) in 2007 and 2009; present-on-admission pressure ulcer rates increased from 2.35% in 2007 to 3.00% in 2009. By clinical stage of pressure ulcer (available in 2009), hospital-acquired stage III–IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for stage III–IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges for a statewide payment decrease of $310,444 (0.001%) for all payors and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers) reducing statewide payment by $62,538,586 (0.21%) for all payors and $47,237,984 (0.32%) for Medicare. CONCLUSION The total financial impact of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than stages III–IV. The removal of payment for hospital-acquired stage III–IV ulcers was more than 200 times less than the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital-Acquired Conditions Initiative. PMID:26140454

  20. Building a Biopsychosocial Conceptual Framework to Explore Pressure Ulcer Pain for Hospitalized Patients

    PubMed Central

    Kim, Junglyun; Ahn, Hyochol; Lyon, Debra E.; Stechmiller, Joyce

    2016-01-01

    Although pressure ulcers are a prevalent condition, pain associated with pressure ulcers is not fully understood. Indeed, previous studies do not shed light on the association between pressure ulcer stages and the experience of pain. Especially, pain characteristics of suspected deep tissue injury, which is a new category that was recently added by the National Pressure Ulcer Advisory Panel, are yet unknown. This is concerning because the incidence of pressure ulcers in hospitalized patients has increased exponentially over the last two decades, and health care providers are struggling to ensure providing adequate care. Thus, in order to facilitate the development of effective interventions, this paper presents a conceptual framework to explore pressure ulcer pain in hospitalized patients. The concepts were derived from a biopsychosocial model of pain, and the relationships among each concept were identified through a literature review. Major propositions are presented based on the proposed conceptual framework, which integrates previous research on pressure ulcer pain, to ultimately improve understanding of pain in hospitalized patients with pressure ulcers. PMID:27417595

  1. Building a Biopsychosocial Conceptual Framework to Explore Pressure Ulcer Pain for Hospitalized Patients.

    PubMed

    Kim, Junglyun; Ahn, Hyochol; Lyon, Debra E; Stechmiller, Joyce

    2016-01-08

    Although pressure ulcers are a prevalent condition, pain associated with pressure ulcers is not fully understood. Indeed, previous studies do not shed light on the association between pressure ulcer stages and the experience of pain. Especially, pain characteristics of suspected deep tissue injury, which is a new category that was recently added by the National Pressure Ulcer Advisory Panel, are yet unknown. This is concerning because the incidence of pressure ulcers in hospitalized patients has increased exponentially over the last two decades, and health care providers are struggling to ensure providing adequate care. Thus, in order to facilitate the development of effective interventions, this paper presents a conceptual framework to explore pressure ulcer pain in hospitalized patients. The concepts were derived from a biopsychosocial model of pain, and the relationships among each concept were identified through a literature review. Major propositions are presented based on the proposed conceptual framework, which integrates previous research on pressure ulcer pain, to ultimately improve understanding of pain in hospitalized patients with pressure ulcers.

  2. Early Detection of Pressure Ulcer Development Following Traumatic Spinal Cord Injury Using Inflammatory Mediators.

    PubMed

    Krishnan, Shilpa; Karg, Patricia E; Boninger, Michael L; Vodovotz, Yoram; Constantine, Greg; Sowa, Gwendolyn A; Brienza, David M

    2016-10-01

    To identify changes in concentrations of inflammatory mediators in plasma and urine after traumatic spinal cord injury (SCI) and before the occurrence of a first pressure ulcer. Retrospective; secondary analysis of existing data. Acute hospitalization and inpatient rehabilitation sites at a university medical center. Individuals with a pressure ulcer and plasma samples (n=17) and individuals with a pressure ulcer and urine samples (n=15) were matched by age and plasma/urine sample days to individuals with SCI and no pressure ulcer (N=35). Not applicable. Plasma and urine samples were assayed in patients with SCI, capturing samples within 4 days after the SCI to a week before the formation of the first pressure ulcer. The Wilcoxon signed-rank test was performed to identify changes in the inflammatory mediators between the 2 time points. An increase in concentration of the chemokine interferon-γ-induced protein of 10kd/CXCL10 in plasma (P<.01) and a decrease in concentration of the cytokine interferon-α in urine (P=.01) were observed before occurrence of a first pressure ulcer (∼4d) compared with matched controls. Altered levels of inflammatory mediators in plasma and urine may be associated with pressure ulcer development after traumatic SCI. These inflammatory mediators should be explored as possible biomarkers for identifying individuals at risk for pressure ulcer formation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline Number 3.

    ERIC Educational Resources Information Center

    Agency for Health Care Policy and Research (DHHS/PHS), Rockville, MD.

    This package includes a clinical practice guideline, quick reference guide for clinicians, and patient's guide to predicting and preventing pressure ulcers in adults. The clinical practice guideline includes the following: overview of the incidence and prevalence of pressure ulcers; clinical practice guideline (introduction, risk assessment tools…

  4. Prevention Practice Differences Among Persons With Spinal Cord Injuries Who Rarely Versus Frequently Sustain Pressure Ulcers

    ERIC Educational Resources Information Center

    Jones, Michael L.; Marini, Irmo; Slate, John R.

    2005-01-01

    Pressure ulcers are common among people with spinal cord injury (SCI) and not only are costly to treat but also affect the quality of life of those affected by them. Despite a plethora of literature on prevention, there are few wellness studies focusing on the practices of people who do not develop pressure ulcers. This preliminary study sought to…

  5. Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients.

    PubMed

    Rich, Shayna E; Margolis, David; Shardell, Michelle; Hawkes, William G; Miller, Ram R; Amr, Sania; Baumgarten, Mona

    2011-01-01

    Frequent manual repositioning is an established part of pressure ulcer prevention, but there is little evidence for its effectiveness. This study examined the association between repositioning and pressure ulcer incidence among bed-bound elderly hip fracture patients, using data from a 2004-2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age ≥ 65 years, underwent hip fracture surgery, and were bed-bound at index study visits (during the first 5 days of hospitalization). Information about repositioning on the days of index visits was collected from patient charts; study nurses assessed presence of stage 2+ pressure ulcers 2 days later. The association between frequent manual repositioning and pressure ulcer incidence was estimated, adjusting for pressure ulcer risk factors using generalized estimating equations and weighted estimating equations. Patients were frequently repositioned (at least every 2 hours) on only 53% (187/354) of index visit days. New pressure ulcers developed at 12% of visits following frequent repositioning vs. 10% following less frequent repositioning; the incidence rate of pressure ulcers per person-day did not differ between the two groups (incidence rate ratio 1.1, 95% confidence interval 0.5-2.4). No association was found between frequent repositioning of bed-bound patients and lower pressure ulcer incidence, calling into question the allocation of resources for repositioning.

  6. Prevention Practice Differences Among Persons With Spinal Cord Injuries Who Rarely Versus Frequently Sustain Pressure Ulcers

    ERIC Educational Resources Information Center

    Jones, Michael L.; Marini, Irmo; Slate, John R.

    2005-01-01

    Pressure ulcers are common among people with spinal cord injury (SCI) and not only are costly to treat but also affect the quality of life of those affected by them. Despite a plethora of literature on prevention, there are few wellness studies focusing on the practices of people who do not develop pressure ulcers. This preliminary study sought to…

  7. 76 FR 74789 - Scientific Information Request on Pressure Ulcer Treatment Medical Devices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-01

    ... online solicitations. We are looking for studies that report on pressure ulcer treatment strategies.... Scientific information is being solicited to inform our Pressure Ulcer Treatment Strategies: A Comparative....AHRQ.gov/index.cfm/submitscientific-information-packets/ . Please select the study for which you are...

  8. Sitting and pressure ulcers 2: ensuring good posture and other preventive techniques.

    PubMed

    Stockton, Lesley; Flynn, Maria

    This second in a two-part unit on sitting and pressure ulcer development explores posture and prevention techniques. The unit highlights points from Tissue Viability Society (2009) guidance. Part 1 examined the risk factors and potential risks of pressure ulcers in seated patients. It also outlined self-repositioning movements for patients.

  9. The pressure is on: midwives and decubitus ulcers.

    PubMed

    Prior, Jenny

    2002-05-01

    Research regarding pressure area care and management in nursing extends back many years, but remains relevant and cited today. With relevant knowledge, midwives can help prevent the development of pressure sores in the maternity setting. Clinical governance and risk management should ensure that the incidence and occurrence of pressure sores in the midwifery arena is reported and fed into appropriate audit analysis at local, regional and national levels. Midwives need to seriously consider the implications of modern midwifery care and management in relation to the development of pressure sores in our population. Labour suite, high dependency, ward and community areas should include guidelines for the prevention, treatment and management of pressure sores, including mattress policies. Prophylactic measures and assessment scores could be incorporated into partogram documentation in the labour suite and as part of postoperative documentation in the ward environment for women who have undergone caesarean section. Trusts may find that a link midwife liasing with tissue viability nurses proves beneficial. Community midwives should forge links with the district nursing services in their Primary Care Trust areas with regard to developing or adapting tools. Knowledge of pathophysiology, prophylaxis and subsequent management of decubitus ulcers in maternity care is sadly lacking in midwifery textbooks. Future authors and editors should include this subject and it should feature more prominently in midwifery education curricula. It is clear that there is much work to be done in this area, both educationally and clinically. Further research is required to evaluate pressure prevention strategies in the midwifery arena, including the increasing provision of one-to-one care in labour suite units. Improvements in the appropriate prevention and subsequent treatment and management of pressure sores will benefit women and help save the NHS hundreds of thousands of pounds in treatment

  10. Hybrid Equation/Agent-Based Model of Ischemia-Induced Hyperemia and Pressure Ulcer Formation Predicts Greater Propensity to Ulcerate in Subjects with Spinal Cord Injury

    PubMed Central

    Solovyev, Alexey; Mi, Qi; Tzen, Yi-Ting; Brienza, David; Vodovotz, Yoram

    2013-01-01

    Pressure ulcers are costly and life-threatening complications for people with spinal cord injury (SCI). People with SCI also exhibit differential blood flow properties in non-ulcerated skin. We hypothesized that a computer simulation of the pressure ulcer formation process, informed by data regarding skin blood flow and reactive hyperemia in response to pressure, could provide insights into the pathogenesis and effective treatment of post-SCI pressure ulcers. Agent-Based Models (ABM) are useful in settings such as pressure ulcers, in which spatial realism is important. Ordinary Differential Equation-based (ODE) models are useful when modeling physiological phenomena such as reactive hyperemia. Accordingly, we constructed a hybrid model that combines ODEs related to blood flow along with an ABM of skin injury, inflammation, and ulcer formation. The relationship between pressure and the course of ulcer formation, as well as several other important characteristic patterns of pressure ulcer formation, was demonstrated in this model. The ODE portion of this model was calibrated to data related to blood flow following experimental pressure responses in non-injured human subjects or to data from people with SCI. This model predicted a higher propensity to form ulcers in response to pressure in people with SCI vs. non-injured control subjects, and thus may serve as novel diagnostic platform for post-SCI ulcer formation. PMID:23696726

  11. Hybrid equation/agent-based model of ischemia-induced hyperemia and pressure ulcer formation predicts greater propensity to ulcerate in subjects with spinal cord injury.

    PubMed

    Solovyev, Alexey; Mi, Qi; Tzen, Yi-Ting; Brienza, David; Vodovotz, Yoram

    2013-01-01

    Pressure ulcers are costly and life-threatening complications for people with spinal cord injury (SCI). People with SCI also exhibit differential blood flow properties in non-ulcerated skin. We hypothesized that a computer simulation of the pressure ulcer formation process, informed by data regarding skin blood flow and reactive hyperemia in response to pressure, could provide insights into the pathogenesis and effective treatment of post-SCI pressure ulcers. Agent-Based Models (ABM) are useful in settings such as pressure ulcers, in which spatial realism is important. Ordinary Differential Equation-based (ODE) models are useful when modeling physiological phenomena such as reactive hyperemia. Accordingly, we constructed a hybrid model that combines ODEs related to blood flow along with an ABM of skin injury, inflammation, and ulcer formation. The relationship between pressure and the course of ulcer formation, as well as several other important characteristic patterns of pressure ulcer formation, was demonstrated in this model. The ODE portion of this model was calibrated to data related to blood flow following experimental pressure responses in non-injured human subjects or to data from people with SCI. This model predicted a higher propensity to form ulcers in response to pressure in people with SCI vs. non-injured control subjects, and thus may serve as novel diagnostic platform for post-SCI ulcer formation.

  12. Predictive Validity of Pressure Ulcer Risk Assessment Tools for Elderly: A Meta-Analysis.

    PubMed

    Park, Seong-Hi; Lee, Young-Shin; Kwon, Young-Mi

    2016-04-01

    Preventing pressure ulcers is one of the most challenging goals existing for today's health care provider. Currently used tools which assess risk of pressure ulcer development rarely evaluate the accuracy of predictability, especially in older adults. The current study aimed at providing a systemic review and meta-analysis of 29 studies using three pressure ulcer risk assessment tools: Braden, Norton, and Waterlow Scales. Overall predictive validities of pressure ulcer risks in the pooled sensitivity and specificity indicated a similar range with a moderate accuracy level in all three scales, while heterogeneity showed more than 80% variability among studies. The studies applying the Braden Scale used five different cut-off points representing the primary cause of heterogeneity. Results indicate that commonly used screening tools for pressure ulcer risk have limitations regarding validity and accuracy for use with older adults due to heterogeneity among studies. © The Author(s) 2015.

  13. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients.

    PubMed

    Cox, Jill; Rasmussen, Louisa

    2014-12-01

    Prevention and healing of pressure ulcers in critically ill patients can be especially challenging because of the patients' burden of illness and degree of physiological compromise. Providing adequate nutrition may help halt the development or worsening of pressure ulcers. Optimization of nutrition can be considered an essential ingredient in prevention and healing of pressure ulcers. Understanding malnutrition in critical care patients, the effect of nutrition on wound healing, and the application of evidence-based nutritional guidelines are important aspects for patients at high risk for pressure ulcers. Appropriate screenings for nutritional status and risk for pressure ulcers, early collaboration with a registered dietician, and administration of appropriate feeding formulations and micronutrient and macronutrient supplementation to promote wound healing are practical solutions to improve the nutritional status of critical care patients. Use of nutritional management and enteral feeding protocols may provide vital elements to augment nutrition and ultimately result in improved clinical outcomes. ©2014 American Association of Critical-Care Nurses.

  14. Treating a pressure ulcer with bio-electric stimulation therapy.

    PubMed

    Hampton, Sylvie; Collins, Fiona

    Mr Jones lived independently until he developed necrotic pressure ulcers over his heels and could no longer mobilize to care for himself. He was transferred to a nursing home where he lived for 18 months and where the nurses could care for his wounds. The wound had been on his right heel without changing over the 18 months and, although attempts to hydrate the eschar had been somewhat successful, the necrotic tissue proved stubborn creating large quantity of fibrous slough. Mr Jones was initially assessed by the tissue viability consultant on 14 March 2005 and agreed to the application of bio-electric stimulation therapy (POSiFEC). The wound change was immediate and was fully healed by 16 June 2005, 12 weeks after his initial assessment. This article outlines his care and the background to bio-electrical stimulation in wounds.

  15. Electronic SSKIN pathway: reducing device-related pressure ulcers.

    PubMed

    Campbell, Natalie

    2016-08-11

    This article describes how an interprofessional project in a London NHS Foundation Trust was undertaken to develop an intranet-based medical device-related pressure ulcer prevention and management pathway for clinical staff working across an adult critical care directorate, where life-threatening events require interventions using medical devices. The aim of this project was to improve working policies and processes to define key prevention strategies and provide clinicians with a clear, standardised approach to risk and skin assessment, equipment use, documentation and reporting clinical data using the Trust's CareVue (electronic medical records), Datix (incident reporting and risk-management tool) and eTRACE (online clinical protocol ordering) systems. The process included the development, trial and local implementation of the pathway using collaborative teamwork and the SSKIN care bundle tool. The experience of identifying issues, overcoming challenges, defining best practice and cascading SSKIN awareness training is shared.

  16. Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location.

    PubMed

    Ledoux, William R; Shofer, Jane B; Cowley, Matthew S; Ahroni, Jessie H; Cohen, Victoria; Boyko, Edward J

    2013-01-01

    We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Diabetic subjects (n=591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure-time integral (PTI) was assessed using Cox regression. During follow-up (2.4years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Location must be considered when assessing the relationship between PPP and plantar ulceration. © 2013.

  17. Moist exposed burn ointment for treating pressure ulcers: A multicenter randomized controlled trial.

    PubMed

    Li, Wei; Ma, Yubo; Yang, Qi; Pan, Yu; Meng, Qinggang

    2017-07-01

    Pressure ulcers often seriously affect the quality of life of patients. Moist Exposed Burn Ointment (MEBO) has been developed to treat patients with pressure ulcers. The present study aimed to evaluate the efficacy and safety of MEBO in the treatment of pressure ulcers in Chinese patients. Seventy-two patients with pressure ulcers were randomly assigned to 2 groups who received a placebo or MEBO for 2 months. The primary outcomes included the wound surface area (WSA) and pressure ulcer scale for healing (PUSH) tool. The secondary outcomes included a visual analog scale (VAS), questionnaire of ulcer status, and adverse effects. Sixty-seven patients completed the study. After 2 months of treatment, the difference of mean change from the baseline was greater for MEBO (vs placebo) for WSA mean (SD) -6.0 (-8.8, -3.3), PUSH Tool -2.6 (-4.7, -1.5), and VAS score -2.9 (-4.4, -1.7). On the basis of the questionnaire, the pressure ulcers were "completely healed" (50.0% vs 16.7%) (P < .05) in patients after 2 months of treatment with MEBO versus placebo. No major adverse effects were found in the 2 groups. We showed that MEBO is effective and well tolerated for improving wound healing in Chinese patients with pressure ulcers.

  18. Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay, and charges to patients.

    PubMed

    Allen, Beverlin

    2013-05-01

    The burden of pressure ulcers will intensify because of a rapidly increasing elderly population. The aim of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on pressure ulcer wound healing, length of hospital stays, and charges for pressure ulcer management. The pre/post quasi-experimental design study comprised of 100 patients (50 patients in each group) 60 years or older with pressure ulcer. Research questions were analyzed using descriptive statistics, frequencies, chi-square tests, and t tests. Study findings indicate that the intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay (LOS) for treatment of pressure ulcer and total hospital LOS, while showing no significant additional charges for treatment of pressure ulcers. The older adults are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life.

  19. Assessment of common interventions and perceived barriers to pressure ulcer prevention in southwest Nigeria.

    PubMed

    Ilesanmi, Rose Ekama; Olabisi, Prisca

    2014-01-01

    We examined the interventions used by nurses to prevent pressure ulcers in 3 hospitals in south west Nigeria and perceived barriers to effective nursing pressure ulcer prevention interventions. One hundred ninety-three nurses were purposively selected from neurological, orthopedic, intensive care, and accident and emergency units of participating hospitals. Study sites were 3 teaching hospitals in south west Nigeria (Lagos State University Teaching Hospital, Lagos; University College Hospital, Ibadan; and Obafemi Awolowo Teaching Hospital Ile-Ife). Data were collected via a structured questionnaire designed for this study. It included 3 sections: demographic information, practices used for pressure ulcer prevention, and perceived barriers to prevention. Sections of the questionnaire that queried interventions and perceived barriers to pressure ulcer prevention were evaluated for face and content validity. Reliability was evaluated via internal consistency; the split half reliability was 0.82. Similar practices regarding pressure ulcer prevention were found across the 3 hospitals. The most commonly used intervention was patient repositioning every 2 hours; the least used intervention was completion of a validated pressure ulcer risk scale. Nurses described using interventions that have not proved effective for pressure ulcer prevention such as massaging bony prominences and application of talcum powder. Nurses identified 2 principal factors that act as barriers to successful prevention of pressure ulcers: inadequate manpower and inadequate supply of linens on the wards. Nurses use a combination of evidence-based interventions, along with interventions that have not proved effective for pressure ulcer prevention. We recommend development of national standards for pressure ulcer prevention in Nigeria that are based on current best evidence and consistent with current international guidelines.

  20. Effect of e-learning program on risk assessment and pressure ulcer classification - A randomized study.

    PubMed

    Bredesen, Ida Marie; Bjøro, Karen; Gunningberg, Lena; Hofoss, Dag

    2016-05-01

    Pressure ulcers (PUs) are a problem in health care. Staff competency is paramount to PU prevention. Education is essential to increase skills in pressure ulcer classification and risk assessment. Currently, no pressure ulcer learning programs are available in Norwegian. Develop and test an e-learning program for assessment of pressure ulcer risk and pressure ulcer classification. Forty-four nurses working in acute care hospital wards or nursing homes participated and were assigned randomly into two groups: an e-learning program group (intervention) and a traditional classroom lecture group (control). Data was collected immediately before and after training, and again after three months. The study was conducted at one nursing home and two hospitals between May and December 2012. Accuracy of risk assessment (five patient cases) and pressure ulcer classification (40 photos [normal skin, pressure ulcer categories I-IV] split in two sets) were measured by comparing nurse evaluations in each of the two groups to a pre-established standard based on ratings by experts in pressure ulcer classification and risk assessment. Inter-rater reliability was measured by exact percent agreement and multi-rater Fleiss kappa. A Mann-Whitney U test was used for continuous sum score variables. An e-learning program did not improve Braden subscale scoring. For pressure ulcer classification, however, the intervention group scored significantly higher than the control group on several of the categories in post-test immediately after training. However, after three months there were no significant differences in classification skills between the groups. An e-learning program appears to have a greater effect on the accuracy of pressure ulcer classification than classroom teaching in the short term. For proficiency in Braden scoring, no significant effect of educational methods on learning results was detected. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Incidence and risk factors for pressure ulcers in the intensive care unit.

    PubMed

    Nijs, Nele; Toppets, Adinda; Defloor, Tom; Bernaerts, Kris; Milisen, Koen; Van Den Berghe, Greet

    2009-05-01

    To determine the incidence of pressure ulcers occurring at least 48 hours after admission and risk factors for pressure ulcers grade 2-4 in a long-stay surgical Intensive Care Unit (ICU) population. The incidence of pressure ulcers in intensive care units is larger than in non-intensive environments. Prospective descriptive research design. Using pressure ulcers grade 2-4 as an outcome measure, a multivariate logistic regression analysis was used to identify the risk factors. Data were obtained on a daily basis in a surgical intensive care unit of the University Hospital Leuven between November 2003-March 2004. A total of 520 long-stay (>or= 24 hours) intensive care patients were included. Cumulative incidence of pressure ulcers grade 2-4 was 20.1%. The following variables were positively associated with pressure ulcers grade 2-4: history of vascular disease, treatment with Dopamine or Dobutamine, intermittent haemodialysis (IHD) or continuous veno-venous haemofiltration (CVVH), mechanical ventilation. Also preventive measures were statistically positively associated with pressure ulcers grade 2-4: turning, floating heels, alternating mattresses, adequate prevention. The use of sedatives, body temperature above 38.5 degrees C and sitting in chair where negatively associated with pressure ulcers. Pressure ulcers are statistically associated with different risk factors and preventive measures. The identified risk factors are eligible to be included in a new risk assessment scale for patients admitted to intensive care units. The novel insights have implications for risk assessment for patients in intensive care units. Patients admitted to intensive care units have other risk factors for pressure ulcers which are eligible to be included in a new risk assessment scale.

  2. Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 1.

    PubMed

    Gefen, Amit

    Pressure ulcers are one of the most potentially devastating complications in individuals confined to a bed or a wheelchair for an extended period. Severe pressure ulcers may form in deep tissues overlying bony prominences, and only at a later stage become visible, or may even induce a full-thickness breakdown of the soft tissues at the affected site. A new type of pressure ulcer known as'deep tissue injury' has therefore been defined internationally. To understand the aetiology of deep tissue injury, health professionals should be able to predict whether or not a certain state of internal mechanical loads in deep tissues, such as tissue deformations and forces per unit area of tissue, would lead to localised irreversible cell damage. Part one of this article explains the concepts of injury thresholds as related to deep tissue injury. Some serious flaws in the classical, commonly used Reswick and Rogers pressure-time curve are analysed, and an alternative contemporary tissue injury threshold, the sigmoid threshold, is suggested. Part two of this article describes recent and ongoing work aimed at defining injury thresholds that are specific for deep tissue injury, standardised and therefore suitable for use with different patients. Clinical implications of current injury thresholds are also discussed, in relation to obese patients and patients with muscle atrophy.

  3. Pressure Ulcer Prevention in the Hospital Setting Using Silicone Foam Dressings

    PubMed Central

    Grigson, Eileen; Patel, Maulik; Liu, Xinwei

    2016-01-01

    Patient care is of the utmost importance in the hospital setting. Bedrest and immobility during hospitalization, especially in the surgical and intensive care setting, place the patient at high risk for pressure ulcers. It is very important to prevent or notice a pressure ulcer forming due to the significant health care costs involved and patient health associated with them. Various measures are in place to prevent patients from getting pressure ulcers, but a newer material, silicone foam dressings, has been introduced as an alternative solution for the prevention of these ulcers. We review the current literature to examine whether the standard protocol or silicone material is superior to the prevention of pressure ulcer formation. We conclude that silicone foam dressings, when used as prophylactic treatment, seems very promising and may even be superior to the standard care of prevention. However, there were limitations to some studies and further research is needed to confirm the role of silicone foam dressings. PMID:27630803

  4. The first national pressure ulcer prevalence survey in county council and municipality settings in Sweden.

    PubMed

    Gunningberg, Lena; Hommel, Ami; Bååth, Carina; Idvall, Ewa

    2013-10-01

    To report data from the first national pressure ulcer prevalence survey in Sweden on prevalence, pressure ulcer categories, locations and preventive interventions for persons at risk for developing pressure ulcers. A cross-sectional research design was used in a total sample of 35,058 persons in hospitals and nursing homes. The methodology used was that recommended by the European Pressure Ulcer Advisory Panel. The prevalence of pressure ulcers was 16.6% in hospitals and 14.5% in nursing homes. Many persons at risk for developing pressure ulcers did not receive a pressure-reducing mattress (23.3-27.9%) or planned repositioning in bed (50.2-57.5%). Despite great effort on the national level to encourage the prevention of pressure ulcers, the prevalence is high. Public reporting and benchmarking are now available, evidence-based guidelines have been disseminated and national goals have been set. Strategies for implementing practices outlined in the guidelines, meeting goals and changing attitudes must be further developed. © 2012 John Wiley & Sons Ltd.

  5. Wound fixation for pressure ulcers: a new therapeutic concept based on the physical properties of wounds.

    PubMed

    Mizokami, Fumihiro; Takahashi, Yoshiko; Nemoto, Tetsuya; Nagai, Yayoi; Tanaka, Makiko; Utani, Atsushi; Furuta, Katsunori; Isogai, Zenzo

    2015-02-01

    A pressure ulcer is defined as damage to skin and other tissues over a bony prominence caused by excess pressure. Deep pressure ulcers that develop over specific bony prominences often exhibit wound deformity, defined as a change in the 3-dimensional shape of the wound. Subsequently, the wound deformity can result in undermining formation, which is a characteristic of deep pressure ulcers. However, to date, a concept with respect to alleviating wound deformity has yet to be defined and described. To clarify the issue, we propose a new concept called "wound fixation" based on the physical properties of deep pressure ulcers with wound deformity. Wound fixation is defined here as the alleviation of wound deformity by exogenous materials. The wound fixation methods are classified as traction, anchor, and insertion based on the relation between the wound and action point by the exogenous materials. A retrospective survey of a case series showed that wound fixation was preferentially used for deep pressure ulcers at specific locations such as the sacrum, coccyx, and greater trochanter. Moreover, the methods of wound fixation were dependent on the pressure ulcer location. In conclusion, our new concept of wound fixation will be useful for the practical treatment and care of pressure ulcers. Further discussion and validation by other experts will be required to establish this concept.

  6. Adverse Outcomes after Major Surgery in Patients with Pressure Ulcer: A Nationwide Population-Based Retrospective Cohort Study

    PubMed Central

    Chou, Chia-Lun; Lee, Woan-Ruoh; Yeh, Chun-Chieh; Shih, Chun-Chuan

    2015-01-01

    Background Postoperative adverse outcomes in patients with pressure ulcer are not completely understood. This study evaluated the association between preoperative pressure ulcer and adverse events after major surgeries. Methods Using reimbursement claims from Taiwan’s National Health Insurance Research Database, we conducted a nationwide retrospective cohort study of 17391 patients with preoperative pressure ulcer receiving major surgery in 2008-2010. With a propensity score matching procedure, 17391 surgical patients without pressure ulcer were selected for comparison. Eight major surgical postoperative complications and 30-day postoperative mortality were evaluated among patients with pressure ulcer of varying severity. Results Patients with preoperative pressure ulcer had significantly higher risk than controls for postoperative adverse outcomes, including septicemia, pneumonia, stroke, urinary tract infection, and acute renal failure. Surgical patients with pressure ulcer had approximately 1.83-fold risk (95% confidence interval 1.54-2.18) of 30-day postoperative mortality compared with control group. The most significant postoperative mortality was found in those with serious pressure ulcer, such as pressure ulcer with local infection, cellulitis, wound or treatment by change dressing, hospitalized care, debridement or antibiotics. Prolonged hospital or intensive care unit stay and increased medical expenditures were also associated with preoperative pressure ulcer. Conclusion This nationwide propensity score-matched retrospective cohort study showed increased postoperative complications and mortality in patients with preoperative pressure ulcer. Our findings suggest the urgency of preventing and managing preoperative pressure ulcer by a multidisciplinary medical team for this specific population. PMID:26000606

  7. Psychometric Properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Pressure Ulcer Risk Assessment During Inpatient Rehabilitation.

    PubMed

    Delparte, Jude J; Scovil, Carol Y; Flett, Heather M; Higgins, Johanne; Laramée, Marie-Thérèse; Burns, Anthony S

    2015-11-01

    To assess the psychometric properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for pressure ulcer (PU) risk assessment during inpatient rehabilitation. Prospective cohort. Tertiary rehabilitation centers. Individuals (N=759) participating in inpatient spinal cord injury rehabilitation between January 3, 2012, and April 23, 2014. Not applicable. Admission SCIPUS scores and the corresponding risk stratification, PU incidence, intraclass correlation coefficient (ICC) for interrater reliability, sensitivity, specificity, and likelihood ratios (LRs). Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC). Mean SCIPUS scores were higher for individuals who developed PUs than for those who did not (mean SCIPUS score, 9.8±2.5 vs 8.5±2.6). Interrater reliability was excellent for SCIPUS composite scores (ICC=.91) and very good for risk stratification (ICC=.86). Using the existing cutoff value of ≥6 for "high risk" category, sensitivity and specificity were estimated to be .97 and .12, respectively, with an LR of 1.1. A cutoff value of ≥8 yielded a better balance between sensitivity and specificity (.85 and .38, respectively). The AUC equaled .64 with an LR of 1.4. Results were similar when the analysis was confined to PUs of stage II or greater. The psychometric properties of the SCIPUS do not currently support its routine use as a measure of PU risk in individuals with spinal cord injury undergoing inpatient rehabilitation. LRs of <2 indicate that stratification as high risk or very high risk does not substantially increase the likelihood of identifying individuals who develop PUs beyond chance alone. AUCs were also below the desired cutoff value of 0.7. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk.

    PubMed

    Cremasco, Mariana F; Wenzel, Fernanda; Zanei, Suely S V; Whitaker, Iveth Y

    2013-08-01

    Aims and objective.  To verify association between PU development with nursing workload and illness severity and to verify whether nursing workload and illness severity are related with Braden Scale scores. Background.  Critically ill patients are more susceptible to treatment complications because of the severity of their clinical condition. Design.  Prospective descriptive study. Methods.  Patients consecutively admitted to three intensive care units (ICUs) of a public university hospital located in Sao Paulo, Brazil and without pressure ulcer (PU) at admission and a minimum stay of 24 hours were included in the sample. Prospective data collection included demographic, clinical and hospitalisation data, Nursing Activities Score (NAS), Simplified Acute Physiology Score (SAPSII) and Braden Scale. Multivariate linear regression analysis was applied to verify whether nursing workload and illness severity are related with Braden Scale scores. Multivariate logistic regression analysis was used to verify whether nursing workload and illness severity were risk factors associated with PU development. Results.  The study sample included 160 patients. The mean Braden score was 12·0 and PU incidence was 34·4%. Multivariate linear regression analysis identified as factors related to variation of Braden scores: illness severity (SAPSII), nursing workload (NAS) and age. Multivariate logistic regression showed a model with risk factors associated with PU development: sex, length of ICU stay, illness severity and nursing workload. Conclusion.  Nursing workload, severity of illness, sex and length of ICU stay were identified as risk factors associated with PU development. However, nursing workload acted as a protective factor. Illness severity, nursing workload and age were related to Braden scores. Relevance to clinical practice.  Accurate identification of risk factors and the use of clinical judgment in skin assessment are prerequisites for determining

  9. Pressure Ulcers in the Hospitalized Neonate: Rates and Risk Factors

    PubMed Central

    Visscher, Marty; Taylor, Teresa

    2014-01-01

    Pressure ulcers (PU) are serious, reportable events causing pain, infection and prolonged hospitalization, particularly among critically ill patients. The literature on PUs in neonates is limited. The objective was to determine the etiology, severity and influence of gestational age on PUs among hospitalized infants. A two-year prospective study was conducted among 741 neonatal intensive care patients over 31,643 patient-days. Risk factors were determined by comparing the characteristics of infants who developed PUs with those who did not. There were 1.5 PUs per 1000 patient days with 1.0 PU per 1000 days in premature infants and 2.7 per 1000 days in term infants. The number of PUs associated with devices was nearly 80% overall and over 90% in premature infants. Infants with PUs had longer hospitalizations and weighed more than those who did not. Infants with device-related PUs were younger, of lower gestational age and developed the PU earlier than patients with PUs due to conventional pressure. The time to PU development was longer in prematurely born versus term infants. Hospitalized neonates are susceptible to device-related injury and the rate of stage II injury is high. Strategies for early detection and mitigation of device-related injury are essential to prevent PUs. PMID:25502955

  10. Pressure ulcers among terminally ill nursing home residents.

    PubMed

    Kayser-Jones, Jeanie; Kris, Alison E; Lim, Kyung-Choon; Walent, Ronald J; Halifax, Elizabeth; Paul, Steven M

    2008-01-01

    The purpose of this prospective, anthropological study was to describe and analyze the experiences and care of terminally ill nursing home residents who were admitted with or acquired pressure ulcers (PUs) after admission. Data were collected in two proprietary nursing homes. Participant observation, in-depth interviews, event analysis, and chart review were used to obtain data. A total of 64 (54.7%) of the 117 terminally ill residents in the study had PUs; 52 (81.3%) of whom died with PUs. The findings disclosed that the absence of family advocacy, inability to speak English, and inadequate staffing and lack of supervision, along with other previously reported risk factors, contributed to the development of PUs. Specifically, inadequate staffing and lack of supervision led to inadequate assistance at mealtime, infrequent repositioning, and inadequate continence care, which in turn led to weight loss, unrelieved pressure on bony prominences, and moist, irritated skin. The outcome was a high rate of residents dying with PUs. Knowledge of and attention to these risk factors can guide nurses in the prevention and management of PUs.

