Incidence Rate Of Pressure Ulcers Research Articles

Evaluation of the effectiveness of Gold STAMP intervention on pressure ulcer reductions

Introduction: This prospective cohort study is to evaluate the effectiveness of the Gold STAMP (Success Through Assessment, Management and Prevention) intervention on reducing pressure ulcer (PU) incidence rates among nursing home residents in New York State. Methods: Nursing home residents (n = 2,480) who did not have PU at baseline were followed to calculate PU incidence. Gold STAMP educational intervention included care assessment, care practice, communication, and collaboration. Covariates included socio-demographics, selected health conditions, and functional status. Kaplan Meier survival analyses were conducted after propensity score matching (PSM) to assess the impact of the Gold STAMP intervention on PU incidence rate reduction. Results: Prevalent conditions were urinary incontinence (83%), bowel incontinence (73%), and arthritis (37%). The Kaplan-Meier survival analyses indicated that the case group had a higher percentage of residents with no PUs after 6 months of follow-up compared to the control group (94% vs. 85%; p = .06). Conclusions: The 9% PU incidence rate reduction is both clinically and financially meaningful. We suggest a longer study period to monitor the long-term effects of the Gold STAMP intervention in reducing PU incidence.

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

Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: a prospective cohort study.

The purpose of this study was to identify pressure ulcer (PU) incidence and risk factors that are associated with PU development in patients in two adult intensive care units (ICU) in Saudi Arabia. A prospective cohort study design was used. A total of 84 participants were screened second daily basis until discharge or death, over a consecutive 30-day period, out of which 33 participants with new PUs were identified giving a cumulative hospital-acquired PU incidence of 39·3% (33/84 participants). The incidence of medical devices-related PUs was 8·3% (7/84). Age, length of stay in the ICU, history of cardiovascular disease and kidney disease, infrequent repositioning, time of operation, emergency admission, mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU. According to binary logistic regression analyses, age, longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs, while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II-IV PUs. In conclusion, PU incidence rate was higher than that reported in other international studies. This indicates that urgent attention is required for PU prevention strategies in this setting.

Application of modified n-shaped sticker to prevent the pressure ulcer caused by scalp venous indwelling needle handle

Objective To explore methods to reduce the incidence of pressure ulcer caused by pediatric scalp venous indwelling needle handle. Methods All the children patients treated with scalp intravenous indwelling needle handle in our Department of Pediatric Orthopedics during January to December 2013, 200 children patients were randomly divided into two groups equally-control group and observation group by hospital bed number. In the control group, the needle handle was fixed by tension free sticker with the pinprickin the center.A modified n-shaped sticker was applied to fix the first quarter of the needle handletaking the pinprickin the centerand the three quarters of needle handle were exposed in the n-shaped space, and then a cross fixation was administered with ventilated adhesive plaster after pasting a sticking membrane in the observation group. The incidence rate of pressure ulcer compared between two groups. Results In the observation group, 4 children patients suffered first phase pressure ulcerand 6 suffered second phase pressure ulcer compared with 12 and 17 children patients undergoing first and second pressure ulcer. The incidence of pressure ulcer in the observation group was significantly less than that of the control group, and significant difference was found (χ2=11.499, P<0.01). Conclusions The modified n-shaped sticker is effective to reduce the incidence of pressure ulcer caused by needle handle and worth of clinical application. Key words: Pressure ulcer; Scalp intravenous indwelling needle; Fixation; N-shaped sticker

Analysis on the risk factors of acute pressure ulcer in liver transplantation patients

