Incidence Of Pressure Ulcers Research Articles

Effect of Nursing Outcome-Oriented Intervention on Airway Management in Elderly Long-Term Bedridden Patients.

Objective This study intended to explore the nursing outcome-oriented intervention's effect on airway management in elderly long-term bedridden patients. Methods A total of 120 cases of elderly long-term bedridden patients admitted to our hospital from May 2018 to June 2020 were enrolled and randomly divided into the observation group (n = 60) and control group (n = 60). The control group received the routine nursing intervention, while the observation group received the nursing outcome-oriented intervention. Forced expiratory volume (FEV1), forced vital capacity (FVC), and maximal voluntary ventilation (MVV) in the first second were compared between the two groups before and after the intervention. The pulmonary infection of the two groups was observed. Total protein, hemoglobin, albumin, and cholesterol levels were compared between the two groups. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the two groups' psychological status before and after the intervention. The Generic Quality of Life Inventory-74 (GQOLI-74) assessed the two groups' quality of life. Results After the intervention, the levels of FEV1, FVC, and MVV; total protein, hemoglobin, albumin, and cholesterol; and scores of physical function, psychological function, social function, and material life function in the observation group were higher than those in the control group. Pulmonary infection, secondary infection, the infection rate is more than 3%, HAMA, and HAMD scores, and the incidence of pressure ulcers, aspiration, constipation, and the falling bed was lower than those in the control group, with statistical significance (all P < 0.05). Conclusion Nursing outcome-oriented intervention can effectively improve lung function, pulmonary infection, nutritional status, negative mood, and quality of life of long-term bedridden elderly patients.

The impact of the pandemic on functional outcomes for joint replacement patients: An observational study.

Elective surgeries, as joint replacement, were resumed after the first COVID-19 pandemic wave in 2020 and a phase of coexistence with the virus began. Surgery was organized in a new way that incorporated procedures aimed at reducing the risk of spreading the virus. The aim of this study is to describe the early functional results for patients undergoing hip and knee replacements at the time healthcare services were being reopened and to compare them with the same outcomes recorded in the prepandemic period. This is a controlled retrospective study. All patients consecutively admitted during 2020 and who underwent hip and knee replacement were enrolled in the study. Patient records from January to March 2020 constituted the prepandemic control group, while patient records from May to December 2020 constituted the study group. Functional recovery was described through the patient's ability to walk using antebrachial devices and to climb up and down 3 steps. The day after surgery on which these activities were first performed was also recorded. The prepandemic group consisted of 183 patients and the pandemic group of 280 patients. The mean age of patients was 66 years (±13.1), female was 44.9% and hip replacement was 66.5%. The number of patients who climbed stairs and the timing thereof was comparable for the 2 groups (68.5% vs 72.2%, respectively; P = .403). There was no significant difference in the incidence of patients able to walk with antebrachial device and incidence of pressure ulcers and major complications. Multivariate analysis confirmed that the incidence of stair climbing was not associated with the prepandemic or pandemic inclusion. During the reopening of orthopedic surgery activity, the reorganization and treatment pathway did not affect the functional outcome achieved by patients underwent joint replacement. Constant monitoring of the functional outcomes will be required so as to further increase the number of joint replacement surgeries.

Pressure injury in the perioperative period during COVID-19 pandemic: Incidence and patient-related risk factors in a hospital in Turkey

• The high incidence of the development of pressure ulcer both creates a major problem during perioperative period and also a burden on health care. During the pandemic period, data containing up-to-date evidence is extremely needed. • Determining the incidence of pressure ulcer and patient-related risks in the perioperative period during the Covid-19 pandemic may play an important role in taking more systematic preventive measures. • Controlling the risk factors affecting the development of pressure ulcers in the perioperative period will affect the quality of health services much more positively. • These findings can drive the implementation of preventive measures to reduce the pressure ulcer factors of risk associated during perioperative period.

Biomarkers for the early detection of pressure ulcers in the intensive care setting: A comparison between sub-epidermal moisture measurements and interleukin-1α.

