Causes Of Pressure Ulcers Research Articles

Knowledge and Attitudes Toward Pressure Ulcer Prevention Evidence-based Guidelines among Nursing Students at Jazan University, Saudi Arabia.

Pressure ulcers (PUs) are a common global problem. They affect health-care costs and patient health because of increased morbidity and mortality rates. Critically ill patients are more prone to acquiring PUs than other patients. As the prevalence of PUs is high in Saudi Arabia, more attention is required for PU prevention. Nurses' knowledge and attitudes toward PU prevention are crucial. This study aimed to assess the knowledge and attitudes of nursing students regarding PU prevention evidence-based guidelines. This descriptive, cross-sectional study was conducted among nursing students at Jazan University. Data were collected using an electronic questionnaire. Data were entered, coded, and analyzed using the SPSS version 23. A total of 378 participants were included. The mean age was 22.4 ± 3.4 years, and the mean knowledge score was 7.6 ± 2.64 (range = 0-16). Of the participants, 365 (96.6%) and 13 (3.4%) were considered to have poor and good knowledge about PUs, respectively. Only 72 (19%) correctly identified a lack of oxygen as the cause of PUs; other participants answered malnutrition and moisture. Conversely, 200 (52.9%) participants indicated that recent weight loss below patients' ideal weight increases the risk for PUs. Concerning knowledge about preventive measures, 64 (16.9%) participants correctly answered that a backward sitting position, with both legs resting on a footrest, can reduce the amount of pressure. Meanwhile, 169 (44.7%) participants correctly selected thick air cushion as a means to reduce the magnitude of pressure when patients are sliding down on a chair. Some participants answered that PUs can be reduced if patients are mobilized. Seventy-two (19%) participants indicated that patients laying on a visco-elastic foam mattress should be repositioned every 2 h to reduce the duration of pressure. Age, year of education, training experience, and department were not significantly associated with knowledge about PUs (P = 0.333, P = 0.370, P = 0.700, and P = 0.810, respectively). The general knowledge and attitudes toward PUs of the nursing students at Jazan University were poor. Nevertheless, they had an average knowledge level regarding PU prevention. Age and training experience were not significantly associated with knowledge about PUs.

Effect of Baicalin on Wound Healing in a Mouse Model of Pressure Ulcers

One of the most frequent comorbidities that develop in chronically ill or immobilized patients is pressure ulcers, also known as bed sores. Despite ischemia-reperfusion (I/R)-induced skin lesion having been identified as a primary cause of pressure ulcers, wound management efforts have so far failed to significantly improve outcomes. Baicalin, or 5,6,7-trihydroxyflavone, is a type of flavonoid which has been shown to possess a variety of biological characteristics, including antioxidative and anti-inflammatory effects and protection of I/R injury. In vitro wound scratch assay was first used to assess the function of baicalin in wound healing. We established a mouse model of advanced stage pressure ulcers with repeated cycles of I/R pressure load. In this model, topically applied baicalin (100 mg/mL) induced a significant increase in the wound healing process measured by wound area. Histological examination of the pressure ulcer mouse model showed faster granulation tissue formation and re-epithelization in the baicalin-treated group. Next, baicalin downregulated pro-inflammatory cytokines (IL-6 and IL-1β), while upregulating the anti-inflammatory IL-10. Additionally, baicalin induced an increase in several growth factors (VEGF, FGF-2, PDGF-β, and CTGF), promoting the wound healing process. Our results suggest that baicalin could serve as a promising agent for the treatment of pressures ulcers.

