Pressure Ulcer Management Research Articles

Sacral Pressure Ulcer Management by Negative Pressure Dressing: a Randomized Open Label Study

Sacral Pressure Ulcer Management by Negative Pressure Dressing: a Randomized Open Label Study

Device-related pressure ulcers: SECURE prevention. Second edition.

Device-related pressure ulcers: SECURE prevention. Second edition.

Pressure redistributing static chairs for preventing pressure ulcers.

Sitting can be viewed as a therapeutic intervention and an important part of a person's recovery process; but the risk of ulceration must be mitigated. Interventions for ulcer prevention in those at risk from prolonged sitting include the use of specialist cushions and surfaces, especially for wheelchair users. Whilst there is interest in the effects of different pressure redistributing cushions for wheelchairs, the benefits of pressure redistributing static chairs, compared with standard chairs, for pressure ulcer development in at-risk people are not clear. To assess the effects of pressure redistributing static chairs on the prevention of pressure ulcers in health, rehabilitation and social care settings, and places of residence in which people may spend their day. In June 2021 we searched the following electronic databases to identify reports of relevant randomised clinical trials: the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase and EBSCO CINAHL Plus (Cumulative Index to Nursing and Allied Health Literature). We also searched clinical trials registers for ongoing and unpublished studies, and reference lists of relevant systematic reviews, meta-analyses and health technology reports. There were no restrictions by language, date of publication or study setting. We sought to include published or unpublished randomised controlled trials that assessed pressure redistributing static chairs in the prevention or management of pressure ulcers. Two review authors independently performed study selection. We planned that two review authors would also assess the risk of bias, extract study data and assess the certainty of evidence according to GRADE methodology. We did not identify any studies that met the review eligibility criteria, nor any registered studies investigating the role of pressure redistributing static chairs in the prevention or management of pressure ulcers. Currently, there is no randomised evidence that supports or refutes the role of pressure redistributing static chairs in the prevention or management of pressure ulcers. This is a priority area and there is a need to explore this intervention with rigorous and robust research.

STUDY OF EFFECTIVENESS OF MASSAGE THERAPY AS A THERAPEUTIC ADJUVANT IN THE MANAGEMENT OF PRESSURE ULCER

Pressure ulcer (PU) is a common cause of morbidity and mortality in spine injuries. We now know that pressure is the single most important etiological factor. The compression of soft tissues results in ischemia and if not relieved, will progress to cause necrosis and ulceration; the basic cause is pressure followed by ischemia and necrosis. PU can develop in Traumatic Brain injured, paraplegic and nonparaplegic patients. Patients with spinal cord injury have reported prevalence of 25 – 40%. Management of pressure ulcer is multicentric. This study was conducted on paraplegic patients admitted in the ward with PU to determine the effectiveness of massage therapy in the management of PU as a therapeutic adjuvant to standard treatment protocol. 36 cases of paraplegic inpatients with stage II and III PU were selected, properly randomized and divided into two groups, A & B. The dimensions of ulcer were recorded. Both groups received standard conventional treatment. Group A received, in addition, massage therapy around the ulcer area using commercially available vibrator for ve minutes continuously, two times daily. Group B patients served as controls. Ulcer diameter and area were measured every week and documented. The group which received massage showed better ulcer heali RESULTS: ng. CONCLUSION. Massage therapy is a cost effective method for management of pressure ulcer and can be easily delivered to the patient by a reliable care giver once it is taught to them.

Assessment of nurses’ and assistants’ knowledge on the prevention and management of pressure ulcers

Background: The pressure ulcers constitute a major clinical problem with enormous socio-economic consequences worldwide. Nurses' knowledge on pressure ulcers’ management plays a crucial role in the prevalence of pressure ulcers.Aim: The investigation of nurses’ knowledge, working in a general hospital, regarding the prevention and management of pressure ulcers. Material and Method: It was a cross-sectional study using a structured questionnaire. The sample consisted of 54 nurses and assistants working in medical and surgical departments of a General Hospital in Athens, Greece. The collection of data took place from June 2019 until November 2019. The analysis of data conducted using the IBM SPSS® program, version 25 (IBM Corp. in Armonk, NY).Results: The mean age of the participants was 42,73 ±8,42 years, and 90,6% were women, with an average work experience of 19,05±9,84 years. The age of nurses of the sample was not associated with the knowledge regarding the prevention of pressure ulcers (p = 0,80). No significant differences were found between their knowledge and the department of work, or the years of work experience and the related seminars organized in the department (p > 0,05). Nurses who had a postgraduate degree had statistically significant more correct answers (p = 0,01).Conclusions: Despite the development of nursing science in the treatment of pressure ulcers, nurses continue to present insufficient knowledge in the daily clinical practice. Τhe implementation of clinical guidelines and the continuing education courses may help nurses to enhance their knowledge.

Augmented flap reconstruction of complex pressure ulcers using synthetic hybrid-scale fiber matrix.