Objective To analyze the risk factors of acute pressure ulcer in liver transplantation patients after operation to look for the nursing method.Methods Ninety-five liver transplantation patients from January 2005 to September 2013 were chosen,and their basic information were collected,and the indicator associated with the occurrence of pressure ulcer before,during and after the operation were recorded and the risk factors were analyzed,and the effect of medical factors on the incidence of pressure ulcer in patients with liver transplantation were evaluated.Results Thirty patients had the pressure ulcers within three days after operation,and the fourteen cases(46.67％) occurred on the day of operation,and nine (30.00％),five (16.67％),two (6.66％) respectively occurred on the first,second and third day of operation.The cases of pressure ulcers occurred in the sacral and heel area were respectively nineteen (63.33％) and nine cases (30.00％).The differences were found in the incidence rate of pressure ulcers in patients with different the score of Braden,the level of serum total protein,the operative time,the blood loss,the first time to get out of bed and compliance behavior (x2/Z =6.338,7.787,4.005,12.960,4.163,6.257,respectively; P ＜ 0.05).The maximum cases of pressure ulcers caused by the lack of cognition were twelve cases (40.00％),followed by seven cases (23.33％) which caused by the less frequency evaluation.Conclusions The occurrence of acute pressure ulcer is closely related to the score of Braden,the level of serum total protein,the operative time,the blood loss,the first time to get out of bed and compliance behavior,and nursing measures should be taken according to the risk factors to reduce the incidence of pressure ulcer after operation. Key words: Liver transplantation; Risk factor; Pressure ulcer

Evaluation of AHRQ’s On-Time Pressure Ulcer Prevention Program

Pressure ulcers present serious health and economic consequences for nursing home residents. The Agency for Healthcare Research & Quality, in partnership with the New York State Department of Health, implemented the pressure ulcer module of On-Time Quality Improvement for Long Term Care (On-Time), a clinical decision support intervention to reduce pressure ulcer incidence rates. To evaluate the effectiveness of the On-Time program in reducing the rate of in-house-acquired pressure ulcers among nursing home residents. We employed an interrupted time-series design to identify impacts of 4 core On-Time program components on resident pressure ulcer incidence in 12 New York State nursing homes implementing the intervention (n=3463 residents). The sample was purposively selected to include nursing homes with high baseline prevalence and incidence of pressure ulcers and high motivation to reduce pressure ulcers. Differential timing and sequencing of 4 core On-Time components across intervention nursing homes and units enabled estimation of separate impacts for each component. Inclusion of a nonequivalent comparison group of 13 nursing homes not implementing On-Time (n=2698 residents) accounts for potential mean-reversion bias. Impacts were estimated via a random-effects Poisson model including resident-level and facility-level covariates. We find a large and statistically significant reduction in pressure ulcer incidence associated with the joint implementation of 4 core On-Time components (incidence rate ratio=0.409; P=0.035). Impacts vary with implementation of specific component combinations. On-Time implementation is associated with sizable reductions in pressure ulcer incidence.

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

A comparison of the efficacy of different wound dressing management techniques in preventing pressure ulcers

Although high-technology wound dressings are widely used in clinical care worldwide, no evidence or discussions have been published regarding the efficacy of these dressings in preventing pressure ulcers. This study presents a repositioning of routine management combined with hydrocolloid dressing or foam dressing for pressure ulcer prevention. We used a quasi-experimental design and recruited a convenience sample of 90 from a surgical intensive care unit (SICU) at a medical center in Hualien County, Taiwan. Participants were allocated randomly to one of three groups: repositioning of routine management, hydrocolloid dressing, and foam dressing. Study instruments included a pressure ulcer risk table (Braden scale) and the pressure ulcer classification system of the European Pressure Ulcer Advisory Panel. An independent sample t-test, ANOVA, and Mann-Whitney U test were used to verify research hypotheses. The repositioning of routine management group had the highest pressure ulcer incidence rate, followed by the hydrocolloid-dressing group. The foam-dressing group recorded no pressure ulcers. Pressure ulcer occurrence grades were primarily level 1 and 2. There was no significance difference in pressure ulcer occurrence time between the repositioning of routine-management group and the hydrocolloid-dressing group. Finally, there were significant differences (p < .05) among gender, hypertension history, and BMI regardless of pressure ulcer incidences. It is recommended that patients in high-risk groups in clinical settings adopt strategies including repositioning and regular visual skin examinations. Also, hydrocolloid or foam dressings may be used as appropriate to prevent sacral pressure ulcers.

