Incidence Rate Of Pressure Ulcers Research Articles

PRESSURE ULCERS INCIDENCE IN A PERIOPERATIVE NEUROSURGICAL SETTING

Background. Pressure ulcer is a major burden in surgical patients, increasing the length of hospital stay and the healing process, possibly leading to infectious complications and higher health care costs. In current literature there is no consensus on which element is mainly responsible for the onset of these lesions neither the role of surgery has been clarified. Methods. We collected a case series of consecutive admitted patients to Cattinara Hospital Neurosurgery Department in Trieste from March 2019 to June 2019. All the patients were assessed for surgery related pressure ulcer (SRPU) risk using the Pressure Score Risk Assessment Scale modified by Scotts. Epidemiologic data of all patients were recorded and the incidence of surgical related pressure ulcer calculated. The sample consisted of 124 patients with an average hospitalization length of 12.45 days; 71.8% of the enrolled patients were elective surgery patients, 5.5% emergency surgery and 22.6% urgency surgery. Comorbidity data were collected for each patient and surgical related time procedures noted. Results. The calculated incidence rate of surgery related pressure ulcer in a single center perioperative neurosurgical setting was 4.8%; the average surgery duration time was 213 minutes (mean ± 81 standard deviation, SD) whilst four out of six of these patients were admitted to intensive care unit due to unstable clinical conditions (average ICU stay time: 2.83 days; mean ± 4.99 standard deviation, SD). Time to SRPU onset was 6.83 days (mean ± 3.66 standard deviation, SD). The main site of SRPU onset was sacrum (66% of patients with developed SRPU). Discussion. This study evaluates single-center incidence of SRPU in neurosurgical perioperative setting with specifically SRPU management trained healthcare providers; deeper and systematic understanding of SRPU epidemiology in other local hospital wards and multi-centered comparison are needed.

Predictors of patient safety activities among registered nurses and nurse aides in long-term care facilities: cross-sectional study

BackgroundIn Korea, nurse aides (NAs) are legally permitted as substitutes for registered nurses (RNs) in long-term care (LTC) facilities, even though they have very different levels of education and qualification standards. Many studies in hospitals have shown better hospital nurse staffing, more educated nurses, and improved nurse work environments have been associated with lower hospital mortality and length of stay. There is research showing that a higher percentage of RNs with a bachelor’s degree corresponded to lower incidence rates of pressure ulcers in Korean LTC facilities. This study aimed to explore the factors that influence patient safety activities of the RNs and NAs working in LTC facilities and to identify the relationship between patient safety culture (PSC) and patient safety activities.MethodsThis study is a descriptive cross-sectional survey. The study participants were conveniently collected from 88 RNs and 71 NAs who worked at 33 LTC facilities for more than three months. The patient safety activities tool was developed by the researchers for residents of LTC facilities based on the tools developed by Park et al. (2012) for hospital nurses and the patient safety goals of the Joint Commission. The questionnaires were collected by email or mobile application and kept confidential. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression analysis.ResultsThe mean scores of PSC and patient safety activities were 4.03 ± 0.51 points and 4.29 ± 0.49 points out of 5, respectively. There was significant correlation between PSC and patient safety activities (r = .23, p = .004). Factors influencing patient safety activities among RNs and NAs in LTC facilities were RNs (β = .377, p < .001), organizational system of PSC (β = .314, p < .010), and work shift type (fixed night shift, on-call, 24-h shift) (β = -.264, p = .004), which explained about 36.0% of total variance (F = 5.69, p < .001).ConclusionThe findings indicate that it is necessary to mandate RNs instead of NAs to enhance residents’ safety in LTC facilities. Additionally, the importance of an organizational safety system and effective working shift types to prevent residents’ safety accidents in LTC facilities is indicated.

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.

Effectiveness of the combination of workshops and flipped classroom model to improve tube fixation training for nursing students.