Lessons learned from patients with spinal cord injury in managing pressure ulcers: A qualitative study

ObjectivesTo explore how individuals with spinal cord injury self-manage the prevention and treatment of pressure ulcers and to provide insight into experiences with self-management support. DesignQualitative study using semi-structured interview and a deductive thematic analysis. SettingCommunity. ParticipantsTwelve of the 14 participating adults with a spinal cord injury had experience with pressure ulcers, and eight of these had a current pressure ulcer. ResultsRespondents suggested to tailor treatment of pressure ulcers to patients’ individual wishes and capabilities of patients. Patients and caregivers need to be aware of the importance of determining the cause of pressure ulcers to prevent deterioration. Patients often depend on informal caregivers for follow-up and prevention, and healthcare professionals in non-SCI specialties often lack the knowledge needed to manage pressure ulcers in this specific patient group. Tailored education and peer support are important for patients to set boundaries, be assertive, and cultivate a positive attitude when dealing with pressure ulcers. It is difficult to combine treatment of severe pressure ulcers and preventive measures with work roles. Managing the social impact of pressure ulcers requires more coordination with caregivers. ConclusionsTo support self-management of pressure ulcers in patients with a spinal cord injury, they must find out which preventive measures and treatments suit them best. Healthcare professionals play an important role in the self-management of pressure ulcers and can help patients deal with the emotional and social impact of pressure ulcers. To know patient's needs and tailor their education, healthcare professionals of non SCI organizations need to have knowledge of pressure ulcers management of this specific patient group.

Using the 'aSSKINg' model in pressure ulcer prevention and care planning.

Pressure ulcers are painful, costly and can negatively affect a patient's quality of life. It has long been recognised that they increase the risk of infection, prolong hospital stays and can result in death. To prevent the occurrence of pressure ulcers, nurses need to understand what a pressure ulcer is and the underlying factors that cause them. Furthermore, it is essential that they recognise why some people are more susceptible to pressure and shear forces than others, so that preventable factors can be addressed. Nursing care to prevent pressure ulcers needs to be planned, implemented and evaluated in a systematic manner following an assessment of the patient and their circumstances. The 'aSSKINg' (assess risk; skin assessment and skin care; surface; keep moving; incontinence and moisture; nutrition and hydration; and giving information or getting help) model ensures all fundamental aspects of pressure ulcer prevention are included in patient care. This article outlines the definitions and causes of pressure ulcers, and explains how nurses can assess, plan, implement and evaluate pressure ulcer preventative care using the aSSKINg model as a guide.

Identifying Factors That Influence Pressure Ulcers by Numerical Simulation and Experimentation Methods

<p>This paper studies the factors that cause the development of pressure ulcers (PUs) and identify the prevention of pressure ulcers (PUs). After presenting the context of pressure ulcers (PUs), we will provide a summary of the causes of pressure ulcers (PUs) formation, which were published in the literature. Then, we will study the investigative processes using numerical simulations and experiments to evaluate the factors that influence the development of pressure ulcers (PUs). The purpose of this research will provide the preventive measures and appropriate treatments for people using a wheelchair or those with disabilities. The results of this study contribute to the prediction of factors that can cause pressure ulcers to improve comfort seating and the quality of life for people with disabilities.</p>

Development of a sensor with a conductive textile for detecting decubitus ulcers

The present paper describes the design and evaluation results of a sensor for measuring body pressure and sweat volume using conductive fibers. Pressure ulcers that develop from staying in the same posture for a long time are a serious problem in nursing care. The main causes of pressure ulcers are blockage of capillaries due to body pressure and skin structure degeneration due to sweat. To quantify the causes of pressure ulcers, Mengeng Liu et al. have developed a sensitive (14.4 kPa−1) pressure sensor using conductive fibers with excellent cleaning and flexibility. However, a conductive fiber sensor that focuses on both body pressure and sweating has not yet been established. Therefore, in the present research, we made a sensor that can measure body pressure and sweat volume with only fibers and evaluated the performance of the proposed method. The fabricated sensor is a parallel plate capacitive sensor made of two conductive fibers that sandwich an insulating cloth. When body pressure is applied, the distance between two parallel conductive fibers increases, and when sweat is applied, the dielectric constant of the fabric changes, increasing the capacitance of the sensor. Capacitance change can be evaluated by peak holding the output of the AC bridge circuit. Through an evaluation experiment using a vise and a constant temperature and constant‐humidity chamber, the fabricated sensor was confirmed to be able to measure a pressure change of 10 mmHg and a humidity change of 10%. This sensor, which can evaluate pressure and humidity (amount of adhering water) at the same time and at low cost, contributes to reducing the burden of nursing care. © 2020 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.

