Higher Prevalence Of Pressure Ulcers Research Articles

The Topical Formulation of Whey Protein for the Prevention of Pressure Ulcers in Critically Ill Patients: A Novel Intervention in a Randomized-Controlled Clinical Trial.

High prevalence of pressure ulcers (PUs) and their complications are important dilemmas in the intensive care unit (ICU). Therefore this study was designed to evaluate the effectiveness of topical whey protein formulation in preventing PUs in patients admitted to the ICU. In this randomized placebo-controlled clinical trial under registration number [IRCTdeted for blinded article], 80 eligible ICU patients were randomly allocated to receive topical ointment of whey protein or placebo on the sacrum with a diameter of 15 cm twice daily for seven days, in addition to the routine care. The mean risk score for developing PUs was calculated at baseline using the Braden tool, and the PUSH score was used to assess PUs on days 4, 7, and 14. Patients' related demographic and clinical variables were also collected using a medical record for more evaluation. Our results showed that demographic characteristics and the Braden scores' baseline mean were not significantly different between groups (P > 0.05). The repeated measures ANOVA test revealed that the mean scores of PUs at various times were markedly lower in the whey protein than in the placebo group (P < 0.001). This intervention can be routinely added as effective, safe, inexpensive, and accessible care to reduce the incidence of PUs for patients at risk of developing this injury.

Indicators of health and safety among institutionalized older adults.

To identify the incidence of mortality, diarrheal diseases, scabies and falls; and the prevalence of pressure ulcers - all of which are related to the safety ofinstitutionalized older adults. This was a documentary retrospective study developed in a long-term residential careinstitution for older adults in the Northeast region of Brazil. The data were gathered from records of health assessment indicators filed between January 2008 and December 2015. Analysis included absolute case frequency; the sum of monthly prevalence and incidence rates; mean values of cases; and mean annual incidence and prevalence rates. The incidence of mortality over these nine years ranged from 9% to 13%; of acute diarrheic disease from 13% to 45%; and scabies from 21% to 63%. The prevalence of pressure ulcers ranged from 8% to 23%. Between 2012 and 2015, the incidence rate of falls without injury varied from 38% to 83%, and with injury from12% to 20%. Analysis of the health indicators revealeda high incidence of scabies and falls and a high prevalence of pressure ulcers. The identification of less than optimal rates for performance indicators canhelp improve the quality of nursing care. Identificar a incidência de mortalidade, doenças diarreicas, escabiose e quedas, e a prevalência de lesões por pressão para a segurança do idoso institucionalizado. Estudo documental, retrospectivo desenvolvido em uma Instituição de Longa Permanência para Idosos, localizada no nordeste do Brasil. Os dados foram coletados por meio dos registros dos indicadores de avaliação de saúde, arquivados de janeiro de 2008 a dezembro de 2015. A análise incluiu a frequência absoluta dos casos; o somatório das taxas de prevalência e incidência mensais; a média de casos e das taxas de incidência e prevalência anuais. Observa-se que a incidência de óbitos nos nove anos considerados variou de 9 a 13%; de doenças diarreicas agudas, de 13 a 45%; e de escabiose, de 21 a 63%. A prevalência de lesão por pressão oscilou de 8 a 23%. Entre os anos de 2012 a 2015, a taxa de incidência de quedas sem lesão variou em torno de 38 a 83%, e com lesão, de 12 a 20%. A análise da amplitude dos indicadores de saúde permitiu identificar a alta incidência de escabiose e de quedas e a elevada prevalência de lesões por pressão. A identificação do comprometimento dos indicadores contribui para otimização da qualidade da assistência de enfermagem.

