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Journal of Tissue Viability Aug 2023To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings. (Review)
Review
OBJECTIVE
To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings.
METHODS
A systematic literature review of quantitative, qualitative, and mixed methods research was undertaken using PubMed, MEDLINE, Embase, CINAHL, and Cochrane Library. Studies that reported barriers or/and facilitators to pressure injury prevention in the acute care settings and published in English from 2008 to 2022 were included. Studies were excluded if they were conducted in residential care facilities and nursing homes, or other long-term community care settings. Two authors independently screened articles against the inclusion and exclusion criteria. Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Reported results were mapped to the Theoretical Domains Framework to identify the barriers and facilitators to pressure injury prevention.
RESULTS
A total of 78 studies were included. There were 65 quantitative studies, 11 qualitative studies, and two mix-methods studies. The most salient Theoretical Domains Framework domains identified in this review were "Knowledge", "Skills", "Environmental Context and Resources", "Optimism", "Social/Professional Role and Identity", and "Social influences".
CONCLUSION
The barriers and facilitators to pressure injury prevention in hospital settings identified in this systematic review were diverse, and included issues at both individual and organizational level. Healthcare organizations can address the barriers and facilitators from the influential Theoretical Domains Framework domains. Future research is required to investigate the effectiveness of behaviour change interventions that specifically target these barriers and facilitators to pressure injury prevention.
Topics: Humans; Pressure Ulcer; Nursing Homes; Hospitals; Crush Injuries; Qualitative Research
PubMed: 37150650
DOI: 10.1016/j.jtv.2023.04.009 -
International Wound Journal Oct 2023This systematic review aimed to examine the knowledge of caregivers regarding pressure ulcer (PU) prevention. A thorough, methodical search was conducted from the... (Review)
Review
This systematic review aimed to examine the knowledge of caregivers regarding pressure ulcer (PU) prevention. A thorough, methodical search was conducted from the earliest date to February 1, 2023 using keywords extracted from Medical Subject Headings such as "Caregivers", "Knowledge", and "Pressure ulcer" in various international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and Scientific Information Database. The quality of the studies included in this systematic review was evaluated using an appraisal tool for cross-sectional studies (AXIS tool). In total, 927 caregivers participated in the eight studies. The average age of the participants was 40.50 (SD = 12.67). Among the participants, 61.87% were women. The average caregiver's knowledge of PU prevention was 53.70 (SD = 14.09) out of 100, which suggests a moderate level of knowledge. Factors such as level of education, age, occupation, information about PUs, attitude, and practice had a significant positive relationship with caregivers' knowledge related to the prevention of PUs. Knowledge had a significantly negative relationship with age. In addition, marital status, type of relationship, age, gender, occupation, level of education, and inpatient wards had a significant relationship with caregivers' knowledge regarding PUs prevention. Therefore, managers and policymakers in the medical field can help increase caregivers' knowledge by providing an online or in-person educational platform relevant to PU prevention.
Topics: Humans; Female; Male; Caregivers; Cross-Sectional Studies; Ulcer; Pressure Ulcer; Suppuration
PubMed: 36960763
DOI: 10.1111/iwj.14168 -
The Cochrane Database of Systematic... May 2021Pressure ulcers (also known as pressure injuries) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pressure ulcers (also known as pressure injuries) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Foam surfaces (beds, mattresses or overlays) are widely used with the aim of preventing pressure ulcers.
OBJECTIVES
To assess the effects of foam beds, mattresses or overlays compared with any support surface on the incidence of pressure ulcers in any population in any setting.
SEARCH METHODS
In November 2019, 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.
SELECTION CRITERIA
We included randomised controlled trials that allocated participants of any age to foam beds, mattresses or overlays. Comparators were any beds, mattresses or overlays.
DATA COLLECTION AND ANALYSIS
At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and the certainty of the evidence assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. If a foam surface was compared with surfaces that were not clearly specified, then the included study was recorded and described but not considered further in any data analyses.