요양병원 입원 환자의 욕창 발생 현황과 관련 요인: 2009년 건강보험 환자표본 자료 이용

본 연구는 2009년 한 해 동안 건강보험심사평가원의 요양급여 전체 청구자료를 통계적으로 표본 추출 한 환자표본자료를 이용하여 의료기관 종류 별 욕창 발생현황과 이중 요양병원 환자의 욕창 발생에 영향을 주는 요인을 규명하기 위해 시도되었다. 전체 의료기관 입원환자의 3.2%(n=25,339)에서 욕창이 발생하였다. 의료기관 종별로는 요양병원 입원환자의 8.2%(n=11,895)에서 욕창이 발생하여 종합병원(2.7%, n=8,052), 일반병원(1.7%, n=5,059) 보다 상대적으로 높은 비율을 보였다. 요양병원 입원환자(n=144,523)의 욕창발생에 영향을 주는 요인을 분석한 결과 의학적 진단 중 요실금을 가진 환자 군이 가지지 않은 군에 비해 욕창 발생이 2.46배 유의하게 높게 나타났다(Odds ratio(OR)=2.462, 95% confidence interval(CI)=2.038-2.974). 더하여, 고혈압질환(OR=1.456, CI=1.400-1.515), 말초혈관 질환(OR=1.357, CI=1.200-1.534)군 순으로 욕창 발생에 영향을 미쳤다. 진단 수(OR=1.193, CI=1.187-1.199)와 나이(OR=1.011, CI=1.009-1.012) 및 100침상 당 의사 수(OR=1.063, CI=1.035-1.091)가 증가할수록, 의료기관의 전체 침상수(OR=.889, CI =.869-.909)가 적을수록 욕창발생은 유의하게 높은 것으로 나타났다. The purpose of this study was to examine the incidence rates of pressure ulcers depending on the types of healthcare organizations and to determine whether the characteristics of patients and facilities influence on the incidence of pressure ulcers in long term facilities. We analyzed data on 796,857 patients of the 2009 National Patient Sample which was extracted from to claims for medical fees to Health Insurance Review & Assesment Service(HIRA). A total of 3.2% of patients(n=25,339) had at least 1 pressure ulcer during their hospitalization. The pressure ulcer rates were highest in long term care facilities(8.2%, n=11,895) following general hospital(2.7%, n=8,052), hospital(1.7%, n= 5,059). According to logistic regression analysis, urinary incontinence (Odds ratio(OR)=2.462, 95% confidence interval(CI)=2.038-2.974), hypertension(OR=1.456, CI=1.400-1.515), peripheral vessel diseases (OR=1.357, CI=1.200-1.534) were significant predictors of pressure ulcers. As the number of diagnoses, age, and the number of doctors per 100 beds increased, the incidence of pressure ulcers increased. In addition, more number of beds was associated with fewer pressure ulcers.

Initial Assessment Effect on Pressure Ulcer Among Adult Patient with Cancer: An Evidence-Based Review

Introduction: Effective prevention of pressure ulcers (PUs) is a major concern in nursing practice worldwide. PU prevention consists of two interrelated steps: (1) risk assessment and (2) applying preventive interventions and measures based on the assumed PU risk level.Purpose: We conducted a review of research into interventions designed to identify effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice.Method: Search different internet data bases including: using “pubmed,” “science direct,” “highwire” and “scientific Google” database.Sample: 80 articles were found; the review utilized 12 articles which met the inclusion criteria. The incidence and prevalence rates of pressure ulcers are different from one hospital to another and from one country to another Studies included in this review focused on the Use of Pressure ulcer in term of assessment and prevention among adult patient in cancer. Result: Future studies should deal with different kinds of PU in order to be able to provide solid data for nursing practice within the vulnerable group of oncology patients. Furthermore, uniform interventions, assessment instruments, and designs should be used for collecting the results to enable comparability.Conclusion: There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate.Recommendations: Complete an initial assessment of the individual with a pressure ulcer, to include the individual's and family's goals of care, Risk for developing additional pressure ulcers, Functional capacity, particularly in regard to positioning, posture and the need for assistive equipment and personnel and Pain related to pressure ulcers.

