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International Wound Journal Nov 2022The aim of this study was to describe pressure ulcer prevalence and prevention interventions in hospital care in Sweden based on nationwide surveys conducted over a...
The aim of this study was to describe pressure ulcer prevalence and prevention interventions in hospital care in Sweden based on nationwide surveys conducted over a 10-year period. All Swedish hospitals were invited to participate in annual pressure ulcer prevalence surveys during the period 2011-2020. The data collection protocols included gender, age, skin assessment, risk assessment, and preventive interventions. In total, more than 130,000 patients were included in the ten prevalence surveys. The prevalence of pressure ulcers in Swedish hospital patients decreased significantly from 17.0 %to 11.4% between 2011 and 2020 and hospital-acquired pressure ulcers decreased from 8.1% to 6.4% between 2018 and 2020. There was no significant decline in medicaldevice-related pressure ulcers during the same period. The proportion of patients who were risk and skin assessed increased, as did the use of pressure-reducing mattresses, sliding sheets, heel protection, and nrepositioning plans. This study shows that the implementation of a national patient safety program has had an impact on the nationwide prevalence of pressure ulcers in hospital care and the occurrence of prevention strategies. However, one in ten patients in Swedish hospitals still suffers from pressure ulcers. Further improvements can be made.
Topics: Humans; Pressure Ulcer; Prevalence; Sweden; Risk Factors; Skin Care
PubMed: 35224868
DOI: 10.1111/iwj.13779 -
International Wound Journal Aug 2023This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for... (Randomized Controlled Trial)
Randomized Controlled Trial
This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n = 115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.
Topics: Aged; Humans; Long-Term Care; Pressure Ulcer; Prevalence; Skin Care; Suppuration
PubMed: 36584884
DOI: 10.1111/iwj.14067 -
Revista Brasileira de Enfermagem 2019To identify and analyze the scientific evidence regarding the occurrence of Medical Device-Related Pressure Injuries, considering the development sites; and to describe... (Review)
Review
OBJETIVES
To identify and analyze the scientific evidence regarding the occurrence of Medical Device-Related Pressure Injuries, considering the development sites; and to describe the devices of risk and the measures of prevention and treatment.
METHOD
Integrative, search-based review: CINAHL, PubMed, Wiley InterScience, Scopus, and Web Of Science. The terms "pressure ulcer" and "medical devices" were used, including original articles and case studies published between 2010 and 2015. Nine studies were selected.
RESULTS
Posterior cervical region and nose had the highest injury frequencies, respectively, 66.0% and 40.0%. Eleven risk devices were identified, with emphasis on Non-Invasive Ventilation masks and orotracheal tube. For prevention and treatment emerged recommendations specific to the device employed and general measures.
CONCLUSION
Medical Device-Related Pressure Injuries are frequent problems, however, they can be prevented and treated based on the recommendations of the articles raised in this review.
Topics: Equipment Safety; Humans; Pressure Ulcer
PubMed: 31017216
DOI: 10.1590/0034-7167-2018-0530 -
Revista Da Escola de Enfermagem Da U S P 2023Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries. (Review)
Review
OBJECTIVE
Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries.
METHOD
Overview of systematic reviews conducted in accordance with Cochrane guidelines. A search was performed in databases, repositories and systematic review registration sites.
RESULTS
15 reviews were included in this overview. The sensitivity analysis showed a reduction in the incidence of pressure injuries with nutritional supplementation compared to the standard hospital diet (Relative Risk (RR) = 0.83; 95% Confidence Interval (CI): 0.72-0.95). There was evidence of the superiority of constant low-pressure surfaces (RR = 0.38; 95% CI;0.24-0.61), alternating pressure devices (RR = 0.31; 95% CI:0.17-0.58) and alternative foams (RR = 0.40; 95% CI:0.21-0.74) when compared to the standard hospital mattress or standard foam. The use of a silicone cover reduced the incidence of pressure injuries by 75% (RR = 0.25; 95%CI:0.16-0.41) when compared to no cover.
CONCLUSION
Although some interventions have been shown to be effective in reducing the incidence of pressure injury, the evidence is limited or very limited and subject to change. Registration CRD42017064586.