BACKGROUNDTube indwelling is a key procedure in modern medicine. Careful tube setup is necessary to prevent unplanned extubation. The training for tube fixation is time- and resource-consuming, and optimal modes of training are currently being sought. Previous studies have compared workshops and flipped classroom models separately using conventional teaching strategies, but no study has examined a combination of both teaching models in nursing training.AIMTo compare the effectiveness of workshops vs workshops combined with the flipped classroom model for improving tube fixation training for nursing students.METHODSThis was a prospective cohort study. In this study, 149 nurses who joined our hospital in 2019 underwent training using workshops combined with the flipped classroom model (experimental group), while 159 nurses who joined the hospital in 2018 received only workshop-based training (control group). The combination of workshops with the flipped classroom training model was divided into two modules: pre-class and in-class training. The participation of nurses in the training activities, on-site assessment of training, nurses’ evaluation of their training, and related indicators of tube quality management were evaluated.RESULTSThe average age of nurses in the control group was 22.94 ± 0.94 years and that of nurses in the experimental group was 25.42 ± 3.23 years (P < 0.01). The qualified rate of after-class assessments for the experimental and control groups was 100.00% (average score: 94.01 ± 2.78 points) and 91.82% (average score: 84.24 ± 2.94 points), respectively (P < 0.01). Most nurses in the experimental group completely agreed that the combined training was helpful to cultivate clinical thinking and independent learning ability and to master knowledge of tube fixation. In addition, the training content within the pre-class teaching video, pre-class tube atlas, pre-class main instructor guidance, in-class demonstration, and in-class practice was very informative. The experimental group had higher evaluation scores than the control group (4.88 ± 0.38 vs 4.67 ± 0.64; P < 0.01). Comparison of tube quality management before and after training in 2018 to 2019 revealed that the unplanned ureteral tube removal rate dropped from 0.25‰ to 0.06‰, the unplanned chest tube removal rate dropped from 1.07‰ to 0.78‰, and the unplanned gastric tube removal rate dropped from 0.36‰ to 0.17‰. The incidence rate of pressure ulcers caused by the tube decreased from 0.78‰ to 0.45‰.CONCLUSIONThe combination of workshop and flipped classroom training is effective in improving tube fixation training of nurses, cultivating nurses’ active learning abilities and clinical thinking, and improving the safety of the procedure.

Evaluation of Patients’ Adverse Events During Contact Isolation for Vancomycin-Resistant Enterococci Using a Matched Cohort Study With Propensity Score

Although contact isolation has been widely recommended for multidrug-resistant organisms, contact isolation has raised some concerns that it may bring unintended patient harms. To compare adverse events between a contact isolation group with vancomycin-resistant Enterococcus (VRE) and a matched comparison group using a relatively large data set from full electronic medical records (EMR) and propensity score-matching methods. This retrospective, matched cohort study was conducted at Seoul National University Bundang Hospital (SNUBH) in Korea, a tertiary, university-affiliated hospital that has 1337 inpatient beds. Participants included a total of 98 529 hospitalized adult patients (aged ≥18 years) during 2015 to 2017. Contact isolation in a single or shared double room. As adverse contact isolation-related outcomes, falls and pressure ulcers were included. All relevant EMR data were extracted from the SNUBH clinical data warehouse. Risk factors for adverse events were included in the propensity score model based on literature reviews, such as Braden scale score and Hendrich II fall risk score. A fine stratification and weighting (FSW) and a 1:10 nearest neighbor (NN) propensity score matching as a sensitivity analysis were adopted to compare adverse events between the 2 groups for the observation period from the study entry date and the exit date. Time-to-event analyses with a Cox proportional hazard model were conducted in December 2021. For comparison of outcomes in wards, 177 patients (mean [SD] age, 67.38 [14.12] years; 98 [55.4%] female) with VRE and 93 022 patients (mean [SD] age, 56.44 [16.88] years; 49 462 [53.2%] female) without VRE were included and no difference was found in basic characteristics from the FSW (VRE contact isolation [n = 172] vs comparison [n = 69 434]) as well as from the 1:10 NN (VRE contact isolation [n = 168] vs comparison [n = 1650]). Among 177 patients with VRE contact isolation, 8 pressure ulcers and 3 falls occurred during their hospital stays; incidence rates of adverse events were 2.5 and 0.9 per 1000 patient-days, respectively (pressure ulcer incidence rate from the FSW: 2.53 per 1000 patient-days [95% CI, 1.09-4.99 per 1000 patient-days]; pressure ulcer incidence rate from the 1:10 NN: 2.54 per 1000 patient-days [95% CI, 1.10-5.01 per 1000 patient-days]; fall incidence rate from the FSW: 0.87 per 1000 patient-days [95% CI, 0.18-2.54 per 1000 patient-days]; fall incidence rate from the 1:10 NN: 0.87 per 1000 patient-days [95% CI, 0.18-2.55 per 1000 patient-days]). The hazard ratios for adverse events showed no statistically significant differences for both groups: 1.42 (95% CI, 0.67-2.99) for pressure ulcer and 0.66 (95% CI, 0.20-2.13) for fall from the FSW. In this cohort study, no association was found between the likelihood of adverse events and contact isolation using propensity score-matching methods and closely related covariates for adverse events.