  11. Preventing in-facility pressure ulcers as a patient safety strategy: a systematic review.

    PubMed

    Sullivan, Nancy; Schoelles, Karen M

    2013-03-05

    Complications from hospital-acquired pressure ulcers cause 60,000 deaths and significant morbidity annually in the United States. The objective of this systematic review is to review evidence regarding multicomponent strategies for preventing pressure ulcers and to examine the importance of contextual aspects of programs that aim to reduce facility-acquired pressure ulcers. CINAHL, the Cochrane Library, EMBASE, MEDLINE, and PreMEDLINE were searched for articles published from 2000 to 2012. Studies (any design) that implemented multicomponent initiatives to prevent pressure ulcers in adults in U.S. acute and long-term care settings and that reported pressure ulcer rates at least 6 months after implementation were selected. Two reviewers extracted study data and rated quality of evidence. Findings from 26 implementation studies (moderate strength of evidence) suggested that the integration of several core components improved processes of care and reduced pressure ulcer rates. Key components included the simplification and standardization of pressure ulcer-specific interventions and documentation, involvement of multidisciplinary teams and leadership, use of designated skin champions, ongoing staff education, and sustained audit and feedback.

  12. Validity and reliability of the Turkish version of the pressure ulcer prevention knowledge assessment instrument.

    PubMed

    Tulek, Zeliha; Polat, Cansu; Ozkan, Ilknur; Theofanidis, Dimitris; Togrol, Rifat Erdem

    2016-11-01

    Sound knowledge of pressure ulcers is important to enable good prevention. There are limited instruments assessing pressure ulcer knowledge. The Pressure Ulcer Prevention Knowledge Assessment Instrument is among the scales of which psychometric properties have been studied rigorously and reflects the latest evidence. This study aimed to evaluate the validity and reliability of the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI-T), an instrument that assesses knowledge of pressure ulcer prevention by using multiple-choice questions. Linguistic validity was verified through front-to-back translation. Psychometric properties of the instrument were studied on a sample of 150 nurses working in a tertiary hospital in Istanbul, Turkey. The content validity index of the translated instrument was 0.94, intra-class correlation coefficients were between 0.37 and 0.80, item difficulty indices were between 0.21 and 0.88, discrimination indices were 0.20-0.78, and the Kuder Richardson for the internal consistency was 0.803. The PUPKAI-T was found to be a valid and reliable tool to evaluate nurses' knowledge on pressure ulcer prevention. The PUPKAI-T may be a useful tool for determining educational needs of nurses on pressure ulcer prevention. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  13. Characterization of a Murine Pressure Ulcer Model to Assess Efficacy of Adipose-derived Stromal Cells.

    PubMed

    Strong, Amy L; Bowles, Annie C; MacCrimmon, Connor P; Lee, Stephen J; Frazier, Trivia P; Katz, Adam J; Gawronska-Kozak, Barbara; Bunnell, Bruce A; Gimble, Jeffrey M

    2015-03-01

    As the world's population lives longer, the number of individuals at risk for pressure ulcers will increase considerably in the coming decades. In developed countries, up to 18% of nursing home residents suffer from pressure ulcers and the resulting hospital costs can account for up to 4% of a nation's health care budget. Although full-thickness surgical skin wounds have been used as a model, preclinical rodent studies have demonstrated that repeated cycles of ischemia and reperfusion created by exposure to magnets most closely mimic the human pressure ulcer condition. This study uses in vivo and in vitro quantitative parameters to characterize the temporal kinetics and histology of pressure ulcers in young, female C57BL/6 mice exposed to 2 or 3 ischemia-reperfusion cycles. This pressure ulcer model was validated further in studies examining the efficacy of adipose-derived stromal/stem cell administration. Optimal results were obtained with the 2-cycle model based on the wound size, histology, and gene expression profile of representative angiogenic and reparative messenger RNAs. When treated with adipose-derived stromal/stem cells, pressure ulcer wounds displayed a dose-dependent and significant acceleration in wound closure rates and improved tissue histology. These findings document the utility of this simplified preclinical model for the evaluation of novel tissue engineering and medical approaches to treat pressure ulcers in humans.

  14. Braden Scale cumulative score versus subscale scores: are we missing opportunities for pressure ulcer prevention?

    PubMed

    Gadd, Molly M

    2014-01-01

    Hospital-acquired pressure ulcer incidence rates continue to rise in the United States in the acute care setting despite efforts to extinguish them, and pressure ulcers are a nursing-sensitive quality indicator. The Braden Scale for Predicting Pressure Sore Risk instrument has been shown to be a valid and reliable instrument for assessing pressure ulcer risk. This case study represented 1 patient out of a chart audit that reviewed 20 patients with confirmed hospital-acquired pressure ulcers. The goal of the audit was to determine whether these ulcers might be avoided if preventive interventions based on Braden subscale scores versus the cumulative score were implemented. This case study describes a patient who, deemed at low risk for pressure ulcer development based on cumulative Braden Scale, may have benefited from interventions based on the subscale scores of sensory perception, activity, and mobility. Further research is needed to determine whether interventions based on subscales may be effective for preventing pressure ulcers when compared to a protocol based exclusively on the cumulative score.

  15. [Surgical management of a series of pressure ulcers: Report of 61 cases].

    PubMed

    Haiun, M; Feuvrier, D; Bayti, T; Pluvy, I; Pauchot, J

    2016-12-01

    Retrospective study about pressure ulcers surgical treatments in a series of 61 in 43 patients. To assess the management of pressure ulcers in spinal cord injury patients who had been operated in our institution. On the 61 pressure ulcers, location was ischial in 35 cases, sacral in 15 cases, trochanteric in 7 cases, lateral malleolar in 2 cases, on the heel in 1 case, and 1 was located lateral to the fibular head. Comorbidities were searched pre- and postoperatively. Fifty-five muscular, cutaneous flaps or myocutaneous, 5 fasciocutaneous and 1 excision/suture were realized. The mean follow-up was 8.6 years, and we observed 9 pressure ulcers recurrences (14.8%). We had a total result of 15 (24.6%) complicated pressure ulcers, with 8 early complications (13.1%) and 7 delay (11.5%). Antibiotic therapy was prescribed in 54 (88.5%) surgery cases and 7 were operated without any (11.5%). Pressure ulcers are major public health focus that need to be improved. A multidisciplinary care, mixed with education of patients are mandatory to achieve these goals: reduce complications and recurrences. Thanks to muscle sparring, perforators flap should become the gold standard of pressure ulcers surgery. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. [A project to reduce the incidence of facial pressure ulcers caused by prolonged surgery with prone positioning].

    PubMed

    Lee, Wen-Yi; Lin, Pao-Chen; Weng, Chia-Hsing; Lin, Yi-Lin; Tsai, Wen-Lin

    2012-06-01

    We observed in our institute a 13.6% incidence of prolonged surgery (>4 hours) induced facial pressure ulcers that required prone positioning. Causes identified included: (1) customized silicon face pillows used were not suited for every patient; (2) our institute lacked a standard operating procedure for prone positioning; (3) our institute lacked a postoperative evaluation and audit procedure for facial pressure ulcers. We designed a strategy to reduce post-prolonged surgery facial pressure ulcer incidence requiring prone positioning by 50% (i.e., from 13.6% to 6.8%). We implemented the following: (1) Created a new water pillow to relieve facial pressure; (2) Implemented continuing education pressure ulcer prevention and evaluation; (3) Established protocols on standard care for prone-position patients and proper facial pressure ulcer identification; (4) Established a face pressure ulcers accident reporting mechanism; and (5) Established an audit mechanism facial pressure ulcer cases. After implementing the resolution measures, 116 patients underwent prolonged surgery in a prone position (mean operating time: 298 mins). None suffered from facial pressure ulcers. The measures effectively reduced the incidence of facial pressure ulcers from 13.6% to 0.0%. The project used a water pillow to relieve facial pressure and educated staff to recognize and evaluate pressure ulcers. These measures were demonstrated effective in reducing the incidence of facial pressure ulcers caused by prolonged prone positioning.

  17. Outcomes after Stroke in Patients with Previous Pressure Ulcer: A Nationwide Matched Retrospective Cohort Study.

    PubMed

    Lee, Shang-Yi; Chou, Chia-Lun; Hsu, Sanford P C; Shih, Chun-Chuan; Yeh, Chun-Chieh; Hung, Chih-Jen; Chen, Ta-Liang; Liao, Chien-Chang

    2016-01-01

    Factors associated with poststroke adverse events were not completely understood. The purpose of this study was to investigate whether stroke patients with previous pressure ulcers had more adverse events after stroke. Using the claims data from Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study matched by propensity score. Three thousand two first-ever stroke patients with previous pressure ulcer and 3002 first-ever stroke patients without pressure ulcer were investigated between 2002 and 2009. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of complications and 30-day mortality after stroke associated with previous pressure ulcer were calculated in the multivariate logistic regressions. Patients with pressure ulcer had significantly higher risk than control for poststroke urinary tract infection (OR: 1.56, 95% CI: 1.38-1.78), pneumonia (OR: 1.35, 95% CI: 1.16-1.58), gastrointestinal bleeding (OR: 1.31, 95% CI: 1.04-1.66), and epilepsy (OR: 1.84, 95% CI: 1.83-1.85). Stroke patients with pressure ulcer had increased 30-day poststroke mortality (OR: 2.01, 95% CI: 1.55-2.61), particularly in those treated with debridement (OR: 2.87, 95% CI: 1.85-4.44) or high quantity of antibiotics (OR: 4.01, 95% CI: 2.10-7.66). Pressure ulcer was associated with poststroke mortality in both genders and patients aged 60 years or older. This study showed increased poststroke complications and mortality in patients with previous pressure ulcer, which suggests the urgent need for monitoring stroke patients for pressure ulcer history. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Longitudinal pressure ulcer rates since the adoption of culture change in Veterans Health Administration nursing homes

    PubMed Central

    Hartmann, Christine W.; Shwartz, Michael; Zhao, Shibei; Palmer, Jennifer A.; Berlowitz, Dan R.

    2015-01-01

    Objective To examine facility-level pressure ulcer development rates and variations in these rates after a system-wide adoption of culture change in Veterans Health Administration (VHA) nursing homes. Design 4-year retrospective longitudinal design. Setting 109 VHA facilities representing 132 nursing homes, known as Community Living Centers (CLCs). Measurements Pressure ulcers were identified using FY08-11 Minimum Data Set (MDS) data. Pressure ulcer development was defined as a stage 2 or larger pressure ulcer on an MDS assessment with no pressure ulcer on the previous assessment. A risk adjustment model was developed using 105,274 MDS observations to predict the likelihood of pressure ulcers (c statistic = 0.72). A Bayesian hierarchical model that adjusted for differences in the precision of pressure ulcer rates from differently sized facilities was used to calculate smoothed risk-adjusted (SRA) rates for each facility. The statistical significance of the trend over the 4 years was determined by examining the 95% interval estimate for the slope. Results Over the 4 year period, the beginning of which coincided with the VHA’s system-wide adoption of culture change as a performance measure, median SRA facility pressure ulcer development rates were fairly consistent at approximately 4%. The range in SRA rates declined from 14.8% to 10.1%. Some facilities had significantly improving SRA rates (e.g., declined steadily from 5.5% to 3.9%) and some had significantly worsening SRA rates (e.g., increased steadily from 5.1% to 7.9%). Seven sites had significantly improving rates (p<.001) that were below the median across all 4 years. Conclusion CLC pressure ulcer development rates were unaffected by a system-wide culture change implementation. There was, however, significant variation in facility rates and some facilities exhibited sustained high performance. PMID:26782865

  19. Patient perceptions of the role of nutrition for pressure ulcer prevention in hospital: an interpretive study.

    PubMed

    Roberts, Shelley; Desbrow, Ben; Chaboyer, Wendy

    2014-01-01

    The aims of this study were to explore (a) patients' perceptions of the role of nutrition in pressure ulcer prevention; and (b) patients' experiences with dieticians in the hospital setting. Interpretive qualitative study. The sample comprised 13 females and 7 males. Their mean age was 61.3 ± 12.6 years (mean ± SD), and their average hospital length of stay was 7.4 ± 13.0 days. The research setting was a public health hospital in Australia. In this interpretive study, adult medical patients at risk of pressure ulcers due to restricted mobility participated in a 20 to 30 minute interview using a semi-structured interview guide. Interview questions were grouped into 2 domains; perceptions on the role of nutrition for pressure ulcer prevention; and experiences with dieticians. Recorded interviews were transcribed and analyzed using content analysis. Within the first domain, 'patient knowledge of nutrition in pressure ulcer prevention,' there were varying patient understandings of the role of nutrition for prevention of pressure ulcers. This is reflected in 5 themes: (1) recognizing the role of diet in pressure ulcer prevention; (2) promoting skin health with good nutrition; (3) understanding the relationship between nutrition and health; (4) lacking insight into the role of nutrition in pressure ulcer prevention; and (5) acknowledging other risk factors for pressure ulcers. Within the second domain, patients described their experiences with and perceptions on dieticians. Two themes emerged, which expressed differing opinions around the role and reputation of dieticians; they were receptive of dietician input; and displaying ambivalence towards dieticians' advice. Hospital patients at risk for pressure ulcer development have variable knowledge of the preventive role of nutrition. Patients had differing perceptions of the importance and value of information provided by dieticians.

  20. Are labour-intensive efforts to prevent pressure ulcers cost-effective?

    PubMed

    Mathiesen, Anne Sofie Mølbak; Nørgaard, Kamilla; Andersen, Marie Frederikke Bruun; Møller, Klaus Meyer; Ehlers, Lars Holger

    2013-10-01

    Pressure ulcers are a major problem in Danish healthcare with a prevalence of 13-43% among hospitalized patients. The associated costs to the Danish Health Care Sector are estimated to be €174.5 million annually. In 2010, The Danish Society for Patient Safety introduced the Pressure Ulcer Bundle (PUB) in order to reduce hospital-acquired pressure ulcers by a minimum of 50% in five hospitals. The PUB consists of evidence-based preventive initiatives implemented by ward staff using the Model for Improvement. To investigate the cost-effectiveness of labour-intensive efforts to reduce pressure ulcers in the Danish Health Care Sector, comparing the PUB with standard care. A decision analytic model was constructed to assess the costs and consequences of hospital-acquired pressure ulcers during an average hospital admission in Denmark. The model inputs were based on a systematic review of clinical efficacy data combined with local cost and effectiveness data from the Thy-Mors Hospital, Denmark. A probabilistic sensitivity analysis (PSA) was conducted to assess the uncertainty. Prevention of hospital-acquired pressure ulcers by implementing labour-intensive effects according to the PUB was cost-saving and resulted in an improved effect compared to standard care. The incremental cost of the PUB was -€38.62. The incremental effects were a reduction of 9.3% prevented pressure ulcers and 0.47% prevented deaths. The PSAs confirmed the incremental cost-effectiveness ratio (ICER)'s dominance for both prevented pressure ulcers and saved lives with the PUB. This study shows that labour-intensive efforts to reduce pressure ulcers on hospital wards can be cost-effective and lead to savings in total costs of hospital and social care. The data included in the study regarding costs and effects of the PUB in Denmark were based on preliminary findings from a pilot study at Thy-Mors Hospital and literature.

  1. Malnutrition and pressure ulcer risk in adults in Australian health care facilities.

    PubMed

    Banks, Merrilyn; Bauer, Judith; Graves, Nicholas; Ash, Susan

    2010-09-01

    To determine the effect of nutritional status on the presence and severity of pressure ulcer. A multicenter, cross-sectional audit of nutritional status of a convenience sample of subjects was carried out as part of a large audit of pressure ulcers in a sample of Queensland, Australia, public healthcare facilities in 2002 and 2003. Dietitians in 20 hospitals and 6 residential aged care facilities conducted single-day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment. The effect of nutritional status on the presence and severity (highest stage and number of pressure ulcers) was determined by logistic regression in a model controlling for age, gender, medical specialty, and facility location. The potential clustering effect of facility was accounted for in the model using an analysis of correlated data approach. Subjects with malnutrition had adjusted odds ratios of 2.6 (95% confidence interval 1.8-3.5, P<0.001) of having a pressure ulcer in acute care facilities and 2.0 (95% confidence interval 1.5-2.7, P<0.001) for residential aged care facilities. There was also increased odds ratio of having a pressure ulcer, and having a more severe pressure ulcer (higher stage pressure ulcer and/or a higher number) with increased severity of malnutrition. Malnutrition was associated with at least twice the odds ratio of having a pressure ulcer of in public health care facilities in Queensland. Action must be taken to identify, prevent, and treat malnutrition, especially in patients at risk of pressure ulcer. (c) 2010. Published by Elsevier Inc. All rights reserved.

  2. [Differentiation between moisture lesions and pressure ulcers using photographs in a critical area].

    PubMed

    Valls-Matarín, Josefa; Del Cotillo-Fuente, Mercedes; Pujol-Vila, María; Ribal-Prior, Rosa; Sandalinas-Mulero, Inmaculada

    2016-01-01

    To identify difficulties for nurses in differentiating between moisture lesions and pressure ulcers, proper classification of pressure ulcers to assess the adequate classification of the Grupo Nacional para el Estudio y Asesoramiento de Úlceras por Presión y Heridas Crónicas (GNEAUPP) and the degree of agreement in the correct assessment by type and category of injury. Cross-sectional study in a critical area during 2014. All nurses who agreed to participate were included. They performed a questionnaire with 14 photographs validated by experts of moisture lesions or pressure ulcers in the sacral area and buttocks, with 6 possible answers: Pressure ulcer category I, II, III, IV, moisture lesions and unknown. Demographics and knowledge of the classification system of the pressure ulcers were collected according to GNEAUPP. It involved 98% of the population (n=56); 98.2% knew the classification system of the GNEAUPP; 35.2% of moisture lesions were considered as pressure ulcers, most of them as a category II (18.9%). The 14.8% of the pressure ulcers photographs were identified as moisture lesions and 16.1% were classified in another category. The agreement between nurses earned a global Kappa index of .38 (95% CI: .29-.57). There are difficulties differentiating between pressure ulcers and moisture lesions, especially within initial categories. Nurses have the perception they know the pressure ulcers classification, but they do not classify them correctly. The degree of concordance in the diagnosis of skin lesions was low. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  3. Efficacy of topical atorvastatin for the treatment of pressure ulcers: a randomized clinical trial.

    PubMed

    Farsaei, Shadi; Khalili, Hossein; Farboud, Effat Sadat; Karimzadeh, Iman; Beigmohammadi, Mohammad Taghi

    2014-01-01

    To evaluate the effects of topical atorvastatin on the healing process of pressure ulcers in critically ill patients. Randomized, double-blind, placebo-controlled clinical trial. Medical-surgical intensive care unit of a university-affiliated teaching hospital in Tehran, Iran. One hundred four patients with stage I or II pressure ulcers, graded according to the 2-digit Stirling Pressure Sore Severity Scale. Patients were randomized to receive topical atorvastatin 1% ointment (51 patients [atorvastatin group]) or placebo ointment (53 patients [control group]) applied once/day to pressure ulcers for 14 days in addition to standard care for pressure ulcers. The efficacy of each treatment was assessed on days 7 and 14. Efficacy was determined based on the degree of healing of the existing pressure ulcer by using the 2-digit Stirling scale. The baseline stage of the pressure ulcers did not differ significantly between the control and atorvastatin groups. However, the mean ± SD stage of pressure ulcers significantly decreased in the atorvastatin group compared with the control group on day 7 (0.97 ± 0.76 vs 1.74 ± 0.75, p<0.01) and day 14 (0.42 ± 0.67 vs 1.71 ± 0.78, p<0.01) of treatment. In addition, the mean ± SD surface areas of ulcers in the atorvastatin group were significantly declined compared with the control group after 7 days (5.55 ± 4.55 vs 9.41 ± 5.03 cm², p<0.01) and 14 days (3.72 ± 4.45 vs 10.41 ± 6.41 cm², p<0.01) of treatment. Topical application of atorvastatin ointment 1% for 14 days in addition to standard care significantly accelerated the healing of stage I or II pressure ulcers in critically ill patients. © 2013 Pharmacotherapy Publications, Inc.

  4. Predictive models for pressure ulcers from intensive care unit electronic health records using Bayesian networks.

    PubMed

    Kaewprag, Pacharmon; Newton, Cheryl; Vermillion, Brenda; Hyun, Sookyung; Huang, Kun; Machiraju, Raghu

    2017-07-05

    We develop predictive models enabling clinicians to better understand and explore patient clinical data along with risk factors for pressure ulcers in intensive care unit patients from electronic health record data. Identifying accurate risk factors of pressure ulcers is essential to determining appropriate prevention strategies; in this work we examine medication, diagnosis, and traditional Braden pressure ulcer assessment scale measurements as patient features. In order to predict pressure ulcer incidence and better understand the structure of related risk factors, we construct Bayesian networks from patient features. Bayesian network nodes (features) and edges (conditional dependencies) are simplified with statistical network techniques. Upon reviewing a network visualization of our model, our clinician collaborators were able to identify strong relationships between risk factors widely recognized as associated with pressure ulcers. We present a three-stage framework for predictive analysis of patient clinical data: 1) Developing electronic health record feature extraction functions with assistance of clinicians, 2) simplifying features, and 3) building Bayesian network predictive models. We evaluate all combinations of Bayesian network models from different search algorithms, scoring functions, prior structure initializations, and sets of features. From the EHRs of 7,717 ICU patients, we construct Bayesian network predictive models from 86 medication, diagnosis, and Braden scale features. Our model not only identifies known and suspected high PU risk factors, but also substantially increases sensitivity of the prediction - nearly three times higher comparing to logistical regression models - without sacrificing the overall accuracy. We visualize a representative model with which our clinician collaborators identify strong relationships between risk factors widely recognized as associated with pressure ulcers. Given the strong adverse effect of pressure ulcers

  5. The Healing Effect of Low-Temperature Atmospheric-Pressure Plasma in Pressure Ulcer: A Randomized Controlled Trial.

    PubMed

    Chuangsuwanich, Apirag; Assadamongkol, Tananchai; Boonyawan, Dheerawan

    2016-08-31

    Pressure ulcers are difficult to treat. Recent reports of low-temperature atmospheric-pressure plasma (LTAPP) indicated its safe and effectiveness in chronic wound care management. It has been shown both in vitro and vivo studies that LTAPP not only helps facilitate wound healing but also has antimicrobial efficacy due to its composition of ion and electron, free radicals, and ultraviolet ray. We studied the beneficial effect of LTAPP specifically on pressure ulcers. In a prospective randomized study, 50 patients with pressure ulcers were divided into 2 groups: Control group received standard wound care and the study group was treated with LTAPP once every week for 8 consecutive weeks in addition to standard wound care. We found that the group treated with LTAPP had significantly better PUSH (Pressure Ulcer Scale for Healing) scores and exudate amount after 1 week of treatment. There was also a reduction in bacterial load after 1 treatment regardless of the species of bacteria identified.

  6. The prevalence and specific characteristics of hospitalised pressure ulcer patients: A multicentre cross-sectional study.

    PubMed

    Zhou, Qing; Yu, Ting; Liu, Yuan; Shi, Ruifen; Tian, Suping; Yang, Chaoxia; Gan, Huaxiu; Zhu, Yanying; Liang, Xia; Wang, Ling; Wu, Zhenhua; Huang, Jinping; Hu, Ailing

    2017-08-17

    The present study aimed to ascertain the pressure ulcer prevalence in secondary and tertiary general hospitals in different areas of Guangdong Province in China and explore the possible risk factors that are related to pressure ulcers. Few multicentre studies have been conducted on pressure ulcer prevalence in Chinese hospitals. A cross-sectional study design was used. Data from a total of 25,264 patients were included in the analysis at 25 hospitals in China. The investigators were divided into two groups. The investigators in Group 1 examined the patients' skin. When a pressure ulcer was found, a pressure ulcers assessment form was completed. The investigators in group 2 provided guidance to the nurses, who assessed all patients and completed another questionnaire. A multivariate logistic regression analysis was used to analyse the relationship between the possible risk factors and pressure ulcer. The overall prevalence rate of pressure ulcers in the 25 hospitals ranged from 0% to 3.49%, with a mean of 1.26%. The most common stage of the pressure ulcers was stage II (41.4%), most common anatomical locations were sacrum (39.5%) and the feet (16.4%). Braden score (p<0.001), expected length of stay (p<0.001), incontinence (p<0.001), Care group (p=0.011), hospital location (p<0.001), type of hospitals (p=0.004), ages of patients (p<0.001) were associations of pressure ulcers from the multivariate logistic regression analysis. The overall prevalence rate of pressure ulcers in Chinese hospitals was lower than that reported in previous investigations. Specific characteristics of pressure ulcer patients were: low Braden score, longer expected length of stay, double incontinence, an ICU and a medical ward, hospital location in the Pearl River Delta, a university hospital, and an elderly patient. The survey could make managers know their prevalence level of pressure ulcers and provide priorities for clinical nurses. This article is protected by copyright. All rights

  7. A comparison of Epi-Lock and saline dressings in the treatment of pressure ulcers.

    PubMed

    Kraft, M R; Lawson, L; Pohlmann, B; Reid-Lokos, C; Barder, L

    1993-11-01

    The use of Epi-Lock dressings was compared to moist saline dressings as a treatment for Stage II and III pressure ulcers in 38 patients. Demographic and clinical data were collected at the onset of the investigation. At the time of enrollment and during weeks six, 12 and 24, pressure ulcers were inspected and measured, and laboratory data were collected. More healing occurred with Epi-Lock dressing than with moist saline dressing for Stage II and III pressure ulcers. Although individual Epi-Lock dressings were more expensive than saline dressings, they required less dressing changes. Therefore considering cost of nursing time, Epi-Lock dressings are more cost effective.

  8. The cost of prevention and treatment of pressure ulcers: A systematic review.

    PubMed

    Demarré, Liesbet; Van Lancker, Aurélie; Van Hecke, Ann; Verhaeghe, Sofie; Grypdonck, Maria; Lemey, Juul; Annemans, Lieven; Beeckman, Dimitri

    2015-11-01

    Pressure ulcers impose a substantial financial burden. The need for high-quality health care while expenditures are constrained entails the interest to calculate the cost of preventing and treating pressure ulcers and their impact on patients, healthcare, and society. The aim of this paper is to provide insight into the cost of pressure ulcer prevention and treatment in an adult population. A systematic literature review was performed to conform the Cochrane Collaboration guidelines for systematic reviews. The search strategy contained index terms and key words related to pressure ulcers and cost. The search was performed in Medline, CINAHL, Web of Science, The Cochrane Library, Embase, and EconLit covering articles up to September 2013. Reference lists and conference abstracts were screened. Articles were eligible if they reported on direct medical cost of pressure ulcer prevention or treatment, and provided national cost estimates, cost per patient, or cost per patient per day. The Consensus on Health Economic Criteria checklist was used to assess methodological quality of the included studies. In total, 2542 records were retrieved. After assessing eligibility, 17 articles were included. Five articles reported on both the cost of prevention and treatment, three articles reported on cost of prevention, and nine articles reported on the cost of pressure ulcer treatment. All articles were published between 2001 and 2013. Cost of pressure ulcer prevention per patient per day varied between 2.65 € to 87.57 € across all settings. Cost of pressure ulcer treatment per patient per day ranged from 1.71 € to 470.49 € across different settings. The methodological heterogeneity among studies was considerable, and encompassed differences regarding type of health economic design, perspective, cost components, and health outcomes. Cost of pressure ulcer prevention and treatment differed considerable between studies. Although the cost to provide pressure ulcer prevention

  9. The reliability of the National Database of Nursing Quality Indicators pressure ulcer indicator: a triangulation approach.

    PubMed

    Bergquist-Beringer, Sandra; Gajewski, Byron; Dunton, Nancy; Klaus, Susan

    2011-01-01

    A triangulation approach was used to examine the reliability of the National Database of Nursing Quality Indicators pressure ulcer indicator that included direct observation of these wounds in hospitalized patients and web-based testing with and without accompanying wound descriptions. Overall κ coefficients for pressure ulcer identification, staging, and origin indicate moderate to near perfect reliability and suggest that web-based testing can estimate the reliability of pressure ulcer staging from direct observation. Nurse certification in wound care and wound descriptors improved reliability levels.

  10. Providers' Perceptions of Spinal Cord Injury Pressure Ulcer Guidelines

    PubMed Central

    Thomason, Susan S; Evitt, Celinda P; Harrow, Jeffrey J; Love, Linda; Moore, D. Helen; Mullins, Maria A; Powell-Cope, Gail; Nelson, Audrey L

    2007-01-01

    Background/Objective: Pressure ulcers are a serious complication for people with spinal cord injury (SCI). The Consortium for Spinal Cord Medicine (CSCM) published clinical practice guidelines (CPGs) that provided guidance for pressure ulcer prevention and treatment after SCI. The aim of this study was to assess providers' perceptions for each of the 32 CPG recommendations regarding their agreement with CPGs, degree of CPG implementation, and CPG implementation barriers and facilitators. Methods: This descriptive mixed-methods study included both qualitative (focus groups) and quantitative (survey) data collection approaches. The sample (n = 60) included 24 physicians and 36 nurses who attended the 2004 annual national conferences of the American Paraplegia Society or American Association of Spinal Cord Injury Nurses. This sample drew from two sources: a purposive sample from a list of preregistered participants and a convenience sample of conference attendee volunteers. We analyzed quantitative data using descriptive statistics and qualitative data using a coding scheme to capture barriers and facilitators. Results: The focus groups agreed unanimously on the substance of 6 of the 32 recommendations. Nurse and physician focus groups disagreed on the degree of CGP implementation at their sites, with nurses as a group perceiving less progress in implementation of the guideline recommendations. The focus groups identified only one recommendation, complications of surgery, as being fully implemented at their sites. Categories of barriers and facilitators for implementation of CPGs that emerged from the qualitative analysis included (a) characteristics of CPGs: need for research/evidence, (b) characteristics of CPGs: complexity of design and wording, (c) organizational factors, (d) lack of knowledge, and (e) lack of resources. Conclusions: Although generally SCI physicians and nurses agreed with the CPG recommendations as written, they did not feel these recommendations

  11. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study.

    PubMed

    Barker, Anna Lucia; Kamar, Jeannette; Tyndall, Tamara Jane; White, Lyn; Hutchinson, Anastasia; Klopfer, Nicole; Weller, Carolina

    2013-06-01

    Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

  12. An alternating pressure sequence proposal for an air-cell cushion for preventing pressure ulcers.

    PubMed

    Arias, Sandra; Cardiel, Eladio; Rogeli, Pablo; Mori, Taketoshi; Nakagami, Gojiro; Noguchi, Hiroshi; Sanada, Hiromi

    2014-01-01

    The distribution and release of pressure on ischial regions are two important parameters for evaluating the effectiveness of a cushion; especially the release of pressure over time on ischial tuberosities, which is significant for preventing pressure ulcers. The aim of this work is to evaluate the effect on interface pressure through the application of a proposed alternating pressure sequence for an air-cell cushion. Six healthy volunteers were asked to sit on the air cell cushion, in static and alternating modes, as well as on a typical foam cushion for 12 minutes. Interface pressure was monitored with a matrix sensor system. Interface pressure values on ischial tuberosities, user contact area and pressure distribution were analyzed. Results showed that IP on IT tends to increase in both foam and static cushions, while in alternating cushion IP on IT tends to decrease. User contact area was significantly larger in alternating cushion than in static or foam cushions. Moreover, there is a better pressure re-distribution with alternating cushion than with the other cushions. The goal of the alternating sequence is to redistribute pressure and stimulate the ischial regions in order to promote blood flow and prevent pressure occurring in wheelchair users.