Topics: Humans; Pressure Ulcer; Systematic Reviews as Topic
PubMed: 38133528
DOI: 10.1590/1980-220X-REEUSP-2023-0039en -
PloS One 2018Pressure ulcers are a prevalent and global issue and support surfaces are widely used for preventing ulceration. However, the diversity of available support surfaces and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pressure ulcers are a prevalent and global issue and support surfaces are widely used for preventing ulceration. However, the diversity of available support surfaces and the lack of direct comparisons in RCTs make decision-making difficult.
OBJECTIVES
To determine, using network meta-analysis, the relative effects of different support surfaces in reducing pressure ulcer incidence and comfort and to rank these support surfaces in order of their effectiveness.
METHODS
We conducted a systematic review, using a literature search up to November 2016, to identify randomised trials comparing support surfaces for pressure ulcer prevention. Two reviewers independently performed study selection, risk of bias assessment and data extraction. We grouped the support surfaces according to their characteristics and formed evidence networks using these groups. We used network meta-analysis to estimate the relative effects and effectiveness ranking of the groups for the outcomes of pressure ulcer incidence and participant comfort. GRADE was used to assess the certainty of evidence.
MAIN RESULTS
We included 65 studies in the review. The network for assessing pressure ulcer incidence comprised evidence of low or very low certainty for most network contrasts. There was moderate-certainty evidence that powered active air surfaces and powered hybrid air surfaces probably reduce pressure ulcer incidence compared with standard hospital surfaces (risk ratios (RR) 0.42, 95% confidence intervals (CI) 0.29 to 0.63; 0.22, 0.07 to 0.66, respectively). The network for comfort suggested that powered active air-surfaces are probably slightly less comfortable than standard hospital mattresses (RR 0.80, 95% CI 0.69 to 0.94; moderate-certainty evidence).
CONCLUSIONS
This is the first network meta-analysis of the effects of support surfaces for pressure ulcer prevention. Powered active air-surfaces probably reduce pressure ulcer incidence, but are probably less comfortable than standard hospital surfaces. Most prevention evidence was of low or very low certainty, and more research is required to reduce these uncertainties.
Topics: Beds; Humans; Incidence; Network Meta-Analysis; Patient Comfort; Pressure Ulcer; Randomized Controlled Trials as Topic; Surface Properties; Treatment Outcome
PubMed: 29474359
DOI: 10.1371/journal.pone.0192707 -
Journal of Wound Care Dec 2020The objective of this educational article is to explain in non-technical terms how the engineering considerations in the design of prophylactic dressings for pressure...
The objective of this educational article is to explain in non-technical terms how the engineering considerations in the design of prophylactic dressings for pressure ulcer (PU, also known as pressure injury) prevention eventually determine the associated clinical and cost-benefit outcomes. The article specifically describes a bioengineering algorithm for quantitative evaluation of the biomechanical efficacy of different prophylactic dressing designs, which is exemplified for two fundamentally different dressing technologies, one based on superabsorbent cellulose core versus the conventional silicone-foam dressing design. A set of three biomechanical indices is described and employed for the above comparative evaluation, namely, the protective efficacy index, the protective endurance and the prophylactic trade-off design parameter. It is demonstrated that the dressing with the superabsorbent cellulose core is at least as good as silicone-foams but, importantly, provides a good balance between its protective performance in its 'new' condition, as opposed to its 'used' condition, i.e., after being exposed to moisture. Most notably, we show that preventative dressings are never equal in their performances; the underlying structure and the dressing ingredients together determine the extent of the delivered tissue protection and its durability.
Topics: Bandages; Humans; Pressure Ulcer; Silicones; Skin Care
PubMed: 33320759
DOI: 10.12968/jowc.2020.29.Sup12.S6 -
Journal of Medical Internet Research Sep 2022Pressure injury is a common complication after a spinal cord injury. Long-term multidisciplinary follow-up is difficult after such patients have been discharged.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pressure injury is a common complication after a spinal cord injury. Long-term multidisciplinary follow-up is difficult after such patients have been discharged. Telemedicine promises to provide convenient and effective support for the prevention and treatment of pressure injury, but previous attempts to demonstrate that have produced inconsistent results.