Effects of registered nurse staffing levels, work environment, and education levels on adverse events in nursing homes

This study examined the effects of nurse staffing levels, work environment, and education levels on adverse events in nursing homes. A cross-sectional study was conducted involving 216 nurses working in 62 nursing homes in South Korea, using self-reported questionnaires and data from the National Health Insurance Service of South Korea. A logistic regression model was used to investigate the effects of nurse staffing levels, work environment, and nursing education levels on the adverse events experienced by residents. An increase of one resident per nurse was significantly associated with a higher incidence of medication error, pressure ulcers and urinary tract infections. A poor work environment increased the incidence of adverse events. Compared to nurses with a bachelor’s degree or higher, those with diplomas reported increased incidence rates of pressure ulcers. Improving the health outcomes of residents in nursing homes requires efforts that strengthen the nursing workforce in terms of numbers and educational level, and which improve their work environment at institutional and policy levels.

Impact of structured educational interventions on the prevention of pressure ulcers in immobile orthopedic patients in India: A pragmatic randomized controlled trial.

Background:Pressure ulcer (PU) is one of the common, neglected and avoidable complications among bedridden patients. Despite the potential to reduce PU incidence, the evidence on the effect of patient/caregiver education is low. This pragmatic randomized controlled trial (CTRI/2011/07/001862) compared the impact of two structured educational interventions to patients and caregivers on prevention of PU in immobile orthopaedic patients.Methodology:Ninety-two orthopedically immobile patients (Braden score ≤12 or stage I PU) and their caregivers were (block) randomized into two equal groups. One group was offered Prevention Package 1 (PP1), i.e., self-instruction manual (SIM), one to one training and counselling on PU care practices. The second group (PP2) was given SIM only. Patients were followed equally at the hospital and home after discharge. Intention to treat analysis was conducted.Results:The cumulative incidence of PU was 8.7% in PP1 and 21.7% in PP2 for the entire study period. PU incidence rate in PP1 and PP2 was 0.9 and 2.41 per 1000 person-days, respectively. Incidence rate ratio was 2.67 (95% CI: 0.89, 8.02, p-0.04). The Kaplan-Meier survival curves of PP1 and PP2 were statistically significantly different (p-0.043). PP1 also showed statistically significant improvement in knowledge on the prevention and management of PU compared to PP2 at post-intervention (p < 0.001).Conclusion:Individualized, structured education of patients and caregiver is effective in improving the knowledge and preventing the PU in immobile orthopaedic patients. A comprehensive approach involving hospital administrators, health care professionals, patients and caregivers may be further researched upon for a sustainable reduction in PU.

Effects of Nurse Staffing, Work Environment, Education on Adverse Events in Nursing Homes

This study examined the effect of registered nurse (RN) staffing level, work environment, and education on adverse events experienced by residents in nursing homes. A cross-sectional study was conducted with 216 RNs working in nursing homes who were selected using random stratified sampling by location and bed size. Self-reported questionnaires regarding staffing level, work environment, education level, adverse events, and nurse characteristics were administered. Data from the National Health Insurance Service were used to describe nursing home characteristics. Both multiple and multinomial logistic regressions were used to control for the characteristics of nurses and nursing homes, and investigate the effects of nursing staffing level (number of older adults assigned to a nurse), work environment (Practice Environment Scale of the Nursing Working Index), and level of nursing education on the adverse events experienced by residents. An increase of one resident per RN was significantly associated with a higher incidence of pressure ulcers (OR= 1.019, 95% CI=1.004-1.035). Poor work environment increased the incidence of adverse events such as pressure ulcers (OR= 3.732, 95% CI=1.155-12.056) and sepsis (OR=3.871, 95%CI=1.086-13.800). Compared to RNs with a baccalaureate or higher, RNs with diplomas reported increased incidence rates of pressure ulcers (OR=2.772, 95%CI= 1.173-6.549). RN staffing, work environment, and education level affect the incidence of pressure ulcers, and the work environment affects the incidence of sepsis among residents in nursing homes. Policy-wise, improving the level of nurse staffing, nursing work environment, and nursing education will improve health outcomes of residents.

