Development Of Pressure Sores Research Articles

Pressure area management in an orthopaedic setting.

Pressure area care for patients who have undergone a hip replacement is extremely difficult as patients' mobility tends to be restricted because of fear of dislocation. Orthopaedic surgeons influence the positional changes and techniques utilized by nurses in the postoperative period. This article reviews factors that prevent early rehabilitation and highlights methods of pressure relief for this patient group. Alternating-pressure mattresses are a main source of pressure-relieving equipment. A pilot study using the Nimbus II mattress was carried out to establish the role of alternating-pressure mattresses in the postoperative management of patients undergoing elective/emergency hip replacement surgery. None of the patients in the pilot study suffered prosthetic dislocation and 87% did not develop pressure sores. Three patients did develop a grade 2 pressure sore postoperatively. The results reinforce the use of alternating-pressure mattresses in the postoperative management of patients undergoing hip replacement surgery.

Preventing pressure sores in oncology patients.

This project addresses staff nurses' concerns about the development of hospital-acquired pressure sores in cancer patients. The Braden Scale and the National Pressure Sore Advisory Panel Staging System were pilot tested. The incidence of hospital-acquired pressure sores was 8% and a mean Braden score of 16 was sufficiently sensitive (82%) and specific (84%) for use with our patient population. Eighty-two percent (9/11) of the patients with a score of 16 on the Braden Scale developed a pressure sore that day. The model of pressure sore development constructed by Braden and Bergstrom (1987) was used to guide the development of a pressure sore prevention protocol. The pilot test of this protocol over 6 months showed no decline in the incidence of hospital-acquired pressure sores and a reduction in the sensitivity and specificity of the Braden Scale. Possible explanations for this finding and revisions to the protocol are suggested.

Hospital-acquired pressure sores in surgical patients.

This study is based on a retrospective analysis of case notes of 314 elective and emergency patients who underwent major surgical procedures between November 1995 and March 1996. The research is part of a larger project on pressure sores in surgical patients. The effects of patient characteristics and the organisational processes of care on the development of hospital-acquired pressure sores were examined. Factors identified can be used as parameters in the assessment of pressure sore risk in surgical patients. This report presents the preliminary results of the univariate statistical analysis.

Nutrient intake and the risk of pressure sore development in older patients.

This study explored the possibility of a link between diet prior to admission to hospital and the development of pressure sores in older patients. The intention was to use this information to develop a nutrient prediction score and nutrient risk indicator. Thirty patients over the age of 75, admitted with either a fractured neck of femur or for hip replacement surgery, formed the study population. A Waterlow assessment was completed on admission and each patient answered a specially developed food frequency questionnaire. Patients in both diagnostic groups had Waterlow scores which put them into the high-risk category. A total of 20 pressure sores developed in the two groups of patients during their stay in hospital. Patients admitted for hip replacement had higher nutrient intake values than patients with fractured neck of femur and they also had a higher occurrence of pressure sores. Overall diet for all patients appeared to be adequate; however, the diet of patients with fractured neck of femur was significantly lower in both iron and vitamin C than that of patients having hip replacement surgery. The nutritional assessment tool was not as sensitive as expected and further development and validation are needed. While no firm conclusions can be drawn from this small study, the results do emphasise the importance of adequate diet in elderly patients prior to admission, especially for planned admissions for hip replacement.

Transfoam Wave: the new addition to the Transfoam range.

There are many types of support surfaces available. Selection of a suitable support surface for an individual patient is best done by first identifying the patient's risk of pressure sore development. Transfoam was originally developed in 1990 and is designed for the medium-risk patient. The new design transfoam Wave combines increased comfort with lower interface pressures, to provide another mattress in the Transfoam family. This product focus examines the original Transfoam mattress produced by Karomed and looks at the design and results of early testing of the new Transfoam Wave.

The problem of pressure sores and how to treat them

Pressure sores are a serious but largely preventable complication of illness and/or disability. They are the source of much pain and discomfort for the patient and are a constant drain on scarce NHS resources. This article outlines the causes and associated risk factors of pressure sore formation. It discusses the importance of risk assessment and highlights relevant measures health-care professionals and carers can implement to reduce the problems associated with pressure sore development. It is crucial that healthcare professionals have both theoretical knowledge and sound clinical skills in order to prevent the development of pressure sores and thus promote good patient care.

Undernutrition in the elderly population living at home in the community: a review of the literature.