Qualidade de vida em portadores de lesão medular com úlceras por pressão

Objetivo: Identificar la prevalencia de úlceras por presión en portadores de traumatismos de la médula espinal y analizar su qcalidad de vida. &lt;br /&gt;&lt;br /&gt;Métodos: Estudio descriptivo, transversal realizado en una institución especializada en rehabilitación de personas con grandes incapacidades. Para colecta se aplicaron el WHOQOL-bref (0 a 100; cuanto mayor la puntuación, mejor calidad de vida) y cuestionario de caracterización sociodemográfica y clínica. &lt;br /&gt;&lt;br /&gt;Resultados: De los 118 portadores de traumatismos de la médula espinal ingresados en el periodo de colecta de datos, 58 (49,1%) presentaron úlceras por presión. De estos, 40 respondieron los instrumentos. El análisis del WHOQOL-bref evidenció puntuación muy baja en el Dominio físico (53,04), seguido de los dominios psicológico (60,94) y ambiental (63,52). El único dominio con puntuación satisfactoria fue el social (70,21). De modo general, estas puntuaciones son preocupantes. &lt;br /&gt;&lt;br /&gt;Conclusión: Se observó una elevada prevalencia de úlceraspor presión entre personas con traumatismos de la médula espinal. La evaluación de la calidad de vida revela una insatisfacción significativa de los participantes, principalmente respecto a los aspectos físicos.&lt;br /&gt;&lt;br /&gt;

Abstract: Notes from the Field: Establishing Baseline Data for Pressure Ulcers in a Rwandan Intensive Care Unit

Abstract Background Pressure ulcers are a common iatrogenic medical problem. Pressure ulcers increase the morbidity and mortality of hospitalized patients as well as the length and cost of hospitalization. It was observed that patients in the Intensive Care Unit (ICU) of a large, referral hospital in Kigali, Rwanda, often had pressure ulcers, however, no data on the ulcers existed. Objectives The objective of this study was to establish baseline data and compare prevalence, incidence, and severity of pressure ulcers in this ICU before and after educational classes. Methods Educational classes on pressure ulcer assessment and classification were held for all ICU nurses. After training, data collection was instituted and conducted over a three month period. Patients were screened upon admission and daily for the presence of pressure ulcers, number of ulcers, ulcer location and ulcer severity. All information was documented in a database. Results Currently, 41 patient stays have been assessed. Eleven patients (27%) arrived with preexisting ulcers, six patients (15%) developed new ulcers during their ICU stay. No pre-existing ulcers notably worsened in severity in the ICU, and new onset ulcers showed a maximum severity of Stage 2. The most common location for both preexisting and new ulcers was the buttocks, and the most common severity for both pre-existing and new onset ulcers was also Stage 2. Conclusion So far, pressure ulcer incidence (new occurrence) has been found to be at 15%, and prevalence at 41%. These statistics suggests that the ICU has an average incidence and moderately high prevalence of pressure ulcers. Further data collection is needed to verify these results. In light of resource limitations and short-staffing, these results are quite positive. Once baseline data is established with further study, the ICU will be able to evaluate the efficacy of future nursing practice changes designed to reduce pressure ulcer incidence and severity in the ICU setting. Key words : pressure ulcer, ICU, quality indicator

Burden and outcomes of pressure ulcers in cancer patients receiving the kerala model of home based palliative care in India: results from a prospective observational study.

Aim:To report the prevalence and outcomes of pressure ulcers (PU) seen in a cohort of cancer patients requiring home-based palliative care.Materials and Methods:All patients referred for home care were eligible for this prospective observational study, provided they were living within a distance of 35 km from the institute and gave informed consent. During each visit, caregivers were trained and educated for providing nursing care for the patient. Dressing material for PU care was provided to all patients free of cost and care methods were demonstrated. Factors influencing the occurrence and healing of PUs were analyzed using logistic regression. Duration for healing of PU was calculated using the Kaplan Meier method. P < 0.05 are taken as significant.Results:Twenty-one of 108 (19.4%) enrolled patients had PU at the start of homecare services. None of the patients developed new PU during the course of home care. Complete healing of PU was seen in 9 (42.9%) patients. The median duration for healing of PU was found to be 56 days. Median expenditure incurred in patients with PU was Rs. 2323.40 with a median daily expenditure of Rs. 77.56.Conclusions:The present model of homecare service delivery was found to be effective in the prevention and management of PUs. The high prevalence of PU in this cohort indicates a need for greater awareness for this complication.Clinical Trial Registry Number:CTRI/2014/03/004477

Pressure Ulcers in the Elderly, as a Public Health Problem

Pressure ulcers (PU) are a common medical complication in the frail elderly. Due to the increase of the elderly population and accrued accompanying comorbidities, there is a higher prevalence of pressure ulcers. These induce suffering and worsening in quality of life and prolong hospitalization. Pressure ulcers are a burden on the medical services and increase their cost substantially. Systemic factors such as aging of the skin, functional impairment, chronic diseases, malnutrition and infection contribute to the appearance of the ulcers and activate development. Low BMI, anemia, low protein and albumin are predisposing factors, as well as serious complications of pressure ulcers interfere with the cure. Prevention of pressure ulcers should be started by the primary care givers through education of the patient and family concerning the external factors as pressure relieving devices, especially mattresses and cushions, position changes, lubrication of the skin and adequate calorie intake for the patient. Attention becomes directed to changes of the skin especially at the location of bone prominences exposed to pressure. A zero-tolerance policy is necessary by the primary physician and the nurse, concerning pressure ulcers. The treating physician familiar with the diseases of the immobile patients and the systemic factors leading to pressure ulcers should apply all available preventive measures.