An integrated experimental-computational study of the microclimate under dressings applied to intact weight-bearing skin.

Pressure ulcers (PUs) are one of the most prevalent adverse events in acute and chronic care. The root aetiological cause of PUs is sustained cell and tissue deformations, which triggers a synergistic tissue damage cascade that accelerates over relatively short time periods. Changes in skin microclimate conditions are known to indirectly contribute to PU-risk levels or to exacerbation of existing wounds. It is therefore surprising that information concerning heat accumulation under dressings is poor. Here, we aimed to investigate the effects of dressings on the microclimate of weight-bearing buttocks skin in 1-hour supine lying sessions. Using a novel and originally developed experimental-computational approach, we compared the combined influence of the mechanical and thermal properties of a polymeric membrane dressing (PolyMem, Ferris Mfg. Corp., Fort Worth, TX) on skin microclimate under and near the dressings with those of a standard placebo foam dressing. We specifically identified the thermal conductivity properties of dressings as being highly important in the context of protective dressing performances, given its association with potential heat accumulation under dressings. Accordingly, this article highlights, for the first time in the literature, the relevance of thermal properties of a dressing in effectively mitigating the risk of developing PUs or aggravating an injury, and offers a systematic, methodological bioengineering process for assessing the thermal performances of dressings.

Sphingobacterium multivorum: An Atypical Bacterium in an Atypical Place.

We present the case of a 75-year-old woman admitted to hospital because of an infected pressure ulcer. Cultures revealed that the responsible bacterium was Sphingobacterium multivorum, which was successfully eradicated with ciprofloxacin. Over the last few years, there have been reports of new cases of infection caused by bacteria previously not thought to be harmful to humans, like S. multivorum. Previous cases were reported mostly in immunosuppressed patients and the present report is, to our knowledge, the first describing a pressure ulcer infected by this bacterium.LEARNING POINTSBacteria previously not thought to be harmful to humans can cause disease.Sphingobacterium multivorum should be considered a potential cause of pressure ulcer infection.As S. multivorum may be resistant to many antibiotics, complete susceptibility testing should be mandatory.

Topical application of quercetin improves wound healing in pressure ulcer lesions.

The ischaemia-reperfusion (I/R)-induced skin lesion has been identified as primary cause of pressure ulcers. To date, attempts to prevent pressure ulcers have not produced a significant improvement. Quercetin, one of the most widely distributed flavonoids in fruits and vegetables, exhibits its antioxidant and anti-inflammatory properties against many diseases, including ischaemic heart disease, atherosclerosis and renal injury. In vitro wound scratch assay was first used to assess the function of quercetin in wounding cell model. Next, animal pressure ulcers model was established with two cycles of I/R. The impact of quercetin in the wound recovery, immune cell infiltration and pro-inflammatory cytokines production was investigated in this model. Mechanistic regulation of quercetin at the wound site was also studied. Quercetin accelerated wound closure in cell scratch assay. Dose-response study suggested 1μmol/L quercetin for in vivo study. In I/R injury model, quercetin treatment significantly accelerated wound closure, reduced immune cell infiltration and pro-inflammatory cytokines production. Signalling study showed quercetin treatment inhibited MAPK but not NFĸB activation. Quercetin treatment improved the wound healing process in I/R lesions by suppressing MAPK pathway. Our results supported that quercetin could be a potential therapeutic agent for pressure ulcers.