The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis.

Pressure ulcer is a health problem worldwide that is common among inpatients and elderly people with physical-motor limitations. To deliver nursing care and prevent the development of pressure ulcers, it is essential to identify the factors that affect it. This global systematic review and meta-analysis was conducted with the aim of evaluating the incidence of pressure ulcers in observational studies. In this study, databases including Web of Science, Embase, PubMed, Scopus, and Google Scholar were searched to collect data. Articles published from 1997 to 2017 about the factors influencing the incidence of pressure ulcers were retrieved and their results were analyzed using meta-analysis according to the Random-Effects Model. The heterogeneity of studies was investigated using the I2 statistic. Data were analyzed using the R and Stata software (version 14). In this study, 35 studies were included in the final analysis. The results showed that the pooled estimate of the incidence rate of pressure ulcer was 12% (95% CI: 10–14). The incidence rates of the pressure ulcers of the first, second, third, and fourth stages were 45% (95% CI: 34–56), 45% (95% CI: 34–56), 4% (95% CI: 3–5), and 4% (95% CI: 2–6), respectively. The highest incidence of pressure ulcers was observed among inpatients in orthopedic surgery ward (18.5%) (95% CI: 11.5–25). According to the final results, better conditions should be provided to decrease the incidence of pressure ulcers in different wards, especially orthopedics, and in patients with diabetes.

Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study.

Pressure ulcers can be painful and negatively affect health‐related quality of life and healthcare costs. Many people living in nursing homes are at risk of developing a pressure ulcer. Nursing home staff, tissue viability nurses and researchers have co‐designed the first theory and evidence‐informed care bundle specifically for nursing homes, which consists of three prevention practices (skin inspection, support surfaces, repositioning) and a range of behaviour change techniques to promote these practices. We conducted a mixed methods feasibility study of the use of this care bundle in one nursing home in the North of England using an uncontrolled, before‐and‐after study design. We collected quantitative data on pressure ulcer prevention behaviours of the nursing home staff and pressure ulcer incidence rates for 5 weeks prior to implementing the bundle. Data collection continued for a further 9 weeks during the bundle implementation phase. We explored adherence to the bundle and participants' experiences of using it. The Conceptual Framework for Implementation Fidelity and the Theoretical Domains Framework informed the semi‐structured interviews. Quantitative and qualitative data were analysed using descriptive statistics and deductive framework analysis respectively. We collected data for 462 resident bed days prior to implementing the bundle; five new pressure ulcers were recorded and repositioning was the only documented pressure ulcer prevention behaviour. We collected data for 1,181 resident bed days during the intervention phase; no new pressure ulcers developed and the documented prevention behaviours included repositioning, skin inspection and checking support surfaces. Participants reported that the bundle enhanced the care they delivered and offered suggestions for future improvements. Our findings have highlighted a number of feasibility issues surrounding recruitment and retention, collecting data and implementation fidelity. A pressure ulcer prevention bundle specifically designed for nursing homes was acceptable. The feasibility work has highlighted the potential for the intervention and the areas that require development and refinement.