MAIN RESULTS
We included 29 studies (9566 participants) in the review. Most studies were small (median study sample size: 101 participants). The average age of participants ranged from 47.0 to 85.3 years (median: 76.0 years). Participants were mainly from acute care settings. We analysed data for seven comparisons in the review: foam surfaces compared with: (1) alternating pressure air surfaces, (2) reactive air surfaces, (3) reactive fibre surfaces, (4) reactive gel surfaces, (5) reactive foam and gel surfaces, (6) reactive water surfaces, and (7) another type of foam surface. Of the 29 included studies, 17 (58.6%) presented findings which were considered at high overall risk of bias.
PRIMARY OUTCOME
pressure ulcer incidence Low-certainty evidence suggests that foam surfaces may increase the risk of developing new pressure ulcers compared with (1) alternating pressure (active) air surfaces (risk ratio (RR) 1.59, 95% confidence interval (CI) 0.86 to 2.95; I = 63%; 4 studies, 2247 participants), and (2) reactive air surfaces (RR 2.40, 95% CI 1.04 to 5.54; I = 25%; 4 studies, 229 participants). We are uncertain regarding the difference in pressure ulcer incidence in people treated with foam surfaces and the following surfaces: (1) reactive fibre surfaces (1 study, 68 participants); (2) reactive gel surfaces (1 study, 135 participants); (3) reactive gel and foam surfaces (1 study, 91 participants); and (4) another type of foam surface (6 studies, 733 participants). These had very low-certainty evidence. Included studies have data on time to pressure ulcer development for two comparisons. When time to ulcer development is considered using hazard ratios, the difference in the risk of having new pressure ulcers, over 90 days' follow-up, between foam surfaces and alternating pressure air surfaces is uncertain (2 studies, 2105 participants; very low-certainty evidence). Two further studies comparing different types of foam surfaces also reported time-to-event data, suggesting that viscoelastic foam surfaces with a density of 40 to 60 kg/m may decrease the risk of having new pressure ulcers over 11.5 days' follow-up compared with foam surfaces with a density of 33 kg/m (1 study, 62 participants); and solid foam surfaces may decrease the risk of having new pressure ulcers over one month's follow-up compared with convoluted foam surfaces (1 study, 84 participants). Both had low-certainty evidence. There was no analysable data for the comparison of foam surfaces with reactive water surfaces (one study with 117 participants). Secondary outcomes Support-surface-associated patient comfort: the review contains data for three comparisons for this outcome. It is uncertain if there is a difference in patient comfort measure between foam surfaces and alternating pressure air surfaces (1 study, 76 participants; very low-certainty evidence); foam surfaces and reactive air surfaces (1 study, 72 participants; very low-certainty evidence); and different types of foam surfaces (4 studies, 669 participants; very low-certainty evidence). All reported adverse events: the review contains data for two comparisons for this outcome. We are uncertain about differences in adverse effects between foam surfaces and alternating pressure (active) air surfaces (3 studies, 2181 participants; very low-certainty evidence), and between foam surfaces and reactive air surfaces (1 study, 72 participants; very low-certainty evidence). Health-related quality of life: only one study reported data on this outcome. It is uncertain if there is a difference (low-certainty evidence) between foam surfaces and alternating pressure (active) air surfaces in health-related quality of life measured with two different questionnaires, the EQ-5D-5L (267 participants) and the PU-QoL-UI (233 participants). Cost-effectiveness: one study reported trial-based cost-effectiveness evaluations. Alternating pressure (active) air surfaces are probably more cost-effective than foam surfaces in preventing pressure ulcer incidence (2029 participants; moderate-certainty evidence).
