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Ontario Health Technology Assessment... 2014Pressure at the interface between bony prominences and support surfaces, sufficient to occlude or reduce blood flow, is thought to cause pressure ulcers (PrUs). Pressure... (Randomized Controlled Trial)
Randomized Controlled Trial
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 turning might increase sleep, improve quality of life, reduce staff injury, and save time for such other activities as feeding, walking, and toileting.
Topics: Aged, 80 and over; Female; Humans; Incidence; Male; Nursing Homes; Patient Positioning; Pressure Ulcer; Risk Factors; Time Factors
PubMed: 26330893
DOI: No ID Found -
International Wound Journal Oct 2022The most common pressure ulcer associated with medical devices in the ICU is pressure injury associated with the endotracheal tube. We aimed to scrutinise the effects of... (Randomized Controlled Trial)
Randomized Controlled Trial
The most common pressure ulcer associated with medical devices in the ICU is pressure injury associated with the endotracheal tube. We aimed to scrutinise the effects of two different techniques of endotracheal tube securement used in the ICU on the occurrence of pressure ulcers. This randomised clinical trial was conducted in 60 patients, 30 of which were intervention and 30 experimental, admittedin the ICU of a training and research hospitaldata were collected using the descriptive and clinical characteristics from the Braden Scale for predicting Pressure Sore Risk, the Pressure Ulcer Scale for healing, The International Staging System for Pressure Injuries and the Eilers Oral Assessment Guide. Based on the Braden Scale scores of the patients, we found that 98.3% of the cases were in the high-risk group before and after the intervention. We also found that the recovery was higher among patients in whom the bandage fixation method was applied compared to those in whom the fixation was done with an endotracheal tube holder.
Topics: Humans; Intensive Care Units; Intubation, Intratracheal; Pressure Ulcer; Risk Factors
PubMed: 35088531
DOI: 10.1111/iwj.13757 -
American Family Physician Aug 2023Pressure injuries are localized damage to skin or soft tissue. They commonly occur over bony prominences and often present as an intact or open wound. Pressure injuries...
Pressure injuries are localized damage to skin or soft tissue. They commonly occur over bony prominences and often present as an intact or open wound. Pressure injuries are common and costly, and they significantly impact patient quality of life. Comprehensive skin assessments are crucial for evaluating pressure injuries. Staging of pressure injuries should follow the updated staging system of the National Pressure Injury Advisory Panel. Risk assessments allow for appropriate prevention and care planning, and physicians should use a structured, repeatable approach. Prevention of pressure injuries focuses on assessing and optimizing nutritional status, repositioning the patient, and providing appropriate support surfaces. Treatment involves pressure off-loading, nutritional optimization, appropriate bandage selection, and wound site management. Pressure injuries and surrounding areas should be cleaned, with additional debridement of devitalized tissue and biofilm if necessary. All injuries should be monitored for local infection, biofilms, and osteomyelitis. Appropriate wound dressings should be selected based on injury stage and the quality and volume of exudate.
Topics: Humans; Pressure Ulcer; Quality of Life; Bandages; Nutritional Status; Osteomyelitis
PubMed: 37590857
DOI: No ID Found -
IEEE Reviews in Biomedical Engineering 2020Pressure injuries are caused by prolonged pressure to an area of the body, which can result in open wounds that descend to the bone. Pressure injuries should not occur... (Review)
Review
Pressure injuries are caused by prolonged pressure to an area of the body, which can result in open wounds that descend to the bone. Pressure injuries should not occur in healthcare settings, and yet, they still affect 2.5 million patients in the United States and have an impact on quality of life. Pressure injuries come at a cost of $11 billion in the United States, and 90% of pressure injuries are a secondary condition. In this paper, we survey the literature on preventative techniques to address pressure injures, which we classify into two categories: active prevention strategies and sensor-based risk-factor monitoring. Within each category of techniques, we discuss the literature and assess each class of strategies based on its commercial availability, results of clinical trials when available, the ability for the strategy to save time for healthcare staff, and whether the technique can be tuned to an individual. Based on our findings, the most promising current solutions, supplementary to nursing guidelines, are electrical stimulation, pressure monitoring, and inertial measurement unit monitoring. We also find a need for a clinical software system that can easily integrate with custom sensors, use custom analysis algorithms, and provide visual feedback to the healthcare staff.
Topics: Algorithms; Biomechanical Phenomena; Humans; Internet of Things; Monitoring, Physiologic; Pressure Ulcer; Risk Factors
PubMed: 31283488
DOI: 10.1109/RBME.2019.2927200 -
Journal of Wound Care Sep 2023Pressure ulcer/injury (PU) risk assessment is widely considered an essential component in clinical practice. It is a complex and broad concept that includes different...
Pressure ulcer/injury (PU) risk assessment is widely considered an essential component in clinical practice. It is a complex and broad concept that includes different approaches, such as clinical judgement, using standardised risk assessment instruments, skin assessments, or using devices to measure skin or tissue properties. A distinction between PU risk assessment and early detection is important. PU risk measures the individual's susceptibility to developing a PU under a specific exposure (primary prevention), and early detection includes the assessment of early (sub)clinical signs and symptoms to prevent progression and to support healing (secondary prevention). PU risk is measured using prognostic/risk factors or prognostic models. Every risk estimate is a probability statement containing varying degrees of uncertainty. It therefore follows that every clinical decision based on risk estimates also contains uncertainty. PU risk assessment and prevention is a complex intervention, where delivery contains several interacting components. There is a huge body of evidence indicating that risk assessment and its outcomes, the selection of preventive interventions and PU incidence are not well connected. Methods for prognostic model development and testing in PU risk research must be improved and follow state-of-the-art methodological standards. Despite these challenges, we do have substantial knowledge about PU risk factors that helps us to make better clinical decisions. An important next step in the development of PU risk prediction might be the combination of clinical and other predictors for more individualised care. Any prognostic test or procedure must lead to better prevention at an acceptable cost.