Undernourishment in elderly people has been found to have a variety of detrimental effects ranging from the development of pressure sores to the incidence of fractured femurs. Surveys within hospital settings have revealed that elderly patients are often admitted from their homes in a state of malnutrition, which would indicate nutritional deficits in at least some of the population. Reliable nutritional assessment in the community, however, is difficult and time consuming, with findings subject to distortions from other influences. Consequently there is inadequate accurate assessment of the current nutritional status of the general elderly population, and assumptions are often based on research findings from the 1960s and 1970s. In view of the demographic changes which have moved towards an increasingly 'old' elderly population such research may no longer be relevant. This paper provides a review of the available literature on nutrition in elderly people living at home and includes possible assessment screening strategies that could be used by community nurses.

The Effectiveness of Pressure-Reducing Table Pads as an Intervention to Reduce the Risk of Intraoperatively Acquired Pressure Sores

The purpose of this study was to determine the effectiveness of specialty pads as an intervention to reduce the incidence of intraoperatively acquired pressure sores. A convenience sample (N = 361) was drawn from all inpatients who underwent cardiothoracic or major vascular surgery on the standard operating room table (group 1), the air-filled pad (group 2), or the specialty foam pad (group 3). This sample was inclusive of 100% of patients during the study period who met the criteria. The incidence of pressure sore development was seven in group 1, zero in group 2, and one in group 3. There was at statistically significant difference (p = 0.0003) between group 1 and group 2. Additionally, a statistically significant difference (p = 0.0003) was found between group 1 and group 3. The foam pad and the air-filled pad were effective interventions for reducing the risk of intraoperatively acquired pressure sores.

The Pegasus Overture alternating-pressure mattress overlay.

Pressure sores affect approximately 10% of the adult population and occur in various hospitals and community settings (Department of Health, 1992). It is therefore essential to adopt a logical approach when selecting the optimum piece of equipment for patients at risk of pressure sore development. Alternating-pressure mattresses have been used for many years in both hospitals and community environments to prevent and treat pressure sores. In September 1995, Pegasus Airwave Limited launched a new alternating-pressure mattress overlay, the Overture. It is designed for use with patients who have mobility problems and are at low to medium risk of developing pressure sores or have superficial tissue damage. This article describes the features of the Overture and its suitability for use in different care settings.

Prevention of Pressure Sores in Acute Spinal Cord Injury: Outside the Specialist Unit

Unless injury occurs on the doorstep of a specialist unit, persons sustaining a traumatic spinal cord injury, will spend at least some part of their hospitalisation in another care setting such as A&E, ITU, a neurological or other ward. During this early period the care team may have to respond to a whole range of life threatening events. It is therefore perhaps not surprising, that the prevention of pressure sores may receive only cursory attention. It is however during this period that this group is at a considerable risk of developing pressure sores. One recent review listed some 200 risk factors in the initial period post injury'. The purpose of this article therefore, is to suggest ways in which the incidence of pressure sores occurring in the acute phase of spinal cord injury, might be reduced, by sharing the practices used in one particular specialist unit with colleagues in the pre-admission area such as A&E and the general hospital. Strategies suggested include a number of lifting and handling methods now available to manage this very problematical care group. In addition, the current approach to pressure sore prevention practiced in one specialist unit, together with the underlying rational is outlined, in the hope that collegues in other care settings may find the information useful in our common endeavour to reduce the incidence of pressure sores.

The point prevalence of wounds in a teaching hospital.

Wounds are a common problem, particularly in the elderly population. The scale of wound problems in hospital is largely unknown because wounds are widely dispersed. The present study examined the point prevalence of hospital wounds and undertook a pressure ulcer risk assessment of all patients on one day. All 360 inpatients were surveyed and thoroughly examined. A risk scale for pressure sore development, the Norton score, was applied. When wounds were found, information was collected to determine their aetiology. Forty leg ulcers, 40 pressure sores, 85 surgical wounds and seven other types of wounds were found. Most leg ulcer and pressure sore cases were admitted for other reasons. The Norton score did not predict all cases of pressure ulceration. A total of 52% of wounds did not qualify for additional funding under current funding criteria. The prevalence of non-surgical wounds in Heidelberg Repatriation Hospital was easily underestimated. Wound care management can be optimized by staff education and protocol design, early identification of troublesome wounds and of at-risk patients, and a cross-sectional approach that incorporates wound-management teams.

The Vicair Academy and Liberty range of pressure-reducing seating.

Many patients can be sitting in a chair for between 3 and 14 hours each day, consequently the type of cushion they are sitting on is of the utmost importance. These patients are often at high risk of developing pressure sores--possibly more so than bed-bound patients. Vicair, whose UK distributor is Gerald Simonds Healthcare, has developed two types of pressure-reducing cushions: the Vicair Academy and Liberty Fluid-Air. These cushions offer pressure reduction in a system that is user-friendly and particularly lightweight. This product focus highlights the problems associated with seating and explains how the Vicair range of cushions attempts to address them.