Pressure ulcer (PU) prevention in the intensive care unit (ICU) is an important clinical issue as critically unwell patients are at high risk of developing PUs. However, current methods of PU detection are limited, especially for early detection. This study aimed to establish the correlation between Interleukin-1α (IL-1α)/total protein (TP) and sub-epidermal moisture (SEM) measurements in the early identification of PUs in ICU patients. This study employed an observational research design using the STROBE guidelines. Following ethical approval, 53 participants were recruited and sebum was obtained using Sebutape from weight-bearing areas (sacrum, heels and a control site). SEM measurements were taken from the same anatomical sites. Both measures were taken at the same time and participants were followed up for 5 days, or until discharge or death. Correlations between SEM delta measurements, IL-1α, TP and PU incidence and other demographic information were explored using Spearman's correlation for data not normally distributed, and Pearson's R correlation coefficient for normally distributed data. Mean baseline SEM delta measurements indicate abnormal readings for all anatomical sites except the control site, consistent with previous studies. Mean baseline IL-1α/TP readings were higher for the sacrum versus both heels and, on average, readings were higher for the control site versus all other anatomical locations. This is conflicting, given that the control site was non-weight bearing. There were very weak or weak correlations between SEM delta measurements and IL-1α/TP readings. SEM measurements are quick and easy to obtain and results are instant, however Sebutape sampling takes significantly longer and is challenging to conduct among haemodynamically unstable patients. Obtaining SEM measurements is more practical and feasible than Sebutape sampling to assess for the presence of inflammation.

Is continuing nursing interventions reduce the incidence of intraoperative pressure ulcers for breast cancer patients?

Is continuing nursing interventions reduce the incidence of intraoperative pressure ulcers for breast cancer patients?

Clarification of issues brought up by 'Is continuing nursing interventions reduce the incidence of intraoperative pressure ulcers for breast cancer patients?'.

Clarification of issues brought up by 'Is continuing nursing interventions reduce the incidence of intraoperative pressure ulcers for breast cancer patients?'.

Pressure Ulcers Risk Assessment According to Nursing Criteria

Pressure ulcers (PU) represent a health problem with a significant impact on the morbidity and mortality of immobilized patients, and on the quality of life of affected people and their families. Risk assessment of pressure ulcers incidence must be carried out in a structured and comprehensive manner. The Braden Scale is the result of an analysis of risk factors that includes subscales that define exactly what should be interpreted in each one. The healthcare work with evidence-based practice with an objective criterion by the nursing professional is an essential addition for the application of preventive measures. Explanatory models based on the different subscales of Braden Scale purvey an estimation to level changes in the risk of suffering PU. A binary-response logistic regression model, supported by a study with an analytical, observational, longitudinal, and prospective design in the Granada-Metropolitan Primary Healthcare District (DSGM) in Andalusia (Southern Spain), with a sample of 16,215 immobilized status patients, using a Braden Scale log, is performed. A model that includes the mobility and activity scales achieves a correct classification rate of 86% (sensitivity (S) = 87.57%, specificity (SP) = 81.69%, positive predictive value (PPV) = 91.78%, and negative preventive value (NPV) = 73.78%), while if we add the skin moisture subscale to this model, the correct classification rate is 96% (S = 90.74%, SP = 88.83%, PPV = 95.00%, and NPV = 80.42%). The six subscales provide a model with a 99.5% correct classification rate (S = 99.93%, SP = 98.50%, PPV = 99.36%, and NPV = 99.83%). This analysis provides useful information to help predict this risk in this group of patients through objective nursing criteria.

