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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 -
Wounds : a Compendium of Clinical... Aug 2019Pressure injury is one of the most prevalent skin injuries and a great challenge in the hospital environment. The implementation of preventive measures contributes to... (Comparative Study)
Comparative Study Randomized Controlled Trial
INTRODUCTION
Pressure injury is one of the most prevalent skin injuries and a great challenge in the hospital environment. The implementation of preventive measures contributes to reducing its occurrence.
OBJECTIVE
This study compares the protective effect of 2 adhesive dressings used in the prevention of pressure injuries in at-risk patients.
MATERIALS AND METHODS
This case series was conducted at a university hospital in southeastern Brazil with 80 hospitalized adult patients at risk for pressure injuries, as per the Braden Scale for Predicting Pressure Sore Risk. Patients were randomized to preventive intervention with either hydrocellular foam (n = 40) or hydrocolloid plate (n = 40) dressing, which was applied to the intact skin over the sacrum and trochanters and changed weekly over 8 weeks.
RESULTS
Of the patients, 56.5% were women, 64.5% were 60 years of age or older, 58.1% were admitted to an intensive care unit, and 63.9% were at high risk for pressure injuries. None of the patients developed a pressure injury. However, the presence of blanchable erythema, desquamation, pruritus, discomfort during dressing removal, and skin damage caused by the strong adhesiveness of the dressings were observed in both groups. In the hydrocolloid plate group, patients reported significantly more discomfort during dressing removal due to its strong adhesion to the skin (P = .004) than those in the hydrocellular foam group.
CONCLUSIONS
Standard preventive measures combined with the use of either hydrocellular foam or hydrocolloid plate contributed to the prevention of pressure injuries in at-risk patients, with hydrocolloid plate being associated with significantly more discomfort during dressing removal.
Topics: Aged; Bandages; Bandages, Hydrocolloid; Female; Humans; Male; Middle Aged; Pressure Ulcer; Treatment Outcome; Wound Healing
PubMed: 31184996
DOI: No ID Found -
Enfermeria Clinica (English Edition) 2023Preventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Preventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings.
METHODS
A literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. Evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model.
RESULTS
Of the 1056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95% CI: 0.19-0.45, P<0.01). We found no significant difference between results of studies conducted in intensive care settings (RR=0.25, 95% CI: 0.15-0.43, P<0.01) and non-intensive care settings (RR=0.38, 95% CI: 0.17-0.83, P=0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95% CI: 0.20-0.48, P<0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95% CI: 0.01-0.73, P=0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27).
CONCLUSION
The present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.
Topics: Humans; Silicones; Bandages; Intensive Care Units; Pressure Ulcer; Hospitalization
PubMed: 35680115
DOI: 10.1016/j.enfcle.2022.05.002 -
Journal of Wound, Ostomy, and...The purpose of this systematic review was to identify and evaluate the use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries (HAPIs).
PURPOSE
The purpose of this systematic review was to identify and evaluate the use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries (HAPIs).
METHODS
A systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis Statement (PRISMA).
SEARCH STRATEGY
Four researchers independently conducted searches in Health Source, Cochrane of Systematic Reviews, CINAHL, and PubMed. Search terms included: "pressure* OR skin breakdown AND sacrum*"; "ICU patient* OR critical care patient*"; and "foam dressing OR prophylactic* or prevent*."
FINDINGS
The search identified 380 articles; 14 met eligibility criteria. The methodological quality of the included studies was variable. Findings from all studies included in our review support a decrease in HAPI incidence with use of sacral foam dressings.
IMPLICATIONS
Findings from this review suggest that prophylactic foam dressings decrease sacral HAPI occurrences in critical care patients. While additional research is needed, current best evidence supports use of prophylactic foam sacral dressings for patients at risk for HAPI.
Topics: Bandages; Hospitals; Humans; Incidence; Pressure; Pressure Ulcer; Sacrococcygeal Region; Wound Healing
PubMed: 33951710
DOI: 10.1097/WON.0000000000000762 -
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 -
Journal of Wound Care Sep 2023
Topics: Humans; Pressure Ulcer; Curriculum
PubMed: 37682785
DOI: 10.12968/jowc.2023.32.9.598 -
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