Suppression of LRRC19 promotes cutaneous wound healing in pressure ulcers in mice

ABSTRACTThe ischemia-reperfusion (I/R) induced skin lesion has been identified as primary cause of pressure ulcer. Better understanding of the mechanism is required for new therapy development. Leucine rich repeat containing protein 19 (LRRC19) is a recently discovered transmembrane protein containing leucine-rich repeats and plays a role in immune response. To investigate the role of LRRC19 in pressure ulcers, mouse ulcer model was established with two cycles of I/R. The expression of LRRC19 was assessed during injury. siRNA mediated LRRC19 downregulation was applied to investigate the disease severity, immune cell infiltration and pro-inflammatory cytokines production. The primary skin fibroblasts were stimulated with IL-1β to dissect the molecular mechanism. LRRC19 was readily induced in I/R induced lesion site in a pattern mimicking the disease progress as measured by wound area. Knockdown of LRRC19 by siRNA significantly alleviated the disease severity and attenuated immune cell infiltration and pro-inflammatory cytokines production. In primary skin fibroblast model, siRNA knockdown of LRRC19 suppressed IL-1β mediated NFκB activation and its downstream cytokines production. LRRC19 was a novel factor for I/R-induced tissue damage by promoting NFκB dependent pro-inflammatory response. Our results supported that LRRC19 could be a potential therapeutic target for pressure ulcers.

Reduction of Prolonged Excessive Pressure in Seated Persons With Paraplegia Using Wireless Lingual Tactile Feedback: A Randomized Controlled Trial.

Pressure ulcers (PU) are known to be a high-cost disease with a risk of severe morbidity. This paper evaluates a new clinical strategy based on an innovative medical device [Tongue Display Unit (TDU)] that implements perceptive supplementation in order to reduce prolonged excessive pressure, recognized as one of the main causes of PU. A randomized, controlled, and parallel-group trial was carried out with 12 subjects with spinal cord injuries (SCI). Subjects were assigned to the control (without TDU, n}{}n=6n) or intervention (with TDU, n}{}n=5n) group. Each subject took part in two sessions, during which the subject, seated on a pressure map sensor, watched a movie for one hour. The TDU was activated during the second session of the intervention group. Intention-to-treat analysis showed that the improvement in adequate weight shifting between the two sessions was higher in the intervention group (0.84 [0.24; 0.89]) than in the control group (0.01 [−0.01; 0.09]; n}{}p=0.004n) and that the ratio of prolonged excessive pressure between the two sessions was lower in the intervention group (0.74 [0.37; 1.92]) than in the control group (1.72 [1.32; 2.56]; n}{}p=0.06n). The pressure map sensor was evaluated as being convenient for use in daily life; however, this was not the case for the TDU. This paper shows that persons with SCI could benefit from a system based on perceptive supplementation that alerts and guides the user on how to adapt their posture in order to reduce prolonged excessive pressure, one of the main causes of PU.

EFFECTIVENESS OF PROGRESSIVE MOBILIZATION LEVEL I AND II ON HEMODYNAMIC STATUS AND DECUBITUS ULCER RISK IN CRITICALLY ILL PATIENTS

Background: Patient immobility remains to be one of the primary causes of pressure ulcers. Therefore, mobilization is necessity for patients being treated in the intensive care unit. However, the occurrence of pressure ulcers is dependent on not only the mobilization but also the bed itself and the type of mattress. This study used the same mattress and bed and compared the effectiveness of progressive mobilization with regular mobilization.
 Objective: This study aims to examine the effectiveness of progressive mobilization level I and II on hemodynamic status and decubitus ulcer risk in critically ill patients.
 Methods: This was a quasi-experimental study using repeated measure design. There were 40 respondents selected using purposive sampling, which 20 respondents assigned in each group. A Braden scale was used to measure the risk of decubitus ulcer. Paired t-test and repeated measures ANOVA were performed for data analysis.
 Results: Paired t-test showed that there was a significant difference of systolic pressure, diastolic pressure, MAP, heart rate, and Braden score after given intervention with p-value <0.05. However, repeated ANOVA test showed that diastolic pressure had p-value >0.05, thus could not be continued to post-hoc test. The progressive mobilization of level I and II in critical patients can stabilize systolic pressure (52.46%), stabilize MAP (58.43%), stabilize heart rate (68.99%), and reduce the risk of decubitus (55.03%) for 7 days of recurrent intervention.
 Conclusion: The progressive mobilization of level I and II can reduce the risk of decubitus and stabilize the patient's hemodynamic status in critical patients.