  13. Effect of polarized light in the healing process of pressure ulcers.

    PubMed

    Iordanou, Pangiota; Baltopoulos, G; Giannakopoulou, M; Bellou, P; Ktenas, E

    2002-02-01

    A trial was conducted to examine the effect of polarized light on pressure ulcers of 1st, 2nd and 3rd grades. Patients with two pressure ulcers, one of which received the polarized light therapy (experimental ulcer) and the other acting as control, were included in the study. The experimental ulcers received treatments for 2 weeks consisting a 5 min therapy session each day, excluding weekends, for 10 days. Experimental and control ulcers were assessed as they appeared on admission and reassessed at the end of each week. Fifty-five patients aged 37-85 years (67.1 +/- 11.9 years) were studied. Pressure ulcers of 1st, 2nd and 3rd grades receiving extra treatment with polarized light had increased values of epithelial tissue between the first and second assessments of 0-30.9% and between the second and third assessments of 30.9-21.7%. Values of the control pressure ulcers were, respectively, from 0 to 5.5% and from 5.5% to 3.1%. The mean pink/white colour values of the experimental ulcers, between the first and second measurements increased significantly compared with the control ulcers (P = 0.021) and also increased significantly between the second and third measurements (P = 0.003). The mean values of 'no and minimal exudate' of the experimental ulcers increased significantly between first and second measurements compared with the control ulcers (P = 0.001), and similarly, significantly between the second and third measurements (P = 0.002). Mean surface areas of the experimental ulcers decreased significantly between the first and second measurements from 2.84 to 2.54 cm2 (P < or = 0.001) and between the first and third measurements from 2.84 to 2.26 cm2 (P < or = 0.001). Mean surface areas of the control ulcers decreased between the first and second measurements from 2.10 to 2.08 cm2 (P < or = 0.42) and between the first and third measurements from 2.10 to 2.04 cm2 (P < or = 0.007). Pressure ulcers subjected to extra treatment with polarized light in the early

  14. On the potential of ultrasound elastography for pressure ulcer early detection

    PubMed Central

    Deprez, Jean-François; Brusseau, Elisabeth; Fromageau, Jérémie; Cloutier, Guy; Basset, Olivier

    2011-01-01

    Purpose Pressure ulcers are areas of soft tissue breakdown induced by a sustained mechanical stress that damages the skin and underlying tissues. They represent a considerable burden to the society in terms of health care and cost. Yet, techniques for prevention and detection of pressure ulcers still remain very limited. In this article, the authors investigated the potential of ultrasound elastography for pressure ulcer early detection. Elastography is an imaging technique providing local information on biological tissue mechanical properties. It is relevant for pressure ulcer detection as this pathology is associated with a gradual stiffening of damaged tissues, beginning in the deeper tissues and progressing toward the skin surface. Methods A 2D ultrasound elastography method was proposed and its ability in terms of pressure ulcer detection was validated through numerical simulations and physical acquisitions on pressure ulcer mimicking phantoms. In vivo experiments on a rat model are also reported. A maintained pressure was applied on the animal thigh, with a view to generate a pressure ulcer, and ultrasound data were acquired and processed before and after application of this pressure. Results Numerical simulations demonstrated that a pressure ulcer can theoretically be detected at a very early stage with ultrasound elastography. Even when the ulcer region was characterized by a low stiffening (ratio of 1.8 relative to normal tissues), the corresponding elastogram clearly underlined the pathological area. This observation was confirmed by the results obtained on a physical phantom mimicking a pressure ulcer at an early stage. Computed elastograms showed strain differences between areas mimicking healthy and pathological tissues. Results corresponding to in vivo experiments revealed a difference in the way tissues behaved before and after the pressure was applied on the animal thigh, which strongly suggests the presence of a pathological area. Conclusions

  15. Pressure Ulcer in Norway-A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care.

    PubMed

    Johansen, Edda; Bakken, Linda N; Moore, Zena

    2015-06-09

    Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O'Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured.

  16. Pressure Ulcer in Norway—A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care

    PubMed Central

    Johansen, Edda; Bakken, Linda N.; Moore, Zena

    2015-01-01

    Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured. PMID:27417771

  17. Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality.

    PubMed

    Díez-Manglano, J; Fernández-Jiménez, C; Lambán-Aranda, M P; Landa-Santesteban, M C; Isasi de Isasmendi-Pérez, S; Moreno-García, P; Bejarano-Tello, E; Barranco-Usón, J; Munilla-López, E; Del Corral-Beamonte, E

    2016-12-01

    To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. National Outcomes after Pressure Ulcer Closure: Inspiring Surgery.

    PubMed

    Diamond, Shawn; Moghaddas, Hassan S; Kaminski, Stephen S; Grotts, Jonathan; Ferrigno, Lisa; Schooler, Wesley

    2016-10-01

    Over two million Americans receive treatment for pressure ulcers (PUs) annually, but national surgical outcomes are not well described. This study investigated rates and risk factors of postoperative complications in patients with PU. The 2011 and 2012 American College of Surgeons-National Surgical Quality Improvement Project database was queried and PU patients undergoing flap closure were identified. Descriptive statistics and multivariate regression analysis was used and reported as odds ratios (ORs) if (P < 0.05). Of 1196 patients identified with a primary diagnosis of PU, 327 (27%) underwent flap closure. Emergency interventions were performed in seven patients who were excluded from analysis. Characteristics were average age 53.3 (±17); 65 per cent male; 41 per cent with grossly contaminated or infected wounds; 29 per cent frail; and 16 per cent with an American Society of Anesthesiologists score of four or five. Myocutaneous or fasciocutaneous flaps were performed in 82 per cent of patients, local skin rearrangements in 17 per cent, and free flap in one patient. Complications were low with 1.9 per cent recurrence and 4.7 per cent reoperation rates. Higher American Society of Anesthesiologists was independently associated with mortality (odds ratio = 6.6) and steroid use correlated with flap failure (odds ratio = 15). No differences in complication profiles were identified based on technique, frailty, or contamination. Surgical closure can be considered reasonable in all patients fit for anesthesia.

  19. [Economic cost of treating pressure ulcers: a theoretical approach].

    PubMed

    Silva, Ana Júlia; Pereira, Sandra Martins; Rodrigues, Alexandre; Rocha, Ana Paula; Varela, Jesuína; Gomes, Luís Miguel; Messias, Norberto; Carvalhal, Rosa; Luís, Rui; Mendes, Luís Filipe Pereira

    2013-08-01

    The present study consisted of a theoretical approach to the problem posed by the economic costs associated with pressure ulcers (PUs). The initial aim was to assess the target problem from a conceptual perspective and then to report the results of prevalence studies that formed the basis for investigations of the disease's economic impact. The purpose of the present article is to discuss the economic costs associated with PUs from both the global point of view (appraising their financial repercussion) and the individual point of view (addressing the intangible costs). Regarding the economic impact of the costs associated with PUs, the total cost of treatment per healthcare setting was estimated relative to the Autonomous Community of Azores. The total cost of all the PU categories was EUR 7,086,415 in the homecare setting, EUR 1,723,509 in the hospital setting, and EUR 1,002,562 in older people's homes. Therefore, the estimated total treatment cost of all the PU categories was approximately EUR 9,812,486 in Azores. However, the emotional impact of this disease imposes high costs on patients and their relatives as a function of the resultant suffering. Indeed, PUs impose high costs not only related to the treatment but also related to the intangible costs of the suffering caused to patients and their caregivers.

  20. Incontinence-associated dermatitis and pressure ulcers in geriatric patients.

    PubMed

    Kottner, J; Beeckman, D

    2015-12-01

    The key characteristics of geriatric patients are advanced age, multimorbidity, a decrease of psychical performance and care dependency. In addition, advanced age, chronic and acute diseases and treatments (e.g. polypharmacy) lead, either directly or indirectly, to a wide range of skin and tissue problems. Incontinence-associated dermatitis and pressure ulcers (PUs) belong to the most prevalent in geriatric settings. Prolonged exposure of the skin to urine and/or stool can cause an irritant contact dermatitis. Skin surface 'wetness', increased skin surface pH, digestive intestinal enzymes, repeated skin cleansing activities, and a possible occlusive environment contribute to irritation and inflammation. Prevention and treatment includes activities to maintain and to enhance continence and to limit, to reduce exposure of the skin to urine and stool, and to promote healing and reepithelialisation. In frail aged skin, it is recommended to use incontinence products with smooth and breathable materials with maximum absorption capacity. Immediate skin cleansing after soiling using mild cleansers and protective and caring leave-on products are recommended. PUs are localized injuries to the skin and/or underlying tissue caused by sustained deformations of skin and underlying soft tissues. PUs management includes risk assessment, repositioning and mobilization, and the use of appropriate support surfaces. Patients must be never positioned directly on an existing PU. Especially at end of life, the PU closure and wound healing may not be the primary therapeutic goal.

  1. Spinal Cord Injury and Pressure Ulcer Prevention: Using Functional Activity in Pressure Relief

    PubMed Central

    Stinson, May; Gillan, Cathy; Morton, Julie; Gardner, Evie; Sprigle, Stephen

    2013-01-01

    Background. People with spinal cord injury (SCI) are at increased risk of pressure ulcers due to prolonged periods of sitting. Concordance with pressure relieving movements is poor amongst this population, and one potential alternative to improve this would be to integrate pressure relieving movements into everyday functional activities. Objectives. To investigate both the current pressure relieving behaviours of SCI individuals during computer use and the application of an ergonomically adapted computer-based activity to reduce interface pressure. Design. Observational and repeated measures design. Setting. Regional Spinal Cord Injury Unit. Participants. Fourteen subjects diagnosed with SCI (12 male, 2 female). Intervention.Comparing normal sitting to seated movements and induced forward reaching positions. Main Outcome Measures. Interface pressure measurements: dispersion index (DI), peak pressure index (PPI), and total contact area (CA). The angle of trunk tilt was also measured. Results. The majority of movements yielded less than 25% reduction in interface pressure compared to normal sitting. Reaching forward by 150% of arm length during an adapted computer activity significantly reduced DI (P < 0.05), angle of trunk tilt (p<0.05), and PPI for both ischial tuberosity regions (P < 0.001) compared to normal sitting. Conclusion. Reaching forward significantly redistributed pressure at the seating interface, as evidenced by the change in interface pressures compared to upright sitting. PMID:23691301

  2. Health care reorganization and quality of care: unintended effects on pressure ulcer prevention.

    PubMed

    Berlowitz, D R; Young, G J; Brandeis, G H; Kader, B; Anderson, J J

    2001-02-01

    Health care reorganizations, with a change in focus from inpatient to outpatient care, are becoming increasingly frequent. Little is known regarding how reorganizations may affect risk-adjusted outcomes for those programs, usually inpatient, that lose resources as a result of the change in organizational focus. To determine changes in risk-adjusted rates of pressure ulcer development over an 8-year period, the final 3 of which were characterized by a significant reorganization of the health care system. This was an observational study that used an existing database. Subjects were residents of Department of Veterans Affairs long-term care units between 1990 and 1997 who were without a pressure ulcer at an index assessment. The study examined risk-adjusted rates of pressure ulcer development, and proportions of new ulcers that were severe (stages 3 or 4) were calculated for successive 6-month periods. Between 1990 and 1994, risk-adjusted rates of pressure ulcer development declined significantly, by 27%. However, beginning in 1995, rates began to increase, and in 1997 they were similar to those in 1990. The proportion of new ulcers that were severe increased significantly over time (P = 0.01). The reorganization of the VA that began in 1995, with its emphasis on outpatient care, was associated with an increase in rates of pressure ulcer development. This highlights the need to carefully monitor the quality of care in programs that may be losing resources as a result of the reorganization.

  3. Tear production and intraocular pressure in canine eyes with corneal ulceration.

    PubMed

    Williams, David L; Burg, Philippa

    2017-01-01

    This study aimed to evaluate changes in lacrimation and intraocular pressure (IOP) in dogs with unilateral corneal ulceration using the Schirmer tear test (STT) and rebound (TonoVet®) tonometry. IOP and STT values were recorded in both ulcerated and non-ulcerated (control) eyes of 100 dogs diagnosed with unilateral corneal ulceration. Dogs presented with other ocular conditions as their primary complaint were excluded from this study. The mean ± standard deviation for STT values in the ulcerated and control eyes were 20.2±4.6 mm/min and 16.7±3.5 mm/min respectively. The mean ± standard deviation for IOP in the ulcerated and control eyes were 11.9±3.1 mmHg and 16.7±2.6 mmHg respectively. STT values were significantly higher (p<0.000001) in the ulcerated eye compared to the control eye while IOP was significantly lower (p<0.0001). There is an increase in lacrimation and a decrease in IOP in canine eyes with corneal ulceration. The higher tear production in ulcerated eyes shows the importance of measuring STT in both eyes in cases of corneal ulceration, since this increased lacrimation may mask an underlying keratoconjunctivitis sicca only evident in the contralateral eye. The lower IOP in ulcerated eyes is likely to relate to mild uveitic change in the ulcerated eye with a concomitant increase in uveoscleral aqueous drainage. While these changes in tear production and IOP in ulcerated eyes are widely recognised in both human and veterinary ophthalmology, it appears that this is the first controlled documented report of these changes in a large number of individuals.

  4. The development of pressure ulcers in patients with hip fractures: inadequate nursing documentation is still a problem.

    PubMed

    Gunningberg, L; Lindholm, C; Carlsson, M; Sjödén, P O

    2000-05-01

    The aims of the study were to investigate, on a daily basis: (i) the development and progress of pressure ulcers, (ii) the documented nursing interventions for prevention and treatment of pressure ulcers, and (iii) when nursing interventions regarding prevention and treatment of pressure ulcers were documented, in relation to patient risk status and the development of pressure ulcers. The study design was prospective, comparative and descriptive. A total of 55 patients with hip fracture were included. To facilitate the nurse's assessment, a 'pressure ulcer card' was developed, consisting of the Modified Norton Scale (MNS) and descriptions of the four stages of pressure ulcers. The incidence of pressure ulcers was 55%. The mean rank of the lowest MNS score was significantly lower for patients who developed pressure ulcers than for patients without pressure ulcers. The majority of the pressure ulcers occurred between admission to the ward and the fourth day after surgery. Documented interventions regarding prevention and treatment were: repositioning, overlays, cushions, use of lotion and observation. The mean number of interventions per patient was 2.2 for patients who developed pressure ulcers during their hospital stay. The comprehensiveness and quality of the nursing record was unsatisfactory, and only three nursing records reached the level required by Swedish law. Preventive interventions such as repositioning were documented when the pressure ulcer had already occurred. The lack of nursing documentation regarding prevention and treatment of pressure ulcers may indicate that nurses did not identify pressure ulcers as a prioritized nursing problem for this patient group. The Modified Norton Scale could be a valuable tool for nurses, both identifying the patient at risk and acting as a guide for nursing interventions. The study was approved by the ethics committee of the Faculty of Medicine at Uppsala University.

  5. Pressure ulcer research funding in America: creation and analysis of an on-line database.

    PubMed

    Zanca, Jeanne M; Brienza, David M; Berlowitz, Dan; Bennett, Richard G; Lyder, Courtney H

    2003-01-01

    To systematically collect information on active research grants to characterize pressure ulcer research funding in the United States and to identify potential targets for future research and funding initiatives. DESIGN A descriptive study. The investigators identified 32 grants, representing 16,444,117 US dollars in research funding. The majority of this funding came from federal sources, including the National Institutes of Health (90%), the Department of Veterans Affairs (7%), the National Institute on Disability and Rehabilitation Research (2%), and the Agency for Healthcare Research and Quality (1%). One quarter of pressure ulcer research grants related to quality improvement. Additional topic areas included risk factors or risk assessment tools (19%), adjunctive therapy (16%), mobilization (13%), and pressure management in foot care for patients with diabetes mellitus (9%). Further grants were in the areas of incidence, assessing tissue damage or healing, support surfaces, dressings and topical agents, nutrition, economic evaluation, and pain. The investment in pressure ulcer research is minute compared with pressure ulcer treatment expenditures. Policy makers are urged to encourage increased federal and foundation funding for research concerning pressure ulcers. Researchers are also encouraged to develop well-designed proposals to obtain available research funding. Additional research is needed in the areas of pressure ulcer incidence and prevalence, support surface design and use, pain, operative treatment, economic impact, and education strategies for caregivers and patients.

  6. [Analysis of prevention and treatment of the pressure ulcers proposed by nurses].

    PubMed

    Medeiros, Adriana Bessa Fernandes; Lopes, Consuelo Helena Aires de Freitas; Jorge, Maria Salete Bessa

    2009-03-01

    Pressure ulcers are still considered a serious problem, especially in elderly people and in situations of chronic-degenerative diseases. The purpose of this study was to identify the literature production about actions of prevention and treatment performed by nurses published from 1999 to 2004, describing the knowledge produced about the theme. This is a descriptive literature review of nursing journals indexed in LILACS and MEDLINE about the theme from 1999 to 2004. Data collection occurred from May to June, 2005. Afterwards, the material was read exhaustively, which yielded three aspects to be studied: prevention of pressure ulcers, treatment of pressure ulcers and nursing care of pressure ulcers. It was also concluded that there is need for research involving the work of the nurses in the clinical evaluation of the client and the development of systematized prevention programs.

  7. Managing pressure ulcers in patients with a spinal cord injury: a case study.

    PubMed

    Warren, Diana V

    Grade 4 pressure ulceration is a common and often unavoidable secondary complication for patients who have sustained a traumatic spinal cord injury. Pressure ulcer management involves treating infection, providing a moist wound-healing environment and choosing the appropriate dressing. However, the case of Mr M highlights other issues such as pain, a poor appetite and sleep disturbance, which all delay wound healing. This article discusses ulcer prevention, from the initial assessment of the spinal injury to patient repositioning using the 'log-rolling' technique. Although this technique is not effective in providing prolonged pressure relief, it did reduce Mr M's pain. This article also suggests recommendations for future practice, including the need to relate to patients on a personal level, which should reduce mental health deterioration and increase the patient's quality of life, and to take a multidisciplinary approach to managing and treating pressure ulceration.

  8. Use of telerehabilitation to manage pressure ulcers in persons with spinal cord injuries.

    PubMed

    Vesmarovich, S; Walker, T; Hauber, R P; Temkin, A; Burns, R

    1999-06-01

    Pressure ulcers are a common and serious secondary complication of spinal cord injury. In addition to being costly and difficult to treat, pressure ulcers may interfere with many aspects of patient and family life, including the ability to meet educational, vocational, and social goals. Treatment of pressure ulcers includes weekly assessment by a clinician, a requirement that often is impossible for clients to meet. In an effort to improve outcomes in wound care treatment, a rehabilitation center undertook an exploratory project to determine whether wound care via telerehabilitation was a viable alternative to clinic visits. Telerehabilitation is the use of telecommunication technology to deliver rehabilitation services at a distance. Eight patients being followed in the outpatient clinic participated in the project. The Picasso Still-Image Videophone was used to capture and send images from the patients' homes to the clinic. Findings from the exploratory study demonstrated that pressure ulcers can be successfully managed via telerehabilitation.

  9. Development of a pressure ulcer trigger tool for the neonatal population.

    PubMed

    Schumacher, Bette; Askew, Mary; Otten, Kathy

    2013-01-01

    A large Midwest level IIIb neonatal intensive care unit located in a 500-bed teaching hospital implemented quarterly skin prevalence surveys to monitor prevalence of altered skin integrity including pressure ulcers, diaper dermatitis (incontinence-associated dermatitis), and skin damage as a result of intravenous therapy, adhesive, or medical devices. Pressure ulcer prevalence varied from 0% to 1% per quarter, and no pressure ulcer risk assessment tool was regularly implemented. Therefore, a working group was formed to identify a risk assessment. The Iowa Model for Evidence-Based Practice was used to guide the project. A literature review was completed to identify validated instruments, but available tools were judged lengthy for routine clinical use. Therefore, we developed a short trigger tool comprising 3 questions to identify infants at risk for pressure ulcer development.

  10. Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital.

    PubMed

    Sardo, Pedro Miguel Garcez; Simões, Cláudia Sofia Oliveira; Alvarelhão, José Joaquim Marques; Simões, João Filipe Fernandes Lindo; Machado, Paulo Alexandre Puga; Amado, Francisco Manuel Lemos; Amaro, António José Monteiro; Melo, Elsa Maria Oliveira Pinheiro de

    2016-11-01

    To gain more insight into the magnitude of the problem of pressure ulcer incidence in general wards of a Portuguese hospital. Retrospective cohort analysis of electronic health record database from 7132 adult patients admitted to medical and surgical wards of Aveiro Hospital during 2012. The development of (at least) one pressure ulcer during the length of stay was associated with age, gender, type of admission, specialty units, first Braden Scale score, length of stay, patient discharge outcome and ICD-9 diagnosis. An incidence of 3.4% participants with pressure ulcer category I-IV in inpatient setting during 2012. During the length of stay, 320 new pressure ulcers were developed, most of them category/stage II. The sacrum/coccyx and the trochanters were the most problematic areas. The major risk factor for the development of a new pressure ulcer during the length of stay was the presence of (at least) one pressure ulcer at the first skin assessment. The length of stay itself, age and lower Braden Scale scores of our participants also played an important role in the odds of developing a pressure ulcer. Infectious diseases, traumatism and fractures and respiratory diseases were the ICD-9 diagnoses with higher frequency of participants that developed (at least) one pressure ulcer during the length of stay. It's important to standardize procedures and documentation in all care settings. The documentation of nursing interventions is vital to evaluate the impact of evidence-based nursing. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  11. Pressure ulcers and the home health aide: evaluation of an educational program.

    PubMed

    Naber, Jessica L; Perlow, Michael

    2008-05-01

    In a 6-month period, it was noted that 3 home care patients had developed pressure ulcers although they had been visited by home health aides providing full hygienic care. In an attempt to improve care, an educational program was developed and provided to the home health aides. After implementation of this program, posttest scores improved. Two new pressure ulcers were identified, reported, and documented by the aides.

  12. Predicting delayed pressure ulcer healing using thermography: a prospective cohort study.

    PubMed

    Nakagami, G; Sanada, H; Iizaka, S; Kadono, T; Higashino, T; Koyanagi, H; Haga, N

    2010-11-01

    To investigate whether thermography can be used to detect latent inflammation in pressure ulcers and predict pressure ulcer prognosis in a clinical setting. For this cohort study, we recruited 35 patients with stage II-IV pressure ulcers on the torso, who underwent thermographic assessment on discovery of their pressure ulcer. The patients were followed up for at least 3 weeks. Thermography was performed immediately after dressing removal. Pressure ulcers were classified into two groups depending on whether or not the wound site temperature was lower or higher than the periwound skin: the low temperature group and the high temperature group respectively. A generalised estimation equation was used to estimate the relative risk of delayed healing of pressure ulcers, comparing wounds with high temperatures and low temperatures. Of the 35 patients, 21 had 'low temperature' wounds and 14 had 'high temperature' wounds at baseline. Two patients in the high temperature group presented with overt infection, and were excluded from further analysis. Twenty-two pressure ulcers were considered to heal 'normally' (that is, the wound area reduced by 30% or more within 3 weeks) and 16 did not heal. The baseline DESIGN score (a measure of gross wound status) did not differ in any subscales between the high and low temperature groups. The relative risk for delayed healing in high temperature cases was 2.25 (95% confidence intervals; 1.13-4.47, p=0.021). Sensitivity was 0.56, specificity was 0.82, positive predictive value was 0.75, and negative predictive value was 0.67. Our results indicate that using thermography to classify pressure ulcers according to temperature could be a useful predictor of healing at 3 weeks, even though wound appearances may not differ at the point of thermographical assessment. The higher temperature in the wound site, when compared with periwound skin, may imply the presence of critical colonisation, or other factors which disturb the wound healing.

  13. Using the Care Dependency Scale for identifying patients at risk for pressure ulcer.

    PubMed

    Dijkstra, Ate; Kazimier, Hetty; Halfens, Ruud J G

    2015-11-01

    The aim of this study was to evaluate risk screening for pressure ulcer by using the Care Dependency Scale (CDS) for patients receiving home care or admitted to a residential or nursing home in the Netherlands. Pressure ulcer is a serious and persistent problem for patients throughout the Western world. Pressure ulcer is among the most common adverse events in nursing practice and when a pressure ulcer occurs it has many consequences for patients and healthcare professionals. Cross-sectional design. The convenience sample consisted of 13,633 study participants, of whom 2639 received home care from 15 organisations, 4077 were patients from 67 residential homes and 6917 were admitted in 105 nursing homes. Data were taken from the Dutch National Prevalence Survey of Care Problems that was carried out in April 2012 in Dutch healthcare settings. For the three settings, cut-off points above 80% sensitivity were established, while in the residential home sample an almost 60% combined specificity score was identified. The CDS items 'Body posture' (home care), 'Getting dressed and undressed' (residential homes) and 'Mobility' (nursing homes) were the most significant variables which affect PU. The CDS is able to distinguish between patients at risk for pressure ulcer development and those not at risk in both home care and residential care settings. In nursing homes, the usefulness of the CDS for pressure ulcer detection is limited. © 2015 John Wiley & Sons Ltd.

  14. Pressure Ulcer Prevalence and Risk Factors among Prolonged Surgical Procedures in the OR

    PubMed Central

    Primiano, Mike; Friend, Michael; McClure, Connie; Nardi, Scott; Fix, Lisa; Schafer, Marianne; Savochka, Kathlyn; McNett, Molly

    2015-01-01

    Pressure ulcer formation related to positioning in the OR increases length of hospital stay and hospital costs, but there is little evidence documenting how positioning devices used in the OR influence pressure ulcer development when examined with traditional risk factors. The aim of this prospective cohort study was to identify prevalence of and risk factors associated with pressure ulcer development among patients undergoing surgical procedures lasting longer than three hours. Participants included all adult same-day admit patients scheduled for a three-hour surgical procedure during an eight-month period (N = 258). Data were gathered preoperatively, intraoperatively, and postoperatively on pressure ulcer risk factors. Bivariate analyses indicated that the type of positioning (ie, heels elevated) (χ2 = 7.897, P = .048), OR bed surface (ie, foam table pad) (χ2 15.848, P = .000), skin assessment in the postanesthesia care unit (χ2 = 41.652, P = .000), and male gender (χ2 = 6.984, P = .030) were associated with pressure ulcer development. Logistic regression analyses indicated that use of foam pad (B = 2.691, P = .024) and a lower day-one Braden score (B = .244, P = .003) were predictive of pressure ulcers. PMID:22118201

  15. Organizational Strategies to Implement Hospital Pressure Ulcer Prevention Programs: Findings from a National Survey

    PubMed Central

    SOBAN, LYNN M.; KIM, LINDA; YUAN, ANITA H.; MILTNER, REBECCA S.

    2017-01-01

    Aim To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system. Background Comprehensive pressure ulcer programs include nursing interventions such as use of a risk assessment tool and organizational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programs. Methods Data were collected by an email survey to all Chief Nursing Officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarize survey responses and evaluate relationships between some variables. Results Organizational strategies that support pressure ulcer prevention program implementation (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalized within individual hospitals. Conclusion Organizational strategies to support implementation of pressure ulcer preventive programs are often not optimally operationalized to achieve consistent, sustainable performance. Implications for Nursing Management The results of this study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. PMID:27487972

  16. The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility

    PubMed Central

    Neloska, Lenche; Damevska, Katerina; Nikolchev, Andjelka; Pavleska, Lidija; Petreska-Zovic, Biljana; Kostov, Milenko

    2016-01-01

    BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU). MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014). We recorded: demographic data, body mass index (BMI), Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels) and presence or absence of malnutrition and pressure ulcers. RESULTS: The pressure ulcer prevalence was 12.9% (256 out of 2099). Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001). This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence. CONCLUSION: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers. PMID:27703567

  17. Concurrent and lagged effects of registered nurse turnover and staffing on unit-acquired pressure ulcers.

    PubMed

    Park, Shin Hye; Boyle, Diane K; Bergquist-Beringer, Sandra; Staggs, Vincent S; Dunton, Nancy E

    2014-08-01

    We examined the concurrent and lagged effects of registered nurse (RN) turnover on unit-acquired pressure ulcer rates and whether RN staffing mediated the effects. Quarterly unit-level data were obtained from the National Database of Nursing Quality Indicators for 2008 to 2010. A total of 10,935 unit-quarter observations (2,294 units, 465 hospitals) were analyzed. This longitudinal study used multilevel regressions and tested time-lagged effects of study variables on outcomes. The lagged effect of RN turnover on unit-acquired pressure ulcers was significant, while there was no concurrent effect. For every 10 percentage-point increase in RN turnover in a quarter, the odds of a patient having a pressure ulcer increased by 4 percent in the next quarter. Higher RN turnover in a quarter was associated with lower RN staffing in the current and subsequent quarters. Higher RN staffing was associated with lower pressure ulcer rates, but it did not mediate the relationship between turnover and pressure ulcers. We suggest that RN turnover is an important factor that affects pressure ulcer rates and RN staffing needed for high-quality patient care. Given the high RN turnover rates, hospital and nursing administrators should prepare for its negative effect on patient outcomes. © Health Research and Educational Trust.

  18. Concurrent and Lagged Effects of Registered Nurse Turnover and Staffing on Unit-Acquired Pressure Ulcers

    PubMed Central

    Park, Shin Hye; Boyle, Diane K; Bergquist-Beringer, Sandra; Staggs, Vincent S; Dunton, Nancy E

    2014-01-01

    Objective We examined the concurrent and lagged effects of registered nurse (RN) turnover on unit-acquired pressure ulcer rates and whether RN staffing mediated the effects. Data Sources/Setting Quarterly unit-level data were obtained from the National Database of Nursing Quality Indicators for 2008 to 2010. A total of 10,935 unit-quarter observations (2,294 units, 465 hospitals) were analyzed. Methods This longitudinal study used multilevel regressions and tested time-lagged effects of study variables on outcomes. Findings The lagged effect of RN turnover on unit-acquired pressure ulcers was significant, while there was no concurrent effect. For every 10 percentage-point increase in RN turnover in a quarter, the odds of a patient having a pressure ulcer increased by 4 percent in the next quarter. Higher RN turnover in a quarter was associated with lower RN staffing in the current and subsequent quarters. Higher RN staffing was associated with lower pressure ulcer rates, but it did not mediate the relationship between turnover and pressure ulcers. Conclusions We suggest that RN turnover is an important factor that affects pressure ulcer rates and RN staffing needed for high-quality patient care. Given the high RN turnover rates, hospital and nursing administrators should prepare for its negative effect on patient outcomes. PMID:24476194

  19. Meeting targets in pressure ulcer prevention in the community by collaborating with industry.

    PubMed

    Woodhouse, Lucy; Graham, Katriona

    2014-12-01

    This article describes how a community health-care trust achieved a reduction in acquired pressure ulcers. Commissioning for Quality and Innovation 2014/15 guidance states that provider organisations should work with their partners across their local health and social care system to address the causes of pressure ulcers and reduce their prevalence, regardless of source. Gloucestershire Care Service NHS Trust was challenged to reduce the number of acquired pressure ulcers by 17% in 2013-14. The challenge for the three members of the tissue viability team was to train the qualified and unqualified staff within seven community hospitals and district nurse teams from 85 GP practices, covering a population of 600 000 within 4 months. Staff shortages and a lack of venues available meant that an adaptive educational approach was necessary. A dedicated programme of educational support from both the tissue viability nurse and an industry partner enabled the delivery of a wide range of educational materials to staff across the county. As a result of this partnership working, there was a reduction of category 3 and 4 pressure ulcers, and an increased awareness of the initial stages of pressure ulcer development demonstrated by an increase in grade 2 pressure ulcers.

  20. Extension of the life span of pressure ulcer fibroblasts with recombinant human interleukin-1 beta.

    PubMed Central

    Vande Berg, J. S.; Robson, M. C.; Mikhail, R. J.

    1995-01-01

    Recombinant human interleukin-1 beta (rhuIL-1 beta) was investigated in a randomized, blinded placebo-controlled trial to evaluate its effect on the healing of chronic pressure ulcers. The influence of this topically applied cytokine to 26 pressure ulcer patients was correlated with tissue culture and electron microscopic evaluation. Cellular replication studies showed that low (0.01 micrograms/cm2/day) and medium (0.1 micrograms/cm2/day) concentrations of rhuIL-1 beta were not effective in extending replication in pressure ulcer fibroblasts, in vitro. Tissue culture measurements from pressure ulcer biopsies demonstrated that, after 29 days of a high level of rhuIL-1 beta treatment (1.0 micrograms/cm2/day), the cytokine was effective in extending the ability of pressure ulcer fibroblasts to replicate. Tissue culture and electron microscopy suggested that, although rhuIL-1 beta promoted increases in fibroblast numbers, the primary effect appeared to be development of the extracellular matrix. The possible direct and indirect influences of rhuIL-1 beta therapy on pressure ulcers are discussed. Images Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 PMID:7747819

  1. A prospective window into medical device-related pressure ulcers in intensive care.

    PubMed

    Coyer, Fiona M; Stotts, Nancy A; Blackman, Virginia Schmied

    2014-12-01

    The aim of this study was to determine the prevalence, severity, location, aetiology, treatment and healing of medical device-related pressure ulcers (PUs) in intensive care patients for up to 7 days. A prospective repeated measures study design was used. Patients in six intensive care units of two major medical centres, one each in Australia and the USA, were screened 1 day per month for 6 months. Those with device-related ulcers were followed daily for up to 7 days. The outcome measures were device-related ulcer prevalence, pain, infection, treatment and healing. Fifteen of 483 patients had device-related ulcers and 9 of 15 with 11 ulcers were followed beyond screening. Their mean age was 60·5 years, and most were men, overweight and at increased risk of PU. Endotracheal (ET) and nasogastric (NG) tubes were the cause of most device-related ulcers. Repositioning was the most frequent treatment. Four of 11 ulcers healed within the 7-day observation period. In conclusion, device-related ulcer prevalence was 3·1%, similar to that reported in the limited literature available, indicating an ongoing problem. Systematic assessment and repositioning of devices are the mainstays of care. We recommend continued prevalence determination and that nurses remain vigilant to prevent device-related ulcers, especially in patients with NG and ET tubes.

  2. Hypotension is a risk factor for new pressure ulcer occurrence in older patients after admission to an acute hospital.

    PubMed

    Man, Shiu-piu; Au-Yeung, Tung-wai

    2013-08-01

    Pressure ulcer occurrence in older patients admitted to hospital has not been studied thoroughly; yet, pressure ulcers frequently develop among the frail older patients who are hospitalized. Identifying risk factors for pressure ulcer occurrence is of utmost importance in preventing its development in this group of patients. Hypoperfusion, as manifested by hypotension, is theoretically important in the development of pressure ulcer. However, studies on this aspect are scarce. To examine whether a hypotensive episode (systolic blood pressure less than or equal to 90 mm Hg) is associated with pressure ulcer occurrence. This was a retrospective cohort study in a regional hospital. It recruited 259 patients aged 65 or older who were admitted to a convalescence ward and had a hospital stay for more than 5 days. Baseline clinical characteristics and the possible risk factors of pressure ulcer occurrence on admission and any episode of hypotension were recorded. The primary outcome measured was the incidence of pressure ulcer occurrence in the index admission. Hypotension was strongly associated with incident pressure ulcer occurrence (odds ratio 6.71, P = .001). Hypotension was an important risk factor for incident pressure ulcer occurrence during hospital stay. Every effort has to be taken to try to prevent hypotension. Precautions to prevent pressure ulcer development should be taken on patients who are hypotensive. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  3. [Effect of two types of intermittent pressure on formation of pressure ulcer in rabbit hind limbs].

