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American Family Physician Nov 2015Patients with limited mobility due to physical or cognitive impairment are at risk of pressure ulcers. Primary care physicians should examine at-risk patients because...
Patients with limited mobility due to physical or cognitive impairment are at risk of pressure ulcers. Primary care physicians should examine at-risk patients because pressure ulcers are often missed in inpatient, outpatient, and long-term care settings. High-risk patients should use advanced static support surfaces to prevent pressure ulcers and air-fluidized beds to treat pressure ulcers. Physicians should document the size and clinical features of ulcers. Cleansing should be done with saline or tap water, while avoiding caustic agents, such as hydrogen peroxide. Dressings should promote a moist, but not wet, wound healing environment. The presence of infection is determined through clinical judgment; if uncertain, a tissue biopsy should be performed. New or worsening pain may indicate infection of a pressure ulcer. When treating patients with pressure ulcers, it is important to keep in mind the patient's psychological, behavioral, and cognitive status. The patient's social, financial, and caregiver resources, as well as goals and long-term prognosis, should also be considered in the treatment plan.
Topics: Education, Medical, Continuing; Humans; Practice Guidelines as Topic; Pressure Ulcer; Risk Factors; United States; Wound Healing
PubMed: 26554282
DOI: No ID Found -
The Surgeon : Journal of the Royal... Aug 2022The utilisation of prone positioning has been vital during the COVID-19 pandemic, however risks the development of anterior pressure ulcers. An observational study was... (Observational Study)
Observational Study
The utilisation of prone positioning has been vital during the COVID-19 pandemic, however risks the development of anterior pressure ulcers. An observational study was performed to examine the prevalence of pressure ulcers in this population and define risk factors. Eighty-seven patients admitted to critical care were studied. Of 62 patients with >1 day in prone position, 55 (88.7%) developed anterior pressure ulcers, 91% of which were anterior. The most commonly affected site were the oral commisures (34.6%), related to endotracheal tube placement. Prone positioning (p < .001) and the number of days prone (OR 3.11, 95% CI 1.46-6.62, p = 0.003) were a significant risk factors in development of an anterior ulcer. Prone positioning is therefore a significant cause of anterior pressure ulcers in this population.
Topics: COVID-19; Humans; Pandemics; Patient Positioning; Pressure Ulcer; Prone Position
PubMed: 34373210
DOI: 10.1016/j.surge.2021.07.001 -
Ostomy/wound Management Oct 2003A non-experimental, retrospective analysis of pressure ulcer quality-assurance data was conducted from October 1997 to October 2002 to ascertain the relationship between...
A non-experimental, retrospective analysis of pressure ulcer quality-assurance data was conducted from October 1997 to October 2002 to ascertain the relationship between the occurrence of nosocomial full-thickness pressure ulcers, healing, and mortality. The records of 74 patients (one woman, 73 men) who developed full-thickness pressure ulcers as inpatients at a regional Veterans Affairs medical center with acute, intensive, and long-term care units were assessed. Start day was the day that the ulcer was determined to have occurred and end day was the date the patient was pronounced dead. Major diagnoses for all patients, 70.7% for whom end-of-life planning was in effect, were cerebrovascular accident, diabetes, and cancer. The majority of ulcers were located in the sacral/coccygeal area (66.2%) and heel (16.2%). None of the ulcers healed in patients who died within 180 days of ulcer onset. A 180-day mortality rate of 68.9% was noted in people who developed nosocomial full-thickness pressure ulcers, with an average of 47.0 days from ulcer onset to death. No deaths were related to the presence of the pressure ulcer. In this data set of people with a heavy disease burden who were approaching the end of life, the development of full-thickness pressure ulcers appeared to be a comorbid pathologic process. Collecting and analyzing long-term pressure ulcer healing and mortality outcomes is a missing component of pressure ulcer quality-assurance data.
Topics: Female; Humans; Male; Pressure Ulcer; Survival Rate; Time Factors; Treatment Outcome; United States; Wound Healing
PubMed: 14652420
DOI: No ID Found -
International Wound Journal Dec 2017The aim of this study was to develop a tool to measure the knowledge of nurses on pressure ulcer prevention. PUKAT 2·0 is a revised and updated version of the Pressure...