Predictive validity of the Jackson–Cubbin scale for pressure ulcers in intensive care unit patients: A meta‐analysis

AbstractBackgroundThe intensive care unit has a much higher pressure ulcers incidence than general wards. Predicting and eliminating the risk of pressure ulcer development is thus of utmost importance in health care, including clinical nursing practice.AimThe meta‐analysis aimed to examine the predictive validity of the Jackson–Cubbin Scale.MethodsThis study is a systematic literature review and meta‐analysis. Research articles published in periodicals indexed targeted the critical care patients and offered sufficient data(true‐positive, false‐positive, true‐negative and false‐negative results) in the EBSCO, PubMed, Ovid, Web of Science and Cochrane databases, as well as those from two journals indexed in a Chinese database (Wangfang Data and China National Knowledge Infrastructure) were reviewed. Preferred reporting items for systematic reviews and meta‐analyses were used; the internal validity of the diagnostic studies was analysed using Quality Assessment of Diagnostic Accuracy Studies 2. Sensitivity, specificity, positive and negative likelihood ratios were counted by STATA 15.0.ResultsNine diagnostic studies with high methodological quality, involving a total of 7684 patients, were retrieved and assessed. This meta‐analysis showed that the pooled sensitivity, specificity and area under the symmetric summary receiver operating characteristic curve of the Jackson–Cubbin Scale were 0.81 (95% confidence interval [CI], 0.58–0.88), 0.76 (95% CI, 0.51–0.95) and 0.84 (95% CI, 0.81–0.87), respectively.ConclusionsThe study suggests that the Jackson–Cubbin Scale has a moderate level of predictive validity. Moreover, Jackson–Cubbin's predictive validity could be increased if it was implemented differently based on the attributes of the research participants.Relevance to Clinical PracticeThe Jackson–Cubbin Scale has a moderate level of predictive validity with good sensitivity and specificity for the determination of the risk of PUs in adult ICU patients. Bedside nurses could use the Jackson–Cubbin scale for dailly assesment for ICU patients.

Prevention of pressure ulcers in older people with frailty.

The incidence of pressure ulcers is highest among older people with frailty. The development of pressure ulcers is a common and challenging issue in this population, which can reduce people's quality of life and increase mortality risk. Multifactorial processes contribute to the development of pressure ulcers in older people with frailty, including age-related skin changes, comorbidities, polypharmacy, reduced mobility, inadequate nutrition and hydration, and continence issues. This article discusses the development and management of pressure ulcers in older people with frailty. It also outlines some of the measures that can be taken by nurses and other healthcare professionals to reduce the risk of pressure ulcers developing in this population.

At-Point Clinical Frailty Scale as a Universal Risk Tool for Older Inpatients in Acute Hospital: A Cohort Study.

BackgroundWhile the Clinical Frailty Scale (CFS) has been extensively validated for predicting health outcomes in older adults, the role of the at-point CFS at the time of examination is unclear. We aimed to examine the ability of the at-point CFS for predicting clinical outcomes of older inpatients.MethodsAs a single-center and prospective cohort study, we enrolled 1,016 older adults who were 65 years or older and were admitted to one of 9 medical or surgical units from May 2021 to September 2021. The associations of the at-point CFS with outcomes of falls, delirium, pressure ulcers, 30-day unplanned readmission and/or emergency department (ED) visits, institutionalization, and a composite outcome were analyzed.ResultsIn the study population (n = 1,016), 26 patients had incident pressure ulcers, 6 patients had falls, 50 patients experienced delirium, and 13 patients died during hospitalization. Also, 37 patients experienced an ED visit and 22 patients had an unplanned readmission within 30 days after discharge. The composite outcome was 1.7% among patients with the CFS < 5 and 28.5% among patients with the CFS ≥ 5. The higher CFS was associated with an increased risk of a fall [odds ratio (OR) 1.74 (1.01–3.01)], pressure ulcers [OR 3.02 (2.15–4.23)], delirium [OR 2.72 (2.13–3.46)], 30-day readmission [OR 1.94 (1.44–2.62)], ED visit [OR 1.81 (1.47–2.23)], death [OR 3.27 (2.02–5.29)], and institutionalization after discharge [OR 1.88 (1.62–2.18)].ConclusionThe at-point CFS assessed in older inpatients can screen high-risk individuals who might experience adverse geriatric conditions and in-hospital outcomes.