    PubMed

    Liu, Jianghui; Wang, Weiping; Wang, Keke; Chen, Xilin; Li, Qiang; Dai, Qiangsheng; Wang, Yongqian; Ji, Zhongliang

    2009-08-01

    To compare the effect of two types of intermittent pressure on formation of pressure ulcer in rabbit hind limbs and to investigate the mechanism of gradually changed intermittent pressure produced by waves bed in the prevention of pressure ulcer. Gracilis (3 cm2) in both hind limbs of 12 adult Japanese white rabbits were randomly loaded with gradually changed intermittent pressure (50-160 mm Hg, 1 mm Hg = 0.133 kPa) and sustained pressure (100 mmHg) serving as the experimental group and the control group, respectively. The experiment was terminated after 4 cycles, and a single cycle included 2 hours of compression and 30 minutes of compression-release. Blood velocity of hind limbs and blood perfusion of wound were detected by bidirectional Doppler blood flow detector and laser Doppler perfusion imaging detection system before compression and at every 10 minutes in compression-release period of each cycle (0, 10, 20 and 30 minutes). After the termination, gross observation of the wound was conducted, pathomorphological changes of tissues from compressed area were observed by HE staining, and contents of NO, malondialdehyde (MDA), and superoxide dismutase (SOD) in muscle tissue were measured using colorimetry method. No significant difference was evident between two groups in terms of blood flow velocity before compression (P > 0.05); the blood flow velocity of two groups decreased significantly at 0 minute in every compression-release period of each cycle, and no significant differences were noted between two groups (P > 0.05); the blood flow velocity of the experimental group was higher than that of the control group at 10, 20 and 30 minutes (P < 0.05). No significant difference was noted between two groups in terms of wound blood perfusion before compression (P > 0.05); the wound blood perfusion of two groups decreased significantly at 0 minute in every compression-release period of each cycle, and no significant differences were noted between two groups (P > 0

  4. Impedance sensing device enables early detection of pressure ulcers in vivo.

    PubMed

    Swisher, Sarah L; Lin, Monica C; Liao, Amy; Leeflang, Elisabeth J; Khan, Yasser; Pavinatto, Felippe J; Mann, Kaylee; Naujokas, Agne; Young, David; Roy, Shuvo; Harrison, Michael R; Arias, Ana Claudia; Subramanian, Vivek; Maharbiz, Michel M

    2015-03-17

    When pressure is applied to a localized area of the body for an extended time, the resulting loss of blood flow and subsequent reperfusion to the tissue causes cell death and a pressure ulcer develops. Preventing pressure ulcers is challenging because the combination of pressure and time that results in tissue damage varies widely between patients, and the underlying damage is often severe by the time a surface wound becomes visible. Currently, no method exists to detect early tissue damage and enable intervention. Here we demonstrate a flexible, electronic device that non-invasively maps pressure-induced tissue damage, even when such damage cannot be visually observed. Using impedance spectroscopy across flexible electrode arrays in vivo on a rat model, we find that impedance is robustly correlated with tissue health across multiple animals and wound types. Our results demonstrate the feasibility of an automated, non-invasive 'smart bandage' for early detection of pressure ulcers.

  5. Pressure ulcers and risk assessment in severe burns.

    PubMed

    Lewis, Giavonni M; Pham, Tam N; Robinson, Ellen; Otto, Andrew; Honari, Shari; Heimbach, David M; Klein, Matthew B; Gibran, Nicole S

    2012-01-01

    Risk and incidence of pressure ulcers (PUs) in the burn population remain poorly understood. The purpose of this study was to determine the timing and incidence of PUs at our regional burn center and to identify early risk factors for PU development in burn patients. A retrospective review of 40 charts was performed from among the 1489 patients admitted to our regional burn center between January 2008 and December 2009. Twenty patients acquired PUs during their admission and were identified on the basis of International Classification of Diseases, ninth revision, designation, hospital stay >7 days, and thermal injury (excluding toxic epidermal necrolysis and purpura fulminans). The remaining 20 patients were matched controls based on ±5 years in age and ±8% TBSA. Patient, injury, and outcome characteristics were compared among patient groups using χ for categorical variables and Mann-Whitney for continuous variables. The incidence of PU was 1.3% of all admissions. PU most commonly occurred at the sacrum/coccyx (eight), lower extremity (seven), and occiput (six). A majority of PU presented at stage 2 (33%), stage 3 (26%), and unstageable (30%). Thirteen were splint or device related and reportable. Ninety percent of patients with PUs presented with a Braden score of 16 or less (P = .03), although 60% of controls also had admission Braden scores less than 16. On an average, PUs were acquired within 17 days of admission. Data suggest burn patients are particularly at risk of developing PU based on admission Braden scores. However, low Braden scores do not necessarily correlate with eventual development of PU. Therefore, early and aggressive PU prevention and risk assessment tools must be used to diagnose PUs at an early and reversible stage.

  6. Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers.

    PubMed

    Ma, Chenjuan; Park, Shin Hye

    2015-11-01

    To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals. A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States. Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals. Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93). Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs. Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention. © 2015 Sigma Theta Tau International.

  7. Pressure-reducing interventions among persons with pressure ulcers: results from the first three national pressure ulcer prevalence surveys in Sweden.

    PubMed

    Bååth, Carina; Idvall, Ewa; Gunningberg, Lena; Hommel, Ami

    2014-02-01

    The overall aim of this study was to describe preventive interventions among persons with pressure ulcer (PU) in three nationwide PU prevalence surveys in Sweden. A cross-sectional research design was used; more than 70 000 persons from different hospitals and nursing homes participated in the three prevalence surveys conducted in March 2011, October 2011 and March 2012. The methodology used was that recommended by the European Pressure Ulcers Advisory Panel. The overall prevalence of PU categories I-IV in hospitals was 16.6%, 14.4% and 16.1%, respectively. Corresponding figures for nursing homes were 14.5%, 14.2% and 11.8%, respectively. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PU category I. Despite the three prevalence studies that have showed high prevalence of PU the use of preventing interventions is still not on an acceptable level. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PUs, and individual-planned repositioning also increased. However, when persons already have a PU they should all have pressure-reducing preventive interventions to prevent the development of more PUs. Preventing PUs presents a challenge even when facilities have prevention programmes. A PU prevention programme requires an enthusiastic leader who will maintain the team's focus and direction for all staff involved in patient care. © 2013 John Wiley & Sons, Ltd.

  8. Plantar pressure distribution patterns during gait in diabetic neuropathy patients with a history of foot ulcers.

    PubMed

    Bacarin, Tatiana Almeida; Sacco, Isabel C N; Hennig, Ewald M

    2009-01-01

    To investigate and compare the influence of a previous history of foot ulcers on plantar pressure variables during gait of patients with diabetic neuropathy. Foot ulcers may be an indicator of worsening diabetic neuropathy. However, the behavior of plantar pressure patterns over time and during the progression of neuropathy, especially in patients who have a clinical history of foot ulcers, is still unclear. Subjects were divided into the following groups: control group, 20 subjects; diabetic neuropathy patients without foot ulcers, 17 subjects; and diabetic neuropathy patients with at least one healed foot ulcer within the last year, 10 subjects. Plantar pressure distribution was recorded during barefoot gait using the Pedar-X system. Neuropathic subjects from both the diabetic neuropathy and DNU groups showed higher plantar pressure than control subjects. At midfoot, the peak pressure was significantly different among all groups: control group (139.4+/-76.4 kPa), diabetic neuropathy (205.3+/-118.6 kPa) and DNU (290.7+/-151.5 kPa) (p=0.008). The pressure-time integral was significantly higher in the ulcerated neuropathic groups at midfoot (CG: 37.3+/-11.4 kPa.s; DN: 43.3+/-9.1 kPa.s; DNU: 68.7+/-36.5 kPa.s; p=0.002) and rearfoot (CG: 83.3+/-21.2 kPa.s; DN: 94.9+/-29.4 kPa.s; DNU: 102.5+/-37.9 kPa.s; p=0.048). A history of foot ulcers in the clinical history of diabetic neuropathy subjects influenced plantar pressure distribution, resulting in an increased load under the midfoot and rearfoot and an increase in the variability of plantar pressure during barefoot gait. The progression of diabetic neuropathy was not found to influence plantar pressure distribution.

  9. The effect of nitric oxide releasing cream on healing pressure ulcers

    PubMed Central

    Saidkhani, Vahid; Asadizaker, Marziyeh; Khodayar, Mohammad Javad; Latifi, Sayed Mahmoud

    2016-01-01

    Background: Pressure ulcer is one of the main concerns of nurses in medical centers around the world, which, if untreated, causes irreparable problems for patients. In recent years, nitric oxide (NO) has been proposed as an effective method for wound healing. This study was conducted to determine the effect of nitric oxide on pressure ulcer healing. Materials and Methods: In this clinical trial, 58 patients with pressure ulcer at hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences were homogenized and later divided randomly into two groups of treatment (nitric oxide cream; n = 29) and control (placebo cream; n = 29). In this research, the data collection tool was the Pressure Ulcer Scale for Healing (PUSH). At the outset of the study (before using the cream), the patients' ulcers were examined weekly in terms of size, amount of exudates, and tissue type using the PUSH tool for 3 weeks. By integrating these three factors, wound healing was determined. Data were analyzed using SPSS. Results: Although no significant difference was found in terms of the mean of score size, the amount of exudates, and the tissue type between the two groups, the mean of total score (healing) between the two groups was statistically significant (P = 0.04). Conclusions: Nitric oxide cream seems to accelerate wound healing. Therefore, considering its easy availability and cost-effectiveness, it can be used for treating pressure ulcers in the future. PMID:27186212

  10. The effect of nitric oxide releasing cream on healing pressure ulcers.

    PubMed

    Saidkhani, Vahid; Asadizaker, Marziyeh; Khodayar, Mohammad Javad; Latifi, Sayed Mahmoud

    2016-01-01

    Pressure ulcer is one of the main concerns of nurses in medical centers around the world, which, if untreated, causes irreparable problems for patients. In recent years, nitric oxide (NO) has been proposed as an effective method for wound healing. This study was conducted to determine the effect of nitric oxide on pressure ulcer healing. In this clinical trial, 58 patients with pressure ulcer at hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences were homogenized and later divided randomly into two groups of treatment (nitric oxide cream; n = 29) and control (placebo cream; n = 29). In this research, the data collection tool was the Pressure Ulcer Scale for Healing (PUSH). At the outset of the study (before using the cream), the patients' ulcers were examined weekly in terms of size, amount of exudates, and tissue type using the PUSH tool for 3 weeks. By integrating these three factors, wound healing was determined. Data were analyzed using SPSS. Although no significant difference was found in terms of the mean of score size, the amount of exudates, and the tissue type between the two groups, the mean of total score (healing) between the two groups was statistically significant (P = 0.04). Nitric oxide cream seems to accelerate wound healing. Therefore, considering its easy availability and cost-effectiveness, it can be used for treating pressure ulcers in the future.

  11. Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with spinal cord injury

    PubMed Central

    Sarasúa, J González; López, S Pérez; Viejo, M Álvarez; Basterrechea, M Pérez; Rodríguez, A Fernández; Gutiérrez, A Ferrero; Gala, J García; Menéndez, Y Menéndez; Augusto, D Escudero; Arias, A Pérez; Hernández, J Otero

    2011-01-01

    Context Pressure ulcers are especially difficult to treat in patients with spinal cord injury (SCI) and recurrence rates are high. Prompted by encouraging results obtained using bone marrow stem cells to treat several diseases including chronic wounds, this study examines the use of autologous stem cells from bone marrow to promote the healing of pressure ulcers in patients with SCI. Objective To obtain preliminary data on the use of bone marrow mononuclear cells (BM-MNCs) to treat pressure ulcers in terms of clinical outcome, procedure safety, and treatment time. Participants Twenty-two patients with SCI (19 men, 3 women; mean age 56.41 years) with single type IV pressure ulcers of more than 4 months duration. Interventions By minimally invasive surgery, the ulcers were debrided and treated with BM-MNCs obtained by Ficoll density gradient separation of autologous bone marrow aspirates drawn from the iliac crest. Results In 19 patients (86.36%), the pressure ulcers treated with BM-MNCs had fully healed after a mean time of 21 days. The number of MNCs isolated was patient dependent, although similar clinical outcomes were observed in each case. Compared to conventional surgical treatment, mean intra-hospital stay was reduced from 85.16 to 43.06 days. Following treatment, 5 minutes of daily wound care was required per patient compared to 20 minutes for conventional surgery. During a mean follow-up of 19 months, none of the resolved ulcers recurred. Conclusions Our data indicate that cell therapy using autologous BM-MNCs could be an option to treat type IV pressure ulcers in patients with SCI, avoiding major surgical intervention. PMID:21756569

  12. Pressure ulcers--randomised controlled trial comparing hydrocolloid and saline gauze dressings.

    PubMed

    Chang, K W; Alsagoff, S; Ong, K T; Sim, P H

    1998-12-01

    An open comparative randomised study comparing the performance of hydrocolloid dressings (DuoDERM CGF) to saline gauze dressings in the treatment of pressure ulcers was done to evaluate the overall dressing performance, wound healing and cost effectiveness. Thirty-four subjects were enrolled at the University Hospital, Kuala Lumpur over a 643 days period. Inclusion criteria were Stage II or III pressure ulcers, at least 18 years of age and written informed consent. Only one pressure ulcer per subject was enrolled in the study. Patients with infected pressure ulcers, diabetes mellitus, an immuno-compromised status and known sensitivity to the study dressings were excluded. Subjects who met the enrollment criteria were randomised to one of the two dressing regimes. They were expected to participate in the study for a maximum of eight weeks or until the pressure ulcer healed, which ever occurred first. Overall subject age averaged 58 years and the mean duration of pressure ulcer existence was about 1 month. Twenty-one of the thirty-four ulcers enrolled were stage II and thirteen were stage III. The majority of the ulcers (88%) were located in the sacral area and seventeen subjects (50%) were incontinent. In the evaluation of dressing performance in terms of adherence to wound bed, exudate handling ability, overall comfort and pain during dressing removal; all favoured the hydrocolloid dressing by a statistically significant margin (p < 0.001). Subjects assigned the hydrocolloid dressing experienced a mean 34% reduction from their baseline surface area measurement compared to a mean 9% increase by subjects assigned gauze dressings. This was not statistically significant (p = 0.2318). In cost evaluation of the study products, there was no statistical significance in the total cost of wound management per subject. When only labour time and cost was evaluated, there was a statistically significant advantage towards hydrocolloid dressings.

  13. Pressure ulcers induced by drug administration: A new concept and report of four cases in elderly patients.

    PubMed

    Mizokami, Fumihiro; Takahashi, Yoshiko; Hasegawa, Keiko; Hattori, Hideyuki; Nishihara, Keiji; Endo, Hidetoshi; Furuta, Katsunori; Isogai, Zenzo

    2016-04-01

    Drug-induced akinesia is a potential cause of pressure ulcers. However, pressure ulcers that are caused by drug-induced akinesia are not considered an adverse drug reaction (ADR). We propose that drug-induced pressure ulcers (DIPU) are pressure ulcers that are caused by an external force that is experienced after drug administration, and we considered resolution of these ulcers after drug discontinuation to be a supportive finding. In this report, we reviewed the medical records of pressure ulcer cases from a 300-bed hospital. Among 148 patients, four patients with pressure ulcers met the criterion for DIPU. In these cases, the suspected DIPU were related to treatment with olanzapine, fluvoxamine, valproic acid, clotiazepam, triazolam and rilmazafone. These drugs were administrated to manage the patients' behavioral and psychological symptoms that accompanied dementia. The DIPU in these patients were categorized as stage IV according to the National Pressure Ulcer Advisory Panel criteria. Discontinuation of the causal drugs led to significant improvements or complete healing of the pressure ulcers, and the patients subsequently recovered their mobility. Therefore, we propose that DIPU are potential ADR that have been overlooked in clinical practice. Thus, recognition of DIPU as an ADR may be important in preventing and appropriately managing pressure ulcers among elderly patients. © 2015 Japanese Dermatological Association.

  14. Effects of L-carnosine and its zinc complex (Polaprezinc) on pressure ulcer healing.

    PubMed

    Sakae, Kensaku; Agata, Toshihiko; Kamide, Ryoichi; Yanagisawa, Hiroyuki

    2013-10-01

    L-carnosine (CAR) is an endogenous dipeptide. We aimed to determine the effects of CAR and its zinc complex polaprezinc (PLZ) on pressure ulcer healing in institutionalized long-term care patients. This study was a nonrandomized controlled trial with a maximum 4-week follow-up. Forty-two patients with stage II-IV pressure ulcers for 4 or more weeks were allocated to 1 of 3 groups in order of recruitment: the control group (n = 14) was untreated, the PLZ group (n = 10) orally received 150 mg/d PLZ (containing 116 mg CAR and 34 mg zinc), and the CAR group (n = 18) orally received 116 mg/d CAR. Pressure ulcer severity was measured weekly using the Pressure Ulcer Scale for Healing (PUSH) score. At baseline, no significant differences were found among groups in demographic and nutrition parameters and pressure ulcer characteristics (severity, size, and staging). After 4 weeks, the rate of pressure ulcer healing, assessed by the mean weekly improvement in PUSH score, was significantly greater in the CAR (1.6 ± 0.2, P = .02) and PLZ groups (1.8 ± 0.2, P = .009) than in the control group (0.8 ± 0.2). The difference between the CAR and PLZ groups was not significant (P = .73). Actual dietary intakes over this period did not differ significantly among groups. Our results suggest that CAR and PLZ may almost equally accelerate pressure ulcer healing during 4 weeks. The results need confirmation by randomized controlled trials with larger sample sizes.

  15. Effectiveness of an e-learning tool for education on pressure ulcer evaluation.

    PubMed

    Morente, Laura; Morales-Asencio, José M; Veredas, Francisco J

    2014-07-01

    To evaluate the effectiveness of information and communication technologies in the undergraduate students' pressure ulcer training as a learning tool, compared with traditional teaching methods. Pressure ulcers constitute one of the great challenges faced by nursing professionals. Currently, pressure ulcer training is based on traditional on-campus teaching, involving lecture-style classes with frequent use of photographs of the wounds. This traditional training has some important weaknesses that can put the efficacy of the training at risk. A randomised controlled trial was developed including undergraduate nursing students. The intervention group used an adaptive self-learning e-learning tool developed by the research team (ePULab) for pressure ulcer assessment and treatment. The control group received a traditional on-campus class on the same topic. Pretest and post-test questionnaires were designed to assess the students' ability in pressure ulcer diagnosis and treatment. The educational intervention based on the use of the ePULab tool produced significantly better learning acquisition results than those obtained by traditional lecture-style classes: the total score improved in the control group from 8·23 (SD 1·23)-11·6 (SD 2·52) after the lecture, whereas in the intervention group, the knowledge score changed from 8·27 (SD 1·39)-15·83 (SD 2·52) (p = 0·01) with the use of ePULab. The results show a higher effectiveness of the devised e-learning approach for education on management of pressure ulcers. Our results reveal the suitability of the ePULab e-learning tool as an effective instrument for training on assessment of and treatment for pressure ulcers and its potential impact on clinical decision-making. © 2013 John Wiley & Sons Ltd.

  16. [Trends in the prevalence of pressure ulcers in an acute care tertiary hospital (2006-2013)].

    PubMed

    Alonso-Lorente, C; Barrasa-Villar, J I; Aibar-Remón, C

    2015-01-01

    To analyse the trends in pressure ulcer prevalence from 2006 to 2013. To determine the main risk factors associated with pressure ulcers. A descriptive study analysing the prevalence in a series of pressure ulcers collected in the study on the prevalence of nosocomial infections in Spain from 2006 to 2013 in the Clinical University Hospital of Zaragoza. The mean prevalence among the 5,354 patients included over the period of study was 4.5% (95% CI=3.9-5.0%). No significant difference in its trend or distribution of pressure ulcers was observed over the several years of the study. Prevalence increased up to 5.0% (95% CI=4.4-5.6%) when short-stay patients (less than 24 hours) and those admitted into low risk units (Paediatrics, Psychiatry and Obstetrics) were removed from the study, but there was still no significant differences in its yearly trend or distribution (p>0.05). Age, length of stay, presence of coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were risk factors associated with pressure ulcer prevalence in the logistic regression. Age, length of stay, coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were independent risk markers for patients with pressure ulcers. No particular trend of pressure ulcer prevalence could be determined to demonstrate any effects from the different strategies of improvement implemented during the period of study, although this fact could be due to the limitations of data used in the study. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  17. Skin assessment and pressure ulcer care in hospital-based skilled nursing facilities.

    PubMed

    Siem, Carol A; Wipke-Tevis, Deidre D; Rantz, Marilyn J; Popejoy, Lori L

    2003-06-01

    The Minimum Data Set, a comprehensive assessment tool for nursing home residents, is used for clinical decision-making, research, quality improvement, and Medicare and Medicaid reimbursement. Within the Minimum Data Set, pressure ulcers and skin condition are evaluated. Because information about pressure ulcer prevalence and care in hospital-based skilled nursing facilities is sparse, a study was conducted to: a) determine pressure ulcer prevalence upon admission to hospital-based skilled nursing facilities in the state of Missouri, and b) ascertain methods of assessment, treatment, and documentation of skin and pressure ulcer care in these facilities. Prevalence data were obtained from analysis of the Minimum Data Set data, and a survey was conducted to obtain skin care practices. The vast majority of residents (96%) were admitted from acute care facilities, and pressure ulcer prevalence on admission was 18.4% +/- 8.0%. Seventy-seven percent (77%) of the 88 surveys mailed were returned. The Braden or Norton Scale for risk assessment is reportedly used by 55% of facilities; whereas, 35% use a facility-developed tool. Commonly reported pressure ulcer prevention/treatment interventions used include: dietitian referral, use of barrier ointments, and a written repositioning schedule. Incontinence management and minimizing the head of bed elevation were infrequently used. Nearly one-half (47%) of facilities reported daily reassessment and documentation of wound status, suggesting less-than-optimal, time-consuming wound care practices. Despite the limitations inherent in survey designs and the use of databases such as the Minimum Data Set, the results of this study suggest that pressure ulcers are a common problem in acute care and hospital-based skilled nursing facilities and research-based risk assessment, prevention, and wound assessment strategies have not been widely implemented. The results of this study provide a basis for developing educational programs and a

  18. Nursing practice in the prevention of pressure ulcers: an observational study of German Hospitals.

    PubMed

    Hoviattalab, Khadijeh; Hashemizadeh, Haydeh; D'Cruz, Gibson; Halfens, Ruud J G; Dassen, Theo

    2015-06-01

    The study aimed to establish the range and extent of preventive interventions undertaken by nurses for patients who are at high risk of developing or currently have a pressure ulcer. Since 2000, the German National Expert Standard for the prevention of pressure ulcers has provided evidence-based recommendations, but limited studies have been published on its adherence in hospitals. There are also limited observational studies that investigated whether patients who are at risk of or have pressure ulcers are provided with appropriate preventative measures. A nonparticipant observational descriptive design was used. A sample of 32 adult patients who were at high risk of developing or currently had a pressure ulcer were observed during all shifts in medical and surgical wards in two general hospitals in Germany. A range of preventive interventions that were in line with the German National Expert Standard was observed. The most frequent preventive measures were 'cleaning the patients' skin' and 'minimizing exposure to moisture' that were undertaken in more than 90% of all patients. The least frequent measures were 'patient and relative education', 'assessment and recording of nutritional status'. This study demonstrates that the pressure ulcers preventive interventions as set out in the German National Expert Standard were not fully implemented. The study highlights the need for further studies on the barriers that impede the undertaking of the interventions that may prevent the development or deterioration of pressure ulcers and the delivery of evidence-based preventative care. This study provides an insight into the extent of pressure ulcers preventive practices used by nurses. The results may serve as a basis for developing an effective strategy to improve nursing practice in this area and the promotion of evidence-based practice. However, our results refer to two general hospitals and for a broader population, further studies with larger data samples are needed.

  19. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

    PubMed

    Brunel, A-S; Lamy, B; Cyteval, C; Perrochia, H; Téot, L; Masson, R; Bertet, H; Bourdon, A; Morquin, D; Reynes, J; Le Moing, V

    2016-03-01

    There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.

  20. Effects of local cooling on sacral skin perfusion response to pressure: implications for pressure ulcer prevention.

    PubMed

    Tzen, Yi-Ting; Brienza, David M; Karg, Patricia; Loughlin, Patrick

    2010-08-01

    People with spinal cord injuries are at high risk for developing pressure ulcers. Increased skin temperature is one of the extrinsic causative factors for this multi-factorial disease. Previous animal studies revealed that local skin cooling reduced the severity of ulceration, and cooling is widely used in plastic surgery and organ transplants for tissue preservation. The objectives of this pilot study were to develop test protocols and instrumentation and to investigate the effect of local cooling on skin perfusion response to pressure on young healthy human subjects. Reactive hyperemia was quantified in this study to compare the effects of pressure with and without cooling. Reactive hyperemia is a normal physiological response occurring after vessel occlusion. Laser Doppler flowmetry was used to measure skin blood flow. Time-dependent spectral analysis was used to analyze and decompose the blood flow data into frequency ranges associated with specific blood flow control mechanisms. The study used a repeated measures design with two test conditions: 8 kPa of pressure with and without cooling to 25 degrees C. We hypothesized that local cooling would reduce the post-ischemic reactive hyperemic response induced by the rigid indenter. Time series results showed that normalized peak perfusion response was significantly lower with cooling (p=0.019). Time-dependent spectral analysis results suggested that both metabolic and myogenic responses contribute to this protective effect. Findings from our study on humans were consistent with previous animal studies. Additional studies on individuals with spinal cord injury are planned to further evaluate the cooling effect in a high-risk population.

  1. A topical haemoglobin spray for oxygenating pressure ulcers: a pilot study.

    PubMed

    Tickle, Joy

    2015-03-01

    The effect of pressure ulcers on patient quality of life have been recognised as a real problem for many years, and the need for robust and effective management of pressure ulcers is now a prominent national health-care issue. Myriad different interventions exist for the treatment of pressure ulcers, including clinically effective dressings and pressure-relieving devices, yet many pressure ulcers still do not heal and often become a chronic wound. This is the second of a series of articles (Norris, 2014) discussing the clinical evaluation of a topical oxygen therapy in practice. It describes a small evaluation involving 18 patients with pressure ulcers. The study set out to determine the effect of a topical oxygen therapy on wound size. The therapy comprises a canister that sprays pure haemoglobin in a water solution into or onto the wound. The haemoglobin spray needs to be used at least once every 3 days, does not require training on its use and can be used in any care setting. Overall, results identified wound healing progression in all 18 wounds and wound size reduction in 17 of the 18 wounds.

  2. The Nursing Diagnosis of risk for pressure ulcer: content validation.

    PubMed

    Santos, Cássia Teixeira Dos; Almeida, Miriam de Abreu; Lucena, Amália de Fátima

    2016-06-14

    to validate the content of the new nursing diagnosis, termed risk for pressure ulcer. the content validation with a sample made up of 24 nurses who were specialists in skin care from six different hospitals in the South and Southeast of Brazil. Data collection took place electronically, through an instrument constructed using the SurveyMonkey program, containing a title, definition, and 19 risk factors for the nursing diagnosis. The data were analyzed using Fehring's method and descriptive statistics. The project was approved by a Research Ethics Committee. title, definition and seven risk factors were validated as "very important": physical immobilization, pressure, surface friction, shearing forces, skin moisture, alteration in sensation and malnutrition. Among the other risk factors, 11 were validated as "important": dehydration, obesity, anemia, decrease in serum albumin level, prematurity, aging, smoking, edema, impaired circulation, and decrease in oxygenation and in tissue perfusion. The risk factor of hyperthermia was discarded. the content validation of these components of the nursing diagnosis corroborated the importance of the same, being able to facilitate the nurse's clinical reasoning and guiding clinical practice in the preventive care for pressure ulcers. validar o conteúdo do novo diagnóstico de enfermagem, denominado risco de úlcera por pressão. trata-se de uma validação de conteúdo, com amostra composta por 24 enfermeiros especialistas no cuidado à pele, procedentes de seis diferentes hospitais do Sul e Sudeste brasileiro. A coleta de dados ocorreu por meio eletrônico, em instrumento construído pelo programa SurveyMonkey, que continha título, definição e 19 fatores de risco para o diagnóstico de enfermagem. Os dados foram analisados pelo método de Fehring e pela estatística descritiva. O projeto foi aprovado em Comitê de Ética em Pesquisa. título, definição e sete fatores de risco foram validados como "muito importante

  3. Costs of topical treatment of pressure ulcer patients.

    PubMed

    Andrade, Cynthia Carolina Duarte; Almeida, Cláudia Fernanda Dos Santos Calixto de; Pereira, Walkíria Euzébio; Alemão, Márcia Mascarenhas; Brandão, Cristina Mariano Ruas; Borges, Eline Lima

    2016-04-01

    To evaluate the costs of a topical treatment of pressure ulcer (PU) patients in a hospital unit for treatment of chronic patients in 2014. This is an activity-based costing study. This method encompasses the identification, measurement and pricing of physical and human resources consumed for dressings. Procedure costs varied between BRL 16.41 and BRL 260.18. For PUs of the same category, of near areas and with the same type of barrier/adjuvant, the cost varied between 3.5% and 614.6%. For most dressings, the cost increased proportionally to the increase of the area and to the development of PU category. The primary barrier accounted for a high percentage of costs among all items required to the application of dressings (human and material resources). Dressings applied in sacral PUs had longer application times. This study allowed us to understand the costs involved in the treatment of PUs, and it may support decision-makers and other cost-effectiveness studies. Realizar uma avaliação do custo do tratamento tópico de pacientes com úlceras por pressão (UP), em uma unidade hospitalar de atendimento a pacientes crônicos no ano de 2014. Trata-se de um estudo de custos baseado no Sistema de custeio Baseado em Atividades. Este método contempla a identificação, mensuração e precificação dos recursos físicos e humanos consumidos para a realização de curativos. Os custos dos procedimentos variaram de R$16,41 a R$260,18. Para UP de mesma categoria, de áreas aproximadas e mesmo tipo de cobertura/adjuvante, a variação entre os custos foi de 3,5% a 614,6%. Para a maioria dos curativos, o custo aumentou proporcionalmente ao aumento da área e à progressão da categoria das UP. A cobertura primária representou elevado percentual nos custos entre todos os itens necessários para realizar os curativos (recursos humanos e materiais). Os curativos realizados nas UP sacrais foram os que apresentaram maiores tempos para execução. Este estudo permitiu conhecer os

  4. Pressure relief behaviour and the prevention of pressure ulcers in wheelchair users in the community.

    PubMed

    Stockton, Lesley; Parker, Dianne

    2002-07-01

    This study aims to provide an insight into wheelchair users' preventative health behaviours with respect to pressure-relief behaviour, perceived risk and attribution of responsibility for preventative health measures. Wheelchair users who are dependent upon a wheelchair for their indoor and outdoor mobility have a long-term risk of developing a pressure ulcer. In an attempt to lessen the risk they need to perform pressure-relieving movements frequently. The Department of Health currently advises wheelchair users to perform a pressure-relieving movement every 15 minutes. Many wheelchair users responding to this large scale survey reported that although they were physically capable of performing pressure-relieving movements without help, they either did not do them or did not adhere to current advice. Of those who responded, 20.8% moved only once an hour and a further 54.7% moved less often than once an hour. This study is part of a wider study investigating the preventative health behaviours of wheelchair users.

  5. Comparing physical assessment with administrative data for detecting pressure ulcers in a large Canadian academic health sciences centre

    PubMed Central

    Vanderloo, Saskia E; Miller, Toba B; Freeman, Lisa; Forster, Alan J

    2016-01-01

    Objective This study aimed to compare classification of pressure ulcers from administrative data with a gold standard assessment, specifically; pressure ulcers confirmed by an independent physical assessment performed by trained nurse surveyors. Setting A retrospective analysis of pooled cross-sectional samples of inpatients assessed across 3 consecutive prevalence surveys in a large academic health sciences centre between 2012 and 2013. Participants There were 2001 patients for whom physical and chart assessments were completed, and for whom a discharge abstract was also available at the time of analysis. The cohort's mean age was 65 years and 55% were women. Results Based on the physical assessment findings, 14.6% of patients (n=292) had at least 1 pressure ulcer, with a total of 345 pressure ulcers documented among these patients: (stage I=162; stage II=120; stage III=22; stage IV=22 and unstageable=19). Based on coded information, 78 (3.9%) of patients had a pressure ulcer. Of patients with a pressure ulcer determined by the physical assessment, only 21% also had a pressure ulcer captured in the administrative data. Furthermore, only 6% of the patients with a hospital-acquired pressure ulcer, stage II or greater determined by the physical assessment were coded in the Discharge Abstract Database (DAD). Conclusions The results of this study demonstrate that coding in the DAD may under-report and fail to accurately reflect the true burden of pressure ulcers in hospitalised patients. This may occur because the presence of pressure ulcers is currently documented in the health record by nurses and not by physicians, yet the administrative data recorded in the DAD only includes physician documented pressure ulcers. We recommend enhancements to the coding methods to monitor and report on pressure ulcers. PMID:27707831

  6. Prevalence of pressure ulcer and associated risk factors in middle and older age medical inpatients in Norway.

    PubMed

    Børsting, Tove Elisabet; Tvedt, Christine Raaen; Skogestad, Ingrid Johansen; Granheim, Tove Irene; Gay, Caryl L; Lerdal, Anners

    2017-09-27

    The objectives of this study are to describe the prevalence of pressure ulcers among middle and older aged patients in a general medical hospital in Norway and to describe the associations between pressure ulcers and potential risk factors additional to the Braden risk score. Degrees of mobility, activity, perfusion and skin status are risk factors for development of pressure ulcer. Nurses' clinical judgements combined with risk assessments tools are effective to detect pressure ulcer risk. Cross-sectional study. The study was performed as part of a research project conducted between September 2012 and May 2014 in a general hospital in the capital of Norway. Registered nurses and nursing students collected data from all eligible patients on 10 days during the students' clinical practice studies. The Braden Scale was used to measure pressure ulcer risk, and skin examinations were performed to classify the skin area as normal or as indicative of pressure ulcer according to the definitions by the National Pressure Ulcer Advisory Panel. Comorbidities were collected by patient's self-report. This analysis focused on the 255 inpatients at the medical wards ≥ 52 years of age, most of whom had more than one comorbidity. The prevalence of pressure ulcers was 14.9% in this sample. Higher age, underweight, diabetes and worse Braden scores were factors associated with pressure ulcer, and pressure ulcer was most frequently sited at the sacrum or heel. Adding age, weight, and diabetes status to pressure ulcer risk assessment scales may improve identification of patients at risk for pressure ulcers. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  7. Comparing physical assessment with administrative data for detecting pressure ulcers in a large Canadian academic health sciences centre.