OBJECTIVE
The aim of this study is to evaluate the effectiveness of telemedicine in preventing and treating pressure injury among community-dwelling patients with spinal cord injury, and determine which telemedicine form is more effective.
METHODS
This systematic review was performed according to the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analysis) standards. Ten databases were searched to identify randomized controlled trials and quasi-experimental studies related to the effectiveness of telemedicine intervention in patients with spinal cord injury. Two researchers worked independently and blindly selected studies, extracted data, and assessed the risk of bias. The results were described as relative risk (RR) and weighted mean difference and 95% CI.
RESULTS
The 35 studies comprised 25 randomized controlled trials and 10 quasi-experimental studies involving 3131 patients. The results showed that telemedicine can significantly (P<.05) reduce the incidence of pressure injury (RR 0.24, 95% CI 0.14-0.41; P<.05; I=0%), promote faster healing (RR 0.73, 95% CI 0.62-0.85; P<.05; I=0%), and yield lower scores on the pressure ulcer scale of healing (weighted mean difference=-1.98, 95% CI -3.51 to -0.46; P<.05; I=0%). Cumulative ranking estimates showed that combining telemedicine with conventional intervention (93.5%) was the most effective approach.
CONCLUSIONS
Telemedicine is a feasible way to prevent pressure injury among patients with spinal cord injuries. It can decrease the incidence and severity of pressure injury and accelerate patients' healing without imposing economic burden. It is best used in tandem with other, more conventional interventions. Due to the limited quality and quantity of included studies, large-scale and well-designed randomized controlled trials are warranted.
Topics: Humans; Incidence; Independent Living; Pressure Ulcer; Spinal Cord Injuries; Telemedicine
PubMed: 36069842
DOI: 10.2196/37618 -
Inquiry : a Journal of Medical Care... 2021We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four... (Review)
Review
We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four stages: literature review and analysis of medical records; preliminary algorithm development; validation of the preliminary algorithm by experts in two rounds; and practical feasibility verification of the revised algorithm by 109 intensive care unit nurses. To verify the algorithm's effectiveness, we compared the incidence of medical device-related pressure injuries between 324 patients without algorithm application (control group) and 312 patients with algorithm application (experimental group). The outcomes were skin inspection of the medical device attachment, pressure injury evaluation, and implementation of pressure injury-preventive nursing care, based on the medical device type. The incidence rates were 1.46 per 100 devices (control group) and 1.19 per 100 devices (experimental group). Since there was no homogeneity in the previous score of the Braden scale in the experimental and control groups, the results regarding the incidence of pressure damage after applying the algorithm should be interpreted with care. Applying this algorithm was a safe intervention that helped prevent medical device-related pressure injuries in this population.
Topics: Algorithms; Humans; Incidence; Intensive Care Units; Pressure Ulcer; Risk Factors
PubMed: 34672226
DOI: 10.1177/00469580211050219 -
The Pan African Medical Journal 2018
Topics: Aged, 80 and over; Humans; Male; Oral Ulcer; Pressure Ulcer; Tongue Diseases
PubMed: 30167058
DOI: 10.11604/pamj.2018.30.31.15007 -
International Journal of Molecular... Dec 2020Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they... (Review)
Review
Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they are characterized by impaired wound healing due to dysregulated immune processes. This review will highlight key biochemical pathways in the pathogenesis of pressure injury and how this signaling leads to impaired wound healing. This review is the first to comprehensively describe the current literature on microRNA (miRNA, miR) regulation of pressure ulcer pathophysiology.
Topics: Animals; Apoptosis; Disease Management; Disease Susceptibility; Extracellular Matrix; Gene Expression Regulation; Gene Regulatory Networks; Humans; Immunity; MicroRNAs; Oxidative Stress; Pressure Ulcer; RNA Interference; Reperfusion Injury; Signal Transduction; Wound Healing
PubMed: 33374656
DOI: 10.3390/ijms22010064