Pressure Ulcer Risk Factors for Patients with Hospital Versus Community Acquired Pressure Ulcers

Abstract

Purpose: Pressure ulcers are a major health problem in the United States. Patients who develop pressure ulcers have longer hospital stays, significant increase in morbidity and mortality, added pain and suffering. The purpose of this study was to examine community versus hospital specific pressure ulcer risk factors to identify whether the most severe pressure ulcer stages can be predicted from the knowledge of an individual's risk factors as has been reported in the literature. Methodology: The sample of patients with stageable III-IV and unstageable pressure ulcer patients included in the analysis was extracted from a Microsoft Access database developed by a WOCN Certified Advanced Practice wound care nurse. Results: The sample was predominantly Caucasian, having community acquired and unstageable pressure ulcers. The risk factors examined in the Chi-square model Pearson's correlation calculated for predictor variables length of stay, age, and Braden scale score (which was analyzed as a continuous variable) showed significant positive relationships between hospital acquired pressure ulcer and length of stay. There were statistically significant differences in the incidence of patients admitted from the community with a pressure ulcer (stageable or unstageable) and those with hospital acquired ulcers. Ninety-five percent of patients had unstageable hospital acquired pressure ulcers compared to 72% of community acquired pressure ulcers. Twenty-seven percent of community acquired pressure ulcers were stageable (27.2%) compared to hospitalized acquired PUs (4.9%). Conclusions: This study demonstrated that a wound care practice and quality database can be used to conduct exploratory descriptive research on a patient population with severe pressure ulcers. Findings indicate that most patients have community acquired pressure ulcers and that these ulcers are unstageable, occur in Caucasian patients, and occur equally in men and women. Although the mean age of patients with these severe pressure ulcers is 74.24 years, patients with longer length of stays were associated with a higher risk for hospital acquired pressure ulcers. Diagnostic groups most common in these patients included patients with sepsis, cardiac and circulatory problems and pulmonary diseases. Hospital acquired pressure ulcers were significantly more likely to be unstageable with slough or eschar in the wound bed.