    PubMed

    Backman, Chantal; Vanderloo, Saskia E; Miller, Toba B; Freeman, Lisa; Forster, Alan J

    2016-10-05

    This study aimed to compare classification of pressure ulcers from administrative data with a gold standard assessment, specifically; pressure ulcers confirmed by an independent physical assessment performed by trained nurse surveyors. A retrospective analysis of pooled cross-sectional samples of inpatients assessed across 3 consecutive prevalence surveys in a large academic health sciences centre between 2012 and 2013. There were 2001 patients for whom physical and chart assessments were completed, and for whom a discharge abstract was also available at the time of analysis. The cohort's mean age was 65 years and 55% were women. Based on the physical assessment findings, 14.6% of patients (n=292) had at least 1 pressure ulcer, with a total of 345 pressure ulcers documented among these patients: (stage I=162; stage II=120; stage III=22; stage IV=22 and unstageable=19). Based on coded information, 78 (3.9%) of patients had a pressure ulcer. Of patients with a pressure ulcer determined by the physical assessment, only 21% also had a pressure ulcer captured in the administrative data. Furthermore, only 6% of the patients with a hospital-acquired pressure ulcer, stage II or greater determined by the physical assessment were coded in the Discharge Abstract Database (DAD). The results of this study demonstrate that coding in the DAD may under-report and fail to accurately reflect the true burden of pressure ulcers in hospitalised patients. This may occur because the presence of pressure ulcers is currently documented in the health record by nurses and not by physicians, yet the administrative data recorded in the DAD only includes physician documented pressure ulcers. We recommend enhancements to the coding methods to monitor and report on pressure ulcers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Dressings as an adjunct to pressure ulcer prevention: consensus panel recommendations.

    PubMed

    Black, Joyce; Clark, Michael; Dealey, Carol; Brindle, Christopher T; Alves, Paulo; Santamaria, Nick; Call, Evan

    2015-08-01

    The formulation of recommendations on the use of wound dressings in pressure ulcer prevention was undertaken by a group of experts in pressure ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum(®) and 3 layer Mepilex Heel(®) dressings by Mölnlycke Health Care, Gothenburg, Sweden) for pressure ulcer prevention in the sacrum, buttocks and heels in high-risk patients, those in Emergency Department (ED), intensive care unit (ICU) and operating room (OR). Literature on which this recommendation is based includes one prospective randomised control trial, three cohort studies and two case series. Recommendations for dressing use in patients at high risk for pressure injury and shear injury were also provided.

  9. A Retrospective Analysis of Pressure Ulcer Incidence and Modified Braden Scale Score Risk Classifications.

    PubMed

    Chen, Hong-Lin; Cao, Ying-Juan; Wang, Jing; Huai, Bao-Sha

    2015-09-01

    The Braden Scale is the most widely used pressure ulcer risk assessment in the world, but the currently used 5 risk classification groups do not accurately discriminate among their risk categories. To optimize risk classification based on Braden Scale scores, a retrospective analysis of all consecutively admitted patients in an acute care facility who were at risk for pressure ulcer development was performed between January 2013 and December 2013. Predicted pressure ulcer incidence first was calculated by logistic regression model based on original Braden score. Risk classification then was modified based on the predicted pressure ulcer incidence and compared between different risk categories in the modified (3-group) classification and the traditional (5-group) classification using chi-square test. Two thousand, six hundred, twenty-five (2,625) patients (mean age 59.8 ± 16.5, range 1 month to 98 years, 1,601 of whom were men) were included in the study; 81 patients (3.1%) developed a pressure ulcer. The predicted pressure ulcer incidence ranged from 0.1% to 49.7%. When the predicted pressure ulcer incidence was greater than 10.0% (high risk), the corresponding Braden scores were less than 11; when the predicted incidence ranged from 1.0% to 10.0% (moderate risk), the corresponding Braden scores ranged from 12 to 16; and when the predicted incidence was less than 1.0% (mild risk), the corresponding Braden scores were greater than 17. In the modified classification, observed pressure ulcer incidence was significantly different between each of the 3 risk categories (P less than 0.05). However, in the traditional classification, the observed incidence was not significantly different between the high-risk category and moderate-risk category (P less than 0.05) and between the mild-risk category and no-risk category (P less than 0.05). If future studies confirm the validity of these findings, pressure ulcer prevention protocols of care based on Braden Scale scores can

  10. The Challenge of Predicting Pressure Ulcers in Critically Ill Patients. A Multicenter Cohort Study.

    PubMed

    Ranzani, Otavio T; Simpson, Evelyn Senna; Japiassú, André M; Noritomi, Danilo Teixeira

    2016-10-01

    Pressure ulcers are preventable events. Critically ill patients are particularly vulnerable. The Braden scale has been used to identify hospitalized patients at high risk for the development of pressure ulcers; however, this predictive tool has not been adequately validated for critically ill patients. We aimed to validate and improve the Braden scale for critically ill patients by adding clinical variables to the original scale. We conducted a cohort study in 12 intensive care units (ICUs) within a network of hospitals in Brazil during 2013. We excluded patients who stayed less than 48 hours, patients with one or more pressure ulcers at admission, and those who developed a pressure ulcer within the first 48 hours. We evaluated the Braden scale and clinical variables through a competing risk analysis. Discrimination and calibration were evaluated using the Concordance index (C-index) and a calibration plot, respectively. We used bootstrapping to assess internal validation. Our primary outcome was incident pressure ulcer within 30 days of ICU admission. We analyzed 9,605 patients and observed 157 pressure ulcers (rate of 3.33 pressure ulcers/1,000 patient-days). The majority of pressure ulcers were detected at stage I or II (28.7 and 66.2%, respectively). The Braden scale had good discrimination (C-index, 0.753; 95% confidence interval, 0.712-0.795), although its performance decreased for the most severely ill patients. We derived a modified predictive tool by adding eight clinical variables to the Braden scale: age, sex, diabetes mellitus, hematological malignancy, peripheral artery disease, hypotension at ICU admission, and need for mechanical ventilation or renal replacement therapy in the first 24 hours after ICU admission. The derived score had better discrimination and calibration than the original Braden scale. The best score cutoff was at least 6 points, with a sensitivity of 87% and a specificity of 71%. The original Braden scale measured at ICU admission

  11. Photographic assessment of the appearance of chronic pressure and leg ulcers.

    PubMed

    Houghton, P E; Kincaid, C B; Campbell, K E; Woodbury, M G; Keast, D H

    2000-04-01

    The purpose of this paper was to examine the validity and reliability of using photographs of wounds to accurately assess wound status. The results of assessing wound appearance using wound photographs was compared to results obtained from a bedside assessment using the Pressure Sore Status Tool (PSST). The photographic wound assessment tool (PWAT) used in this comparison represents a modified version of the PSST and includes the six domains that can be determined from wound photographs. The PWAT was used on photographs of both chronic pressure ulcers (n = 56) and leg ulcers due to vascular insufficiency (n = 81). The photographic tool has excellent intrarater (ICC = 0.96) and interrater (ICC = 0.73) reliability and good concurrent validity (r = 0.70) compared with a full bedside assessment PSST. The PWAT has also shown to be sensitive to change in wound appearance of healing ulcers, but not nonhealing ulcers. These results would suggest that in the event that a full bedside assessment is not possible, wound photographs may be used to accurately assess wound appearance of both chronic pressure ulcers located on the trunk and vascular ulcers of the lower extremity. Establishing a valid and reliable assessment of wound healing using photographic images is of great relevance to the advancing fields of computer image analysis and telemedicine.

  12. Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience

    DTIC Science & Technology

    2015-10-01

    AWARD NUMBER: W81XWH-14-1-0618 TITLE: Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury...Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience 5a. CONTRACT NUMBER...DISTRIBUTION / AVAILABILITY STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Development of a pressure

  13. Resina Draconis as a topical treatment for pressure ulcers: A systematic review and meta-analysis.

    PubMed

    Xu, Jiaqi; Xiong, Tian; Yang, Ying; Li, Jie; Mao, Jing

    2015-01-01

    In recent years, a number of studies have reported on Resina Draconis (RD) as a topical treatment for pressure ulcers. To evaluate these studies, we performed a systematic review and meta-analysis aimed to examine the efficacy of RD for pressure ulcers. We searched eight electronic databases to identify randomized controlled trials in which RD treatment was compared with other topical treatment of pressure ulcers from 1980 to 2014. Selection of studies, study appraisal, data extraction and analysis were undertaken using standard methods. Fourteen randomized controlled trials were included involving 618 patients. The results of the meta-analysis showed that, RD treatment was significantly associated with a higher healing rate for pressure ulcers (risk ratio 2.07, 95% confidence intervals 1.73-2.48, p < 0.001). The results of descriptive analysis showed that, compared with the control group, RD treatment shortened healing time. As for safety, adverse reactions had not been reported. These results suggest that RD can improve the healing rate for pressure ulcers and shorten the healing time, compared with other topical treatments. However, due to limited quality and quantity of the included studies, this conclusion needs to be proved by more high quality studies. © 2015 by the Wound Healing Society.

  14. Development and psychometric characteristics of the SCI-QOL Pressure Ulcers scale and short form

    PubMed Central

    Kisala, Pamela A.; Tulsky, David S.; Choi, Seung W.; Kirshblum, Steven C.

    2015-01-01

    Objective To develop a self-reported measure of the subjective impact of pressure ulcers on health-related quality of life (HRQOL) in individuals with spinal cord injury (SCI) as part of the SCI quality of life (SCI-QOL) measurement system. Design Grounded-theory based qualitative item development methods, large-scale item calibration testing, confirmatory factor analysis (CFA), and item response theory-based psychometric analysis. Setting Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. Participants Adults with traumatic SCI. Main Outcome Measures SCI-QOL Pressure Ulcers scale. Results 189 individuals with traumatic SCI who experienced a pressure ulcer within the past 7 days completed 30 items related to pressure ulcers. CFA confirmed a unidimensional pool of items. IRT analyses were conducted. A constrained Graded Response Model with a constant slope parameter was used to estimate item thresholds for the 12 retained items. Conclusions The 12-item SCI-QOL Pressure Ulcers scale is unique in that it is specifically targeted to individuals with spinal cord injury and at every stage of development has included input from individuals with SCI. Furthermore, use of CFA and IRT methods provide flexibility and precision of measurement. The scale may be administered in its entirety or as a 7-item “short form” and is available for both research and clinical practice. PMID:26010965

  15. Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes

    PubMed Central

    Fawzy, Olfat A; Arafa, Asmaa I; El Wakeel, Mervat A; Abdul Kareem, Shaimaa H

    2014-01-01

    BACKGROUND Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP) and other characteristics were assessed in a group of 100 Egyptian patients with diabetes with or without neuropathy and foot ulcers. The aim was to study the relationship between plantar pressure (PP) and neuropathy with or without ulceration and trying to clarify the utility of pedobarography as an ulceration risk assessment tool in patients with diabetes. SUBJECTS AND METHODS A total of 100 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS), for peripheral vascular disease using ankle brachial index, and for dynamic foot pressures using the MAT system (Tekscan). The studied patients were grouped into: (1) diabetic control group (DC), which included 37 patients who had diabetes without neuropathy or ulceration and MNDS ≤2; (2) diabetic neuropathy group (DN), which included 33 patients who had diabetes with neuropathy and MNDS >2, without current or a history of ulceration; and (3) diabetic ulcer group (DU), which included 30 patients who had diabetes and current ulceration, seven of those patients also gave a history of ulceration. RESULTS PP parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure (FFPPP), rearfoot peak plantar pressure (RFPPP), forefoot/rearfoot ratio (F/R), forefoot peak pressure gradient (FFPPG) rearfoot peak pressure gradient (RFPPG), and forefoot peak pressure gradient/rearfoot peak pressure gradient (FFPPG/RFPPG) (P < 0.05). FFPPP and F/R were significantly higher in the DU group compared to the DN and DC groups (P < 0.05), with no significant difference between DN and DC. FFPPG was significantly higher in the DU and DN groups compared to the DC group (P < 0.05). RFPPP and FFPPG/RFPPG were significantly higher in the DU and DN

  16. Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers.

    PubMed

    Visscher, Marty O; White, Cynthia C; Jones, Jennifer M; Cahill, Thomas; Jones, Donna C; Pan, Brian S

    2015-11-01

    Pressure ulcers (stages III and IV) are serious safety events (ie, never events). Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers at our institution. A prospective cohort study investigated factors contributing to pressure ulcer development in 50 subjects using face masks for noninvasive ventilation. Color imaging, 3-dimensional surface imaging, and skin hydration measurements were used to identify early skin compromise and evaluate 3 interventions to reduce trauma: (1) a silicone foam dressing, (2) a water/polyethylene oxide hydrogel dressing, and (3) a flexible cloth mask. A novel mask fit technique was used to examine the impact of fit on the potential for skin compromise. Fifty subjects age 10.4 ± 9.1 y participated with color images for 22, hydration for 34, and mask fit analysis for 16. Of these, 69% had diagnoses associated with craniofacial anomalies. Stage I pressure ulcers were the most common injury. Skin hydration difference was 317 ± 29 for sites with erythema versus 75 ± 28 for sites without erythema (P < .05) and smallest for the cloth mask (P < .05). Fit distance metrics differed for the nasal, oronasal, and face shield interfaces, with threshold distances being higher for the oronasal mask than the others (P < .05). Areas of high contact were associated with skin erythema and pressure ulcers. This fit method is currently being utilized to select best-fit masks from available options, to identify the potential areas of increased tissue pressure, and to prevent skin injuries and their complications. Improvement of mask fit is an important priority for improving respiratory outcomes. Strategies to maintain normal skin hydration are important for protecting tissue integrity. Copyright © 2015 by Daedalus Enterprises.

  17. Evaluation of a formal care worker educational intervention on pressure ulceration in the community.

    PubMed

    Cross, Carol; Hindley, Jenny; Carey, Nicola

    2017-09-01

    To develop and evaluate an educational intervention for formal care workers on pressure ulceration in the community. Pressure ulcers are a major burden to health care and with an ageing population likely to increase. Formal care workers are ideally placed to identify high risk but lack standardised educational provision. An insider approach to action research in one provider organisation, November 2014-May 2015. Number and categorisation of pressure ulcers, within three community nursing teams before and four months after intervention was delivered to a purposive sample (n = 250) of formal care workers, were assessed and the taught element evaluated using a questionnaire and verbal feedback. Total number of pressure ulcers reduced from 28-20, category II, 19-11, III unchanged at 6 and IV from 2-0 following the educational intervention. Key risk factors included impaired mobility (71%), urinary incontinence (61%) and previous pressure damage (25%), and 71% had formal care worker input. The intervention was highly rated 4·95/5 by 215 (86%) formal care workers in the evaluation questionnaire. Formal care workers receive little, if any, education on pressure ulceration. An educational intervention can have a positive effect within community care, with the potential to reduce direct costs of care. However, a standardised approach to education is required; an urgent review of the education provision to formal care workers, in the UK and around the world, is therefore essential if the potential that formal care workers offer is to be realised. Formal care workers are ideally placed to help identify and alert healthcare professionals about patients at high risk of developing pressure ulcers. If this potential is to be realised, a standardised approach to education is required. © 2016 John Wiley & Sons Ltd.

  18. Is the use of low-pressure pulsatile lavage for pressure ulcer management associated with environmental contamination with Acinetobacter baumannii?

    PubMed

    Ho, Chester H; Johnson, Tova; Miklacic, Joan; Donskey, Curtis J

    2009-10-01

    Ho CH, Johnson T, Miklacic J, Donskey CJ. Is the use of low-pressure pulsatile lavage for pressure ulcer management associated with environmental contamination with Acinetobacter baumannii? To determine the extent of environmental contamination associated with low-pressure pulsatile lavage of stage III or IV pressure ulcers in patients with spinal cord injury (SCI) when routine infection control precautions are used for wounds colonized or infected with Acinetobacter baumannii. Prospective investigation in which pressure ulcer cultures and environmental cultures were obtained before and after low-pressure pulsatile lavage treatment, and before and after regular dressing changes. Environmental cultures included the patient's bedrail and settle plates placed 0.6, 1.5, and 2.4m from the wound to assess airborne spread of A. baumannii. SCI inpatient unit in a Department of Veterans Affairs Medical Center. Inpatients (N=15) with SCI receiving daily low-pressure pulsatile lavage treatment for stage III or IV pressure ulcers with standard dressing change, as well as regular dressing changes without low-pressure pulsatile lavage at other times of the day. Standard, regular dressing changes and dressing changes with low-pressure pulsatile lavage. Comparison of frequency of environmental contamination with A. baumannii associated with low-pressure pulsatile lavage versus regular dressing changes. Of the 15 SCI inpatients meeting inclusion criteria, 9 (60%) grew A. baumannii from their wounds. Of the 9 patients with wound cultures positive for A. baumannii, only 1 (11%) had environmental contamination with this organism after performance of low-pressure pulsatile lavage, and the same patient had environmental contamination after a standard dressing change. The antibiotic susceptibility patterns of the wound and environmental A. baumannii isolates were identical. Low-pressure pulsatile lavage using the infection control methods described is not associated with an increased

  19. Iyengar Yoga Therapy Intervention for Ischial Pressure Ulcers in a Patient with Amyotrophic Lateral Sclerosis: A Case Study.

    PubMed

    Ribeiro, Subbappa

    2015-09-01

    Although some research suggests that the formation of pressure ulcers is rare in patients with amyotrophic lateral sclerosis (ALS), several patients have nonetheless developed this problem. To date, however, no case reports in the literature have described patients with ALS who develop ischial pressure ulcers. Outside of the ALS literature, evidence suggests that ischial pressure ulcers frequently develop in wheelchair users and also in patients treated in various health care settings. A patient diagnosed with ALS reported the development of ischial pressure ulcers after consistent immobility for 1 year (32 months after her ALS diagnosis). This patient, who was sitting on the wounds, was treated with ointment and morphine; the latter was ineffective in controlling the pain. Moving the patient from sitting to supine, lateral, or semilateral positions, either on the bed or wheelchair, to separate the ulcers from the surface of the chair or bed was deemed impossible because of exaggeration of other symptoms, including shortness of breath and pain in other parts of the body. A new method of postural alignment was developed to alleviate the pain associated with the pressure ulcer. This method, Iyengar yoga therapy, which uses props to reposition a patient, alleviated pain and healing of two pressure ulcers of the patient after 3 weeks of starting this intervention. Although the ischial pressure ulcers were successfully treated in a patient with ALS, further study is necessary to investigate the effectiveness of this postural alignment intervention in ALS and other patient populations for the management of ischial pressure ulcers.

  20. Enhancing host resistance to pressure ulcers: a new approach to prevention.

    PubMed

    Mawson, A R; Siddiqui, F H; Biundo, J J

    1993-05-01

    Pressure ulcers are notoriously common in spinal-cord-injured patients, in patients with other neurological deficits, in malnourished and severely debilitated patients, and in the frail elderly. Prolonged localized external pressure, coupled with insensitivity to ischemia resulting from neurologic injury, has long been considered the major causal factor. Preventive efforts have focused on the relief of pressure via frequent repositioning and the use of pressure-relieving devices. However, consensus is growing that host factors also play a role in the development of pressure ulcers, the most important in spinal-cord-injured patients being the injury-induced loss of vasomotor control below the level of the lesion, resulting in hypoxemia. Accordingly, pressure ulcers may be prevented not only by reducing external pressure but also by increasing the patient's resistance to pressure, that is, by directly influencing tissue oxygenation. Review of the literature suggests that electrical stimulation increases cutaneous blood flow and promotes the healing of pressure ulcers. Moreover, high-voltage pulsed galvanic stimulation (75 V, 10 Hz) applied to the back at spinal level T6 in spinal-cord-injured persons lying supine on egg-crate mattresses can raise sacral transcutaneous oxygen tension levels into the normal ranges (A. R. Mawson, F. H. Siddiqui, B. J. Connolly, C. J. Sharp, W. R. Summer, and J. J. Biundo, Jr., Paraplegia in press). Randomized controlled trials are needed to determine the efficacy of high-voltage pulsed galvanic stimulation for preventing pressure ulcers in spinal-cord-injured persons and other groups at high risk.

  1. Prevalence of postoperative pressure ulcer: A systematic review and meta-analysis

    PubMed Central

    Shafipour, Vida; Ramezanpour, Ensieh; Gorji, Mohammad Ali Heidari; Moosazadeh, Mahmood

    2016-01-01

    Introduction A pressure ulcer is a serious safety issue in healthcare systems. The patient’s rate of infection with an ulcer, especially a postoperative ulcer, is critical, as it is dictated by factors such as being in a fixed position during surgery, the type of anesthesia used, the duration of surgery, and patient-related factors. The present study was conducted to carry out a systematic assessment of the prevalence of a postoperative pressure ulcer and to find its general prevalence using a meta-analysis. Methods The researchers searched databases, including PubMed, Google Scholar, Scopus, Science Direct, the Thomson Reuters’ Web of Science (WOS). For English articles published online between January 2000 and October 2015 on the subject of a pressure ulcer, a total of 19 articles were ultimately selected based on the study inclusion criteria. Then results were analyzed in Stata-11. Results The 19 articles qualified for entering the meta-analysis examined a total of 9527 patients. The studies estimated the general prevalence of a postoperative pressure ulcer as 18.96% (CI 95%: 15.3–22.6); the prevalence by gender was reported as 10.1% (CI 95%: 7.2–13.01) in men and 12.8% (CI 95%: 8.3–17.2) in women. Stage 1 ulcer had a 17.02% prevalence (CI 95%: 11.04–22.9), stage 2 a 6.7% prevalence (CI 95%: 3.8–9.7), stage 3 a 0.9% prevalence (CI 95%: 0.2–1.6), and stage 4 a 0.4% (CI 95%: −0.05–0.8) prevalence. Conclusion The prevalence of a postoperative pressure ulcer is high among the entire population; however, it is still higher in women than in men. The prevalence of a stage 1 ulcer is higher than the prevalence of the other stages of an ulcer. PMID:28070249

  2. Reduced pressure for fewer pressure ulcers: can real-time feedback of interface pressure optimise repositioning in bed?

    PubMed

    Gunningberg, Lena; Carli, Cheryl

    2016-10-01

    The aim of this study was to (i) describe registered nurses' and assistant nurses' repositioning skills with regard to their existing attitudes to and theoretical knowledge of pressure ulcer (PU) prevention, and (ii) evaluate if the continuous bedside pressure mapping (CBPM) system provides staff with a pedagogic tool to optimise repositioning. A quantitative study was performed using a descriptive, comparative design. Registered nurses (n = 19) and assistant nurses (n = 33) worked in pairs, and were instructed to place two volunteers (aged over 70 years) in the best pressure-reducing position (lateral and supine), first without viewing the CBPM monitor and then again after feedback. In total, 240 positionings were conducted. The results show that for the same person with the same available pressure-reducing equipment, the peak pressure varied considerably between nursing pairs. Reducing pressure in the lateral position appeared to be the most challenging. Peak pressures were significantly reduced, based on visual feedback from the CBPM monitor. The number of preventive interventions also increased, as well as patients' comfort. For the nurses as a group, the knowledge score was 59·7% and the attitude score was 88·8%. Real-time visual feedback of pressure points appears to provide another dimension to complement decision making with respect to PU prevention. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  3. The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: a cross-sectional study.

    PubMed

    Bredesen, Ida Marie; Bjøro, Karen; Gunningberg, Lena; Hofoss, Dag

    2015-01-01

    Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals. To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level. A cross-sectional study. Six of the 11 invited hospitals in South-Eastern Norway agreed to participate. Inpatients ≥18 years at 88 somatic hospital wards (N=1209). Patients in paediatric and maternity wards and day surgery patients were excluded. The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels. The prevalence was 18.2% for pressure ulcer category I-IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level. Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Hematological change parameters in patients with pressure ulcer at long-term care hospital

    PubMed Central

    Neiva, Giselle Protta; Carnevalli, Julia Romualdo; Cataldi, Rodrigo Lessa; Furtado, Denise Mendes; Fabri, Rodrigo Luiz; Silva, Pâmela Souza

    2014-01-01

    Objective To assess factors associated with the development of pressure ulcers, and to compare the effectiveness of pharmacological treatments. Methods The factors associated with the development of pressure ulcers were compared in lesion-carrying patients (n=14) and non-carriers (n=16). Lesion-carrying patients were treated with 1% silver sulfadiazine or 0.6IU/g collagenase and were observed for 8 weeks. The data collected was analyzed with p<0.05 being statistically relevant. Results The prevalence of pressure ulcers was about 6%. The comparison of carrier and non-carrier groups of pressure ulcers revealed no statistically significant difference in its occurrence with respect to age, sex, skin color, mobility, or the use of diapers. However, levels of hemoglobin, hematocrit, and red blood cells were found to be statistically different between groups, being lower in lesion-carrying patients. There was no significant difference found in lesion area between patients treated with collagenase or silver sulfadiazine, although both groups showed an overall reduction in lesion area through the treatment course. Conclusion Hematologic parameters showed a statistically significant difference between the two groups. Regarding the treatment of ulcers, there was no difference in the area of the lesion found between the groups treated with collagenase and silver sulfadiazine. PMID:25295450

  5. Prevention of facial pressure ulcers using the Mayfield clamp for sacral tumor resection.

    PubMed

    Goodwin, C Rory; Recinos, Pablo F; Omeis, Ibrahim; Momin, Eric N; Witham, Timothy F; Bydon, Ali; Gokaslan, Ziya L; Wolinsky, Jean-Paul

    2011-01-01

    Sacral neoplasm resection is managed via partial or total sacrectomy that is performed via the Kraske approach. The combination of the patients positioning and the relatively long operative time required for this procedure increase the risk of pressure ulcers. Facial pressure ulcers can cause tissue necrosis and/or ulceration in a highly visible area, leading to a cosmetically disfiguring lesion. Here, the authors report the use of a Mayfield clamp in the positioning of patients undergoing sacral tumor resection to prevent facial pressure ulceration. After the patient is placed prone in the Kraske or Jackknife position, the hips and knees are flexed with arms to the side. Then while in the prone position, the patient is physically placed in pins, and the Mayfield clamp is fixated at the center of the metal arch via the Mayfield sitting adapter to the Andrews frame, suspending the head (and face) over the table. The authors find that this technique prevents the development of facial pressure ulcers, and it has the potential to be used in patients positioned in the Kraske position for other surgical procedures.

  6. Risk management for pressure ulcers: when the family shows up with a camera.

    PubMed

    Levine, Jeffrey M; Savino, Fay; Peterson, Marilyn; Wolf, Carolyn Reinach

    2008-06-01

    Pressure ulcers, although sometimes unavoidable, are frequently viewed as a failure of the health care system. Private civil lawsuits alleging malpractice or negligence related to pressure ulcers are becoming increasingly common. Because of their graphic nature, a photograph of a wound may add value to a plaintiff's case whether or not a negligent act has truly occurred. When the family shows up with a camera, caregivers should be "on notice" that a lawsuit may occur. This applies not only to nursing homes, but to any setting in which pressure ulcers occur including hospital, rehabilitation facility, home care, or hospice. When the threat of litigation arises, we recommend steps that include reestablishing trust with the family, reassessing the patient, reevaluating the care plan, documenting problem behaviors, and incorporating Quality Improvement principles.

  7. Personalized modeling for real-time pressure ulcer prevention in sitting posture.

    PubMed

    Luboz, Vincent; Bailet, Mathieu; Boichon Grivot, Christelle; Rochette, Michel; Diot, Bruno; Bucki, Marek; Payan, Yohan

    2017-06-15

    Ischial pressure ulcer is an important risk for every paraplegic person and a major public health issue. Pressure ulcers appear following excessive compression of buttock's soft tissues by bony structures, and particularly in ischial and sacral bones. Current prevention techniques are mainly based on daily skin inspection to spot red patches or injuries. Nevertheless, most pressure ulcers occur internally and are difficult to detect early. Estimating internal strains within soft tissues could help to evaluate the risk of pressure ulcer. A subject-specific biomechanical model could be used to assess internal strains from measured skin surface pressures. However, a realistic 3D non-linear Finite Element buttock model, with different layers of tissue materials for skin, fat and muscles, requires somewhere between minutes and hours to compute, therefore forbidding its use in a real-time daily prevention context. In this article, we propose to optimize these computations by using a reduced order modeling technique (ROM) based on proper orthogonal decompositions of the pressure and strain fields coupled with a machine learning method. ROM allows strains to be evaluated inside the model interactively (i.e. in less than a second) for any pressure field measured below the buttocks. In our case, with only 19 modes of variation of pressure patterns, an error divergence of one percent is observed compared to the full scale simulation for evaluating the strain field. This reduced model could therefore be the first step towards interactive pressure ulcer prevention in a daily set-up. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  8. Pressure Ulcer Incidence in Patients Wearing Nasal-Oral Versus Full-Face Noninvasive Ventilation Masks.

    PubMed

    Schallom, Marilyn; Cracchiolo, Lisa; Falker, Antoinette; Foster, Jennifer; Hager, JoAnn; Morehouse, Tamara; Watts, Peggy; Weems, Linda; Kollef, Marin

    2015-07-01

    Device-related pressure ulcers from noninvasive ventilation masks alter skin integrity and cause patients discomfort. To examine the incidence, location, and stage of pressure ulcers and patients' comfort with a nasal-oral mask compared with a full-face mask. A before-after study of a convenience sample of patients with noninvasive ventilation orders in 5 intensive care units was conducted. Two groups of 100 patients each received either the nasal-oral mask or the full-face mask. Skin was assessed before the mask was applied and every 12 hours after that or upon mask removal. Comfort levels were assessed every 12 hours on a Likert scale of 1 to 5 (1, most comfortable). A pressure ulcer developed in 20% of patients in the nasal-oral mask group and 2% of patients in the full-face mask group (P < .001). Comfort scores were significantly lower (more comfortable) with the full-face mask (mean [SD], 1.9 [1.1]) than with the nasal-oral mask (mean [SD], 2.7 [1.2], P < .001). Neither mean hours worn nor percentage adherence differed significantly: 28.9 (SD, 27.2) hours and 92% for full-face mask and 25 (SD, 20.7) and 92% for nasal-oral mask. No patients who had a pressure ulcer develop with the nasal-oral mask had a pressure ulcer develop with the full-face mask. The full-face mask resulted in significantly fewer pressure ulcers and was more comfortable for patients. The full-face mask is a reasonable alternative to traditional nasal-oral masks for patients receiving noninvasive ventilation. ©2015 American Association of Critical-Care Nurses.

  9. Inpatient Pressure Ulcer Prevalence in an Acute Care Hospital Using Evidence-Based Practice.

    PubMed

    Beal, M Elizabeth; Smith, Kimberly

    2016-04-01

    A national goal was set in 2004 for decreasing hospital-acquired pressure ulcers (HAPUs). A mean to achieve that goal was initiated in 2005 with long-term care facilities. Acute care facilities, with encouragement from the Centers for Medicare and Medicaid Services, took action. Pressure ulcer prevention efforts at MaineGeneral Medical Center (MGMC), a 192-bed acute care hospital in Augusta, Maine, sought to reduce HAPU prevalence from a mean of 7.8% in 2005. A retrospective study over a 10-year period, from 2005 through 2014, tracked HAPUs and evidence-based practice (EBP) initiatives to decrease the annual mean prevalence rate. The annual mean HAPU prevalence rate of 7.8% in 2005 decreased to 1.4% in 2011, then maintaining this level through 2014 at MGMC. Evidence-based practices for pressure ulcer prevention were implemented using data collection tools from the National Database of Nursing Quality Indicators; guidelines from the National Pressure Ulcer Advisory Panel; and procedural guidance tools from the 5 Million Lives Campaign and the Agency for Healthcare Research and Quality. Accurate data collection methods and evidence-based guidelines are vital to improving care; yet planning with annual review, fostering an EBP culture, by-in of stakeholders, and education, are the means to long-term consistent implementation of pressure ulcer prevention measures. Keys to decreasing and maintaining the rate were based on effective scientific evidence for prevention of pressure ulcers: assessment tools, education, planning guidance, documentation, and evidence-based practice guidelines. © 2016 Sigma Theta Tau International.

  10. Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers.