The effect of a pressure ulcer prevention care bundle on nursing workload costs

AimThis study investigated the effect of care under the guidance of a pressure ulcer prevention care bundle on pressure ulcer incidence rates and on nursing workload costs. Design, setting, and participantsThis prospective pre-post interventional study was conducted in an anesthesia and reanimation intensive care unit. The sample consisted of 16 nurses and 84 patients. MethodsThe study was conducted in two periods: (1) nursing workload of pre-care bundle period and (2) nursing workload of post-care bundle period. In the collection of data, 6 forms (the demographic data forms, the Braden scale, nurse information form, the care bundle follow-up form and nursing workload follow-up form) were administered. The main outcomes of the study; Pressure ulcer incidence rate was evaluated with Form V, and nursing workload costs were evaluated with Form VI. These forms were evaluated daily by the nurses. In the first period (15.09.2018–30.11.2018), pressure ulcer incidence rates and nursing workload costs were evaluated before training. Then, the researcher trained nurses on how to prevent pressure ulcers and use the care bundle. The care bundles components were risk assessment, skincare, activity, in-service training, nutrition, wetness/incontinence and support surface management, and keeping records. In the second period (01.12.2018–15.02.2019), pressure ulcer incidence rates and nursing workload costs were evaluated after the training. The outcomes of the two periods regarding the incidence of pressure ulcers and nursing workload costs were compared. ResultsThe pressure ulcer incidence rates before and after the care bundle were 22.1 and 13.0 per 100 patient-day, respectively. There was a decrease in pressure ulcer incidence rates after the care bundle, but it wasn't significant (p = 0.138). The total workload cost of pressure ulcer prevention was significantly lower after the care bundle than before (p = 0.001). ConclusionThe pressure ulcer incidence rates were lower after the care bundle than before, albeit insignificantly. The total pressure ulcer prevention workload costs were significantly lower after the care bundle than before. The reduction in pressure ulcer incidence and workload cost indicates that the use of care bundle is effective. Healthcare professionals in intensive care units should use a pressure ulcer prevention care bundle more often.

Using Air Cushion in the Prevention of Occipital Pressure Ulcer in Children Undergoing Heart Surgery

Background &amp; Aims: Congenital heart disease is one of the main causes of death in their first year of life. One of the most significant complications of surgery in these patients is pressure ulcers. The aim of this study was to determine the effect of using air cushion in the prevention of occipital pressure ulcer in children undergoing heart surgery. Materials &amp; Methods: The present study was a randomized clinical trial and 135 children undergoing open heart surgery aged 0 to 12 years referred to two cardiac centers in Tabriz and Tehran. They were randomly assigned to the intervention and control groups by continuous sampling during one year (September 2016- September 2017). The group of intervention used air cushions that has an air inlet and outlet pump and is filled and emptied by a pump alternately and creates 3 to 4 cm waves. This air cushion with dimensions of 30 to 40 cm waterproof and anti-allergy air cushion covered with a cotton cover. Data collection tools included: National Pressure Ulcer Advisor Panel and Braden Q. Chi-square, Fisher's exact test, independent t-test, Mann-Whitney and analysis of covariance were used to achieve the goals. Results: The incidence of occipital pressure ulcer in the control group after surgery was 38.7%, the first day after surgery was 71% and the second day after surgery was 67.7%. However, in the intervention group no occipital pressure ulcer was observed in all periods after surgery. There was no significant difference in the scores of pressure ulcers in the preoperative times between the intervention and control groups (P&lt;0.05), but after operation and the second day of surgery, the scores of pressure ulcers in the intervention group were significantly higher than the control group (P=0.002). This means that the pressure ulcer scores in the intervention group were better than the control group. Conclusion: The use of air cushion appropriate to the size and weight of children is a suitable equipment to prevent occipital pressure ulcer in children undergoing open heart surgery.