AUTHORS' CONCLUSIONS
Current evidence suggests uncertainty about the differences in pressure ulcer incidence, patient comfort, adverse events and health-related quality of life between using foam surfaces and other surfaces (reactive fibre surfaces, reactive gel surfaces, reactive foam and gel surfaces, or reactive water surfaces). Foam surfaces may increase pressure ulcer incidence compared with alternating pressure (active) air surfaces and reactive air surfaces. Alternating pressure (active) air surfaces are probably more cost-effective than foam surfaces in preventing new pressure ulcers. Future research in this area should consider evaluation of the most important support surfaces from the perspective of decision-makers. Time-to-event outcomes, careful assessment of adverse events and trial-level cost-effectiveness evaluation should be considered in future studies. Trials should be designed to minimise the risk of detection bias; for example, by using digital photography and by blinding adjudicators of the photographs to group allocation. Further review using network meta-analysis will add to the findings reported here.
Topics: Aged; Aged, 80 and over; Air; Bedding and Linens; Beds; Bias; Female; Gels; Humans; Incidence; Male; Middle Aged; Pressure Ulcer; Randomized Controlled Trials as Topic; Viscoelastic Substances
PubMed: 34097765
DOI: 10.1002/14651858.CD013621.pub2 -
Advances in Skin & Wound Care Jan 2023To investigate the relationship between COVID-19 related variables and hospital-acquired pressure injuries (HAPI) incidence.
OBJECTIVE
To investigate the relationship between COVID-19 related variables and hospital-acquired pressure injuries (HAPI) incidence.
DATA SOURCES
The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as COVID-19, hospital-acquired pressure injuries, pressure ulcer, pressure injury, decubitus ulcer, and hospitalization.
STUDY SELECTION
The systematic search of the literature identified 489 publications that matched the inclusion criteria. This included peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously and 19 publications were included.
DATA EXTRACTION
Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies.
DATA SYNTHESIS
A narrative synthesis of the extracted data was carried out because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence.
CONCLUSIONS
This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should employ more robust methodology and focus on quantitative modeling to iteratively improve in-patient HAPI guidelines.
PubMed: 36705972
DOI: 10.1097/01.ASW.0000919408.20614.61 -
Advances in Skin & Wound Care Aug 2023To investigate the relationship between COVID-19-related variables and hospital-acquired pressure injury (HAPI) incidence.
OBJECTIVE
To investigate the relationship between COVID-19-related variables and hospital-acquired pressure injury (HAPI) incidence.
DATA SOURCES
The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as "COVID-19," "hospital-acquired pressure injuries," "pressure ulcer," "pressure injury," "decubitus ulcer," and "hospitalization."
STUDY SELECTION
The systematic search of the literature identified 489 publications that matched the inclusion criteria. Articles were included in the review if they were peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously, and 19 publications were included.
DATA EXTRACTION
Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies.
DATA SYNTHESIS
The authors carried out a narrative synthesis of the extracted data because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence.
CONCLUSIONS
This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should use more robust methodology and focus on quantitative modeling to iteratively improve inpatient HAPI guidelines.
Topics: Humans; Male; COVID-19; Hospitalization; Hospitals; Length of Stay; Pressure Ulcer
PubMed: 37471447
DOI: 10.1097/ASW.0000000000000005 -
International Wound Journal Sep 2023The aim of this systematic review and meta-analysis is to provide an overview of the prevalence of pressure ulcers (PU) in orthopaedic wards. A comprehensive, systematic... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review and meta-analysis is to provide an overview of the prevalence of pressure ulcers (PU) in orthopaedic wards. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Prevalence", "Pressure ulcer", "Pressure sore", and "Orthopaedics" from the earliest to February 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. Finally, 11 studies were included in the final analysis. The results indicated that the prevalence of PU in orthopaedic departments was 18% (ES: 0.18, 95% CI: 0.10-0.26, Z = 4.53, I : 99.09%). Although the odds ratio of PU was lower in men than women, it was not statistically significant (OR: 0.91, 95% CI: 0.74-1.11, Z = 0.95, I : 17.4%, P = .34). Also, results showed the prevalence of PU was higher among studies with a sample size of more than 200 (ES: 0.19, 95% CI: 0.10-0.28, Z = 4.07, I : 99.1%), Europe region (ES: 0.20, 95% CI: 0.14-0.26, Z = 6.7, I : 93.0%) and prospective design (ES: 0.23, 95% CI: 0.18-0.27, Z = 9.47, I : 83.3%) when compared with other sub-groups. In sum, considering the 18% prevalence of PU in the orthopaedic department, it is recommended to focus on detecting risk factors and design interventions to reduce PU in the patients admitted orthopaedic department.