Do Patients in Dutch Nursing Homes Have More Pressure Ulcers Than Patients in German Nursing Homes? A Prospective Multicenter Cohort Study

To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents. A prospective multicenter cohort study. Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg). A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer. Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants. A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home. The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular internal quality controls.

Effect of humanistic nursing on prevention compliance of patients with high risk of pressure ulcer

Objective To discuss the effect of patient-demand-oriented humanistic nursing on prevention compliance of patients with high risk of pressure ulcer.Methods Totals of 773 cases of patients with high risk of pressure ulcer were randomly divided into two groups.The control group,with 406 cases,received conventional nursing method,while the experiment group,with 367 cases,received patient-demand-oriented humanistic nursing in addition.Prevention compliance,patients' satisfaction and incidence rate of pressure ulcer were compared between two groups.Results Prevention compliance rate was 85.6％ in the experiment group and 55.9％ in the control group,and the difference was statistically significant (x2 =84.71,P ＜ 0.01).Patients' satisfaction rate was 95.6％ in the experiment group and 81.5％ in the control group,and the difference was statistically significant (x2 =36.97,P ＜ 0.01).Incidence rate of pressure ulcer was 0.8％ in the experiment group and 3.0％ in the control group,and the difference was statistically significant (x2 =4.63,P ＜ 0.05).Conclusions Patient-demand-oriented humanistic nursing plays an important role to improve the prevention compliance of patients with high risk of pressure ulcer. Key words: Humanistic nursing; Pressure ulcer; High risk group; Prevention; Compliance

Reusability of EMR Data for Applying Cubbin and Jackson Pressure Ulcer Risk Assessment Scale in Critical Care Patients

ObjectivesThe purposes of this study were to examine the predictive validity of the Cubbin and Jackson pressure ulcer risk assessment scale for the development of pressure ulcers in intensive care unit (ICU) patients retrospectively and to evaluate the reusability of Electronic Medical Records (EMR) data.MethodsA retrospective design was used to examine 829 cases admitted to four ICUs in a tertiary care hospital from May 2010 to April 2011. Patients who were without pressure ulcers at admission to ICU, 18 years or older, and had stayed in ICU for 24 hours or longer were included. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) were calculated.ResultsThe reported incidence rate of pressure ulcers among the study subjects was 14.2%. At the cut-off score of 24 of the Cubbin and Jackson scale, the sensitivity, specificity, positive predictive value, negative predictive value, and AUC were 72.0%, 68.8%, 27.7%, 93.7%, and 0.76, respectively. Eight items out 10 of the Cubbin and Jackson scale were readily available in the EMR data.ConclusionsThe Cubbin and Jackson scale performed slightly better than the Braden scale to predict pressure ulcer development. Eight items of the Cubbin and Jackson scale except mobility and hygiene can be extracted from the EMR, which initially demonstrated the reusability of EMR data for pressure ulcer risk assessment. If the Cubbin and Jackson scale is a part of the EMR assessment form, it would help nurses perform tasks to effectively prevent pressure ulcers with an EMR alert for high-risk patients.