Conservative Therapy of Pressure Ulcers Using Physical Methods (Review)

In Russia and European countries, the incidence of pressure (decubitus) ulcers in sedentary patients with severe comorbidities, spinal trauma, and cerebral accident sequelae varies from 3 to 40 %, reaching 80 % in the chronic critical illness. The final result of conservative treatment of pressure ulcers (PU) with adequate correction of comorbidities and proper care of the immobilized patient depends largely on the choice of local interventions. Aim of the review: to demonstrate the range of effective methods of physical treatment of pressure ulcers suitable for conservative treatment. Materials and methods. We selected and analyzed 80 scientific publications. Sources were selected from the PubMed, Scopus, and RSCI databases of medical and biological publications. The following methods were covered: negative pressure wound therapy, ultrasonic methods, hydrosurgical treatment, plasma flows, laser therapy (including low-level laser therapy), «hardware» acceleration of regenerative processes, including electrical stimulation, as well as a combination of these methods. Results. The variety of physical methods of wound treatment, on the one hand, provides an opportunity to select an individual therapy program. On the other hand, each method has its own limitations and contraindications. That is why in practice various combinations of these methods are reasonable. Conclusion. For several objective reasons, no reduction of PU incidence in clinical practice is expected. Therefore, studying the issues of evidence-based clinical effectiveness and economic feasibility of various conservative techniques of decubitus treatment to find best solutions in this area is warranted.

Differences in the Incidence of Adverse Events in Acute Care Hospitals: Results of a Multicentre Study.

Background: Adverse events are indicators of patient safety and quality of care. Adverse events clearly have negative impacts on healthcare system costs. Organizational and unit characteristics are not very often studied in relation to adverse events. The aim of the study was to find the differences in the incidence of adverse events and healthcare-associated infections in hospitalized patients in Czech acute care hospitals according to type of hospital and type of unit. Methods: This cross-sectional multicentre study was conducted in 105 acute care medical and surgical units located in 14 acute care hospitals throughout the Czech Republic. The data on adverse events and healthcare-associated infections were reported monthly by nurse researchers. The data were collected from June 2020 to October 2020. Results: The incidence of healthcare-associated infections, pressure ulcers, and medication errors was significantly lower in large hospitals. Statistically significant differences have been further found between the incidence of pressure ulcers (<0.001), falls without injury (<0.001), and falls with injury (<0.001) in surgical and medical units. More pressure ulcers, falls without injury, and falls with injury have been reported in surgical units. Conclusion: The type of hospital and type of unit affected the incidence of adverse events at acute care hospitals. To reduce adverse events, a systematic adverse event measurement and reporting system should be promoted.

Pressure Ulcers in Admitted Patients at a Tertiary Care Hospital.

BackgroundPressure ulcers (PUs) occur when the skin covering a weight-bearing part of the body is compressed for a long time between bone, any other part of the body, bed, chair, or any other hard surface. This study aimed to determine the prevalence of pressure ulcers at a tertiary care hospital in all specialty departments including COVID-19.MethodsA retrospective study was conducted at North West General Hospital and Research Center, Peshawar, Pakistan. After obtaining ethical approval, data were obtained from the hospital database from July 2020 to June 2021. The keywords “bed sore,” “pressure sore,” and “pressure ulcer” were used to search for relevant cases, and patient demographics, including age and gender, site of pressure ulcer, stage of pressure ulcer, whether the pressure ulcer was single or multiple, length of stay at the hospital, and specialty department, were collected.ResultsIn total, 99 patients met the inclusion criteria, of which 65 (65.7%) were males, while 34 (34.3%) were females. The age of the patients ranged from 15 to 92 years, with a mean age of 59.93 years. Of the patients, 87 (87.9%) had acquired only a single pressure ulcer. Stage 2 pressure ulcers were the most documented, making up 43.1% of the total cases reported, while stage 4 cases were only 3.3%. The sites most frequently affected by pressure ulcers were the gluteal and sacral regions, accounting for 34.4% and 30.3%, respectively. The incidence of pressure ulcers was the highest in the COVID-19 ward, i.e., 25.3%, followed by the neurosurgery ward with a 20.2% incidence.ConclusionPressure ulcers occur frequently in almost all the specialty departments of a healthcare setting, especially in COVID-19 and neurosurgery wards, and impose significant physical, psychological, and financial burdens. The prevention of pressure ulcers is the best approach to avert patients and their families from all the burdens associated with pressure ulcers.