Effects of wound therapists' behavioral intervention on primary caregivers of high-risk populations with pressure ulcers in the community

Objective To explore the effects of wound therapists involved in health education for pressure ulcer prevention on the behavior of primary caregivers of high-risk populations with pressure ulcers in the community. Methods Totally 112 primary caregivers of high-risk populations with pressure ulcers from 2 communities near China-Japan Union Hospital of Jilin University were selected in September 2017 using convenient sampling, who received a 3-month health education for pressure ulcer prevention which involved wound therapists. Health Information Seeking Behavior (HISB) and Caregiver Behavior Scale (CBS) were used to evaluate the primary caregivers' initiative to learn health behaviors and their nursing behaviors for pressure ulcers at admission and 3 months post intervention. Results After 3 months, the subjects' score of HISB and CBS were higher than that before the intervention (P<0.01) . Conclusions Health education for pressure ulcer prevention which involves wound therapists helps to enhance the initiative to learn health behaviors in on the primary caregivers of high-risk populations with pressure ulcers in the community, improve their nursing behaviors for pressure ulcers, and reduce the incidence rate of pressure ulcers in high-risk populations in the community. Key words: Pressure ulcers; Caregivers; Wound therapists; Initiative to learn health behaviors; Nursing behaviors; Community nursing

Organisation of health services for preventing and treating pressure ulcers.

Organisation of health services for preventing and treating pressure ulcers.

Incidence and risk factors of pressure ulcers among general surgery patients

Context: Pressure ulcers are among the main postoperative complications which isassociated with an increased length of hospitalization. Determining risk factors of postsurgical pressureulcers is crucial for developing prevention and treatment strategies. Aims: This study aimed to investigate the incidence rate of pressure ulcer and related risk factors after general surgery. Settings and Design: This descriptive cross-sectional study was carried out in three hospitals in Mazandaran province in 2016. Materials and Methods: The sample size was 191 surgical patients undergoing general surgery by using census method. Data were collected in pre-, intra-, and post-operative period using demographic and clinical questionnaires and also, through the Braden Scale for Predicting Pressure Ulcer Risk. Statistical Analysis Used: Descriptive statistics, t-test, Chi-square, and univariateand multivariate logistic regression were used to analyze the data. Results: The incidence rate of postoperative pressure ulcers in patients was 17.8% (34 out of 191 patients). Based on the multivariate logistic regression model, significant correlations existed between the incidence of pressure ulcers and the following variables: age over 70 years old (P = 0.003), history of hypertension (P = 0.035), history of heart diseases (P = 0.029), Braden score Conclusions: Since it is critical to consider the incidence of postoperative pressure ulcers among patients, further measurements are required to identify high-risk people and use preventive protocols by nurses at pre-, intra-, and post-operative levels. Moreover, it requires extra attention in patients over 70 years, those with a history of hypertension and heart diseases, and those undergoing emergency surgery and spinal anesthesia.

Oncology Nurses’ Beliefs, Attitudes, Perceived Barriers towards Pressure Ulcer Prevention.

Introduction: Pressure ulcer incidence rate continuously increase alarming-both community and hospital acquired. Nurses’ response may have an important role in pressure ulcer prevention. This study aims to assess the oncology nurses’ attitude, knowledge and perceived barriers towards pressure ulcer prevention and identify the type of pressure ulcer training they had attended. Method: The respondents of this study are oncology nurses working in Comprehensive Cancer Center. A cross-sectional descriptive research survey and convenience sampling technique was used. This study involved 118 nurses from cancer center. Result: A positive attitude (mean=51.18%) was reported by oncology nurses concerning pressure ulcer prevention with a high frequency of agreement to the positive statements. The condition of the patient was the leading perceived barrier to a proper assessment of pressure ulcer (76%) and followed by appropriate application of prevention measures (67%). Lack of time, lack of cooperation, lack of staff also was reported as hindrances. In-service and lectures topped the educational training they had attended. Conclusion: Oncology nurses have a positive attitude towards pressure ulcer prevention. Nurses' positive response may be utilized to achieve the overall goal of decreasing incidence and recurrence of pressure ulcer among cancer patients. Though some trends may be deemed inevitable, continuous education and innovative approach may be implemented to help in fulfilling the roles and responsibilities set for each nurse working in a clinical setting.

Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit.

