-
International Wound Journal Dec 2022Previous research shows that maximum interface pressure increases when the patient is lying in the lateral position. However, it was unclear whether it was better to...
Previous research shows that maximum interface pressure increases when the patient is lying in the lateral position. However, it was unclear whether it was better to increase or decrease the internal air pressure to reduce the maximum interface pressure in the lateral position; thus, this study investigated this issue. In this study, we investigated the change in pressure redistribution because of the difference in internal air pressure between the supine and lateral positions on an active air mattress for pressure ulcer prevention management. Each participant's five internal air pressure values served as the independent variables. The interface pressure on the active air mattress was measured for 20 minutes. The sacral left iliac crest and left greater trochanteric interface pressures were measured using a portable pressure-measuring device. When seven of the 10 participants switched from the supine position to the left lateral position, there was a decrease in the maximum interface pressure as the internal air pressure increased. The maximum interface pressure in the greater trochanter in the lateral position was twice that in the sacral region in the supine position. These results show that increasing the internal air pressure in the lateral position might help reduce the maximum interface pressure.
Topics: Humans; Air Pressure; Pressure Ulcer; Beds; Sacrococcygeal Region; Pressure
PubMed: 35474638
DOI: 10.1111/iwj.13817 -
Annals of Internal Medicine Mar 2015
Topics: Evidence-Based Medicine; Humans; Practice Guidelines as Topic; Pressure Ulcer; Risk Assessment
PubMed: 25732284
DOI: 10.7326/M15-0190 -
International Journal of Nursing Studies Jan 2024Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package.
TRIAL DESIGN
A two-arm cluster-randomised controlled trial was conducted.
METHODS
In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed.
RESULTS
A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial.
CONCLUSIONS
The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function.
TRIAL REGISTRATION
This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31, 2019).
Topics: Humans; Aged; Pressure Ulcer; Quality of Life; Skin; Intertrigo; Pain
PubMed: 37956524
DOI: 10.1016/j.ijnurstu.2023.104627 -
The Cochrane Database of Systematic... Sep 2015Pressure 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... (Review)
Review
BACKGROUND
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.
OBJECTIVES
To assess the impact of wound-care teams in preventing and treating pressure ulcers in people of any age, nursed in any healthcare setting.
SEARCH METHODS
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.
SELECTION CRITERIA
We considered RCTs that evaluated the effect of any configuration of wound-care teams in the treatment or prevention of pressure ulcers.
DATA COLLECTION AND ANALYSIS
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.
MAIN RESULTS
We identified no studies that met the inclusion criteria.
AUTHORS' CONCLUSIONS
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 ulcers. Well-designed trials addressing important clinical, quality of life and economic outcomes are justified, based on the incidence of the problem and the high costs associated with pressure ulcer management.
Topics: Humans; Patient Care Team; Pressure Ulcer
PubMed: 26373268
DOI: 10.1002/14651858.CD011011.pub2 -
Journal of Tissue Viability May 2022This systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions... (Review)
Review
AIM
This systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions taken to prevent these injuries.
METHOD
Relevant studies were retrospectively searched. Seven English keywords identified from MESH were used while searching. The search was carried out in five international databases by trying various combinations of these words during February 15-25, 2021. This systematic review was updated by rescanning databases on December 20, 2021 and a total of 611 studies were attained.
RESULTS
17 studies which met the study inclusion criteria, which were conducted mostly through online survey method in different study designs and which included a total of 24,889 healthcare professionals were examined. The incidence of PPE-related pressure ulcers was found to be between 30% and 92.8%. Grade I pressure ulcers were the most common (44.1%-82%). The incidence of skin problems except PPE-related pressure ulcers such as itching, redness and dry skin was found to be between 42.8-88.1%. Risk factors that frequently played a role in the development of PPE-related pressure ulcers and other skin problems were longer use of PPE and sweating. PPE-related pressure ulcers and other skin problems were more frequent over the nose (nasal bone/nasal bridge), ears, forehead and cheeks. PPE-related itching, redness and dry skin mostly occurred. Several dressing applications were found to be effective in the prevention of PPE-related pressure ulcers and other skin problems that might develop especially on the facial region.