Prevalence of Pressure Ulcers by Race and Ethnicity for Older Adults Admitted to Nursing Homes

Little is known about the prevalence of pressure ulcers (PUs) among racial and ethnic groups of older individuals admitted to nursing homes (NHs). NHs admitting higher percentages of minority individuals may face resource challenges for groups with more PUs or ones of greater severity. This study examined the prevalence of PUs (Stages 2 to 4) among older adults admitted to NHs by race and ethnicity at the individual, NH, and regional levels. Results show that the prevalence of PUs in Black older adults admitted to NHs was greater than that in Hispanic older adults, which were both greater than in White older adults. The PU rate among admissions of Black individuals was 1.7 times higher than White individuals. A higher prevalence of PUs was observed among NHs with a lower percentage of admissions of White individuals. [Journal of Gerontological Nursing, 40(3), 20-26.].

Practices and Outcomes

The objective of this study was to compare reported pressure ulcer prevention and treatment practices in nursing facilities with high prevalence of pressure ulcers versus nursing facilities with low prevalence of pressure ulcers. A 26-item survey on implementation of nationally accepted standards for pressure ulcer prevention and treatment was mailed to directors of nursing in all 68 nursing facilities in an urban county. There were no statistically significant differences on reported pressure ulcer prevention interventions based on pressure ulcer prevalence. When treating pressure ulcers, respondents of facilities with high prevalence of pressure ulcers reported more frequent pain assessments, more frequent use of low air-loss beds, and daily wound assessments. The study failed to support the hypothesis that nursing facilities with low prevalence of pressure ulcers report using more guideline-recommended pressure ulcer prevention and treatment interventions than facilities with high prevalence of pressure ulcers. Reported adherence to recommended interventions for repositioning and pressure relief measures, moisture management, and attention to nutrition exceeded 60% in all facilities. The disparity between reported interventions and pressure ulcer prevalence rates offers an opportunity for future collaborative quality improvement projects, research, and the need for leadership to develop systems of care to ensure the use of pressure ulcer prevention guidelines.

African Americans show increased risk for pressure ulcers: A retrospective analysis of acute care hospitals in America

In an earlier study, we reported a significantly increased risk of pressure ulcer hospital discharge diagnoses in African Americans, higher age groups, and those with certain medical conditions. The objectives of the present study were to: (a) investigate the demographics associated with a higher odds ratio (OR) in African Americans and (b) determine whether African Americans have different rates of medical risk factors. The 2003 Nationwide Inpatient Sample database was queried. Patients with pressure ulcers were identified by discharge diagnoses using ICD-9 codes 707.0-707.09. Discharge diagnosis was examined using the agency for healthcare research and quality clinical classifications software (CCS). The present study used identified CCS discharge diagnoses present in at least 5% of all patients, with an OR>2. African Americans exhibited a higher incidence of an OR>2 for 28 identified CCS risk factors for pressure ulcers. The pressure ulcer diagnoses tended to occur at younger ages in African Americans. No significant differences were noted in African Americans with pressure ulcers when a subanalysis was conducted by zip code income quartile, region of the country, or teaching status of the hospital. Hospitalized African Americans exhibit an age-dependent, higher prevalence of pressure ulcers compared with Caucasians. Socioeconomic factors tracked within the Nationwide Inpatient Sample do not provide an explanation for this phenomenon.

Body Mass Index, Weight, and Pressure Ulcer Prevalence

To assess the relationships among pressure ulcer prevalence, body mass index (BMI), and weight, this report analyzed the US data from the 2006 and 2007 International Pressure Ulcer Prevalence Surveys. Findings indicated an overall reduction in pressure ulcer prevalence from 2004 and 2005 to 2006 and 2007; there was a higher prevalence of pressure ulcers in patients with low BMI and patients with both low and high weights. One in 10 patients were extremely obese.