    PubMed

    Bosch, Marije; Halfens, Ruud J G; van der Weijden, Trudy; Wensing, Michel; Akkermans, Reinier; Grol, Richard

    2011-03-01

    Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high-quality care is inconsistent. To determine if the type of organizational culture (Competing Values Framework), team climate (Team Climate Inventory), and preventive pressure ulcer quality management at ward level were related to the prevalence of pressure ulcers. Also, we wanted to determine if the type of organizational culture, team climate, or the institutional quality management related to preventive quality management at the ward level. In this cross-sectional observational study multivariate (logistic) regression analyses were performed, adjusting for potential confounders and institution-level clustering. Data from 1274 patients and 460 health care professionals in 37 general hospital wards and 67 nursing home wards in the Netherlands were analyzed. The main outcome measures were nosocomial pressure ulcers in patients at risk for pressure ulcers (Braden score ≤ 18) and preventive quality management at ward level. No associations were found between organizational culture, team climate, or preventive quality management at the ward level and the prevalence of nosocomial pressure ulcers. Institutional quality management was positively correlated with preventive quality management at ward level (adj. β 0.32; p < 0.001). Although the prevalence of nosocomial pressure ulcers varied considerably across wards, it did not relate to organizational culture, team climate, or preventive quality management at the ward level. These results would therefore not subscribe the widely suggested importance of these factors in improving health care. However, different designs and research methods (that go beyond the cross-sectional design) may be more informative in studying relations between such complex factors and outcomes in a more meaningful way

  11. Identifying and classifying quality-of-life tools for assessing pressure ulcers after spinal cord injury

    PubMed Central

    Hitzig, Sander L.; Balioussis, Christina; Nussbaum, Ethne; McGillivray, Colleen F.; Catharine Craven, B.; Noreau, Luc

    2013-01-01

    Context Although pressure ulcers may negatively influence quality of life (QoL) post-spinal cord injury (SCI), our understanding of how to assess their impact is confounded by conceptual and measurement issues. To ensure that descriptions of pressure ulcer impact are appropriately characterized, measures should be selected according to the domains that they evaluate and the population and pathologies for which they are designed. Objective To conduct a systematic literature review to identify and classify outcome measures used to assess the impact of pressure ulcers on QoL after SCI. Methods Electronic databases (Medline/PubMed, CINAHL, and PsycInfo) were searched for studies published between 1975 and 2011. Identified outcome measures were classified as being either subjective or objective using a QoL model. Results Fourteen studies were identified. The majority of tools identified in these studies did not have psychometric evidence supporting their use in the SCI population with the exception of two objective measures, the Short-Form 36 and the Craig Handicap Assessment and Reporting Technique, and two subjective measures, the Life Situation Questionnaire-Revised and the Ferrans and Powers Quality of Life Index SCI-Version. Conclusion Many QoL outcome tools showed promise in being sensitive to the presence of pressure ulcers, but few of them have been validated for use with SCI. Prospective studies should employ more rigorous methods for collecting data on pressure ulcer severity and location to improve the quality of findings with regard to their impact on QoL. The Cardiff Wound Impact Schedule is a potential tool for assessing impact of pressure ulcers-post SCI. PMID:24090238

  12. [Design and evaluation of preventive seats for pressure ulcers associated with spinal injuries].

    PubMed

    Gayol-Mérida, Diana Alicia; Pérez-Zavala, Ramiro; Reyes-Aguilar, Primitivo; Pineda, Carlos

    2014-07-01

    Pressure ulcers are a dominant health problem for people who, for various reasons, must spend most of their time in a seated position. The spinal cord injury patients are the most affected for this situation. One strategy to prevent pressure ulcers is throughthe use of special seats. In the Instituto Nacional de Rehabilitación, contoured special seats have been developed according to anatomical measure of spinal cord injured patients. To find one or more combinations of test materials that reduced pressure below 60 mmHg, in the ischial area, in order to help to prevent pressure ulcers. The special seats were fabricated using thermoplastic materials and polyurethane foams, following prosthetic fitting technique; and were tests in healthy volunteers. The results were compared with a vinyl seat, because most of wheelchairs have it. All different test combinations were superior to vinyl seat, specially the two polyurethane foam- polypropylene combinations. A group of nine patients with spinal cord injury were recruited to test the designed seats, for a three month period. The results showed that pressure values are lower in the special seats than in the vinyl seats. No complications or pressure ulcers were found during follow up.

  13. Clinical Evaluation of a New Pressure Ulcer Risk Assessment Instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T).

    PubMed

    Coleman, Susanne; Smith, Isabelle L; McGinnis, Elizabeth; Keen, Justin; Muir, Delia; Wilson, Lyn; Stubbs, Nikki; Dealey, Carol; Brown, Sarah; Nelson, E Andrea; Nixon, Jane

    2017-08-23

    To test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter-rater and test-retest reliability, convergent validity and data completeness. Methodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056). Observational field test. For this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from 4 secondary care and 4 community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE-T assessments were undertaken. Follow-up retest was undertaken by the expert nurse. Field notes of PURPOSE-T use were collected. Data were collected October 2012-Jan 2013. The clinical evaluation demonstrated 'very good' (kappa) inter-rater and test-retest agreement for PURPOSE-T assessment decision overall. The percentage agreement for 'problem/no problem' was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs. The PURPOSE-T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE-T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  14. Management of Marjolin's ulcer in a chronic pressure sore secondary to paraplegia: a radical surgical solution.

    PubMed

    Fairbairn, Neil G; Hamilton, Stuart A

    2011-10-01

    Marjolin's ulcer refers to malignant degeneration in a chronic wound. Although originally described in an area of burns scar, many other chronic wounds such as osteomyelitis sinus tracts, venous stasis ulcers and chronic pressure sores have the potential to undergo malignant transformation. We present an interesting case of malignant degeneration in a male paraplegic patient with chronic sacral and ischial pressure sores. By discussing our radical surgical solution to this problem, we aim to highlight the importance of prompt diagnosis. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  15. [Systematic pressure ulcer risk management.: Results of implementing multiple interventions at Charité-Universitätsmedizin Berlin].

    PubMed

    Hauss, Armin; Greshake, Susanne; Skiba, Thomas; Schmidt, Kristine; Rohe, Julia; Jürgensen, Jan Steffen

    2016-01-01

    Pressure ulcers impose a high burden of disease on both the affected individual and society. Demographic change and multimorbidity aggravate the problem. The present study describes the systematic implementation of a comprehensive approach to reduce the incidence of pressure ulcers in an inpatient setting. The introduction of systematic risk assessment and the subsequent risk-adjusted application of evidence-based prevention, combined with continuous feedback of outcomes as well as tailored training, were associated with a significant decline in the incidence of pressure ulcers. Especially the occurrence of high-grade ulcers could be minimized by this systems approach.

  16. The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial.

    PubMed

    Chaboyer, Wendy; Bucknall, Tracey; Webster, Joan; McInnes, Elizabeth; Gillespie, Brigid M; Banks, Merrilyn; Whitty, Jennifer A; Thalib, Lukman; Roberts, Shelley; Tallott, Mandy; Cullum, Nicky; Wallis, Marianne

    2016-12-01

    Hospital-acquired pressure ulcers are a serious patient safety concern, associated with poor patient outcomes and high healthcare costs. They are also viewed as an indicator of nursing care quality. To evaluate the effectiveness of a pressure ulcer prevention care bundle in preventing hospital-acquired pressure ulcers among at risk patients. Pragmatic cluster randomised trial. Eight tertiary referral hospitals with >200 beds each in three Australian states. 1600 patients (200/hospital) were recruited. Patients were eligible if they were: ≥18 years old; at risk of pressure ulcer because of limited mobility; expected to stay in hospital ≥48h and able to read English. Hospitals (clusters) were stratified in two groups by recent pressure ulcer rates and randomised within strata to either a pressure ulcer prevention care bundle or standard care. The care bundle was theoretically and empirically based on patient participation and clinical practice guidelines. It was multi-component, with three messages for patients' participation in pressure ulcer prevention care: keep moving; look after your skin; and eat a healthy diet. Training aids for patients included a DVD, brochure and poster. Nurses in intervention hospitals were trained in partnering with patients in their pressure ulcer prevention care. The statistician, recruiters, and outcome assessors were blinded to group allocation and interventionists blinded to the study hypotheses, tested at both the cluster and patient level. The primary outcome, incidence of hospital-acquired pressure ulcers, which applied to both the cluster and individual participant level, was measured by daily skin inspection. Four clusters were randomised to each group and 799 patients per group analysed. The intraclass correlation coefficient was 0.035. After adjusting for clustering and pre-specified covariates (age, pressure ulcer present at baseline, body mass index, reason for admission, residence and number of comorbidities on

  17. Plantar pressure and daily cumulative stress in persons affected by leprosy with current, previous and no previous foot ulceration.

    PubMed

    van Schie, Carine H M; Slim, Frederik J; Keukenkamp, Renske; Faber, William R; Nollet, Frans

    2013-03-01

    Not only plantar pressure but also weight-bearing activity affects accumulated mechanical stress to the foot and may be related to foot ulceration. To date, activity has not been accounted for in leprosy. The purpose was to compare barefoot pressure, in-shoe pressure and daily cumulative stress between persons affected by leprosy with and without previous or current foot ulceration. Nine persons with current plantar ulceration were compared to 15 with previous and 15 without previous ulceration. Barefoot peak pressure (EMED-X), in-shoe peak pressure (Pedar-X) and daily cumulative stress (in-shoe forefoot pressure time integral×mean daily strides (Stepwatch™ Activity Monitor)) were measured. Barefoot peak pressure was increased in persons with current and previous compared to no previous foot ulceration (mean±SD=888±222 and 763±335 vs 465±262kPa, p<0.05). In-shoe peak pressure was only increased in persons with current compared to without previous ulceration (mean±SD=412±145 vs 269±70kPa, p<0.05). Daily cumulative stress was not different between groups, although persons with current and previous foot ulceration were less active. Although barefoot peak pressure was increased in people with current and previous plantar ulceration, it did not discriminate between these groups. While in-shoe peak pressure was increased in persons with current ulceration, they were less active, resulting in no difference in daily cumulative stress. Increased in-shoe peak pressure suggests insufficient pressure reducing footwear in persons with current ulceration, highlighting the importance of pressure reducing qualities of footwear.

  18. Nurses' Knowledge, Practices, and Barriers in Care of Patients with Pressure Ulcers in a Ugandan Teaching Hospital

    PubMed Central

    Mwebaza, Ivan; Katende, Godfrey; Groves, Sara; Nankumbi, Joyce

    2014-01-01

    Pressure ulcers have been identified as a major burden of hospitalization worldwide, and nurses are at the forefront of prevention. The purpose of this study was to determine the nurses' knowledge and practices regarding risk factors, prevention, and management of pressure ulcers at a teaching hospital in Uganda. The study employed a descriptive cross-sectional design. Fifty-six Ugandan registered practicing nurses were sampled. A composite self-administered questionnaire and an observation checklist were utilized. The nurses had limited knowledge about critical parameters of pressure ulcers. Prevention practices were observed to be unreliable and uncoordinated related to a significant shortage of staff and logistics for pressure ulcer prevention. Nurses had poor access to current literature on pressure ulcer prevention. Translation of nurses' knowledge into practice is possible if barriers like staff shortage, pressure relieving devices provision, and risk assessment tools are addressed at Mulago. PMID:24707398

  19. Systematic Review and Operative Technique of Recalcitrant Pressure Ulcers Using a Fillet Flap Technique

    PubMed Central

    Rao, Venkat K.

    2016-01-01

    Background: The purpose of this article is to describe the indications, operative technique, outcomes, and systematic review of the literature on the reconstruction of patients with end-stage pressure ulcers using a fillet flap technique. In this technique, the femur, tibia, and fibula are removed from the thigh and leg, and the soft tissue is used as a pedicled, or free, myocutaneous flap for reconstruction. Long-term outcomes, salient surgical technique of flap elevation, and design are detailed for patients who had a fillet of leg flap for reconstruction of extensive pressure ulcers. Methods: The indications, surgical technique, and postoperative outcomes of 5 patients who had pedicled fillet flaps are reviewed including patient age, sex, underlying comorbidities, duration of paraplegia, operative technique, and complications. A systematic review of the literature was performed searching PubMed, Cochrane Database, and Medline with the following MeSH terms: pressure ulcer, pressure sore, decubitus ulcer, fillet flap, and fillet flap. Inclusion criteria were use of a fillet technique, article data on the number of reconstructions before fillet flap, complications, and English language. Results: Most of our patients were male 75% (n = 3) with an average age of 47.5 years, had been paralyzed for an average of 16 years, and had few medical comorbidities. Two patients (3 flaps) required hip disarticulation, 1 patient had a bilateral fillet flaps, and 3 patients had resection of tibia/fibula. After following patients for an average of 1.4 years (4 mo to 2 yr), complications were limited to 1 patient who had partial-thickness flap loss at the distal skin flap that healed by secondary intention and 1 patient who had ulcer recurrence because of noncompliance. Four articles met inclusion criteria for systematic review and 3 were excluded. Conclusions: The fillet of leg flap remains a useful and reliable method of reconstructing end-stage pressure ulcers. PMID:27622082

  20. Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury.

    PubMed

    Cogan, Alison M; Blanchard, Jeanine; Garber, Susan L; Vigen, Cheryl Lp; Carlson, Mike; Clark, Florence A

    2017-07-01

    To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI). Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication. Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results. The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported. At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.

  1. Design and development of the pressure ulcer nursing information system for clinical risk management.

    PubMed

    Chan, W C F; Wong, K S T; Pang, M C S; Fan, K L; Au, Y M A; Chan, E; Chong, C K D; Aboo, G; Leung, S K C

    2006-01-01

    Since 2002, hospitals have to report to Nursing Service Department, Hospital Authority Head Office on the pressure ulcer trends for risk management in Hong Kong. In line with the strategy, hospitals have designed their own patient observation records and reporting forms for monthly analysis and reporting of in-patient hospital acquired pressure ulcers. The incidence rates of individual hospital and its specialties are then calculated manually or using electronic spread sheets. However, the diversity in data definition and vocabulary use generates difficulties in communication among professionals and hospital managers. The development of the system would help to standardize the requirements and to reduce the time required for generating trends and ulcer information. The system also lays the foundation for future systems integration with the changing information system infrastructure.

  2. Acemannan hydrogel dressing versus saline dressing for pressure ulcers. A randomized, controlled trial.

    PubMed

    Thomas, D R; Goode, P S; LaMaster, K; Tennyson, T

    1998-10-01

    Aloe vera has been used for centuries as a topical treatment for various conditions and as a cathartic. An amorphous hydrogel dressing derived from the aloe plant (Carrasyn Gel Wound Dressing, Carrington Laboratories, Inc., Irving, TX) is approved by the Food and Drug Administration for the management of Stages I through IV pressure ulcers. To evaluate effectiveness of this treatment, 30 patients were randomized to receive either daily topical application of the hydrogel study dressing (acemannan hydrogel wound dressing) or a moist saline gauze dressing. Complete healing of the study ulcer occurred in 19 of 30 subjects (63%) during the 10-week observation period. No difference was observed in complete healing between the experimental and the control groups (odds ratio 0.93, 95% CI 0.16, 5.2). This study indicates that the acemannan hydrogel dressing is as effective as, but is not superior to, a moist saline gauze wound dressing for the management of pressure ulcers.

  3. Potential efficiency of antioxidants to prevent pressure ulcers. A neglected hypothesis.

    PubMed

    Bonne, Claude

    2016-06-01

    Pressure ulcers are necrotic lesions mainly due to capillary hypoperfusion. It is well known that hypoxia and also subsequent oxygenation at reperfusion provoke the formation of reactive oxygen species (ROS) responsible for cell death. The hypothesis of their participation in the pathogenesis of pressure ulcers has already been tested; several antioxidants have the capacity to inhibit skin necrosis in animal models but their efficiency in preventing bedsores has never been demonstrated in patients. The failure of clinical trials to show the protective activity of some antioxidants does not rule out the involvement of ROS in ischemic ulcers and the potential efficacy of other antioxidants in preventing their formation remains possible. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Longitudinal Outcomes of Home Care in Korea to Manage Pressure Ulcers.

    PubMed

    Lee, Eunhee

    2017-06-01

    Home care provides preventive, support, and treatment services to economically vulnerable community populations. In this study, we examined the outcomes of a home care program for pressure ulcers (PrUs) in an economically vulnerable group. The 184 participants were admitted with PrUs and received services from a home care agency in South Korea during a study window of 5 years. The changes in PrU staging over time were analyzed in relation to the agency's home care data and the participants' health data. At enrollment, approximately 60% had a single ulcer; 40% had two or more. Most patients' ulcers were at stages 3 or 4, and most patients were bedridden. The maximum odds of reduced ulcer size from one measurement point to the next was estimated at 14.3% for ulcers in stages 1 and 2, 33.4% of those in stage 3, and 25.5% of those in stage 4; more than 10% of ulcers healed completely within a year. PrUs were a serious problem in this community-dwelling economically vulnerable group, and home care played a critical role in providing health care to this population. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  5. What patient characteristics guide nurses' clinical judgement on pressure ulcer risk? A mixed methods study.

    PubMed

    Balzer, K; Kremer, L; Junghans, A; Halfens, R J G; Dassen, T; Kottner, J

    2014-05-01

    Nurses' clinical judgement plays a vital role in pressure ulcer risk assessment, but evidence is lacking which patient characteristics are important for nurses' perception of patients' risk exposure. To explore which patient characteristics nurses employ when assessing pressure ulcer risk without use of a risk assessment scale. Mixed methods design triangulating observational data from the control group of a quasi-experimental trial and data from semi-structured interviews with nurses. Two traumatological wards at a university hospital. Quantitative data: A consecutive sample of 106 patients matching the eligibility criteria (age ≥ 18 years, no pressure ulcers category ≥ 2 at admission and ≥ 5 days expected length of stay). Qualitative data: A purposive sample of 16 nurses. Quantitative data: Predictor variables for pressure ulcer risk were measured by study assistants at the bedside each second day. Concurrently, nurses documented their clinical judgement on patients' pressure ulcer risk by means of a 4-step global judgement scale. Bivariate correlations between predictor variables and nurses' risk estimates were established. Qualitative data: In interviews, nurses were asked to assess fictitious patients' pressure ulcer risk and to justify their risk estimates. Patient characteristics perceived as relevant for nurses' judements were thematically clustered. Triangulation: Firstly, predictors of nurses' risk estimates identified in bivariate analysis were cross-mapped with interview findings. Secondly, three models to predict nurses' risk estimates underwent multiple linear regression analysis. Nurses consider multiple patient characteristics for pressure ulcer risk assessment, but regard some conditions more important than others. Triangulation showed that these are measures reflecting patients' exposure to pressure or overall care dependency. Qualitative data furthermore indicate that nurses are likely to trade off risk-enhancing conditions against

  6. A systematic review of economic evaluations assessing interventions aimed at preventing or treating pressure ulcers.

    PubMed

    Palfreyman, Simon J; Stone, Patricia W

    2015-03-01

    Pressure ulcers have an adverse impact on patients and can also result in additional costs and workload for healthcare providers. Interventions to prevent pressure ulcers are focused on identifying at risk patients and using systems such as mattresses and turning to relieve pressure. Treatments for pressure ulcers are directed towards promoting wound healing and symptom relief. Both prevention and treatments have associated costs for healthcare providers. The aim of this study was to systematically review the economic evidence for prevention and treatment interventions for pressure ulcers. A systematic review of comparative clinical studies that evaluate interventions to either prevent or treat pressure ulcers. Searches of the major electronic databases were conducted to identify citations that reported costs or economic analysis for interventions directed towards prevention or treatment of pressure ulcers. Only comparative clinical studies were included. Review articles, case-series, non-randomised studies, and studies in a foreign language that did not have an abstract in English were excluded from the review. Decisions regarding inclusion or exclusion were based on a consensus of the authors after review of the title or abstract. Potential citations were obtained for more detailed review and assessed against the inclusion criteria. The studies identified for inclusion were assessed against the 24 key criteria contained in the CHEERS checklist. Costs were standardised to US dollars and adjusted for inflation to 2012 rates. The searches identified 105 potential studies. After review of the citations a total of 23 studies were included: 12 examined prevention interventions and 11 treatments. Review against the CHEERS criteria showed that the majority of included trials had poor reporting and a lack of detail regarding how costs were calculated. Few studies reported more than aggregate costs of treatments with only a small number reporting unit cost outcomes

  7. Patient-reported outcome measures for chronic wounds with particular reference to pressure ulcer research: a systematic review.

    PubMed

    Gorecki, Claudia; Nixon, Jane; Lamping, Donna L; Alavi, Yasmene; Brown, Julia M

    2014-01-01

    Pressure ulcers are a major health problem, affect patient psychological, physical and social functioning, and cause significant treatment burden. For comprehensive assessment of the benefits of an intervention, patient-reported evidence of the impact of an intervention on important patient outcomes should be made. We systematically reviewed the quality of life literature on chronic wounds to determine the suitability of generic and chronic wound-specific outcome measures for use in evaluating patient outcomes in pressure ulcer research. A systematic review of the literature. Searches of eight electronic databases from inception until May 2012 were undertaken. Quality of life domains, item content and content relevance were determined for identified outcome measures. The content validity of identified measures was assessed against an empirically derived pressure ulcer-specific conceptual framework. Three generic and 14 chronic wound measures were identified but no pressure ulcer-specific measures. None of the existing measures cover all quality of life domains important in pressure ulcers. One condition-specific measure, the Venous Leg Ulcer Measure, matched most closely conceptually, but failed to represent three important domains and contained items not specific to pressure ulcers. Currently, outcomes important in pressure ulcers are inadequately covered by generic and chronic wound-specific instruments despite similar conceptual models. Highlighted is the need for clear conceptualisation of content as well as determining appropriateness when selecting outcome measures in the future. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Bodily pain intensity in nursing home residents with pressure ulcers: analysis of national minimum data set 3.0.

    PubMed

    Ahn, Hyochol; Stechmiller, Joyce; Fillingim, Roger; Lyon, Debra; Garvan, Cynthia

    2015-06-01

    Clinical reports suggest that superficial pressure ulcers produce pain, but that pain decreases as the wound advances in stage. This study of the relationship between pressure ulcer stage and bodily pain intensity in nursing home residents was a secondary analysis of the national Minimum Data Set 3.0 assessment data in long-term care facilities, collected from nursing home residents at least 65 years of age. Data were examined from residents with pressure ulcers who completed a bodily pain intensity interview between January and March 2012 (N = 41,680) as part of the MDS comprehensive assessment. After adjusting for other variables (e.g., cognition, functional impairment, presence of comorbidities, use of scheduled pain medication, and sociodemographic variables), bodily pain intensity for those with more severe pressure ulcers in comparison to those with Stage I ulcers was higher by 11% (Stage II), 14% (Stage III), 24% (Stage IV), and 22% (suspected deep tissue injury). Because multivariate analysis showed that greater bodily pain intensity was associated with an advanced stage of pressure ulcer, health care providers should assess bodily pain intensity and order appropriate pain management for nursing home residents with pressure ulcers, particularly for those with advanced pressure ulcers who are vulnerable to greater bodily pain intensity. © 2015 Wiley Periodicals, Inc.

  9. Negative pressure wound therapy in the treatment of ulcerated infantile haemangioma.

    PubMed

    Fox, Carly M; Johnson, Bethan; Storey, Kristen; Das Gupta, Romi; Kimble, Roy

    2015-07-01

    Infantile haemangioma is a common benign tumour of infancy. Ulceration is the most common complication and is often painful and difficult to treat. Propranolol therapy is widely used to induce involution in rapidly growing or ulcerated lesions, or those in anatomically awkward locations. The ideal dressing regimen for these lesions would provide effective analgesia, act as a wound dressing, and aid involution of the primary lesion. To date, no ideal regimen has been established. Negative pressure wound therapy (NPWT) has been used in adult and paediatric populations to help improve wound healing in a variety of settings. It may provide a useful alternative to traditional dressing regimens in ulcerated infantile haemangioma. Six consecutive patients with ulcerating infantile haemangioma presenting to the Royal Children's Hospital vascular anomalies clinic were included in the study. Each patient was treated with a combination of NPWT and propranolol. Outcomes including time to wound healing, perceived ease of dressing management, and analgesia were recorded. Complete wound healing was obtained in all cases. Patient outcomes in terms of analgesia, comfort, and ease of wound dressing were improved following application of NPWT. We propose that this regimen represents a novel therapy for management of ulcerated infantile haemangioma. Possible mechanisms for healing effect, and improved analgesia are discussed. Further investigation is required to determine if negative pressure wound therapy results in faster healing times compared to traditional dressing regimens.

  10. Predicting Pressure Ulcer Development in Clinical Practice: Evaluation of Braden Scale Scores and Nutrition Parameters.

    PubMed

    Miller, Natasha; Frankenfield, David; Lehman, Erik; Maguire, Melissa; Schirm, Victoria

    2016-01-01

    Accurate patient assessment and screening for pressure ulcer (PU) is difficult in the clinical setting, and evaluation of nutritional status is especially problematic. The aim of this retrospective study was to determine the extent to which Braden Scale scores and other nutrition screening parameters (body mass index, poor intake, and weight loss) predict PU development in general and heel and sacral ulcers specifically. Records of 230 hospitalized patients who developed PU were compared to a matched control group without PU. Logistic regression was used to determine the association of total Braden scores, Braden nutrition subscale scores, and nutrition factors with PU development at any time, within week 1, or within week 2 of hospitalization; and development of sacral and heel ulcers at these same periods. Braden Scale scores on hospital admission were predictive of hospital-acquired pressure ulcer development at some point during the hospital stay; and more specifically Braden scores on day 7 were predictive of PU development within week 2 of hospitalization. Among nutrition screening factors and PU development, a low body mass index showed a statistically significant relationship with sacral ulcer development. Findings indicate that the overall Braden score is a valid predictor of PU development. Implications for clinical practice to decrease the risk for PU development include appropriate use of reliable and valid scales by nurses along with careful evaluation of nutrition parameters.

  11. PUMA project: Active involving of end users to achieve a smart solution to prevent pressure ulcer.

    PubMed

    Laparra-Hernández, José; Chicote, Juan Carlos; Medina, Enrique; Barberà, Ricard; Durà-Gil, Juan V; Lozano, Vicente; Gil, Ángel; Bermejo, Ignacio

    2015-01-01

    This paper shows the benefits to include spinal cord injury users and the other stakeholders during the development of a new system to prevent pressure ulcers. The complementary of information has been key and has enhanced the possibility to achieve market acceptance and introduction.

  12. SCI Survey to Determine Pressure Ulcer Vulnerability in the Outpatient Population

    DTIC Science & Technology

    2012-10-01

    research that identifies risk factors for development and recurrence of Pressure Ulcers (PrUs) has been conducted in the nursing home elderly or in the...include: Violence as a mechanism of injury, FIM score ≤ 87, ASIA-A, BMI ≤ 25, lifetime tobacco exposure ≥30 pack years. Diabetes, age >65 and duration

  13. [A Structural Equation Model of Pressure Ulcer Prevention Action in Clinical Nurses].

    PubMed

    Lee, Sook Ja; Park, Ok Kyoung; Park, Mi Yeon

    2016-08-01

    The purpose of this study was to construct and test a structural equation model for pressure ulcer prevention action by clinical nurses. The Health Belief Model and the Theory of Planned Behavior were used as the basis for the study. A structured questionnaire was completed by 251 clinical nurses to analyze the relationships between concepts of perceived benefits, perceived barriers, attitude, subjective norm, perceived control, intention to perform action and behavior. SPSS 22.0 and AMOS 22.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factors affecting pressure ulcer prevention action among clinical nurses. The model fitness statistics of the hypothetical model fitted to the recommended levels. Attitude, subjective norm and perceived control on pressure ulcer prevention action explained 64.2% for intention to perform prevention action. The major findings of this study indicate that it is essential to recognize improvement in positive attitude for pressure ulcer prevention action and a need for systematic education programs to increase perceived control for prevention action.

  14. Concordance of Shape Risk Scale, a new pressure ulcer risk tool, with Braden Scale.

    PubMed

    Soppi, Esa T; Iivanainen, Ansa K; Korhonen, Pasi A

    2014-12-01

    The occurrence of pressure ulcers was examined in a cross-sectional study in 23 health care facilities and in home care involving 548 patients. The screening of pressure ulcer risk was assessed simultaneously using the Braden Scale and the new Shape Risk Scale (SRS), and the results were compared. The overall prevalence of pressure ulcers in the study population was 15·5% (85/548). The Braden Scale was performed as described in the literature. The direct concordance of the Braden and SRS scales was 46%. In more than 90% of cases, the SRS classified patients as well as or better than the Braden Scale. The SRS allocates patients significantly different from the Braden Scale into the risk categories, especially the difference is significant between the low and medium-risk categories. The greatest advantage of SRS to Braden Scale is that it correctly identifies patients with low risk of pressure ulcers. It is interesting that the two risk scores, taking into consideration the basically different pathophysiological factors, can still give rather similar results. The users considered that both scales are easy to use.

  15. Risk factors for pressure ulcer development in Intensive Care Units: A systematic review.

    PubMed

    Lima Serrano, M; González Méndez, M I; Carrasco Cebollero, F M; Lima Rodríguez, J S

    Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered. From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning. There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  16. Risk, prevention and treatment of pressure ulcers--nursing staff knowledge and documentation.

    PubMed

    Gunningberg, L; Lindholm, C; Carlsson, M; Sjödén, P O

    2001-01-01

    The aims were to investigate (i) registered nurses' and nursing assistants' knowledge of risk, prevention and treatment of pressure ulcer before implementing a system for risk assessment and pressure ulcer classification for patients with hip fracture (ii) interventions documented in the patient's records by registered nurses, and (iii) to what extent reported and documented interventions accord with the Swedish quality guidelines. Nursing staff (n=85) completed a questionnaire, and patient's records (n=55) were audited retrospectively. The majority of the nursing staff reported that they performed risk assessment when caring for a patient with hip fracture. These risk assessments were, however, not comprehensive. The most frequently reported preventive interventions were repositioning, use of lotion, mattresses/overlays and cushions for the heels. These interventions were to some extent documented in the patient's records. Nutritional support, reduction of shear and friction, hygiene and skin moisture, and patient's education were reported to a small extent and not documented at all. The Swedish quality guidelines regarding prevention and treatment of pressure ulcers were not fully implemented in clinical practice. It was concluded that nursing staff's knowledge and documentation of risk, prevention and treatment of pressure ulcers for patients with hip fractures could be improved.

  17. Developing a pressure ulcer risk factor minimum data set and risk assessment framework.

    PubMed

    Coleman, Susanne; Nelson, E Andrea; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Muir, Delia; Farrin, Amanda; Dowding, Dawn; Schols, Jos M G A; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Bader, Dan L; Gefen, Amit; Oomens, Cees W J; Schoonhoven, Lisette; Nixon, Jane

    2014-10-01

    To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework. A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study. Consensus study. A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011. The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways. The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework. © 2014 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  18. Factors associated with the incidence of pressure ulcer during hospital stay.

    PubMed

    Matozinhos, Fernanda Penido; Velasquez-Melendez, Gustavo; Tiensoli, Sabrina Daros; Moreira, Alexandra Dias; Gomes, Flávia Sampaio Latini

    2017-05-25

    Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers. Estimar a taxa de incidência de úlcera por pressão e verificar fatores associados a essa ocorrência em uma coorte de pacientes hospitalizados. Trata-se de estudo de coorte no qual o desfecho foi a ocorrência da úlcera por pressão. A estimativa do efeito das variáveis para a proporção de incidência acumulada do desfecho foi realizada utilizando o modelo de riscos proporcionais de Cox. A seleção das variáveis ocorreu por meio do teste de hipóteses Logrank. A amostra foi composta de 442 adultos, com 25 casos incidentes de úlcera por pressão. Pacientes com altos escores na escala de Braden apresentaram maior risco de incidência de úlcera por pressão quando comparados com aqueles classificados na categoria de baixo escore. Os resultados reforçam a importância do uso da Escala de Braden para auxiliar na identificação dos pacientes com maior probabilidade de desenvolver úlcera por pressão.

  19. Developing a pressure ulcer risk factor minimum data set and risk assessment framework

    PubMed Central

    Coleman, Susanne; Nelson, E Andrea; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Muir, Delia; Farrin, Amanda; Dowding, Dawn; Schols, Jos MGA; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Bader, Dan L; Gefen, Amit; Oomens, Cees WJ; Schoonhoven, Lisette; Nixon, Jane

    2014-01-01

    Aim To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework. Background A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study. Design Consensus study. Method A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010–December 2011. Findings The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways. Conclusion The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework. PMID:24845398

  20. Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location☆,☆☆,★

    PubMed Central

    Ledoux, William R.; Shofer, Jane B.; Cowley, Matthew S.; Ahroni, Jessie H.; Cohen, Victoria; Boyko, Edward J.

    2014-01-01

    Aims We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Methods Diabetic subjects (n = 591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure–time integral (PTI) was assessed using Cox regression. Results During follow-up (2.4 years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194 kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Conclusions Location must be considered when assessing the relationship between PPP and plantar ulceration. PMID:24012295

  1. Managing Pressures Ulcers in a Resource Constrained Situation: A Holistic Approach

    PubMed Central

    Dam, Abhijit; Datta, Nivedita; Mohanty, Usha Rani; Bandhopadhyay, Chandreyi

    2011-01-01

    Managing pressure ulcers remain a challenge and call for a multidisciplinary team approach to care. Even more daunting is the management of such patients in remote locations and in resource constrained situations. The management of pressure sores in a patient with progressive muscular atrophy has been discussed using resources that were locally available, accessible, and affordable. Community participation was encouraged. A holistic approach to care was adopted. PMID:22346055

  2. Under Pressure: Financial Effect of the Hospital-Acquired Conditions Initiative-A Statewide Analysis of Pressure Ulcer Development and Payment.