The aim of this study was to develop a tool to measure the knowledge of nurses on pressure ulcer prevention. PUKAT 2·0 is a revised and updated version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) developed in 2010 at Ghent University, Belgium. The updated version was developed using state-of-the-art techniques to establish evidence concerning validity and reliability. Face and content validity were determined through a Delphi procedure including both experts from the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Ulcer Advisory Panel (NPUAP) (n = 15). A subsequent psychometric evaluation of 342 nurses and nursing students evaluated the item difficulty, discriminating power and quality of the response alternatives. Furthermore, construct validity was established through a test-retest procedure and the known-groups technique. The content validity was good and the difficulty level moderate. The discernment was found to be excellent: all groups with a (theoretically expected) higher level of expertise had a significantly higher score than the groups with a (theoretically expected) lower level of expertise. The stability of the tool is sufficient (Intraclass Correlation Coefficient = 0·69). The PUKAT 2·0 demonstrated good psychometric properties and can be used and disseminated internationally to assess knowledge about pressure ulcer prevention.
Topics: Adult; Belgium; Clinical Competence; Female; Humans; Male; Middle Aged; Nursing Staff, Hospital; Pressure Ulcer; Prospective Studies; Psychometrics; Reproducibility of Results; Students, Nursing; Young Adult
PubMed: 28547752
DOI: 10.1111/iwj.12758 -
Computational Intelligence and... 2022Pressure ulcers are a type of injury that causes tissue ischemia, a deficiency of nutrition and oxygen to the tissues, and, eventually, tissue necrosis when an area of...
Pressure ulcers are a type of injury that causes tissue ischemia, a deficiency of nutrition and oxygen to the tissues, and, eventually, tissue necrosis when an area of skin is placed under constant pressure for an extended length of time. With the acceleration of the aging process, the problem of providing care for pressure ulcers for the bedridden elderly becomes increasingly urgent. This study conducts a field survey based on the research status of 221 disabled elderly in 16 communities on 7 typical streets in Beijing, focusing on the problem of pressure ulcer complications caused by bedridden. An automatic inflatable airbag mattress is designed according to anthropometric dimensions of bedridden elderly, pressure ulcer-prone areas, and the decompression standard, so that the airbag mattress can reduce the pressure in its initial shape. To achieve accurate control of the pressure in the pressure-prone areas of an airbag, air pressure control system is proposed which can control airbags individually and link multiple airbags, evaluating the safety of pressure ulcer points based on the data from sensors and making corresponding air pressure changes to reduce the possibility of generating pressure ulcers. The proposed pressure ulcer preventing system will be an efficient healthcare tool for families who had elderly bedridden patients, patients with chronic degenerative disease side effects, and terminal and postsurgical patients, as well as femur fractures, in their homes.
Topics: Aged; Beds; Beijing; Humans; Pressure Ulcer
PubMed: 35942465
DOI: 10.1155/2022/4895038 -
Ostomy/wound Management Oct 2007Multiple factors affect the specific condition and overall clinical profile of individuals at risk for chronic wounds. The complexity of the pressure ulcer problem lends... (Review)
Review
Multiple factors affect the specific condition and overall clinical profile of individuals at risk for chronic wounds. The complexity of the pressure ulcer problem lends itself to the application of the National Institute of Health Roadmap Initiative that encourages interdisciplinary research and new organizational models. An overview of research studies relevant to telemedicine and neuromuscular electrical stimulation in the care and prevention of pressure ulcers as well as preliminary results of an innovative multidisciplinary skin care team approach to the primary and tertiary prevention of pressure ulcers are encouraging. The team's pilot study results indicate that patients are satisfied with telehealth provision of care; however, literature and experience also suggest that discrepancies in the inter-rater assessment of wounds using digital photography remain, particularly with regard to wound dimension variables assessed (P<0.01). In another endeavor, the skin care team developed a Longitudinal Analysis with Self-Registration statistical algorithm to assess the effects of electrical stimulation; in a preliminary study, this tool documented improvement in gluteus maximus health and resultant ability to withstand pressure. As the number of groups pursuing multidisciplinary research and care increases, so, too, will the evidence base required to address these common, and complex, chronic wounds.
Topics: Chronic Disease; Electric Stimulation Therapy; Humans; Models, Organizational; Ohio; Patient Care Team; Photography; Pilot Projects; Pressure Ulcer; Telemedicine
PubMed: 17978412
DOI: No ID Found -
The Tokai Journal of Experimental and... Jul 2022We report a case of severe sacral osteomyelitis and sepsis with pressure ulcer infection treated with negative pressure wound therapy with instillation and dwelling...