The development of pressure sores in patients with spinal cord injury.

A discussion of the reasons why provision of information regarding pressure sore prevention to patients with spinal cord injury is not always effective in preventing the development of sores

Shear stress measured on beds and wheelchairs

Local shear is understood to be one of the principal risk factors for the development of pressure sores. There is a need for a small deformable sensor that can measure the shear force between skin and deformable materials without disturbing the shear phenomenon. In the present study a new shear sensor is introduced with a contact area of 4.05 cm2. A series of validation experiments was performed with ten healthy young subjects. It was demonstrated that with a forward-tilted seat, the sum of the local shear forces between skin and sensormat is equal to the resultant shear force measured with a force plate. This result serves as a validation of the new sensor. The shear values recorded are 4.8 kPa in the longitudinal direction and 8.5 kPa in the transversal direction while sitting in a wheelchair, and 5.6 kPa in the longitudinal direction and 3.1 kPa in the transversal direction on a mattress of a hospital bed, while in sitting position in bed.

Impaired blood flow response following pressure load in diabetic patients with cardiac autonomic neuropathy

Objective: An impaired blood flow response is associated with an increased risk of developing decubitus ulcers. This study investigated wheather diabetic patients with autonomic neuropathy show an impaired blood flow response following pressure load, compared with healthy controls. Design: Before-after trial. Setting: University hospital. Patients: Eighteen patients with type I diabetes and autonomic neuropathy, and 15 healthy volunteers. Results: The blood flow response starts with a latency period followed by a temperature increase (described by the “time constant”). The blood flow response in both groups showed significant ( p < 01) differences. In diabetic patients, the latency time was 312 ± 221sec, the time constant was 339 ± 149sec, and the recovery time was 538 ± 184sec. In controls, latency time was 83 ± 47sec, time constant was 79 ± 69sec, and recovery time was 162 ± 103sec. The velocity of the blood flow response decreased with increasing duration of diabetes mellitus ( p = .02). Conclusions: Diabetic patients with autonomic neuropathy show an impaired blood flow response after pressure relief. This finding suggest that these patients have an increased risk of developing decubitus ulcers.

Pressure sore risk assessment in children.

A multi-centred study was undertaken involving 300 children ranging from neonates to children aged 16 years. The purpose of the study was to investigate the possibility of designing a pressure sore risk assessment scoring system suitable for the paediatric area of care. It was found that the following conclusions can be drawn: (i) Children are at risk of developing pressure sores; (ii) A version of the adult Waterlow card was not appropriate, especially at the younger end of the scale; (iii) There are identifiable situations and treatments which do pose a risk of pressure sore development. Admission documentation and a care plan within a hospital policy is recommended as the best method of drawing nurses' attention to the risk factors involved and the measures which need to be taken to alleviate the risk of tissue damage.

Overview of the etiology of wound infections with particular emphasis on community-acquired illnesses.

Wound cultures represent a general catchall category for a group of extremely diverse anatomic samples that range from superficial specimens of cutaneous structures (folliculitis, cellulitis) to specimens revealing invasive infections involving deep fascial planes and muscle (myonecrosis). Because of the complex nature of these infective processes, the terminology associated with such infections is often imprecise and confusing. Wounds are the result of trauma, either intentionally or accidentally induced. Nosocomial wound infections result primarily from surgical procedures, the development of pressure sores, or catheterization. Community-acquired wound infections are often preceded by injuries resulting from occupational exposure or recreational activities and are associated with a greater diversity of microorganisms due to the exposure of open wounds to inhabitants of the microbial biosphere. This review provides a general overview of the categories of wound infections and describes their acquisition and clinical significance. Particular emphasis is placed on selected community-acquired wound infections and the etiologic agents associated with such conditions.

Practical use of the Waterlow tool in the community

In the first paper of this focus, Judy Waterlow discusses her views on community use of the Waterlow pressure sore risk tool (Waterlow 1988). The author suggests it is essential that pressure sore risk assessment systems are seen as tools to be used as part of the decision making process to identify people at risk of developing sores. They should not be seen as calculators, which can single handedly predict pressure sore development. Provided that assessors understand its function, the Waterlow pressure sore risk assessment tool may be used successfully in the community, despite being developed in a hospital environment.

Zinc and vitamin C in the aetiology of pressure sores.

A review of studies which have considered the role of two important nutrients in the development of pressure sores.

Protein levels and the aetiology of pressure sores.

This review considers studies which have investigated the role of nutrition and, in particular, of proteins in the development and healing of pressure sores.