    PubMed

    Meddings, Jennifer; Reichert, Heidi; Rogers, Mary A M; Hofer, Timothy P; McMahon, Laurence F; Grazier, Kyle L

    2015-07-01

    To assess the financial effect of the 2008 Hospital-Acquired Conditions Initiative (HACI) pressure ulcer payment changes on Medicare, other payers, and hospitals. Retrospective before-and-after study of all-payer statewide administrative data for more than 2.4 million annual adult discharges in 2007 and 2009 using the Healthcare Cost and Utilization Project State Inpatient Datasets for California. How often and by how much the 2008 payment changes for pressure ulcers affected hospital payment was assessed. Nonfederal acute care California hospitals (N = 311). Adults discharged from acute-care hospitals. Pressure ulcer rates and hospital payment changes. Hospital-acquired pressure ulcer rates were low in 2007 (0.28%) and 2009 (0.27%); present-on-admission pressure ulcer rates increased from 2.3% in 2007 to 3.0% in 2009. According to clinical stage of pressure ulcer (available in 2009), hospital-acquired Stage III and IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for Stage III and IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges, for a statewide payment decrease of $310,444 (0.001%) for all payers and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers), reducing statewide payment by $62,538,586 (0.21%) for all payers and $47,237,984 (0.32%) for Medicare. The total financial effect of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than Stages III and IV. The removal of payment for hospital-acquired Stage III and IV ulcers by implementation of the HACI policy was 1/200th that of the removal of payment for other types of pressure ulcers that occurred in implementation of the

  3. A review of the surgical management of heel pressure ulcers in the 21st century.

    PubMed

    Bosanquet, David C; Wright, Ann M; White, Richard D; Williams, Ian M

    2016-02-01

    Heel ulceration, most frequently the result of prolonged pressure because of patient immobility, can range from the trivial to the life threatening. Whilst the vast majority of heel pressure ulcers (PUs) are superficial and involve the skin (stages I and II) or underlying fat (stage III), between 10% and 20% will involve deeper tissues, either muscle, tendon or bone (stage IV). These stage IV heel PUs represent a major health and economic burden and can be difficult to treat. The worst outcomes are seen in those with large ulcers, compromised peripheral arterial supply, osteomyelitis and associated comorbidities. Whilst the mainstay of management of stage I-III heel pressure ulceration centres on offloading and appropriate wound care, successful healing in stage IV PUs is often only possible with surgical intervention. Such intervention includes simple debridement, partial or total calcanectomy, arterial revascularisation in the context of coexisting peripheral vascular disease or using free tissue flaps. Amputation may be required for failed surgical intervention, or as a definitive first-line procedure in certain high-risk or poor prognosis patient groups. This review provides an overview of heel PUs, alongside a comprehensive literature review detailing the surgical interventions available when managing such patients. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  4. Point prevalence of pressure ulcers in three second-level hospitals in Mexico.

    PubMed

    Galván-Martínez, Iris L; Narro-Llorente, Roberto; Lezama-de-Luna, Favio; Arredondo-Sandoval, Jesus; Fabian-Victoriano, Ma Rosy; Garrido-Espindola, Ximena; Lozano-Platonoff, Adriana; Contreras-Ruiz, Jose

    2014-12-01

    Pressure ulcers (PU) are the source of multiple complications and even death. To our knowledge, there is no available data about PU prevalence in Mexico. The objective of this study was to determine the point prevalence of PU in three second-level hospitals in Mexico. Every adult hospitalised patient was included in each hospital. Age, gender, hospitalisation ward, Braden score, and the number, location and stage of the ulcers encountered were recorded, as well as any pressure relief measures. In total, 294 patients were examined (127 were male); of these, 63 were considered to be at risk. The average age was 48·6 years. The overall prevalence of the PU was 17%. The service with the highest prevalence was the ICU. The most frequent stage was II (32%) and they were most commonly found in the sacrum (74%). The average Braden score of the patients with ulcers was 10, and 21·4% of the patients obtained moderate- to high-risk Braden scores. Of them, 60·3% had ulcers and only 46% had any preventive measures. The prevalence of PU in three hospitals in Mexico is 17%. The most common stage is II and the most commonly affected site is the sacrum. Only 46% of patients with PU had at least one pressure release measure.

  5. The Application of Negative Pressure Wound Therapy in the Treatment of Chronic Venous Leg Ulceration: Authors Experience

    PubMed Central

    Mieszczański, Paweł; Wilemska-Kucharzewska, Katarzyna; Taradaj, Jakub; Kuropatnicki, Andrzej; Śliwiński, Zbigniew

    2014-01-01

    The aim of the study was to use negative pressure wound therapy (NPWT) in patients with chronic venous leg ulceration. The authors present their experience in treatment of 15 patients whose average ulceration surface area was 62.6 cm2. In 10 patients, the ulcers healed within 6 weeks and in the remaining patients within 20 weeks. Based on the results obtained, the authors imply that NPWT is an effective method in the treatment of chronic venous leg. PMID:24696847

  6. Enhancing pressure ulcer prevention using wound dressings: what are the modes of action?

    PubMed

    Call, Evan; Pedersen, Justin; Bill, Brian; Black, Joyce; Alves, Paulo; Brindle, C Tod; Dealey, Carol; Santamaria, Nick; Clark, Michael

    2015-08-01

    Recent clinical research has generated interest in the use of sacral wound dressings as preventive devices for patients at risk of ulceration. This study was conducted to identify the modes of action through which dressings can add to pressure ulcer prevention, for example, shear and friction force redistribution and pressure distribution. Bench testing was performed using nine commercially available dressings. The use of dressings can reduce the amplitude of shear stress and friction reaching the skin of patients at risk. They can also effectively redirect these forces to wider areas which minimises the mechanical loads upon skeletal prominences. Dressings can redistribute pressure based upon their effective Poisson ratio and larger deflection areas, providing greater load redistribution.

  7. Assessing Predictive Validity of Pressure Ulcer Risk Scales- A Systematic Review and Meta-Analysis

    PubMed Central

    PARK, Seong-Hi; LEE, Hea Shoon

    2016-01-01

    Background: The purpose of this study was to present a scientific reason for pressure ulcer risk scales: Cubbin& Jackson modified Braden, Norton, and Waterlow, as a nursing diagnosis tool by utilizing predictive validity of pressure sores. Methods: Articles published between 1966 and 2013 from periodicals indexed in the Ovid Medline, Embase, CINAHL, KoreaMed, NDSL, and other databases were selected using the key word “pressure ulcer”. QUADAS-II was applied for assessment for internal validity of the diagnostic studies. Selected studies were analyzed using meta-analysis with MetaDisc 1.4. Results: Seventeen diagnostic studies with high methodological quality, involving 5,185 patients, were included. In the results of the meta-analysis, sROC AUC of Braden, Norton, and Waterflow scale was over 0.7, showing moderate predictive validity, but they have limited interpretation due to significant differences between studies. In addition, Waterlow scale is insufficient as a screening tool owing to low sensitivity compared with other scales. Conclusion: The contemporary pressure ulcer risk scale is not suitable for uninform practice on patients under standardized criteria. Therefore, in order to provide more effective nursing care for bedsores, a new or modified pressure ulcer risk scale should be developed upon strength and weaknesses of existing tools. PMID:27114977

  8. Pressure ulcer prevalence, use of preventive measures, and mortality risk in an acute care population: a quality improvement project.

    PubMed

    Leijon, Siv; Bergh, Ingrid; Terstappen, Karin

    2013-01-01

    The primary aim of this quality improvement project was to determine pressure prevalence, risk of mortality, and use of preventive measures in a group of hospitalized patients. Two hundred fifty-eight patients recruited from Skaraborg Hospital in Sweden were assessed. A 1-day point prevalence study was carried out using a protocol advocated by the European PU Advisory Panel. Patients' age, gender, severity of PU (grades I-IV), anatomical location of PU, and use of preventive measures were recorded. The Swedish language version of the Modified Norton Scale was used for PU risk assessment. Data were collected by nurses trained according to the Web-based training: PU classification, "ePuclas2." After 21 months, a retrospective audit of the electronic records for patients identified with pressure ulcers was completed. The point prevalence of pressure ulcers was 23%. The total number of ulcers was 85, most were grade 1 (n = 39). The most common locations were the sacrum (n = 15) and the heel (n = 10). Three percent of patients (n = 9) had been assessed during their current hospital stay using a risk assessment tool. There was a statistically significant relationship between pressure ulcer occurrence and a low total score on the Modified Norton Scale. The patients' ages correlated significantly to the presence of a pressure ulcer. Patients with a pressure ulcer had a 3.6-fold increased risk of dying within 21 months, as compared with those without a pressure ulcer. Based on results from this quality improvement project, we recommend routine pressure ulcer risk assessment for all patients managed in a hospital setting such as ours. We further recommend that particular attention should be given to older and frail patients who are at higher risk for pressure ulcer occurrence and mortality.

  9. Acoustic pressure wound therapy to facilitate granulation tissue in sacral pressure ulcers in patients with compromised mobility: a case series.

    PubMed

    Schmuckler, Jo

    2008-08-01

    Electrical stimulation and other modalities are recommended for treatment of pressure ulcers in spinal cord injury patients but their use may be limited by clinical contraindications such as necrosis and infection. Acoustic pressure wound therapy can be used to address infection and has no known contraindications related to wound status. A retrospective nonconsecutive study was conducted involving five inpatients with sacral pressure ulcers and compromised mobility (spinal cord injury, ventilator/mobility dependency, or persistent vegetative state) treated with acoustic pressure wound therapy three times per week, 4 to 6 minutes per session, for 5 weeks to 5.5 months. Acoustic pressure wound therapy was administered until necrotic tissue was removed, granulation was complete, drainage resolved to moderate levels, and wound size was compatible with indications for high-voltage electrical stimulation. Within 1 to 4 weeks of starting acoustic pressure wound therapy, four out of five wounds with substantial yellow slough or eschar demonstrated 100% granulation tissue and wound area and volume decreased 71% to 97% and 75% to 99%, respectively. Subsequent treatments included electrical stimulation alone (three patients) or in conjunction with negative pressure wound therapy (one patient), and silver foam (one patient). Acoustic pressure wound therapy was found to be an effective option in preparing wounds for subsequent therapy.

  10. A pilot randomised controlled trial of negative pressure wound therapy to treat grade III/IV pressure ulcers [ISRCTN69032034

    PubMed Central

    2012-01-01

    Background Negative pressure wound therapy (NPWT) is widely promoted as a treatment for full thickness wounds; however, there is a lack of high-quality research evidence regarding its clinical and cost effectiveness. A trial of NPWT for the treatment of grade III/IV pressure ulcers would be worthwhile but premature without assessing whether such a trial is feasible. The aim of this pilot randomised controlled trial was to assess the feasibility of conducting a future full trial of NPWT for the treatment of grade III and IV pressure ulcers and to pilot all aspects of the trial. Methods This was a two-centre (acute and community), pilot randomised controlled trial. Eligible participants were randomised to receive either NPWT or standard care (SC) (spun hydrocolloid, alginate or foam dressings). Outcome measures were time to healing of the reference pressure ulcer, recruitment rates, frequency of treatment visits, resources used and duration of follow-up. Results Three hundred and twelve patients were screened for eligibility into this trial over a 12-month recruitment period and 12/312 participants (3.8%) were randomised: 6 to NPWT and 6 to SC. Only one reference pressure ulcer healed (NPWT group) during follow-up (time to healing 79 days). The mean number of treatment visits per week was 3.1 (NPWT) and 5.7 (SC); 6/6 NPWT and 1/6 SC participants withdrew from their allocated trial treatment. The mean duration of follow-up was 3.8 (NPWT) and 5.0 (SC) months. Conclusions This pilot trial yielded vital information for the planning of a future full study including projected recruitment rate, required duration of follow-up and extent of research nurse support required. Data were also used to inform the cost-effectiveness and value of information analyses, which were conducted alongside the pilot trial. Trial registration Current Controlled Trials ISRCTN69032034. PMID:22839453

  11. Use of mobility subscale for risk assessment of pressure ulcer incidence and preventive interventions: A systematic review.

    PubMed

    Mordiffi, Siti Zubaidah; Kent, Bridie; Phillips, Nicole; Chi Tho, Poh

    2011-01-01

    Pressure ulcers remain a serious problem for patients and providers in healthcare. When a pressure ulcer develops, it can inflict pain and cause untoward complications such as severe infections, surgery, prolonged hospital stay and even death. The objective of this review was to establish whether using the Braden subscale mobility assessment is comparable to using the full Braden pressure ulcer risk assessment scale. However, due to lack of research studies, the focus of this review was extended to include the use of other assessment tools for hospital acquired pressure ulcer risk. Quantitative studies that reported data on mobility and pressure ulcer development or preventive interventions, irrespective of their design were included in the review.The review focused on adult patients admitted to an acute care facility, who underwent a pressure ulcer risk assessment, and had no pressure ulcers on admission.This review considered studies that use Braden mobility subscale assessmentThis review compared the use of full Braden risk assessment scale where available only when it was included within the same study,This review considered: SEARCH STRATEGY: A search for published and unpublished studies from 2000 to 2010 of major healthcare related electronic databases was conducted. Studies in other languages that were translated into English were included in the review. The papers that were selected for possible inclusion were assessed by two independent reviewers for methodological validity using standardised critical appraisal instruments from the Joanna Briggs Institute. Data from included studies were extracted and analysed using Revman5 software. Eighteen studies were included in this review. The findings suggest that the risk of pressure ulcer development was higher when the patient was identified as having impaired mobility, as assessed using the Braden subscale mobility or other similar mobility scales. However, there is little conclusive evidence to indicate that

  12. Nursing care missed in patients at risk of or having pressure ulcers

    PubMed Central

    Valles, Jonathan Hermayn Hernández; Monsiváis, María Guadalupe Moreno; Guzmán, Ma. Guadalupe Interial; Arreola, Leticia Vázquez

    2016-01-01

    ABSTRACT Objective: to determine the nursing care missed as perceived by the nursing staff and its relation with the nursing care missed identified in the assessment of patients at risk of or having pressur ulcers. Method: descriptive correlation study. The participants were 161 nurses and 483 patients from a public hospital. The MISSCARE survey was used in combination with a Nursing Care Assessment Form for Patients at Risk of or having pressure ulcers. For the analysis, descriptive and inferential statistics were used. Results: the nursing staff indicated greater omission in skin care (38.5%), position change (31.1%) and the registration of risk factors for the development of pressure ulcers (33.5%). The nursing care missed identified in the assessment related to the use of pressure relief on bony prominences and drainage tubes interfering in the patient's movements (both with 58.6%) and the use of pneumatic mattresses (57.6%). Conclusion: a high percentage of nursing care missed was found according to the staff's perception. Nevertheless, the assessment of the nursing care missed was much higher. No significant relation was found between both. Therefore, it is a priority to reflect on the importance of objective patient assessments. PMID:27878218

  13. Use of negative pressure wound therapy as an adjunct to the treatment of extremity soft-tissue sarcoma with ulceration or impending ulceration.

    PubMed

    Chen, Y U; Xu, Song-Feng; Xu, Ming; Yu, Xiu-Chun

    2016-07-01

    Major wound complications of the extremities, following wide tumor resection and reconstruction for soft-tissue sarcomas (STSs), remain a challenge for limb-sparing surgery. Furthermore, STSs with ulceration or impending ulceration predispose patients to an increased risk of post-operative infection. The present study was conducted to assess the efficacy of negative pressure wound therapy (NPWT) in preventing wound complications associated with surgical treatment of STSs with ulceration or impending ulceration, in patients treated between February 2012 and January 2013. A total of 5 patients, with a mean age of 48 years (range, 24-68 years), were enrolled in the present study. The diagnoses consisted of undifferentiated pleomorphic sarcoma (n=2), leiomyosarcoma (n=1), synovial sarcoma (n=1) and epithelioid sarcoma (n=1). According to American Joint Committee on Cancer criteria, 3 cases were stage III tumors, and the remaining 2 cases were of stages IIA and IIB, respectively. A total of 3 patients exhibited ulceration at diagnosis, and the remaining patients demonstrated impending ulceration. The mean wound area following wide resection of the tumor was 73 cm(2) (range, 45-110 cm(2)). A continuous suction mode, with pressures measuring -200 to -300 mmHg, was used for 7-10 days on the soft-tissue defects as preparation for wound closure. Soft-tissue reconstruction included muscle flaps (n=2) and skin grafts (n=5). No major wound complications occurred. Post-operative functional and cosmetic outcomes were acceptable. A single patient demonstrated local recurrence 12 months after surgery and re-excision of the tumor was performed. All patients remained alive at the conclusion of follow-up, with a mean follow-up time of 26 months (range, 12-36 months). The present study demonstrated that NPWT is effective and safe when used as an adjunct to wound closure following resection of extremity STS with ulceration/impending ulceration.

  14. Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure-induced tissue damage (pressure ulcers).

    PubMed

    Moore, Zena; Patton, Declan; Rhodes, Shannon L; O'Connor, Tom

    2017-04-01

    Current detection of pressure ulcers relies on visual and tactile changes at the skin surface, but physiological changes below the skin precede surface changes and have a significant impact on tissue health. Inflammatory and apoptotic/necrotic changes in the epidermal and dermal layers of the skin, such as changes in interstitial fluid (also known as subepidermal moisture (SEM)), may precede surface changes by 3-10 days. Those same epidermal and subepidermal changes result in changes in the electrical properties (bioimpedance) of the tissue, thereby presenting an objective, non-invasive method for assessing tissue damage. Clinical studies of bioimpedance for the detection of pressure ulcers have demonstrated that changes in bioimpedance correlate with increasing severity of pressure ulcer stages. Studies have also demonstrated that at anatomical locations with pressure ulcers, bioimpedance varies with distance from the centre of the pressure ulcers. The SEM Scanner, a handheld medical device, offers an objective and reliable method for the assessment of local bioimpedance, and therefore, assessment of tissue damage before signs become visible to the unaided eye. This literature review summarises pressure ulcer pathophysiology, principles of bioimpedance and clinical research using bioimpedance technology to assess pressure ulcers. © 2016 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  15. Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration.

    PubMed

    Fernando, Malindu E; Crowther, Robert G; Lazzarini, Peter A; Sangla, Kunwarjit S; Wearing, Scott; Buttner, Petra; Golledge, Jonathan

    2016-09-15

    Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls). Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm's correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen's d values (standardised mean difference) were reported for all significant outcomes. The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p < 0.05). The stance phase duration was also significantly higher in cases compared to both control groups (p < 0.05). The main limitations of the study were the small number of cases studied and the inability to adjust analyses for multiple factors. This study shows that plantar pressures are higher in cases with active diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether

  16. Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes

    PubMed Central

    Bergstrom, Nancy; Horn, Susan D.; Rapp, Mary; Stern, Anita; Barrett, Ryan; Watkiss, Michael; Krahn, Murray

    2014-01-01

    Background Pressure at the interface between bony prominences and support surfaces, sufficient to occlude or reduce blood flow, is thought to cause pressure ulcers (PrUs). Pressure ulcers are prevented by providing support surfaces that redistribute pressure and by turning residents to reduce length of exposure. Objective We aim to determine optimal frequency of repositioning in long-term care (LTC) facilities of residents at risk for PrUs who are cared for on high-density foam mattresses. Methods We recruited residents from 20 United States and 7 Canadian LTC facilities. Participants were randomly allocated to 1 of 3 turning schedules (2-, 3-, or 4-hour intervals). The study continued for 3 weeks with weekly risk and skin assessment completed by assessors blinded to group allocation. The primary outcome measure was PrU on the coccyx or sacrum, greater trochanter, or heels. Results Participants were mostly female (731/942, 77.6%) and white (758/942, 80.5%), and had a mean age of 85.1 (standard deviation [SD] ± 7.66) years. The most common comorbidities were cardiovascular disease (713/942, 75.7%) and dementia (672/942, 71.3%). Nineteen of 942 (2.02%) participants developed one superficial Stage 1 (n = 1) or Stage 2 (n = 19) ulcer; no full-thickness ulcers developed. Overall, there was no significant difference in PrU incidence (P = 0.68) between groups (2-hour, 8/321 [2.49%] ulcers/group; 3-hour, 2/326 [0.61%]; 4-hour, 9/295 [3.05%]. Pressure ulcers among high-risk (6/325, 1.85%) versus moderate-risk (13/617, 2.11%) participants were not significantly different (P = 0.79), nor was there a difference between moderate-risk (P = 0.68) or high-risk allocation groups (P = 0.90). Conclusions Results support turning moderate- and high-risk residents at intervals of 2, 3, or 4 hours when they are cared for on high-density foam replacement mattresses. Turning at 3-hour and at 4-hour intervals is no worse than the current practice of turning every 2 hours. Less frequent

  17. The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study.

    PubMed

    Mallah, Zeinab; Nassar, Nada; Kurdahi Badr, Lina

    2015-05-01

    Pressure Ulcers (PUs) are associated with high mortality, morbidity, and health care costs. In addition to being costly, PrUs cause pain, suffering, infection, a lower quality of life, extended hospital stay and even death. Although several nursing interventions have been advocated in the literature, there is a paucity of research on what constitutes the most effective nursing intervention. To determine the efficacy of multidisciplinary intervention and to assess which component of the intervention was most predictive of decreasing the prevalence of Hospital acquired pressure ulcers (HAPU) in a tertiary setting in Lebanon. An evaluation prospective research design was utilized with data before and after the intervention. The sample consisted of 468 patients admitted to the hospital from January 2012 to April 2013. The prevalence of HAPU was significantly reduced from 6.63% in 2012 to 2.47. Sensitivity of the Braden scale in predicting a HAPU was 92.30% and specificity was 60.04%. A logistic multiple regression equation found that two factors significantly predicted the development of a HAPU; skin care and Braden scores. The multidisciplinary approach was effective in decreasing the prevalence of HAPUs. Skin care management which was a significant predictor of PUs should alert nurses to the cost effectiveness of this intervention. Lower Braden scores also were predictive of HAPUs. Published by Elsevier Inc.

  18. What is different for people with MS who have pressure ulcers: A reflective study of the impact upon people's quality of life?

    PubMed

    McGinnis, Elizabeth; Andrea Nelson, E; Gorecki, Claudia; Nixon, Jane

    2015-08-01

    Multiple Sclerosis (MS) is a progressive, degenerative disease of the central nervous system. People with advanced disease who have compromised mobility, activity, sensory and/or cognitive abilities are at risk of pressure ulcers. Having a pressure ulcer has a substantial impact on a person's quality of life; a generic pressure ulcer Health Related Quality of Life (HRQL) framework has been used in this study. To explore the views and opinions of patients with MS who have a pressure ulcer using a thematic framework and compare these to the general pressure ulcer population. Data for six MS patients was obtained through secondary analysis of transcripts from semi-structured interviews conducted during two studies which were part of a programme of HRQL Research. Patients with MS reported that their pressure ulcer affected their lives physically, psychologically and socially. All were confined to bed (as part of their pressure ulcer treatment) and therefore unable to participate in activities. Difficulties with movement and activity were partially attributed to the MS. Patients with MS did not report feeling ill with their pressure ulcer and expressed positive emotions and optimism. Pain or discomfort was a feature of the pressure ulcer for most patients. Pressure ulcers have a major impact on QOL for all patients. Problems with mobility and activity associated with the pressure ulcer were confounded by the MS. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  19. [Mapping the nursing care with the NIC for patients in risk for pressure ulcer].

    PubMed

    Pereira, Ana Gabriela Silva; Santos, Cássia Teixeira Dos; Menegon, Dóris Baratz; Mello, Bruna Schroeder; Azambuja, Fernanda; Lucena, Amália de Fátima

    2014-06-01

    To identify the nursing care prescribed for patients in risk for pressure ulcer (PU) and to compare those with the Nursing Interventions Classification (NIC) interventions. Cross mapping study conducted in a university hospital. The sample was composed of 219 adult patients hospitalized in clinical and surgical units. The inclusion criteria were: score ≤ 13 in the Braden Scale and one of the nursing diagnoses, Self-Care deficit syndrome, Impaired physical mobility, Impaired tissue integrity, Impaired skin integrity, Risk for impaired skin integrity. The data were collected retrospectively in a nursing prescription system and statistically analyzed by crossed mapping. It was identified 32 different nursing cares to prevent PU, mapped in 17 different NIC interventions, within them: Skin surveillance, Pressure ulcer prevention and Positioning. The cross mapping showed similarities between the prescribed nursing care and the NIC interventions.

  20. [Pressure ulcer care quality indicator: analysis of medical records and incident report].

    PubMed

    dos Santos, Cássia Teixeira; Oliveira, Magáli Costa; Pereira, Ana Gabriela da Silva; Suzuki, Lyliam Midori; Lucena, Amália de Fátima

    2013-03-01

    Cross-sectional study that aimed to compare the data reported in a system for the indication of pressure ulcer (PU) care quality, with the nursing evolution data available in the patients' medical records, and to describe the clinical profile and nursing diagnosis of those who developed PU grade 2 or higher Sample consisted of 188 patients at risk for PU in clinical and surgical units. Data were collected retrospectively from medical records and a computerized system of care indicators and statistically analyzed. Of the 188 patients, 6 (3%) were reported for pressure ulcers grade 2 or higher; however, only 19 (10%) were recorded in the nursing evolution records, thus revealing the underreporting of data. Most patients were women, older adults and patients with cerebrovascular diseases. The most frequent nursing diagnosis was risk of infection. The use of two or more research methodologies such as incident reporting data and retrospective review of patients' records makes the results trustworthy.

  1. Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends

    PubMed Central

    Kruger, Erwin A.; Pires, Marilyn; Ngann, Yvette; Sterling, Michelle; Rubayi, Salah

    2013-01-01

    Pressure ulcers in spinal cord injury represent a challenging problem for patients, their caregivers, and their physicians. They often lead to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They present a significant cost to the healthcare system, they require a multidisciplinary team approach to manage well, and outcomes directly depend on patients' education, prevention, and compliance with conservative and surgical protocols. With so many factors involved in the successful treatment of pressure ulcers, an update on their comprehensive management in spinal cord injury is warranted. Current concepts of local wound care, surgical options, as well as future trends from the latest wound healing research are reviewed to aid medical professionals in treating patients with this difficult problem. PMID:24090179

  2. Assessment of the risk of pressure ulcer development among hospitalized HIV/Aids patients.

    PubMed

    Cidral, Silvana; Silva, Waldirene Fernandes; Visentin, Angelita; Borghi, Angela Cristina da Silva; Mantovani, Maria de Fátima; Hey, Ana Paula

    2016-01-01

    to assess the risk of pressure ulcer development among hospitalized HIV/Aids. Metod: study quantitative descriptive with 35 patients admitted to an infectious diseases hospital in Curitiba-PR-BR. Characterized clinical and epidemiological of patients using a data collection instrument and the Braden Scale. Data was compiled using Excel® and a simple descriptive analysis. two patients were found to have pressure ulcers and the most common comorbidities associated with HIV/Aids were pneumocystis pneumonia, caused by pneumocisti cariini (16), and pulmonary tuberculosis (13). The lowest scores were obtained in the friction and shear subscale, followed by the activity, nutrition, mobility and moisture subscales. The highest score was obtained in the sensory perception subscale. Two patients were classified as 'very high risk', six as 'high risk', three as 'low risk', and the rest as 'no risk'. risk assessment using scales provides objective information to assist with systemized and targeted nursing decision-making.

  3. Manualization of Occupational Therapy Interventions: Illustrations from the Pressure Ulcer Prevention Research Program

    PubMed Central

    Blanche, Erna Imperatore; Fogelberg, Donald; Diaz, Jesus; Carlson, Mike; Clark, Florence

    2011-01-01

    The manualization of a complex occupational therapy intervention is a crucial step in ensuring treatment fidelity for both clinical application and research purposes. Towards this latter end, intervention manuals are essential for assuring trustworthiness and replicability of randomized controlled trials (RCT’s) that aim to provide evidence of the effectiveness of occupational therapy. In this paper, literature on the process of intervention manualization is reviewed. The prescribed steps are then illustrated through our experience in implementing the University of Southern California/Rancho Los Amigos National Rehabilitation Center’s collaborative Pressure Ulcer Prevention Project (PUPP). In this research program, qualitative research provided the initial foundation for manualization of a multifaceted occupational therapy intervention designed to reduce incidence of medically serious pressure ulcers in people with SCI. PMID:22214116

  4. [Crosscultural adaptation of the pressure ulcer scale for healing to the portuguese language].

    PubMed

    Santos, Vera Lúcia Conceição de Gouveia; Azevedo, Maria Augusta Junqueira; Silva, Thais Salimbeni da; Carvalho, Vilma Maria Justo; Carvalho, Viviane Fernandes de

    2005-01-01

    This study aimed to carry out a crosscultural adaptation of the Pressure Ulcer Scale for Healing (PUSH) to the Portuguese language through the translation of the instrument into Portuguese (by bilingual specialists and a specialist committee) and the validation of inter-rater reliability (comparison between nurses' and stomal therapists' observations) and convergent validity (correlation between pressure ulcers - PU - stages and type of tissue factor and total scale score). Besides the Kappa index, we also used Fisher's and Spearman's Tests. The Kappa indices (0.90 to 1.00) obtained for the comparison between all nurses and stomal therapists' observations for all sub-scales and for the total score and the presence of a positive and statistically significant correlation (p<0.001) between PU stages and total score for nurses and stomal therapists confirmed both scales' measuring properties, thus pointing towards the future use of the PUSH adapted version in the Portuguese culture.

  5. Treatment of Severe (Stage III and IV) Chronic Pressure Ulcers Using Pulsed Radio Frequency Energy in a Quadriplegic Patient

    PubMed Central

    Porreca, Eugene G.; Giordano-Jablon, Gina M.

    2008-01-01

    Objective: To report an adjuvant treatment to basic wound care of stage III and IV pressure ulcers in a patient with quadriplegia. Methods: Pulsed radio frequency energy was used as an adjunct to basic wound care of 3 large, long-standing (6 years) stage III and IV pressure ulcers that were unresponsive to conventional therapy in a 59-year-old man with quadriplegia. Results: The ulcers (on right foot, left heel, and sacrum) markedly decreased in size (16.7, 28.5, and 13.1 mm2 per day, respectively). The ulcer on the right foot healed within 4 weeks, the left heel ulcer reduced in size by 95% at 7 months, and the large sacral ulcer healed to closure in 11 months. Conclusion: Pulsed radio frequency energy treatment with basic wound care, if administered early in the course of pressure ulcer therapy, might avoid the lengthy hospitalizations and repeated surgical procedures necessary for treatment of uncontrolled ulcers, reducing the overall cost of treatment and improving the quality of life for chronically ill or injured patients. PMID:19008935

  6. Investigating staff knowledge of safeguarding and pressure ulcers in care homes.

    PubMed

    Ousey, K; Kaye, V; McCormick, K; Stephenson, J

    2016-01-01

    To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers (PUs) in nursing/care homes. Within one clinical commissioning group, 65 staff members from 50 homes completed a questionnaire assessing their experiences of avoidable and unavoidable PUs, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members. Staff observed an average of 2.72 PUs in their workplaces over the previous 12 months, judging 45.6% to be avoidable. Only a minority of respondents reported knowledge of a grading system (mostly the EPUAP/NPUAP system). Most respondents would refer PUs to the safeguarding team: the existence of a grading system, or guidance, appeared to increase that likelihood. Safeguarding was considered a priority in most homes; interviewees were familiar with the term safeguarding, but some confusion over its meaning was apparent. Quality of written documentation and verbal communication received before residents returned from hospital was highlighted. However, respondents expressed concern over lack of information regarding skin integrity. Most staff had received education regarding ulcer prevention or wound management during training, but none reported post-registration training or formal education programmes; reliance was placed on advice of district nurses or tissue viability specialists. Staff within nursing/care homes understand the fundamentals of managing skin integrity and the importance of reporting skin damage; however, national education programmes are needed to develop knowledge and skills to promote patient health-related quality of life, and to reduce the health-care costs of pressure damage. Further research to investigate understanding, knowledge and skills of nursing/care home staff concerning pressure ulcer development and safeguarding will become increasingly

  7. Detecting early stage pressure ulcer on dark skin using multispectral imager

    NASA Astrophysics Data System (ADS)

    Yi, Dingrong; Kong, Linghua; Sprigle, Stephen; Wang, Fengtao; Wang, Chao; Liu, Fuhan; Adibi, Ali; Tummala, Rao

    2010-02-01

    We are developing a handheld multispectral imaging device to non-invasively inspect stage I pressure ulcers in dark pigmented skins without the need of touching the patient's skin. This paper reports some preliminary test results of using a proof-of-concept prototype. It also talks about the innovation's impact to traditional multispectral imaging technologies and the fields that will potentially benefit from it.

  8. Health Behavior Theory for Pressure Ulcer Prevention: Root-Cause Analysis Project in Critical Care Nursing.

    PubMed

    Choi, Kristen R; Ragnoni, Jennifer A; Bickmann, Jonathan D; Saarinen, Hannah A; Gosselin, Ann K

    2016-01-01

    The purpose of this project was to use a behavioral theory to examine pressure ulcer prevention by nurses in a critical care setting. A root-cause analysis approach was used, including an integrative literature review, operationalization of behavioral constructs into a survey, and root-cause analysis application in a cardiovascular intensive care unit. This article highlights an innovative approach to quality improvement in critical care.

  9. Hospital-acquired pressure ulcer prevalence--evaluating low-air-loss beds.

    PubMed

    Johnson, Jane; Peterson, Darcie; Campbell, Betty; Richardson, Regina; Rutledge, Dana

    2011-01-01

    Higher-category pressure redistribution mattresses are considered a critical component of a pressure ulcer prevention program, but few studies have quantified the impact of specific preventive measures on the incidence or prevalence of hospital-acquired pressure ulcers (HAPUs). Therefore, this study was undertaken to determine the impact of low-air-loss beds on HAPU prevalence. This prospective, comparative cohort study monitored the prevalence of HAPU at our hospital and compared rates of matched medical-surgical units with and without low-air-loss beds. Units without low-air-loss beds used a variety of alternative pressure redistribution devices for patients deemed at risk for pressure ulceration. The prevalence of HAPU was operationally defined as the number of patients with HAPUs divided by numbers of patients observed. The prevalence of HAPU over 3 quarters in 2008 ranged from 1.0% to 3.3% (overall rate 2.4%). Eighty-three percent of patients with HAPUs were cared for on low-air-loss beds. Of 12 patients with 16 HAPUs during this time, 75% were aged 70 years or older and 25% were managed in critical care units. Over half of patients who developed HAPUs had been hospitalized for 20 days or more. Half of the patients with HAPUs were scored as no-low risk on the Braden Scale.On the paired medical-surgical units, no statistically significant differences were found when patients with low-air-loss beds were compared to standard hospital mattresses supplemented by a variety of pressure redistribution devices. Seven of 11 HAPUs (63%) occurred in patients placed on low-air-loss beds. The prevalence of HAPU in patients placed on low-air-loss beds was no different from patients placed on standard hospital mattresses supplemented by a variety of pressure redistribution devices. Further research is needed to determine the impact of specific strategies on prevention of HAPU.