Topics: Male; Humans; Female; Ulcer; Cross-Sectional Studies; Risk Factors; Hospitals; Europe; Pressure Ulcer
PubMed: 36960790
DOI: 10.1111/iwj.14156 -
International Wound Journal Mar 2024This review aims to systematically evaluate the association between hypertension and pressure ulcer (PU). PubMed, Embase, Web of Science, and Cochrane Library were... (Meta-Analysis)
Meta-Analysis Review
This review aims to systematically evaluate the association between hypertension and pressure ulcer (PU). PubMed, Embase, Web of Science, and Cochrane Library were searched for studies from their inception until September 12, 2023. Literature search, data extraction, and quality assessment were conducted independently by two researchers. The random-effects model was used to calculate the combined odds ratio (OR) and corresponding 95% confidence interval (CI) of hypertension in patients with PU; subgroup analyses were performed to explore the source of between-study heterogeneity; sensitivity analysis was used to test the robust of the combined result; and funnel plot and Egger's test were used to assess the publication bias. Finally, a total of 19 studies with 564 716 subjects were included; the overall pooled result showed no significant association between hypertension and risk of developing PU (OR = 1.15, 95% CI = 0.90-1.47, p = 0.27); and the sensitivity analysis and publication bias analysis showed robust of the combined result. Subgroup analysis indicated a significant association between hypertension and PU when the primary disease was COVID-19 (OR = 1.73, 95% CI = 1.35-2.22, p < 0.0001). No association between hypertension and PU was seen in subgroup analysis on the patient source and study design. In sum, there is no significantly statistical association between hypertension and the occurrence of PU in most cases, while the risk of PU significantly elevates among COVID-19 patients combined with hypertension regardless of patient source and study design.
Topics: Humans; Pressure Ulcer; Hypertension; Research Design; COVID-19
PubMed: 38494175
DOI: 10.1111/iwj.14829 -
Journal of Tissue Viability Aug 2022Pressure ulcer (PU), as a long-term disabling condition, is an important indicator for patient safety and quality of nursing care in hospitals. This systematic review... (Review)
Review
INTRODUCTION
Pressure ulcer (PU), as a long-term disabling condition, is an important indicator for patient safety and quality of nursing care in hospitals. This systematic review aimed to evaluate the knowledge, attitude, and practice of Iranian nurses towards PU prevention.
METHODS
A systematic search was conducted on PubMed, Web of Science, Scopus databases, Google Scholar Search Engine, as well as Magiran, Iranmedex, and Scientific Information Database (SID) Persian databases using the relevant keywords, from the earliest date available to August 21, 2020. Studies were appraised using the appraisal tool for cross-sectional studies (AXIS tool).
FINDINGS
Among a total of 1,543 Iranian nurses included in the 9 studies, 80.53% were female with a mean age of 31.14 (SD = 5.52) years. The mean work experience of the participants was 7.94 years (SD = 5.44). The knowledge and practice of Iranian nurses toward PU prevention were insufficient and relatively desirable, respectively. Also, the present study showed that nurses' attitudes toward PU prevention were contradictory. Age, gender, level of education, work experience, and participation in previous educational workshops were possible factors related to nurses' knowledge about PU prevention. Women with higher work experience had a more positive attitude.