Effects of Silicone Mattress Combined with Hydrocolloid Dressing on Pressure Ulcers and Phlebitis in ICU Patients with Liver Failure.

Objective This study was aimed at clarifying the application effect of silicone mattress combined with hydrocolloid dressing in ICU patients with liver failure. Methods A total of 86 patients with liver failure admitted to the intensive care unit (ICU) of the Fifth Medical Center of Chinese PLA General Hospital from September 2018 to September 2020 were selected as the research subjects. Patients treated with conventional sponge mattress and routine nursing care were included in group A (n = 43), and those treated with silicone mattress combined with hydrocolloid dressing were included in group B (n = 43). The incidence of pressure ulcers and phlebitis, the scores of Visual Analogue Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI), and the nursing satisfaction were observed and compared between the two groups. Results The incidence of pressure ulcers in group B (6.98%) was lower than that in group A (25.58%). The incidence of phlebitis in group B was lower than that in group A (20.93% vs. 53.49%). The VAS score of group B was 2.16 ± 0.38, which was lower than that of group A (4.86 ± 1.09). The PSQI score of group B was lower than that of group A (9.74 ± 2.76 vs. 14.84 ± 3.95). A higher nursing satisfaction was determined in group B compared with group A (93.02% vs. 76.74%). Conclusions Silicone mattress combined with hydrocolloid dressing can reduce the incidence of pressure ulcers and phlebitis in ICU patients with liver failure, reduce complications, and improve nursing satisfaction, which is worthy of clinical promotion.

Pressure ulcers from prone positioning in COVID-19 patients: Developing clinical indicators in evidence-based practice: A retrospective study

Background: A notable pandemic arisen during the COVID-19 pandemic has developed globally in intensive care units, with patients developing pressure ulcers (PUs) after being ventilated mechanically in the prone position. Objectives: The aim was to identify risk factors independently predictive of the development of PUs in adult patient populations treated with prone positioning and to evaluate a possible epidemiological association between the prevalence of PUs and specific clinical characteristics so as to develop clinical indicators for the prevention of PUs. Finally, the aim was to examine our study participants against the incidence of PUs with respect to the length of their stay. Methods: : This retrospective study enrolled patients hospitalized during the period of May 2020 through January 2021. Data was collected from 299 patients hospitalized and having required prone positioning ventilatory therapy in critical care areas (short-stay units, emergency units, and intensive care units), all of which had developed Pus of at least grade two according to the classification system proposed by the NPUAP/EPUAP. Results: : Patients who had developed PUs had a longer hospitalization stay overall and were more prone to die during hospitalization. Patients who developed Pus were more frequently males, with higher initial levels of CPK and ferritin. Conclusions: The study reveals valuable information on the most important risk factors in the development of PUs due to prone positioning. We have described how the total number of days of hospitalization is significantly related to the development of PUs. Even a PU is not a life-threatening lesion, the implementation of improved positioning protocols may enhance results in critical patient care. We believe that this is a current, globally underestimated problem as the incidence of COVID-19 patients requiring prone positioning—and, therefore, at risk for PUs—is increasing daily.

What is the better choice for nurses? Alternating air pressure mattresses versus static air mattresses to prevent pressure ulcers in elderly hospitalized patients: A protocol for systematic review and meta-analysis.