Prevalence and incidence rates of pressure ulcers in an Emergency Department

Older patients represent an increasing population in emergency department (ED) with underlying diseases and longer ED length of stay, which are potential risk factors of pressure ulcers (PUs). The aim of the study was to determine the prevalence and incidence rates of PUs in an Emergency Department and to analyse variables related to PUs occurrence. The study was carried out in the Emergency Department of Bordeaux (France), and included 602 patients from 1 to 15 June 2010. All the potential body sites of pressure were examined at admission and discharge for all the patients by trained nurses. Comorbidity score, list of treatment, length of stay (hours), PUs (including stage I) and C-reactive protein (CRP) level were systematically recorded. A total of 47 (7·8%) patients had prevalent PUs at admission and 74 (12·3%) at discharge. The cumulative incidence was 4·9% and the incidence density was 5·4 per 1000 patients per hour. In multivariate analysis, higher comorbidities (OR 1·3; P = 0·014) and CRP levels (OR 1·005; P = 0·017) were both independent risk factors for developing PU. In conclusion, these data show that even a very short stay to the ED is sufficient to induce PUs especially stage I.

A pressure ulcer prevention programme specially designed for nursing homes: does it work?

The aim of this study was to evaluate a pressure ulcer prevention programme for nursing homes to ascertain the feasibility of its implementation, impact on care staff and outcomes for pressure ulcer knowledge and skills and pressure ulcer reduction. No pressure ulcer prevention protocol for long-term care settings has been established to date. The first author of this study thus developed a pressure ulcer prevention programme for nursing homes. A quasi-experimental pretest and post-test design was adopted. Forty-one non-licensed care providers and eleven nurses from a government-subsidised nursing home voluntarily participated in the study. Knowledge and skills of the non-licensed care providers were assessed before, immediately after and six weeks after the training course, and pressure ulcer prevalence and incidence were recorded before and during the protocol implementation. At the end of the programme implementation, focus group interviews with the subjects were conducted to explore their views on the programme. A statistically significant improvement in knowledge and skills scores amongst non-licensed care providers was noted. Pressure ulcer prevalence and incidence rates dropped from 9-2·5% and 2·5-0·8%, respectively, after programme implementation. The focus group findings indicated that the programme enhanced the motivation of non-licensed care providers to improve their performance of pressure ulcer prevention care and increased communication and cooperation amongst care staff, but use of the modified Braden scale was considered by nurses to increase their workload. A pressure ulcer prevention programme for nursing homes, which was feasible and acceptable, with positive impact and outcome in a nursing home was empirically developed. The study findings can be employed to modify the programme and its outcomes for an evaluation of effectiveness of the programme through a randomised controlled trial.

The Significance of Introducing Permanent Assignments for Nursing Assistants at a Long-Term Care Setting on the Incidence Rate of Facility-Acquired Pressure Ulcers Among Elderly Patients

Pressure ulcer prevalence remains a major health concern in long-term care facilities. The treatment of these pressure ulcers causes a financial drain on health care resources and adds potential costs for the family of the institutionalized elderly, according to the Agency for Healthcare Research and Quality. The prevention of pressure ulcer development continues to be an essential objective of caregivers for elderly people. This study demonstrated a correlation between the permanent assignment of nursing assistants and the prevention of pressure ulcers among the elderly in a nursing home.

Interface shear and pressure characteristics of wheelchair seat cushions

Pressure ulcer incidence rates have remained constant despite advances in support surface technology. Interface shear stress is recognized as a risk factor for pressure ulcer development and is the focus of many shear reduction technologies incorporated into wheelchair cushions; however, shear reduction has not been quantified in the literature. We evaluated 21 commercial wheelchair seat cushions using a new methodology developed to quantify interface shear stress, interface pressure, and horizontal stiffness. Interface shear stress increased significantly with applied horizontal indenter displacement, while no significant difference was found for interface pressure. Material of construction resulted in significant differences in interface shear stress, interface pressure, and horizontal stiffness. This study shows that the existing International Organization for Standardization (ISO) 16840-2 horizontal stiffness measure provides similar information to the new horizontal stiffness measure. The lack of a relationship between interface shear stress and the overall horizontal stiffness measure, however, suggests that a pressure and shear force sensor should be used with the ISO 16840-2 horizontal stiffness measure to fully quantify a cushion's ability to reduce interface shear stress at the patient's bony prominences.

Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients.

Frequent manual repositioning is an established part of pressure ulcer prevention, but there is little evidence for its effectiveness. This study examined the association between repositioning and pressure ulcer incidence among bed-bound elderly hip fracture patients, using data from a 2004-2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age ≥ 65 years, underwent hip fracture surgery, and were bed-bound at index study visits (during the first 5 days of hospitalization). Information about repositioning on the days of index visits was collected from patient charts; study nurses assessed presence of stage 2+ pressure ulcers 2 days later. The association between frequent manual repositioning and pressure ulcer incidence was estimated, adjusting for pressure ulcer risk factors using generalized estimating equations and weighted estimating equations. Patients were frequently repositioned (at least every 2 hours) on only 53% (187/354) of index visit days. New pressure ulcers developed at 12% of visits following frequent repositioning vs. 10% following less frequent repositioning; the incidence rate of pressure ulcers per person-day did not differ between the two groups (incidence rate ratio 1.1, 95% confidence interval 0.5-2.4). No association was found between frequent repositioning of bed-bound patients and lower pressure ulcer incidence, calling into question the allocation of resources for repositioning.

Qualitätssicherung in deutschen Krankenhäusern: „Einrichtungsübergreifende Qualitätssicherung“ im Vergleich zur „Qualitätsmessung aus Routinedaten“. Ein direkter Vergleich am Beispiel „Dekubitus“

Quality assurance is a backbone for the provision of health care. This has lead to the introduction of systems to evaluate and improve patient care. Currently, a 29-category monitoring is mandatory for all German hospitals (EQS, Einrichtungsübergreifende Qualitätssicherung). Since 2007, the incidence rate of pressure ulcers as an indicator for quality of care has been incorporated. A concern associated with the EQS is the requirement for active data entry by doctors and nurses, whereas the US-based patient safety indicator "PSI 3 - pressure ulcer" relies on routine clinical data without the need for additional documentation. In this study, we perform a head-to-head comparison of the 2 methods and analyze the feasibility of implementing the PSI 3 system in German hospitals on the example of pressure ulcer incidence in a German academic hospital. Our analysis shows that the usage of the PSI 3 is feasible. In particular, all clinical data are readily available. Critical advantages of the PSI 3 include the low time consumption and the positive economic impact due to increased work-flow. A prerequisite for the accuracy of the PSI 3 is the careful distinction and documentation of whether a condition (in our case: pressure ulcers) is pre-existing or hospital-acquired. In this regard, the accurate documentation of admission diagnoses is a potential weakness because these are not essential for reimbursement from health insurances and thus tend to be less well documented. In the US and Australia this problem has been addressed by introducing "present on admission" tabs into patient records. In conclusion, our study demonstrates that the usage of a quality assurance system based on routinely acquired clinical data in German hospitals is feasible, and encourages further evaluation.

Analysis of pressure ulcer wound fluid using two‐dimensional electrophoresis

The incidence rate of pressure ulcers in the USA ranges from 0.4% to 38% in acute care settings and from 2.2% to 23.9% in long-term care settings, and their treatment costs are in the billions of dollars yearly. The proteome of wound fluid may contain early indicators or biomarkers associated with healing in pressure ulcers that would enable treatment regimes to be optimised for each individual. Wound fluid was collected from the interior and periphery of 19 chronic pressure ulcers at 15 time points during 42 days for an analysis of protein expression. Proteins were fractionated using two-dimensional polyacrylamide gel electrophoresis. A comparison of the spot distributions indicates a biochemical difference between the interior and the periphery of wounds. Pressure ulcers that healed show a greater number of spots for interior and peripheral locations combined over time when compared with wounds that did not heal. Using this technique, protein S100A9 was identified as a potential biomarker of wound healing. The identification of differences within the proteome of healing versus non healing pressure ulcers could have great significance in the use of current treatments, as well as the development of new therapeutic interventions.