We report a case of severe sacral osteomyelitis and sepsis with pressure ulcer infection treated with negative pressure wound therapy with instillation and dwelling (NPWTi-d) V.A.C.ULTA from an early stage. Case: A 76-year-old man, bedridden because of dementia and an old cerebral infarction, was treated in a nursing facility for a sacral region pressure ulcer. He had a fever for three days and was transferred to the emergency department. The quick SOFA (sequential organ failure assessment) score at the hospital visit was three points. A coccyx and black mud-formed necrotic tissue attached to the sacral region pressure ulcer with a strong putrid odor sloughed off. Sacral region pressure ulcer infection, sepsis, disseminated intravascular coagulation, and purulent sacral osteomyelitis were diagnosed, and urgent debridement was performed. We treated the patient with meropenem, clindamycin, and vancomycin, and we performed irrigation debridement every day and transduced the V.A.C.ULTA care system from AOD9, that led to good granulation at the infection site. The wound area underwent simple closure on AOD35 and the patient was transferred to the medical treatment hospital. Since dressing change is relatively easy in the emergency department of a secondary medical care institution with little man power, V.A.C.ULTA therapy may be useful in treating severe cases of pressure ulcer infections.
Topics: Aged; Humans; Male; Negative-Pressure Wound Therapy; Osteomyelitis; Pressure Ulcer; Sacrococcygeal Region; Sepsis
PubMed: 35801547
DOI: No ID Found -
Nutricion Hospitalaria Nov 2015Pressure ulcer (PU) is a lesion in the skin and/or underlying tissue, usually over bony prominences caused by pressure and / or shear associated. Although preventable,... (Observational Study)
Observational Study
UNLABELLED
Pressure ulcer (PU) is a lesion in the skin and/or underlying tissue, usually over bony prominences caused by pressure and / or shear associated. Although preventable, is still very prevalent, and pointed out that multiple factors are involved in its etiology.
OBJECTIVE
to identify the incidence of pressure ulcers, clinical and nutritional factors associated in patients admitted to the Intensive Care Unity (ICU) of a university hospital.
METHODS
a prospective, observational study, with patients admitted to an ICU from June to November 2014. The UP was determined by inspection body three times a week during the morning bath, based on the characteristics established by the National Pressure Ulcer Advisory Panel, 2014. We collected demographic, clinical, biochemical and nutritional. The Braden Scale was used to verify individuals at risk of PU development.
RESULTS
the sample consisted of 51 patients with a mean age of 57.7 (± 16.4) years. There was an incidence of UP 52.9%, and the factors associated with its development were: use of vasoactive drugs (p = 0.029), length of hospital stay > 10 days (p ≤ 0.001) and absence of anemia (p = 0.011).
CONCLUSION
the high incidence of UP highlights the vulnerability of patients in intensive care. Although characterized by being a multifactorial condition only the use of vasoactive drugs, length of hospital stay and the absence of anemia were associated with the appearance of refs. Nutritional and clinical factors often related to trauma were not associated with their development.
Topics: Adult; Aged; Critical Care; Female; Hospitals, University; Humans; Incidence; Length of Stay; Male; Middle Aged; Nutritional Status; Pressure Ulcer; Prospective Studies
PubMed: 26545684
DOI: 10.3305/nh.2015.32.5.9646 -
International Journal of Nursing Studies May 2020Pressure ulcer rates are persistently high despite years of research and practice policies focused on prevention. Prior research found crosssectional associations...
BACKGROUND
Pressure ulcer rates are persistently high despite years of research and practice policies focused on prevention. Prior research found crosssectional associations between care interventions, hospital and nursing unit characteristics and pressure ulcer rates. Whether these associations persist over time is unknown. Finally, comparisons of quality measures across rural and urban location have mixed findings.
OBJECTIVE
Our study examined effects of care interventions on unit-acquired pressure ulcer rates over 4 years controlling for community, hospital, and nursing unit characteristics in rural and urban locations.