CONCLUSION
PPE-related pressure ulcers and other skin problems were found to be higher among healthcare professionals. Data regarding the sealing of dressing applications against viral transmission in the prevention of PPE-related pressure ulcers and other skin problems are limited. It is estimated that future studies will be performed to prevent device-related pressure ulcers in healthcare workers. It is suggested that there is a need to conduct studies with larger samples where expert researchers make observations for pressure ulcers in order to determine the prevalence and incidence of PPE-related pressure ulcers.
Topics: COVID-19; Health Personnel; Humans; Pandemics; Personal Protective Equipment; Pressure Ulcer; Pruritus; Retrospective Studies
PubMed: 35210162
DOI: 10.1016/j.jtv.2022.02.004 -
Spinal Cord Series and Cases Jun 2020This is a retrospective, non-randomized cohort study, with data collected during the regular annual visits between 2001 and 2019.
STUDY DESIGN
This is a retrospective, non-randomized cohort study, with data collected during the regular annual visits between 2001 and 2019.
OBJECTIVES
The aim of this study was to evaluate the efficacy of coccygectomy for coccygeal pressure ulcers in individuals with paraplegia due to spinal cord injury or other neurological causes and to evaluate its role in the prophylaxis of ulcer recurrence.
SETTINGS
This study included inpatients and outpatients with a coccygeal pressure ulcer who were treated surgically at our Institution REHAB Basel and were followed with regular annual check-ups.
METHODS
Individuals with category 3 or 4 acute or chronic coccygeal pressure ulcer (classification according European Pressure Ulcer Advisory Panel (EPUAP)) received coccygectomy in addition to rotation flap surgery. The operative care was provided exclusively by the head of the plastic surgery department at REHAB Basel. Standardized follow-up treatment was carried out according to the "Basel Decubitus Concept" and thus allowed continuous and usually lifelong, regular follow-up care.
RESULTS
Forty-nine individuals underwent coccygectomy from 2001 to 2019 due to coccygeal category 3 or 4 pressure ulcers. The observation period was between 1.5 and 18.3 years. In 86% of the individuals, no relapse occurred during the first year. Over the next 5 years 78% remained relapse free.
CONCLUSIONS
In coccygeal pressure ulcer category 3 or 4, coccygectomy, in addition to sufficient rotation flap surgery, is a suitable method for recurrence prevention of pressure ulcer in this anatomic area.
Topics: Aged; Female; Humans; Male; Middle Aged; Paraplegia; Pressure Ulcer; Recurrence; Retrospective Studies; Sacrococcygeal Region; Secondary Prevention; Treatment Outcome
PubMed: 32555143
DOI: 10.1038/s41394-020-0299-0 -
Assistive Technology : the Official... Sep 2022Wheelchair users often experience prolonged periods of stationary sitting. Such periods are accompanied with increased loading of the ischial tuberosities. This can lead...
Wheelchair users often experience prolonged periods of stationary sitting. Such periods are accompanied with increased loading of the ischial tuberosities. This can lead to the development of pressure ulcers which can cause complications such as sepsis. Periodic pressure offloading is recommended to reduce the onset of pressure ulcers. Experts recommend the periodic execution of different movements to provide the needed pressure offloading. Wheelchair users, however, might not remember to perform these recommended movements in terms of both quality and quantity. A system that can detect such movements could provide valuable feedback to both wheelchair users as well as clinicians. The objective of this study was to present and validate the WiSAT - a system for characterizing in-seat activity for wheelchair users. WiSAT is designed to detect two kinds of movements - weight shifts and in-seat movements. Weight shifts are movements that offload pressure on ischial tuberosities by 30% as compared to upright sitting and are maintained for 15 seconds. In-seat movements are shorter transient movements that involve either a change in the center of pressure on the sitting buttocks or a transient reduction in total load by 30%. This study validates the use of WiSAT in manual wheelchairs. WiSAT has a sensor mat which was inserted beneath a wheelchair cushion. Readings from these sensors were used by WiSAT algorithms to predict weight shifts and in-seat movements. These weight shifts and in-seat movements were validated against a high-resolution interface pressure mat in a dataset that resembles real-world usage. The proposed system achieved weight shift precision and recall scores of 81% and 80%, respectively, while in-seat movement scores were predicted with a mean absolute error of 22%. Results showed that WiSAT provides sufficient accuracy in characterizing in-seat activity in terms of weight shifts and in-seat movement.