Not So Black and White: Nursing Home Concentration of Hispanics Associated with Prevalence of Pressure Ulcers

To examine the association between the nursing home (NH) concentration of Hispanics and prevalence of pressure ulcer. Secondary data analysis using data from the national repository of the 2000 Minimum Data Set (MDS) and On-Line Survey Certification and Reporting (OSCAR) data. We used a multivariate logistic model, with the Huber-White correction to account for clustering of persons within a nursing facility, to examine the association of Hispanic NH concentration with the prevalence of pressure ulcers, after adjusting for resident level characteristics. Five states with a high population of Mexican-Americans (California, New Mexico, Arizona, Colorado, and Texas). A total of 74,343 persons (9.26% black, 11.28% Hispanic, 79.46% non-Hispanic white) in a NH located in 1 of these 5 states during the last quarter of 2000. The prevalence of Stage II-IV pressure ulcers was examined in the last quarter of 2000. Stage II-IV pressure ulcers, resident demographics, and medical illness data were documented by nursing staff on the MDS. Hispanics and non-Hispanic blacks had a higher prevalence of pressure ulcers than non-Hispanic whites (7.60%, 9.71% and 12.10%, respectively). A facility's concentration of Hispanic residents was associated with prevalent pressure ulcers after adjustment for resident characteristics. Residents in nursing homes in which there is a higher concentration of Hispanic residents are more likely to have a pressure ulcer.

Impact of Pain on Outcomes in Long‐Term Care Residents with and without Multiple Sclerosis

To compare long-term care (LTC) residents with and without multiple sclerosis (MS); to compare admission status of pain, physical disability, pressure ulcers, depression, and cognitive performance in LTC residents with and without MS; and to examine the impact of MS and pain on outcomes 90 and 180 days after LTC admission. Retrospective analysis of a large data set. LTC facilities in Missouri. Residents admitted to non-hospital-based LTC facilities. Minimum Data Set/Resident Assessment Instrument, Version 2.0; Activities of Daily Living Scale; Cognitive Performance Scale. Residents with and without MS had similar pain prevalence and intensity after admission, with daily pain more frequent in residents with MS (P=.03). On admission, residents with MS had more physical disability (P<.001) and a greater prevalence of pressure ulcers (P=.004) and depression (P<.001) than residents without MS. In all LTC residents, initial pain status was associated with physical disability (P<.001), pressure ulcers (P<.001), depression (P<.001), and cognitive performance (P<.001) 90 and 180 days after admission. A diagnosis of MS was associated with physical disability (P<.001) 90 and 180 days after admission and pressure ulcer development 180 days after admission (P=.02). Residents with MS were more physically disabled and had more frequent pain and a higher prevalence of pressure ulcers and depression on admission than residents without MS. Pain, or lack thereof, in residents with and without MS on admission may warn of problems that could occur within 6 months after admission to a LTC facility.

The Cost Efficiency and Clinical Quality of Institutional Long-Term Care for the Elderly

This study applied the stochastic frontier cost function with inefficiency effects to estimate the association between quality of care and cost efficiency in institutional long-term care wards for the elderly in Finland. We used several clinical quality indicators for indicating adverse care processes and outcomes, based on the Resident Assessment Instrument (RAI)/Minimum Data Set (MDS). Average cost inefficiency among the wards was 22%. We found an association between the clinical quality indicators and cost inefficiency. Higher prevalence of pressure ulcers was associated with higher costs, whereas the higher prevalence of use of depressants and hypnotics increased inefficiency.

Prevalence, prevention, and treatment of pressure ulcers: descriptive study in 89 institutions in the Netherlands.

The purpose of the present study was to assess the prevalence of pressure ulcers and the use of Dutch guidelines for the prevention and treatment of pressure ulcers. A survey of 16,344 patients in 89 health care institutions on 1 day showed a mean prevalence of pressure ulcers of 23.1%. It was found that Dutch guidelines on some aspects of prevention and treatment of pressure ulcers were not being followed. Only 53% of the patients who should have been positioned on a support surface were positioned on such a device. Fewer than one-third of the patients who should have been repositioned, should have received nutritional support, or should have been educated received these interventions, and only 33.6% of all pressure ulcers were dressed as recommended. More attention to the dissemination and implementation of the guidelines is needed to reduce this high prevalence of pressure ulcers.