Effect of quality control circle on reducing the incidence of pressure ulcer during operation

Objective To explore the effect of quality control circle (QCC) on reducing the incidence of pressure ulcer during operation. Methods The quality control circle was organized by who aimed to reduce the incidence of pressure ulcer for patients undergoing operations. A total of 260 cases of operating patients were selected as control group from May 2013 to July 2013 (Before the QCC group) and investigated the conditions of the pressure ulcer form during operation. By a series of QCC activity, we set target, found out the cause of pressure ulcer during operation, and took countermeasures to improve quality continually. A total of 282 operating patients had been accounted for the incidence of pressure ulcer from October 2013 to December 2013 (after the QCC group). We compared the skin damage related operation, the knowledge control of pressure ulcer among theatre nurses, standard rate of operation posture, et al. Results After the QCC activities, the rate of pressure ulcer was reduced from 9.3% to 1.4%, nursing knowledge control of the pressure ulcer among theatre nurses and standard rate of operation posture were improved obviously compared these of group before QCC (P<0.05). Conclusions The QCC activities can minimize the incidence rate of pressure ulcer, but promote knowledge control of pressure ulcer among theatre and the standard rate of operation posture. Key words: Operation Room; Pressure Ulcer related to operation; Nursing care; Quality control circle; Operation posture

Meeting targets in pressure ulcer prevention in the community by collaborating with industry.

This article describes how a community health-care trust achieved a reduction in acquired pressure ulcers. Commissioning for Quality and Innovation 2014/15 guidance states that provider organisations should work with their partners across their local health and social care system to address the causes of pressure ulcers and reduce their prevalence, regardless of source. Gloucestershire Care Service NHS Trust was challenged to reduce the number of acquired pressure ulcers by 17% in 2013-14. The challenge for the three members of the tissue viability team was to train the qualified and unqualified staff within seven community hospitals and district nurse teams from 85 GP practices, covering a population of 600 000 within 4 months. Staff shortages and a lack of venues available meant that an adaptive educational approach was necessary. A dedicated programme of educational support from both the tissue viability nurse and an industry partner enabled the delivery of a wide range of educational materials to staff across the county. As a result of this partnership working, there was a reduction of category 3 and 4 pressure ulcers, and an increased awareness of the initial stages of pressure ulcer development demonstrated by an increase in grade 2 pressure ulcers.

Analysis of operating room related factors and nursing countermeasures for pressure ulcers in patients with laparoscopic surgery

Objective To study operating room related factors and nursing countermeasures for pressure ulcers in patients with lap -aroscopic surgery.Methods Totaled of 180 patients with laparoscopic surgery data were retrospectively analysized , the operating room relat-ed causes of pressure ulcers were discussed , and put forward nursing countermeasures.Results Among the 186 patients with laparoscopic surgery a total of stage Ⅰ-Ⅱpressure sores 17cases, the incidence of pressure ulcers was 9.14%;operating rooms related reasons includ-ed operation position , operation time too long , skin moisture, intraoperative hypotension state duration , hypoxemia etc ..Conclusions Laparoscopic surgery in patients with postoperative pressure sores are the result of a variety of factors , according to the related reasons for pressure sores , intraoperative strengthen preventive measures can help to reduce the incidence of pressure ulcers after surgery . Key words: Laparoscopic surgery Pressure ulcers Operating room Related reasons Nursing countermeasures

Interface pressure, pressure gradient with pressure ulcer development in Intensive Care Units