Topics: Buttocks; Fitness Trackers; Humans; Pressure; Pressure Ulcer; Wheelchairs
PubMed: 33617402
DOI: 10.1080/10400435.2021.1893237 -
International Wound Journal Nov 2022Alleviation of localised, sustained tissue loads and microclimate management are the most critical performance criteria for materials in use for pressure ulcer...
Alleviation of localised, sustained tissue loads and microclimate management are the most critical performance criteria for materials in use for pressure ulcer prevention, such as in prophylactic dressings, padding or cushioning. These material performance criteria can be evaluated by calculating the extents of matching between the material stiffness (elastic modulus) and the thermal conductivity of the protective dressing, padding or cushioning with the corresponding properties of native skin, separately or in combination. Based on these bioengineering performance criteria, hydrocolloids, which are commonly used for prophylaxis of medical device-related pressure ulcers, exhibit poor stiffness matching with skin. In addition, there is remarkable variability in the modulus and thermal conductivity matching levels of different material types used for pressure ulcer prevention, however, it appears that among the materials tested, hydrogels provide the optimal matching with skin, followed by gels and silicone foams. The stiffness matching for hydrocolloids appears to be inferior even to that of gauze. This article provides quantitative performance criteria and metrics for these evaluations, and grades commonly used material types to biomechanically guide clinicians and industry with regards to the selection of dressings for pressure ulcer prevention, both due to bodyweight forces and as a result of applied medical devices.
Topics: Humans; Pressure Ulcer; Bandages; Skin Care; Hydrogels; Colloids
PubMed: 35274443
DOI: 10.1111/iwj.13784 -
Revista Brasileira de Enfermagem 2021to create and validate a serial album for Pressure Ulcer prevention in the hospital environment. (Review)
Review
OBJECTIVES
to create and validate a serial album for Pressure Ulcer prevention in the hospital environment.
METHODS
a methodological study with the production of the serial album and validation by 22 judges and 22 patients. The content was based on the integrative review and the reports of the World Health Organization. It was considered a Content Validity Index equal to or greater than 80% in the items and the binomial test for the judges' agreement.
RESULTS
the serial album entitled "Pressure Ulcer Prevention in the hospital environment" has 13 pages. In the content and layout validation, all items had an agreement above 80% among the participants. The overall Content Validity Index was 0.99 for the judges and 1.0 for the patients.
CONCLUSIONS
the constructed and validated material presented itself as an adequate instrument to be used in health education activities.
Topics: Health Education; Humans; Pressure Ulcer; Surveys and Questionnaires
PubMed: 34161505
DOI: 10.1590/0034-7167-2020-1060 -
Journal of Tissue Viability Feb 2018Costs for the prevention and management of pressure ulcers have increased significantly with limited published advice from health and social care organisations on...
BACKGROUND
Costs for the prevention and management of pressure ulcers have increased significantly with limited published advice from health and social care organisations on seating and preventing pressure ulcers. At the request of the UK Tissue Viability Society the aim of the publication was to develop a practical guide for people, carers and health and social care professionals on how the research and evidence base on pressure ulcer prevention and management can be applied to those who remain seated for extended periods of time.
METHODS AND FINDINGS
The evidence base informing the guidelines was obtained by applying a triangulation of methods: a literature review, listening event and stakeholder group consultation. The purpose was to engage users and carers, academics, clinicians, inspectorate and charities, with an interest in seating, positioning and pressure management to: gather views, feedback, stories, and evidence of the current practices in the field to create a greater awareness of the issue.
CONCLUSION
The new guidelines are inclusive of all people with short and long-term mobility issues to include all population groups. The document includes evidence on where pressure ulcers develop when seated, risk factors, best possible seated position and what seat adjustments are required, the ideal seating assessment, interventions, self-help suggestions and key seating outcomes. The updated TVS CPGs have been informed by the best available evidence, the insights and wisdom of experts, stakeholders and people who spend extended periods of time sitting.
Topics: Equipment and Supplies; Guidelines as Topic; Humans; Posture; Pressure Ulcer; Tissue Survival
PubMed: 28919021
DOI: 10.1016/j.jtv.2017.09.006