  10. [Preparation of a manual treatment of pressure ulcers which draws attention to moisture of the affected part].

    PubMed

    Nohara, Yohko; Mizuno, Masako; Kamei, Harue; Yamada, Misao; Fujii, Keiko; Satoh, Noriko; Nitao, Naoe; Renda, Akiyoshi; Yuasa, Takashi; Hamazaki, Mitsuaki; Shimauchi, Atsushi; Hirai, Yutaka; Yasui, Hisakatsu; Muramatsu, Shuichi; Noda, Yasuhiro; Furuta, Katsunori

    2003-12-01

    As for pressure ulcers care, prevention is the most important approach. However, pressure ulcers, might develop despite enough care, depending on each person's physical condition. As for the treatment of pressure ulcers, maintenance of a moderately moist environment (60-70%) is quite important. We propose the use of ointment to control the moisture of a pressure ulcer environment. One ointment base absorbs moisture, while another provides moisture. We have prepared a manual that allows the user to select the medicine according to the degree of moisture of the affected part. When the moisture cannot be regulated with one ointment, it can be adjusted by mixing two or more ointments. In choosing a drug for external use, it is important to pay attention not only to the effect of the main ingredient but also to the physicochemical properties of the ointment base that serves as vehicle for that active component.

  11. Calibration power of the Braden scale in predicting pressure ulcer development.

    PubMed

    Chen, Hong-Lin; Cao, Ying-Juan; Wang, Jing; Huai, Bao-Sha

    2016-11-02

    Calibration is the degree of correspondence between the estimated probability produced by a model and the actual observed probability. The aim of this study was to investigate the calibration power of the Braden scale in predicting pressure ulcer development (PU). A retrospective analysis was performed among consecutive patients in 2013. The patients were separated into training a group and a validation group. The predicted incidence was calculated using a logistic regression model in the training group and the Hosmer-Lemeshow test was used for assessing the goodness of fit. In the validation cohort, the observed and the predicted incidence were compared by the Chi-square (χ(2)) goodness of fit test for calibration power. We included 2585 patients in the study, of these 78 patients (3.0%) developed a PU. Between the training and validation groups the patient characteristics were non-significant (p>0.05). In the training group, the logistic regression model for predicting pressure ulcer was Logit(P) = -0.433*Braden score+2.616. The Hosmer-Lemeshow test showed no goodness fit (χ(2)=13.472; p=0.019). In the validation group, the predicted pressure ulcer incidence also did not fit well with the observed incidence (χ(2)=42.154, p=0.000 by Braden scores; and χ(2)=17.223, p=0.001 by Braden scale risk classification). The Braden scale has low calibration power in predicting PU formation.

  12. Preventing heel pressure ulcers and plantar flexion contractures in high-risk sedated patients.

    PubMed

    Meyers, Tina R

    2010-01-01

    An intervention using heel pressure ulcer and plantar flexion contracture prevention protocols for high-risk patients was established to promote earlier recognition of heel skin issues and provide effective prevention of both conditions. Fifty-three patients who were sedated, managed in an intensive care unit for 5 days or more, and had a Braden Scale score of 16 or less were treated with heel protector devices that maintained the foot in a neutral position and floated the heel off the bed. On admission to the intensive care unit, heel skin assessment and the Braden Scale were administered to all patients. Initial ankle range of motion was measured with a goniometer on admission and before the application of the heel protector. Goniometric measurements were documented every other day. Heel assessments and the Braden Scale for Predicting Pressure Sore Prevention and Ramsay Sedation Scale scores were recorded in every shift and recorded as part of the study every other day. Measurements continued until the patient was transferred, the heel protector boot was discontinued by the physician, or the patient's Braden Scale score rose above 16. Application of the heel protectors led to a 50% reduction in prevalence of abnormal heel position. No patients developed plantar flexion contractures or new heel ulcers. Patients with normal heels had significantly higher Braden Scale scores compared to those with abnormal heels (P 5 .0136). Despite their high risk, no patients using the heel protector device developed a heel pressure ulcer or plantar flexion contracture.

  13. Intraoperatively acquired pressure ulcers and perioperative normothermia: a look at relationships.

    PubMed

    Fred, Cynthia; Ford, Sharon; Wagner, Doreen; Vanbrackle, Lewis

    2012-09-01

    The risk of developing an intraoperatively acquired pressure ulcer (IAPU), which is recognized as a significant complication of deep tissue injury occurrence, is associated with duration of surgery and patient positioning. There is a strong association between hypothermia, tissue viability, and surgical site infections; however, the relationship between hypothermia and pressure ulcers has not been fully explored. We examined the incidence of pressure ulcers in surgical patients and determined that there is a relationship between maintaining perioperative normothermia and a reduction in IAPU development. We used a retrospective, explanatory, nonexperimental design, and we fit a binary logistic model to the data. This study shows that patients at higher risk for developing an IAPU include those who are critically ill, have a low Braden Scale skin assessment score, are thin, and are male with at least a 1° F (1.8° C) drop in temperature. These are important risks for perioperative nurses to take into account during care of surgical patients. More perioperative research is needed to identify ways to reduce risk, provide close assessment of high-risk patients, and implement the identified risk-reduction strategies.

  14. Nursing Home Work Environment and the Risk of Pressure Ulcers and Incontinence

    PubMed Central

    Temkin-Greener, Helena; Cai, Shubing; Zheng, Nan Tracy; Zhao, Hongwei; Mukamel, Dana B

    2012-01-01

    Objective To examine the association between nursing home (NH) work environment attributes such as teams, consistent assignment and staff cohesion, and the risk of pressure ulcers and incontinence. Data Sources/Setting Minimum dataset for 46,044 residents in 162 facilities in New York State, for June 2006–July 2007, and survey responses from 7,418 workers in the same facilities. Study Design For each individual and facility, primary and secondary data were linked. Random effects logistic models were used to develop/validate outcome measures. Generalized estimating equation models with robust standard errors and probability weights were employed to examine the association between outcomes and work environment attributes. Key independent variables were staff cohesion, percent staff in daily care teams, and percent staff with consistent assignment. Other facility factors were also included. Principal Findings Residents in facilities with worse staff cohesion had significantly greater odds of pressure ulcers and incontinence, compared with residents in facilities with better cohesion scores. Residents in facilities with greater penetration of self-managed teams had lower risk of pressure ulcers, but not of incontinence. Prevalence of consistent assignment was not significantly associated with the outcome measures. Conclusions NH environments and management practices influence residents’ health outcomes. These findings provide important lessons for administrators and regulators interested in promoting NH quality improvement. PMID:22098384

  15. A systematic review of the performance of instruments designed to measure the dimensions of pressure ulcers.

    PubMed

    O'Meara, Susan M; Bland, J Martin; Dumville, Jo C; Cullum, Nicky A

    2012-01-01

    The objective was to undertake a systematic review of the performance of wound measurement instruments used for patients with pressure ulcers. Studies of any design, evaluating methods for estimating wound diameter, depth, surface area, or volume in patients with pressure ulcers were included. Eligible evaluations had to report intra- or inter-rater reliability, accuracy, agreement, or feasibility of methods. Electronic databases and other sources were accessed for study identification. Included studies were critically appraised using a modified checklist for diagnostic test evaluations. Twelve studies were included. Most had methodological problems and/or used inappropriate statistical methods. Reliable methods for measuring pressure ulcer surface area may include: grid tracings from photographs combined with whole plus partial square count; a portable digital pad; and stereophotogrammetry combined with computerized image analysis. The agreement between photographic tracing and direct transparency tracing may be satisfactory (both methods being combined with computerized planimetry). No definitive conclusions could be reached about studies of diameter or depth; this means that there is little evidence to underpin recommendations in clinical guidelines. Evaluations of volume measurement were of poor quality, and there were few data on feasibility. Further primary research is needed to evaluate methods of wound measurement used in clinical practice.

  16. The effect of nurse manager turnover on patient fall and pressure ulcer rates.

    PubMed

    Warshawsky, Nora; Rayens, Mary Kay; Stefaniak, Karen; Rahman, Rana

    2013-07-01

    The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. Patients in medical/surgical units experienced more falls than in intensive care units (F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events. © 2013 John Wiley & Sons Ltd.

  17. Pressure Ulcers in the United States' Inpatient Population From 2008 to 2012: Results of a Retrospective Nationwide Study.

    PubMed

    Bauer, Karen; Rock, Kathryn; Nazzal, Munier; Jones, Olivia; Qu, Weikai

    2016-11-01

    Pressure ulcers are common, increase patient morbidity and mortality, and costly for patients, their families, and the health care system. A retrospective study was conducted to evaluate the impact of pressure ulcers on short-term outcomes in United States inpatient populations and to identify patient characteristics associated with having 1 or more pressure ulcers. The US Nationwide Inpatient Sample (NIS) database was analyzed using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes as the screening tool for all inpatient pressure ulcers recorded from 2008 to 2012. Patient demographics and comorbid conditions, as identified by ICD-9 code, were extracted, along with primary outcomes of length of stay (LOS), total hospital charge (TC), inhospital mortality, and discharge disposition. Continuous variables with normal distribution were expressed in terms of mean and standard deviation. Group comparisons were performed using t-test or ANOVA test. Continuous nonnormal distributed variables such as LOS and TC were expressed in terms of median, and nonparametric tests were used to compare the differences between groups. Categorical data were presented in terms of percentages of the number of cases within each group. Chi-squared tests were used to compare categorical data in different groups. For multivariate analysis, linear regressions (for continuous variable) and logistic regression (for categorical variables) were used to analyze the possible risk factors for the investigated outcomes of LOS, TC, inhospital mortality, and patient disposition. Coefficients were calculated with multivariate regression with all included patients versus patients with pressure ulcers alone. The 5-year average number of admitted patients with at least 1 pressure ulcer was determined to be 670 767 (average overall rate: 1.8%). Statistically significant differences between patients with and without pressure ulcers were observed for

  18. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway.

    PubMed

    Magny, Emmanuelle; Vallet, Helene; Cohen-Bittan, Judith; Raux, Mathieu; Meziere, Antony; Verny, Marc; Riou, Bruno; Khiami, Frédéric; Boddaert, Jacques

    2017-08-29

    Despite orthogeriatric management, 12% of the elderly experienced PUs after hip fracture surgery. PUs were significantly associated with a low albumin level, history of atrial fibrillation coronary artery disease, and diabetes. The risk ratio of death at 6 months associated with pressure ulcer was 2.38 (95% CI 1.31-4.32%, p = 0.044). Pressure ulcers in hip fracture patients are frequent and associated with a poor outcome. An orthogeriatric management, recommended by international guidelines in hip fracture patients and including pressure ulcer prevention and treatment, could influence causes and consequences of pressure ulcer. However, remaining factors associated with pressure ulcer occurrence and prognostic value of pressure ulcer in hip fracture patients managed in an orthogeriatric care pathway remain unknown. From June 2009 to April 2015, all consecutive patients with hip fracture admitted to a unit for Post-operative geriatric care were evaluated for eligibility. Patients were included if their primary presentation was due to hip fracture and if they were ≥ 70 years of age. Patients were excluded in the presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multi-component intervention to improve pressure ulcer prevention and management. Patients were followed-up until 6 months after discharge. Five hundred sixty-seven patients were included, with an overall 14.4% 6-month mortality (95% CI 11.6-17.8%). Of these, 67 patients (12%) experienced at least one pressure ulcer. Despite orthogeriatric management, pressure ulcers were significantly associated with a low albumin level (RR 0.90, 95% CI 0.84-0.96; p = 0.003) and history of atrial fibrillation (RR 1.91, 95% CI 1.05-3.46; p = 0.033), coronary artery disease (RR 2.16, 95% CI 1.17-3.99; p = 0.014), and diabetes (RR 2.33, 95% CI 1.14-4.75; p = 0.02). A pressure ulcer was associated

  19. Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States.

    PubMed

    Padula, William V; Makic, Mary Beth F; Mishra, Manish K; Campbell, Jonathan D; Nair, Kavita V; Wald, Heidi L; Valuck, Robert J

    2015-06-01

    Prevention of pressure ulcers, one of the hospital-acquired conditions (HACs) targeted by the 2008 nonpayment policy of the Centers for Medicare & Medicaid Services (CMS), is a critical issue. This study was conducted to determine the comparative effectiveness of quality improvement (QI) interventions associated with reduced hospital-acquired pressure ulcer (HAPU) rates. In an quasi-experimental design, interrupted time series analyses were conducted to determine the correlation between HAPU incidence rates and adoption of QI interventions. Among University HealthSystem Consortium hospitals, 55 academic medical centers were surveyed from September 2007 through February 2012 for adoption patterns of QI interventions for pressure ulcer prevention, and hospital-level data for 5,208 pressure ulcer cases were analyzed. Between- and within-hospital reduction significance was tested with t-tests post-CMS policy intervention. Fifty-three (96%) of the 55 hospitals used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates by greater than 1 case per 1,000 patient discharges per quarter: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition. The greatest reductions in rates occurred earlier in the adoption process (p<.05). Five QI interventions had clinically meaningful associations with reduced stage III and IV HAPU incidence rates in 55 academic medical centers. These QI interventions can be used in support of an evidence-based prevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.

  20. Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know

    PubMed Central

    Dana, Ali N.; Bauman, William A.

    2015-01-01

    Individuals with spinal cord injury (SCI) are at increased risk for the development of pressure ulcers. These chronic wounds are debilitating and contribute to prolonged hospitalization and worse medical outcome. However, the species of bacteria and the role that specific species may play in delaying the healing of chronic pressure ulcers in the SCI population has not been well characterized. This study will review the literature regarding what is known currently about the bacteriology of pressure ulcers in individuals with SCI. An electronic literature search of MEDLINE (1966 to February 2014) was performed. Eleven studies detailing bacterial cultures of pressure ulcers in the SCI population met inclusion criteria and were selected for review. Among these studies, bacterial cultures were often polymicrobial with both aerobic and anaerobic bacteria identified with culture techniques that varied significantly. The most common organisms identified in pressure ulcers were Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, and Enterococcus faecalis. In general, wounds were poorly characterized with minimal to no physical description and/or location provided. Our present understanding of factors that may alter the microbiome of pressure ulcers in individuals with SCI is quite rudimentary, at best. Well-designed studies are needed to assess appropriate wound culture technique, the impact of bacterial composition on wound healing, development of infection, and the optimum medical and surgical approaches to wound care. PMID:25130374

  1. Nursing students' knowledge and attitude on pressure ulcer prevention evidence-based guidelines: a multicenter cross-sectional study.

    PubMed

    Simonetti, Valentina; Comparcini, Dania; Flacco, Maria Elena; Di Giovanni, Pamela; Cicolini, Giancarlo

    2015-04-01

    Pressure ulcers still remain a significant problem in many healthcare settings. Poor knowledge and negative attitudes toward pressure ulcer prevention could undesirably affect preventive care strategies. To assess both knowledge and attitudes among nursing students on Pressure Ulcer Prevention Evidence-Based Guidelines. A multicenter cross-sectional survey was carried out from December 2012 to August 2013. The study was carried out in seven Italian nursing schools. We involved a convenience sample of nursing students (n=742) METHODS: Data were collected using two validated questionnaires to assess students' knowledge and attitudes on pressure ulcer prevention. The overall Knowledge and Attitude scores were 51.1% (13.3/26) and 76.7% (39.9/52), respectively. We found a weak correlation between total Knowledge scores and total Attitude scores (rho=0.13, p<0.001). We also observed that nursing students' year of education, training experience and number of department frequented during their clinical placement were significantly related to both the Knowledge and the Attitude total scores (p<0.05). Nursing students' knowledge on pressure ulcer prevention was relatively low. However, we observed an association between a high level of education/training experience and higher knowledge scores. Most of the participants showed high attitude scores. These results suggest that positive attitudes toward pressure ulcer prevention may contribute to the compliance with the guidelines in clinical practice. Published by Elsevier Ltd.

  2. Pressure ulcer risk assessment and prevention: what difference does a risk scale make? A comparison between Norway and Ireland.

    PubMed

    Johansen, E; Moore, Z; van Etten, M; Strapp, H

    2014-07-01

    To explore similarities and differences in nurses' views on risk assessment practices and preventive care activities in a context where patients' risk of developing pressure ulcers is assessed using clinical judgment (Norway) and a context where patients' risk of developing pressure ulcers is assessed using a formal structured risk assessment combined with clinical judgement (Ireland). A descriptive, qualitative design was employed across two different care settings with a total of 14 health care workers, nine from Norway and five from Ireland. Regardless of whether risk assessment was undertaken using clinical judgment or formal structured risk assessment, identified risk factors, at risk patients and appropriate preventive initiatives discussed by participant were similar across care settings. Furthermore, risk assessment did not necessarily result in the planning and implementation of appropriate pressure ulcer prevention initiatives. Thus, in this instance, use of a formal risk assessment tool does not seem to make any difference to the planning, initiation and evaluation of pressure ulcer prevention strategies. Regardless of the method of risk assessment, patients at risk of developing pressure ulcers are detected, suggesting that the practice of risk assessment should be re-evaluated. Moreover, appropriate preventive interventions were described. However, the missing link between risk assessment and documented care planning is of concern and barriers to appropriate pressure ulcer documentation should be explored further. This work is partly funded by a research grant from the Norwegian Nurses Organisation (NNO) (Norsk Sykepleierforbund NSF) in 2012. The authors have no conflict of interest to declare.

  3. An in vitro quantification of pressures exerted by earlobe pulse oximeter probes following reports of device-related pressure ulcers in ICU patients .

    PubMed

    Goodell, Teresa T

    2012-11-01

    The earlobe often is used to monitor perfusion when pulse oximeter signal quality is impaired in the fingers and toes. Prompted by intermittent occurrences of roughly circular earlobe pressure ulcers among patients in intensive care units, a convenience sample of seven calibrated pulse oximeter probes was used to quantify earlobe pressure exerted by these devices in vitro. All were tested twice with an electronic load cell, a strain gauge with a transducer that transforms the measured force into a readable numerical signal. The probe was clipped to the load cell just as it is clipped to the earlobe in the clinical setting. The probes exerted an average of 0.24 lb (SD 0.6) of force over an area of 0.3 square inches, equal to an average of 20.7 mm Hg (SD 0.6) pressure on tissue. This value exceeds some empirically derived values of capillary perfusion pressure. The occurrence of device-related pressure ulcers, as well pressure ulcers on the ears, has been documented, but little is known about device-related earlobe pressure ulcers or the actual pressure exerted by these devices. Additional in vitro studies are needed to quantify the pressures exerted by these and other probes, and future prevalence and incidence studies should include more detailed pressure ulcer location and device use documentation. Until more is known about the possible role of these devices in the development of pressure ulcers, clinicians should be cognizant of their potential for causing pressure ulcers, particularly in patients whose conditions can compromise skin integrity.

  4. Elevated plantar pressure and ulceration in diabetic patients after panmetatarsal head resection: two case reports.

    PubMed

    Cavanagh, P R; Ulbrecht, J S; Caputo, G M

    1999-08-01

    Panmetatarsal head resection (variously called forefoot arthroplasty, forefoot resection arthroplasty, the Hoffman procedure, and the Fowler procedure) was developed for the relief of pain and deformity in rheumatoid arthritis. Although there are successful retrospective series reported in the literature, such an approach is not supported by carefully designed controlled trials. This procedure has also been advocated by some for the relief of plantar pressure in diabetic patients who are at risk for plantar ulceration. The efficacy of the procedure in this context is not supported by existing pressure measurements on rheumatoid arthritis patients in the literature, which has tended to show that although pain relief is obtained, the procedure results in elevation of forefoot pressure. Case reports are described of two patients (three feet) with sensory neuropathy who presented to our clinic 1 to 2 years after panmetatarsal head resections had been performed. Peak plantar pressures in these feet during first step gait were above the 99th percentile and outside the measuring range of the device used (EMED SF platform; NOVEL Electronics Inc., St. Paul, MN). Both patients had also experienced plantar ulcers subsequent to the surgery. Combining the information on patients with rheumatoid arthritis (RA) with that from our two case studies, we conclude that panmetatarsal head resection does not necessarily eliminate focal regions of elevated plantar pressure.

  5. A Computational, Tissue-Realistic Model of Pressure Ulcer Formation in Individuals with Spinal Cord Injury

    PubMed Central

    Ziraldo, Cordelia; Solovyev, Alexey; Allegretti, Ana; Krishnan, Shilpa; Henzel, M. Kristi; Sowa, Gwendolyn A.; Brienza, David; An, Gary; Mi, Qi; Vodovotz, Yoram

    2015-01-01

    People with spinal cord injury (SCI) are predisposed to pressure ulcers (PU). PU remain a significant burden in cost of care and quality of life despite improved mechanistic understanding and advanced interventions. An agent-based model (ABM) of ischemia/reperfusion-induced inflammation and PU (the PUABM) was created, calibrated to serial images of post-SCI PU, and used to investigate potential treatments in silico. Tissue-level features of the PUABM recapitulated visual patterns of ulcer formation in individuals with SCI. These morphological features, along with simulated cell counts and mediator concentrations, suggested that the influence of inflammatory dynamics caused simulations to be committed to “better” vs. “worse” outcomes by 4 days of simulated time and prior to ulcer formation. Sensitivity analysis of model parameters suggested that increasing oxygen availability would reduce PU incidence. Using the PUABM, in silico trials of anti-inflammatory treatments such as corticosteroids and a neutralizing antibody targeted at Damage-Associated Molecular Pattern molecules (DAMPs) suggested that, at best, early application at a sufficiently high dose could attenuate local inflammation and reduce pressure-associated tissue damage, but could not reduce PU incidence. The PUABM thus shows promise as an adjunct for mechanistic understanding, diagnosis, and design of therapies in the setting of PU. PMID:26111346

  6. A Computational, Tissue-Realistic Model of Pressure Ulcer Formation in Individuals with Spinal Cord Injury.

    PubMed

    Ziraldo, Cordelia; Solovyev, Alexey; Allegretti, Ana; Krishnan, Shilpa; Henzel, M Kristi; Sowa, Gwendolyn A; Brienza, David; An, Gary; Mi, Qi; Vodovotz, Yoram

    2015-06-01

    People with spinal cord injury (SCI) are predisposed to pressure ulcers (PU). PU remain a significant burden in cost of care and quality of life despite improved mechanistic understanding and advanced interventions. An agent-based model (ABM) of ischemia/reperfusion-induced inflammation and PU (the PUABM) was created, calibrated to serial images of post-SCI PU, and used to investigate potential treatments in silico. Tissue-level features of the PUABM recapitulated visual patterns of ulcer formation in individuals with SCI. These morphological features, along with simulated cell counts and mediator concentrations, suggested that the influence of inflammatory dynamics caused simulations to be committed to "better" vs. "worse" outcomes by 4 days of simulated time and prior to ulcer formation. Sensitivity analysis of model parameters suggested that increasing oxygen availability would reduce PU incidence. Using the PUABM, in silico trials of anti-inflammatory treatments such as corticosteroids and a neutralizing antibody targeted at Damage-Associated Molecular Pattern molecules (DAMPs) suggested that, at best, early application at a sufficiently high dose could attenuate local inflammation and reduce pressure-associated tissue damage, but could not reduce PU incidence. The PUABM thus shows promise as an adjunct for mechanistic understanding, diagnosis, and design of therapies in the setting of PU.

  7. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study.

    PubMed

    Ham, Wietske H W; Schoonhoven, Lisette; Schuurmans, Marieke J; Leenen, Luke P H

    2016-09-01

    To describe the occurrence and severity of pressure ulcers, indentation marks and pain from the extrication collar combined with headblocks. Furthermore, the influence of time, injury severity and patient characteristics on the development of pressure ulcers, indentation marks and pain was explored. Observational. Level one trauma centre in the Netherlands. Adult trauma patients admitted to the Emergency Department in an extrication collar combined with headblocks. Between January and December 2013, 342 patients were included. Study outcomes were incidence and severity of pressure ulcers, indentation marks and pain. The following dependent variables were collected: time in the cervical collar and headblocks, Glasgow Coma Scale, Mean Arterial Pressure, haemoglobin, Injury Severity Score, gender, age, and Body Mass Index. 75.4% of the patients developed a category 1 and 2.9% a category 2 pressure ulcer. Indentation marks were observed in 221 (64.6%) patients; 96 (28.1%) had severe indentation marks. Pressure ulcers and indentation marks were observed most frequently at the back, shoulders and chest. 63.2% experienced pain, of which, 38.5% experienced severe pain. Pain was mainly located at the occiput. Female patients experienced significantly more pain (NRS>3) compared to male patients (OR=2.14, 95% CI 1.21-3.80) None of the investigated variables significantly increased the probability of developing PUs or indentation marks. The high incidence of category 1 pressure ulcers and severe indentation marks indicate an increased risk for pressure ulcer development and may well lead to more severe PU lesions. Pain due to the application of the extrication collar and headblocks may lead to undesirable movement (in order to relieve the pressure) or to bias clinical examination of the cervical spine. It is necessary to revise the current practice of cervical spine immobilization. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit.

    PubMed

    Behrendt, Robert; Ghaznavi, Amir M; Mahan, Meredith; Craft, Susan; Siddiqui, Aamir

    2014-03-01

    Critically ill patients are vulnerable to the development of hospital-associated pressure ulcers (HAPUs). Positioning of patients is an essential component of pressure ulcer prevention because it off-loads areas of high pressure. However, the effectiveness of such positioning is debatable. A continuous bedside pressure mapping (CBPM) device can provide real-time feedback of optimal body position though a pressure-sensing mat that displays pressure images at a patient's bedside, allowing off-loading of high-pressure areas and possibly preventing HAPU formation. A prospective controlled study was designed to determine if CBPM would reduce the number of HAPUs in patients treated in our medical intensive care unit. In 2 months, 422 patients were enrolled and assigned to beds equipped with or without a CBPM device. Patients' skin was assessed daily and weekly to determine the presence and progress of HAPUs. All patients were turned every 2 hours. CBPM patients were repositioned to off-load high-pressure points during turning, according to a graphic display. The number of newly formed HAPUs was the primary outcome measured. A χ(2) test was then used to compare the occurrence of HAPUs between groups. HAPUs developed in 2 of 213 patients in the CBPM group (0.9%; both stage II) compared with 10 of 209 in the control group (4.8%; all stage II; P = .02). Significantly fewer HAPUs occurred in the CBPM group than the control group, indicating the effectiveness of real-time visual feedback in repositioning of patients to prevent the formation of new HAPUs.

  9. Identification of pre-operative and intra-operative variables predictive of pressure ulcer development in patients undergoing urologic surgical procedures.

    PubMed

    Connor, Tom; Sledge, Jennifer A; Bryant-Wiersema, Laurel; Stamm, Linda; Potter, Patricia

    2010-01-01

    This study examined variables predictive of pressure ulcers among patients undergoing urologic surgical procedures. Anesthesia duration and total time of the diastolic blood pressure was less than 50 Hgmm were statistically significant predictors. Dynamic pressure-relieving devices are recommended to reduce incidences of pressure ulcer incidence.

  10. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study 1

    PubMed Central

    Borghardt, Andressa Tomazini; do Prado, Thiago Nascimento; de Araújo, Thiago Moura; Rogenski, Noemi Marisa Brunet; Bringuente, Maria Edla de Oliveira

    2015-01-01

    AIMS: to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients. METHOD: this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow) upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories. RESULTS: the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71%) and low specificity (21% and 47%) respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale. CONCLUSION: the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power. PMID:25806628

  11. [Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients].

    PubMed

    Roca-Biosca, A; Garcia-Fernandez, F P; Chacon-Garcés, S; Rubio-Rico, L; Olona-Cabases, M; Anguera-Saperas, L; Garcia-Grau, N; Tuset-Garijo, G; de Molina-Fernández, I; Velasco-Guillen, M C

    2015-01-01

    To contribute to the validation of the EMINA and EVAUCI scales for assessing the risk of pressure ulcers in the critical patient and compare their predictive capacity in this same context. Prospective study from December 2012 until June 2013. Polyvalent intensive care unit of 14 beds in a reference hospital for two sanitary areas. patients of 18 years of age or older and without pressure ulcers were included. They were followed until development of a pressure ulcer of grade I or greater, medical discharge, death or 30 days. presence of ulcers, daily score of the risk of developing pressure ulcers through EMINA and EVARUCI evaluation. The validity of both scales was calculated using sensitivity, specificity, and positive and negative predictive value. The level of significance was P≤0.05. A total of 189 patients were evaluated. 67.2% were male with a mean age of 59.4 (DE: 16,8) years old, 53 (28%) developed pressure ulcers, being the incidence rate of 41 ulcers per 1000 admission days. The mean day of diagnosis was 7.7 days (DE: 4,4) and the most frequent area was the sacrum. The sensitivity and specificity for the mean of observations was 94.34 (IC95% 87.17-100) and 33.33 (IC95% 25.01-41.66) for the EMINA scale for a risk>10 and 92.45 (IC95% 84.40-100) and 42.96 (IC95% 34.24-51.68) for the EVARUCI scale for a risk of>11. No differences were found in predictive capacity of both scales. For sensitivities>90%the scales show to be insufficiently specific in the pressure ulcer risk detection in critical patients. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  12. A pressure ulcer and fall rate quality composite index for acute care units: A measure development study.

    PubMed

    Boyle, Diane K; Jayawardhana, Ananda; Burman, Mary E; Dunton, Nancy E; Staggs, Vincent S; Bergquist-Beringer, Sandra; Gajewski, Byron J

    2016-11-01

    Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. The study objective was to develop a unit-level inpatient composite nursing care quality performance index-the Pressure Ulcer and Fall Rate Quality Composite Index. Two-phase measure development study. 5144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors(®) during the year 2013. The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. The Pressure Ulcer and Fall Rate Quality Composite Index=100-PUR-FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of physical restraint use were not associated with higher Pressure

  13. Pressure Ulcer Risk Factors Among the Elderly Living in Long-term Institutions .

    PubMed

    Ferreira Chacon, Julieta Marie; Nagaoka, Caroline; Blanes, Leila; Masako Ferreira, Lydia

    2010-04-01

     Although many intrinsic and extrinsic risk factors are involved, pressure is the most important factor in the development of pressure ulcers. The elderly are more susceptible to the development of these skin lesions as a result of changes associated with the aging process. The aim of this study was to identify the risk factors for pressure ulcers in the elderly living in long-term institutions. An analytic cross-sectional study of 40 patients age 60 years and older with pressure ulcers was conducted in six long-term institutions for the elderly (LTIE) in the West Side of São Paulo, Brazil. The present study evaluates pressure ulcers and their associated risk factors. Statistical analysis was performed using Pearson's chi-square test, Student's t-test, and Fisher's exact test. A statistically significant association between the risk factors evaluated in this study and the development of pressure ulcers in the sample was not found. According to the Braden scale, 67.5% of the patients were at high risk for pressure ulcer development. Fifty-one pressure ulcers were detected, with the majority (56.2%) being located in the sacral region. In the present study, more than 50% of the patients had low sensory perception, mobility, nutrition, and friction and shear subscales scores. The most prevalent risk factors were advanced age (mean, 83.8 years), length of stay that exceeded 31 months, white skin, neuromotor and skeletal muscle disorders, urinary and fecal incontinence, and continuous use of sedatives, analgesics, and hypotensives. The knowledge of risk factors is essential for healthcare professionals in planning effective prevention programs that target the elderly living in LTIE.

  14. Pressure ulcer prevention in Australia: the role of the nurse practitioner in changing practice and saving lives.

    PubMed

    Asimus, Margo; Maclellan, Lorna; Li, Pui Iris

    2011-10-01

    This paper reports on a successful nurse practitioner-led Pressure Ulcer Prevention Program (PUPP), established with members from nursing, allied health and senior management, within a regional area health service in Australia. The aims of PUPP were to quantify the prevalence of pressure ulcers within the health organisation, evaluate the policy compliances, identify cost effectiveness by implementing appropriate pressure redistributing surfaces and raise awareness of pressure ulcer prevention amongst all levels of clinical staff. The strategies include annual point prevalence study across 41 facilities, mattress replacement and online education program. The prevalence survey data were collected by skin inspection and chart audits by the trained surveyors. Since this quality improvement program commenced in 2008, it has demonstrated a reduction in pressure ulcer prevalence by 16.4%, increased pressure ulcer risk assessment by 7.9% and use of appropriate pressure-relieving devices by 46.5%, which led to cost saving of AUD 500 000. This paper highlights the patient and organisation benefits that management and clinicians can accomplish through a systemic collaborative approach, in particular with strong support from the Area Executive Team of the health organisation. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  15. Prevention of Pressure Ulcers Among People With Spinal Cord Injury: A Systematic Review.

    PubMed

    Groah, Suzanne L; Schladen, Manon; Pineda, Cynthia G; Hsieh, Ching-Hui J

    2015-06-01

    To evaluate the literature on the effectiveness of bed and wheelchair positioning and repositioning in the prevention of pressure ulcers (PUs) in both the spinal cord injury (SCI) and non-SCI populations. Systematic review. PubMed, CINAHL, PsycINFO, and EMBASE were queried with the subject heading terms "pressure sore," "pressure ulcer," "position or turn in bed, wheelchair," "pressure relief," and "pressure release." All study design types that assessed the effectiveness of bed and wheelchair positioning and pressure relief maneuvers in any patient group and in any setting were sought. Three independent reviewers extracted and summarized details of eligible trials using a standardized method. Two independent reviewers assessed the methodological quality of each trial using the American Academy of Neurology guidelines. When reviewers were not able to reach consensus, a third independent reviewer served as tiebreaker. We identified 2820 publications, of which 49 met inclusion criteria. Of these publications, the subject population was 2834 (923 persons with SCI, 717 persons without SCI, and 1194 healthy control subjects). Among studies exami