CONCLUSION
This review found inappropriate knowledge, attitude, and practice of Iranian nurses toward PU prevention and highlights the importance of regular upgrading of nurses' knowledge and practice related to PU prevention.
Topics: Adult; Clinical Competence; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Iran; Male; Nurses; Pressure Ulcer; Surveys and Questionnaires
PubMed: 35718594
DOI: 10.1016/j.jtv.2022.06.004 -
International Wound Journal Oct 2023The purpose of this review study is to investigate the attitude of nursing students toward the prevention of pressure ulcers (PUs) and related factors. From February 1,... (Review)
Review
The purpose of this review study is to investigate the attitude of nursing students toward the prevention of pressure ulcers (PUs) and related factors. From February 1, 2023, a comprehensive search was conducted in international and Persian electronic databases such as Web of Science, PubMed, Scopus, Iranmedex, and Scientific information database (SID). The keywords obtained from Medical Subject Headings, including "Attitude", "Nursing students", and "Pressure ulcer" were used in this search. The quality assessment of the present studies in this systematic review was based on the appraisal tool for cross-sectional studies (AXIS tool). A total of 6454 nursing students participated in ten cross-sectional studies. All students were studying at the undergraduate level and 81.20% of them were female. Nursing students were in the first (39.27%), second (28.19%), and third and fourth (32.54%) academic years. Among the participants, 49.86% have completed at least 2 clinical units. The mean scores of attitudes toward PU prevention in nursing students based on attitude toward PU prevention (APuP) and researcher-made questionnaires were 75.01% and 68.82%, respectively. The attitude of nursing students was influenced by various factors, including age, sex, academic year, clinical experience, number of clinical units, experience in caring for PU patients, previous courses on PU in the curriculum, and contribution of training to knowledge. Also, in the present study, the positive relationship between the attitude and knowledge of nursing students was shown as the only significant correlation. In sum, the attitude of the majority of nursing students toward the prevention of PUs was at a satisfactory level. Therefore, it is expected to transfer the necessary knowledge to them with proper planning so that preventive actions can be carried out by following the guidelines.
Topics: Humans; Female; Male; Ulcer; Students, Nursing; Cross-Sectional Studies; Surveys and Questionnaires; Pressure Ulcer; Health Knowledge, Attitudes, Practice; Suppuration; Attitude of Health Personnel
PubMed: 37434034
DOI: 10.1111/iwj.14191 -
Annals of Medicine and Surgery (2012) May 2021Postoperative pressure ulcers are known as the most important quality indicators of intraoperative care that create critical and costly complications during hospital... (Review)
Review
BACKGROUND AND OBJECTIVE
Postoperative pressure ulcers are known as the most important quality indicators of intraoperative care that create critical and costly complications during hospital care. Accordingly, this study was performed to determine the risk factor for diabetes in postoperative pressure ulcers.
MATERIALS AND METHODS
The present study is a systematic review of PubMed, Scopus and the Web of Science databases with using standardized keywords of the performed English language articles between Jan 2010 to Jan 2020. The articles were searched independently by two related researchers to avoid possible biases. Then, all collected articles were reviewed, and articles with inclusion criteria were evaluated using a data collection table. It should be noted that the data were analyzed using STATA software version 11.1.
RESULTS
Overall, the results showed that 19724 patients were identified from 15 studies conducted in Asia (six), the America (four), Europe (four), and Australia (one) from 1989 to 2019. The results showed that patients with diabetes were more likely to experience surgery-related pressure ulcers than patients without diabetes (The odds ratio of 1.52; the 95% confidence interval: 1.25-1.85).
CONCLUSION
In general, patients with diabetes increased the risk of surgery-related pressure ulcers about 1.5 times more than others. Accordingly, the reduction of surgery-induced pressure ulcers should be more extensively considered in patients with diabetes.
PubMed: 33996066
DOI: 10.1016/j.amsu.2021.102336