To determinate the incidence, incidence rate and risk factors of pressure ulcers in critical care patients. Pressure ulcers represent one of the most frequent health problems in clinical practice. Specifically, critical patients who are hospitalised in intensive care units have a higher risk of developing a pressure ulcer, with an incidence that fluctuates between 3.3-39.3% according to previous studies. Prospective cohort study. Three hundred and thirty-five adult patients (over 18 years old) who were hospitalised in intensive care units for at least 24hr were monitored for a maximum of 32days. They were excluded if they had a pressure ulcers at admission. The survival rate for pressure ulcers, from stages I-IV, was calculated using the Kaplan-Meier method. A multivariate Cox regression model was adjusted to identify the main risk factors for pressure ulcers: demographic, clinical, prognostic and therapeutic variables. The incidence of pressure ulcers in critical patients was 8.1%, and the incidence rate was 11.72 pressure ulcers for 1,000days of intensive care units stay; 40.6% of pressure ulcers were of stage I and 59.4% of stage II, mainly in the sacrum. According to the Cox model, the main risk factors for pressure ulcers were in-hospital complications, prognostic scoring system (SAPS III) and length of immobilisation. The incidence of pressure ulcers is lower than that shown in recent studies. Complications on the unit and the prognosis score were risk factors associated with pressure ulcers but, surprisingly, length of immobilisation was a protective factor. Survival analysis of pressure ulcer allows for identification of risk factors associated with this health problem in the intensive care units. Identifying these factors can help nurses establish interventions to prevent pressure ulcers in this healthcare scenario, given that pressure ulcers prevention is an indicator of nursing quality.

Application of target management on pressure ulcer prevention in surgical patients

Objective To explore the effects of target management on pressure ulcer prevention in surgical patients. Method The patients with selective operation were selected as study objects from January 2013 to December 2015. The traditional nursing for pressure ulcer prevention was carried out for operation patients from January 2013 to December 2013. The target management for pressure ulcer prevention was carried out for operation patients from January 2014 to December 2015. And then, we compared the incidence of pressure ulcer, that of patients with high risk of pressure ulcer, annual incidence rate of pressure ulcer of patients with lying position for surgery, distribution of ulcer stage and so on before and after target management. Results The annual incidence rate of pressure ulcer of 2013, 2014, 2015 was 0.23%, 0.11%, 0.07%. The incidence rate of pressure ulcer of 2014 and 2015 was lower than that of 2013 with significant differences (χ2=24.23, 43.32 ; P 0.05). The incidence rate of pressure ulcer of patients with high risk of pressure ulcer in 2013 and 2014 was also higher than that in 2015 with significant differences (χ2=13.00, 4.88; P<0.05). At the same time, the incidence rate of pressure ulcer of patients with lying position for surgery in 2013, 2014, 2015 was 6.00%, 3.53%, 1.06%. The incidence rate of pressure ulcer of patients with lying position for surgery in 2014 and 2015 was lower than that in 2013 with significant differences (χ2=7.63, 47.05; P<0.05). Conclusions The implementation of target management can reduce the incidence of pressure ulcer, that of patients with high risk of pressure ulcer, that of patients with lying position for surgery, guarantee the safety of patient and improve the quality of nursing care in operating room. Key words: Pressure unclear; Operating room; Target managements

Factors associated with the incidence of pressure ulcer during hospital stay.

Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers. Estimar a taxa de incidência de úlcera por pressão e verificar fatores associados a essa ocorrência em uma coorte de pacientes hospitalizados. Trata-se de estudo de coorte no qual o desfecho foi a ocorrência da úlcera por pressão. A estimativa do efeito das variáveis para a proporção de incidência acumulada do desfecho foi realizada utilizando o modelo de riscos proporcionais de Cox. A seleção das variáveis ocorreu por meio do teste de hipóteses Logrank. A amostra foi composta de 442 adultos, com 25 casos incidentes de úlcera por pressão. Pacientes com altos escores na escala de Braden apresentaram maior risco de incidência de úlcera por pressão quando comparados com aqueles classificados na categoria de baixo escore. Os resultados reforçam a importância do uso da Escala de Braden para auxiliar na identificação dos pacientes com maior probabilidade de desenvolver úlcera por pressão.