Topics: Humans; Pressure Ulcer; Risk Factors; Risk Assessment; Secondary Prevention; Skin
PubMed: 37682783
DOI: 10.12968/jowc.2023.32.9.560 -
Physical Medicine and Rehabilitation... Nov 2022Pressure injuries (PIs) are a spectrum of localized tissue destruction that develops most often at a bony prominence. PIs are the result of a combination of extrinsic... (Review)
Review
Pressure injuries (PIs) are a spectrum of localized tissue destruction that develops most often at a bony prominence. PIs are the result of a combination of extrinsic (eg, pressure, shear, friction, and moisture) and intrinsic (nutritional status, spasticity, decreased sensation, and vascular disease) factors. Given their complex etiology, management of PIs requires a multidisciplinary approach from a team of health care professionals. After addressing both extrinsic and intrinsic factors, local wound care is generally recommended for stages 1 to 2 PIs and surgical intervention for stages 3 to 4.
Topics: Health Personnel; Humans; Nutritional Status; Pressure Ulcer
PubMed: 36243469
DOI: 10.1016/j.pmr.2022.06.002 -
The International Journal of Lower... Sep 2022Pressure ulcer (PU) is one of the most common occurrences in bedridden subjects. Despite the standard of care, there is a huge challenge in monitoring immobile subjects... (Review)
Review
Pressure ulcer (PU) is one of the most common occurrences in bedridden subjects. Despite the standard of care, there is a huge challenge in monitoring immobile subjects in all the bodily pressure points. This increases the chance of onset of PU which in turn increases the expenditure for treating and managing the PU. Hence, we made a study on the biological and physiological factors that are responsible for the formation of PU and also on various techniques used for diagnosis. Thus, we have summarised the efficacy of various advanced diagnostic procedures with their limitations. Though there are advanced imaging techniques, risk assessment tools based on the visual inspection are widely followed in hospitals. Based on our observation, we here have identified three major areas; one being the development of mathematical modeling, the second is towards the development of non-invasive devices and finally to automate cot facility. We have also provided possible suggestions as to solutions that could be useful to researchers and for society. Thus, this review covers the present difficulty faced by bedridden subjects and respective care-takers along with the knowledge gap and a few suggestions as to future scope.
Topics: Humans; Pressure Ulcer
PubMed: 35188406
DOI: 10.1177/15347346221081603 -
Journal of Wound Care Feb 2020
Topics: Consensus Development Conferences as Topic; Equipment and Supplies; Humans; Practice Guidelines as Topic; Pressure Ulcer
PubMed: 32058852
DOI: 10.12968/jowc.2020.29.2.77 -
British Journal of Nursing (Mark Allen... Feb 2023Pressure ulcer (PU) prevention is a high priority for health professionals in all settings. While PU incidence is expected to rise given the ageing population in the UK...
Pressure ulcer (PU) prevention is a high priority for health professionals in all settings. While PU incidence is expected to rise given the ageing population in the UK and Europe, PUs can occur in people of any age. It is therefore imperative that all practitioners know about the causes and consequences of PUs and be aware of up-to-date guidance on the prevention and management in patients who have developed a PU or who are at risk of developing a PU. Health professionals should also be aware of preventive equipment highlighted in national and local guidance, prevention strategies and protocols. This article discusses these issues and the Devon (Cardinal Health) prevention and repositioning product range.
Topics: Humans; Pressure Ulcer; Patient Positioning; Europe; Protective Devices; Suppuration
PubMed: 36763473
DOI: 10.12968/bjon.2023.32.3.108 -
British Journal of Community Nursing Jun 2024Pressure ulcers (PUs) represent a burden to the health economy and patients alike. Despite national and international guidelines regarding the management of risk, the... (Review)
Review
Pressure ulcers (PUs) represent a burden to the health economy and patients alike. Despite national and international guidelines regarding the management of risk, the incidence and prevalence across England remains high. Detecting early the risk of PUs is paramount, and requires using a valid risk assessment tool alongside clinical judgement and management of associated risk factors. There is a need to implement prevention strategies. Introducing care bundles for pressure ulcers, for example SKIN, SSKIN and most recently aSSKINg, is designed to guide clinicians and reduce variations in care. This article presents a review of the evidence on compliance with guidelines, frameworks, pathways or care bundles within primary and secondary care settings. This article focuses on the literature review that was conducted to inform a subsequent clinical audit of compliance with the aSSKINg framework in a Community NHS Foundation Trust in the South East of England.
Topics: Humans; Pressure Ulcer; England; Risk Assessment; Risk Factors; Practice Guidelines as Topic; Guideline Adherence; Patient Care Bundles; State Medicine
PubMed: 38814848
DOI: 10.12968/bjcn.2024.29.Sup6.S16