Background:Evidence on the comparative effectiveness between commercially available support surfaces in preventing pressure ulcer development is lacking. The purpose of this study was to compare the efficacy and safety of alternating air pressure mattresses (AAPMs) versus static air mattresses to prevent pressure ulcers in elderly hospitalized patients and to provide evidence for clinical practice.Methods:The electronic databases of Cochrane Library, EMBASE, PubMed, and Web of Science will be searched in April 2022 using the following key terms: “pressure ulcers,” “support surface,” and “pressure mattresses,” for all relevant studies. Only English publications are included. The primary outcome is the incidence of pressure ulcers; secondary outcomes include patient satisfaction, cost, and other bedridden complications. The Cochrane risk of bias tool will be independently used to evaluate the risk of bias of included randomized cohort studies by 2 reviewers. A modified version of the Downs and Black tool is adopted to evaluate the quality of nonrandomized cohort studies. All outcomes are pooled on random-effect model.Results:We hypothesized that group with AAPMs will provide better therapeutic benefits compared with control group.Conclusions:It is worthy to critically review the evidence of the assessment of AAPMs and static air mattresses to inform clinical practice.OSF registration number:10.17605/OSF.IO/MYPZ2.

Pressure ulcers from prone positioning in COVID-19 patients: Developing clinical indicators in evidence-based practice: A retrospective study

Background: A notable pandemic arisen during the COVID-19 pandemic has developed globally in intensive care units, with patients developing pressure ulcers (PUs) after being ventilated mechanically in the prone position. Objectives: The aim was to identify risk factors independently predictive of the development of PUs in adult patient populations treated with prone positioning and to evaluate a possible epidemiological association between the prevalence of PUs and specific clinical characteristics so as to develop clinical indicators for the prevention of PUs. Finally, the aim was to examine our study participants against the incidence of PUs with respect to the length of their stay. Methods: : This retrospective study enrolled patients hospitalized during the period of May 2020 through January 2021. Data was collected from 299 patients hospitalized and having required prone positioning ventilatory therapy in critical care areas (short-stay units, emergency units, and intensive care units), all of which had developed Pus of at least grade two according to the classification system proposed by the NPUAP/EPUAP. Results: : Patients who had developed PUs had a longer hospitalization stay overall and were more prone to die during hospitalization. Patients who developed Pus were more frequently males, with higher initial levels of CPK and ferritin. Conclusions: The study reveals valuable information on the most important risk factors in the development of PUs due to prone positioning. We have described how the total number of days of hospitalization is significantly related to the development of PUs. Even a PU is not a life-threatening lesion, the implementation of improved positioning protocols may enhance results in critical patient care. We believe that this is a current, globally underestimated problem as the incidence of COVID-19 patients requiring prone positioning—and, therefore, at risk for PUs—is increasing daily.

3D hybrid scaffold with aligned nanofiber yarns embedded in injectable hydrogels for monitoring and repairing chronic wounds

Pressure ulcers (PU) as a major clinical concern are disproportionately affecting the older adult population and resulting in a lot of medical expenses. The issues of preventing the incidence of PU and treating chronic wounds are urgent to be solved at the present stage. Here, a 3D hybrid scaffold with conductive and antibacterial properties is designed to monitor and repair chronic wounds. The 3D hybrid scaffold is prepared by encapsulating nanofiber yarns (NFY) network into the injectable hydrogel which is cross-linked by Schiff base . The aligned NFY networks assembled by weaving nanofiber yarns consisting of polyacrylonitrile (PAN) and reduced graphene oxide (rGO) can induce cellular elongation and alignment on their 3D peripheral surface. The injectable hydrogels outside not only provide the protection for the cells on the surfaces of the NFYs, but also mimic a native extracellular matrix (ECM) to supply a much more suitable 3D microenvironment for the cells proliferation and arrangement. The addition of ions within the hydrogel endows the hydrogels with excellent conductivity , making the hydrogels the potential flexible strain sensor to exactly monitor the wound pressure. The 3D hybrid scaffold with aligned nanofiber yarns embedded in injectable hydrogels displays favorable biocompatibility, self-healing and antibacterial properties, showing promising medical applications especially in tissue engineering and wearable electronics .