Application effect of link management in prevention of medical device related pressure ulcers in NICU

Objective To explore the link management of medical device related pressure ulcers in neonatal intensive care unit (NICU), and reduce the incidence of NICU medical device related pressure ulcers through various link management. Methods From June 2012 to May 2014, 726 cases of patients in our department were selected as the control group and received commonly used preventive measures and conventional pressure ulcer grading nursing care. From June 2014 to May 2016, another 869 patients in our department was selected as the observation group, and they received link intervention based on the routine nursing method which includes the establishment of pressure ulcer steering group, developing nursing measures of common medical device related pressure ulcers, establishing management principles of prevention and management of medical devices related pressure ulcers and strengthening personnel training and development of all levels of responsibility. The incidence rate of NICU medical device related pressure ulcers was observed. Results There were 28 cases of medical device related pressure ulcers in the control group, and the incidence rate was 3.9% (28/726); while there were 7 cases of medical instrument pressure ulcers in the observation group, and the incidence rate was 0.8% (7/869). The severity of pressure ulcer in the control group was significantly higher than that in the observation group; the cure rate of the wound was significantly lower than that of the observation group (U=-2.001, P<0.05). The score of nursing staff on the knowledge of medical device related pressure ulcers was (26.2±1.7) after training, which was higher than that before training (17.6±0.8) (t=-6.04, P<0.01). Conclusions Through the link management of medical device related pressure ulcers, incidence rate of pressure ulcers is reduced; the quality of nursing is improved; the use of medical equipment is standardized; and the new concept of medical device related pressure ulcers is updated. Key words: Pressure ulcers; Medical instrument; Risk management; Neonatal intensive care unit (NICU)

Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit.

In critically ill patients, prevention of pressure ulcers is a challenge because of the high risk for multiple comorbid conditions, immobility, hemodynamic instability, and increased use of medical devices. To compare the difference in incidence rates of hospital-acquired pressure ulcers (HAPUs) in critically ill patients between those treated with usual preventive care and a 5-layered soft silicone foam dressing versus a control group receiving usual care. Secondary goals were to examine risk factors for HAPUs in critically ill patients and to explicate cost savings related to prevention of pressure ulcers. A prospective, randomized controlled trial in the intensive care units at a 569-bed, level II trauma hospital. All 366 participants received standard pressure ulcer prevention; 184 were randomized to have a 5-layered soft silicone foam dressing applied to the sacrum (intervention group) and 182 to receive usual care (control group). The incidence rate of HAPUs was significantly less in patients treated with the foam dressing than in the control group (0.7% vs 5.9%, P = .01). Time to injury survival analysis (Cox proportional hazard models) revealed the intervention group had 88% reduced risk of HAPU development (hazard ratio, 0.12 [95% CI, 0.02-0.98], P = .048). Use of a soft silicone foam dressing combined with preventive care yielded a statistically and clinically significant benefit in reducing the incidence rate and severity of HAPUs in intensive care patients. This novel, cost-effective method can reduce HAPU incidence in critically ill patients.

Application of quality control circle in reducing incidence rate of pressure ulcers in elderly patients whose Braden scale ≤16

Objective To explore the application and effect of quality control circle in reducing incidence rate of pressure ulcers in elderly patients whose Braden scale ≤16. Methods The actual reasons in elderly patients with pressure ulcers were found through the application of quality control circle method, which included the following six aspects: single prevention equipment of pressure ulcers; imperfect execution path of prevention measures of pressure ulcers; imperfect prevention process of special patients with pressure ulcers; not improve the risk assessment content of pressure ulcers in time; no educational manual of pressure ulcers prevention with pictures; new progress in pressure ulcer prevention knowledge training of not reach the designated position. According to the true cause, countermeasures were made and standardized management was implementation, and quality improvement was continued. According to the true cause, corresponding measures were formulated and implemented, and the standardized management system was maintained. Results After the implementation of quality control circle, the incidence rate of elderly patients with pressure ulcers whose Braden scale ≤16 points was decreased from 6.06% to 2.19% after the implementation of quality control circle. Conclusions The application of quality control circle method in security management of elderly patients whose Braden score ≤ 16 points, can reduce the incidence rate of pressure ulcers in elderly patients whose Braden scale ≤ 16, and also can improve the quality of nursing, circle member work enthusiasm, creative thinking, responsibility and honor, QCC technique application and team spirit. Key words: Elderly patients; Pressure ulcers; Quality control circle; Braden score