The pressure gradient can predict skin breakdown when combined with high pressure. We investigate the relationships between Peak Interface Pressure (PIP) and peak pressure gradient (PPG) for predicting and understanding the causes of pressure ulcers. Design of this research was a prospective cohort design. Pressure ulcers were identified and classified using the National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Interface pressure was measured at the patient’s sacrum three times once every three days until pressure ulcers develop. The assessment was measured after the 24-hours monitoring period had expired for a newly admitted patient to the intensive care unit (ICU). The locations of the pressure ulcers were found using trace sheets. The 87 patients were obtained from two hospitals. The incidence of pressure ulcers was 12.6%. The PIP was 66.2 mmHg and PPG was 12.1 mmHg for a pressure ulcer compared to without a pressure ulcer ( p 50.0 mmHg and PPG > 8.0 mmHg/cm were risk pressure ulcers. The correlation between the PIP and PPG were high correlation ( r = 0.925). The PIP and PPG may be a useful indicator for the development of pressure ulcers.

Potential application of in vivo imaging of impaired lymphatic duct to evaluate the severity of pressure ulcer in mouse model

Ischemia-reperfusion (IR) injury is a cause of pressure ulcer. However, a mechanism underlying the IR injury-induced lymphatic vessel damage remains unclear. We investigated the alterations of structure and function of lymphatic ducts in a mouse cutaneous IR model. And we suggested a new method for evaluating the severity of pressure ulcer. Immunohistochemistry showed that lymphatic ducts were totally vanished by IR injury, while blood vessels were relatively preserved. The production of harmful reactive oxygen species (ROS) was increased in injured tissue. In vitro study showed a high vulnerability of lymphatic endothelial cells to ROS. Then we evaluated the impaired lymphatic drainage using an in vivo imaging system for intradermally injected indocyanine green (ICG). The dysfunction of ICG drainage positively correlated with the severity of subsequent cutaneous changes. Quantification of the lymphatic duct dysfunction by this imaging system could be a useful strategy to estimate the severity of pressure ulcer.

A Rare Cause of a Pressure Ulcer: A Single Hair

Pressure ulcers are the loss of tissue and remain a common problem in critically ill patients. These patients are at high risk for developing pressure ulcers because of their hemodynamic instability, malnutrition, and strictly limited physical activity and mobility due to neurological damage or drugs such as sedatives and muscle relaxants. Pressure is the most important cause of pressure ulcers. Contact surfaces such as patient’s bed or wheelchair, and some medical devices such as pulse oximetry probe and urethral catheter can result in pressure. The case is reported here of a very rare cause of a pressure ulcer, which was a single hair on the patient’s face.

Trykksår etter ryggmargsskade

Pressure ulcers are a serious and frequently occurring complication in patients with a traumatic spinal cord injury. The purpose of the article is to consider the causes of pressure ulcers and how to prevent them. The article is based on a non-systematic search in the PubMed database and own clinical experience. 30-40 % of patients with spinal cord injuries develop pressure ulcers during the acute and rehabilitation phases, most frequently over bony prominences such as the sacrum, tuber ischii, heel, malleolus and trochanter. Risk factors are reduced activity/immobility, lack of sensibility, moisture due to urinary or faecal incontinence, muscular atrophy, prolonged time since injury, depression, smoking and poor nutrition. The most important preventive measures are pressure relief, regular change of position and frequent observation of the skin over bony prominences. In most cases, patients with traumatic spinal cord injuries can be prevented from developing pressure ulcers. Prevention saves patients from long-term hospitalisation and the healthcare system from high costs.

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review

The formation and underlying causes of pressure ulcers (PUs) are quite complex, with multiple influencing factors. However, by definition pressure ulcers cannot form without loading, or pressure, on tissue. Clinical interventions typically target the magnitude and/or duration of loading. Pressure magnitude is managed by the selection of support surfaces and postural supports as well as body posture on supporting surfaces. Duration is addressed via turning and weight shifting frequency as well as with the use of dynamic surfaces that actively redistribute pressure on the body surfaces. This article shows that preventative interventions must be targeted to both magnitude and duration and addresses the rationale behind several common clinical interventions--some with more scientific evidence than others.