DESIGN
Guided by contingency theory a longitudinal study was conducted to examine associations between context, staffing, care interventions, nurse outcomes, and pressure ulcer rates, using unit-level data from the National Database of Nursing Quality Indicators 2010-2013 (16 quarters) augmented with data on rural classifications and case mix index. Ulcer rates were measured as percentage of patients with a nursing unit-acquired pressure ulcer. The three care interventions were unit-percentage of patients receiving skin assessment on admission, receiving risk assessment on admission, and receiving any risk assessment before the pressure ulcer. Nursing unit characteristics were RN staffing, education, and experience. Nurse outcomes were job satisfaction and intent-to-stay.
PARTICIPANTS
We included 5761 units (332 rural and 5429 urban) in 772 hospitals (89 rural and 683 urban) that reported ulcer rates in two or more quarters during the study period.
METHODS
Rural and urban units were examined separately using multilevel binomial regression in which within-unit changes in pressure ulcer rates were related to the within-unit changes in the explanatory variables, controlling for region, hospital size, unit type, case mix index, and percentage of patients at risk for pressure ulcers.
RESULTS
An increase in the three care interventions, RN skill mix, and the two nurse outcomes were associated with a decrease in unit-acquired pressure ulcers. For example, in rural units a 10% increase in unit-percentage of any risk assessment and in urban units a 10% increase in skin assessment on admission were associated with a 21% and 5% decrease in the odds of developing an ulcer. A 10% increase in RN skill mix was associated with 17-18% and 5-6% decrease in ulcer rates in rural and urban units respectively.
CONCLUSION
Hospitals aiming to improve pressure ulcer prevention should focus on organizational structures that support improved nurses work environments and workflow that will enhance nursing care interventions. Future studies should include both contextual and patient characteristics along with care interventions.
Topics: Humans; Longitudinal Studies; Personnel Staffing and Scheduling; Practice Patterns, Nurses'; Pressure Ulcer; Rural Health Services; Skin Care; United States; Urban Health Services
PubMed: 32203754
DOI: 10.1016/j.ijnurstu.2019.103455 -
Journal of Wound, Ostomy, and... Mar 1997The purpose of this study was to identify risk factors contributing to pressure ulcer development in patients undergoing scheduled, prolonged operative procedures. (Review)
Review
OBJECTIVE
The purpose of this study was to identify risk factors contributing to pressure ulcer development in patients undergoing scheduled, prolonged operative procedures.
DESIGN
A descriptive study was conducted.
SETTING AND SUBJECTS
A large university teaching facility provided the setting. Thirty-three subjects who underwent operative procedures lasting longer than 10 hours, as determined from the daily operating room schedule through a 6-month period, were included in the study.
INSTRUMENTS
Braden Scale for Predicting Pressure Sore Risk was used before the operation. Visual skin inspection, preoperative interventions, and demographic information were documented with a data-collection tool. Postoperative skin breakdown and its severity were assessed as stage I through IV according to the Pressure Ulcer Classification System recommended by the National Pressure Ulcer Advisory Panel.
METHODS
Visual preoperative skin assessment was performed and the Braden Scale was completed in the operating room holding area. Demographic information was collected from patient interviews and the medical record. Patient positioning and the placement of all positioning and thermal devices were observed and recorded in the operating room. Within 48 hours after the surgical procedure, the patients' skin was visually inspected. Pressure ulcers were noted, staged, and recorded.
MAIN OUTCOME MEASURES
The chi 2 analyses compared those who did and those who did not acquire pressure ulcers for differences in gender, type of operation, position used in the operating room, and types of positioning devices. Student's t tests compared those who did and did not acquire pressure ulcers for differences in age, Braden Scale score, number of positioning devices, and length of operation.
RESULTS
Of the 33 patients studied, 15 (45%) were found to acquire stage I or II pressure ulcers within 48 hours after their procedure. Of the 15 patients who acquired pressure ulcers, 75% were placed on a warming blanket during the procedure. This was the only significant finding among the risk factors investigated in the comparison of those who did and did not acquire pressure ulcers (chi 2 = 4.3, p < 0.05).
CONCLUSIONS
Removal of the warming blanket from routine intraoperative use with patients undergoing prolonged operations is indicated. Continued follow-up of this patient population will help to determine whether avoidance of warming blankets is sufficient to lower the incidence of pressure ulcer formation.
Topics: Adolescent; Adult; Aged; Female; Humans; Intraoperative Care; Male; Middle Aged; Nursing Assessment; Pressure Ulcer; Risk Factors; Skin Care; Time Factors
PubMed: 9204857
DOI: 10.1016/s1071-5754(97)90077-2