Flap reconstruction of pressure ulcers offers an important clinical means of decreasing morbidity in hospitalized patients. A new, novel method of managing pressure ulcer wounds uses a synthetic hybrid-scale fiber matrix prior to tissue flap reconstruction. This synthetic hybrid-scale fiber matrix is comprised of micron-scale and nanoscale fiber structure similar to that of human extracellular matrix and supports cell ingrowth, retention, and granulation tissue formation. The primary objective of the present study was to examine use of the synthetic hybrid-scale fiber matrix as a means of encouraging granulation tissue within complex wounds to promote successful and lasting wound closure following flap reconstruction. Patients included in this retrospective study had pressure ulcers that were not successfully managed with other wound therapies; in addition, these patients presented with various risk factors for postoperative complications. Before treatment, sharp debridement of the wound margins and wound bed was performed. Wounds were subsequently treated by applying synthetic hybrid-scale fiber matrix prior to flap reconstruction, based on physician assessment of wound status. The primary objective to include the synthetic hybrid-scale fiber matrix in the treatment approach of pressure ulcers in this case series was to ensure (1) integration to the wound bed prior to flap closure to encourage granulation tissue formation at a later time and (2) lasting successful wound closure following flap reconstruction. Overall, the patient outcomes indicated that the synthetic hybrid-scale fiber matrix was used to manage pressure ulcers successfully, with a wound closure rate of 90.9% (10 cases of complete wound closure and 1 case of 97.2% wound area reduction). Additionally, no complication related to the application of each synthetic hybrid-scale fiber matrix was reported. Application of synthetic hybrid-scale fiber matrix to the wound bed prior to flap closure promotes cellular ingrowth and granulation tissue formation, which promotes successful and lasting wound closure following flap reconstruction.

Impact and prospects of WOCN outreach activities in pressure ulcer management at a small long-term care hospital

Impact and prospects of WOCN outreach activities in pressure ulcer management at a small long-term care hospital

Analysis of the effect of interventions by wound, ostomy, and continence nurses in a small hospital with no pressure ulcer management specialist

Analysis of the effect of interventions by wound, ostomy, and continence nurses in a small hospital with no pressure ulcer management specialist

Prevention Effects of Chain Management on Pressure Ulcers of Hospitalized Patients.

The study focused on the preventive effects of the chain management model on pressure ulcers in the operating room. Sqoop big data collection module is used to collect patient information from various hospital information systems in a distributed manner. The data were from the clinical data center of the Zhongshan Hospital Xiamen University General Hospital, and 268 patients were selected as the research subjects. A chain management model is constructed, concerning the preventive measures, the management of each link, the perioperative pressure ulcer management, and the reporting of pressure ulcers. Then, the two groups were compared for the SAS and SDS scores before and after nursing, the pressure ulcer sites, pressure ulcer reporting rate, pressure ulcer staging, and nursing satisfaction. The results show that it is not that more collection modules will lead to better cluster performance and that the execution delay is caused by MapReduce requiring the JAVA virtual machine, and after reaching a certain point, the increase in the number of tasks will slow down the process, and as data size increases, DataNote has an expanded capability to analyze data. After nursing treatment, the SAS and SDS scores of the two groups of patients were significantly lower than before treatment (P < 0.05). The pressure ulcers were mainly distributed in the forehead, mandible, cheeks, front chest, and knees in the two groups, and the difference between the two groups was statistically significant (P < 0.05). The total satisfaction of the observation group was 93.28%, and the total satisfaction of the control group was 92.54%. The patients' satisfaction with the chain management model was higher than that of conventional nursing.

An Overview on Pressure Ulcers: Prevention and Management

Pressure ulcers are significant and painful side effects that might indicate a lack of care. The formation of a pressure ulcer is a major complication of reduced mobility. And since over 65-year-olds are the fastest-growing sector of the population in many developed countries, it imposes the risk of increasing disease incidences. There are also higher rates of obesity, diabetes, and cardiovascular disease, which also increase the risk. There are many causes that can contribute to the formation of pressure ulcers; tissue ischemia is the most prevalent route to ulceration. Pressure ulcer prevention generally begins with an examination to determine who is most vulnerable to pressure ulcers, such as the elderly, the immobile, or individuals with a spinal cord injury. Wound dressings, debridement, physical therapy, antibiotics, and antimicrobials are all possible therapeutic options for pressure ulcers. Interventions such as mobilization, positioning, and repositioning, as well as support surfaces, are utilized in conjunction with other wound care methods. In this review we’ll be looking at prevention and management of pressure ulcers.

980 Technological Innovations in The Management of Pressure Ulcers: A Systematic Review and Discussion

Abstract Aim Pressure ulcers (PUs) affect over 700,000 patients per annum and are associated with an up to fourfold increase in mortality rate in older populations with complex pathologies. NICE guidelines for PU management involve a combination of low-grade technological interventions, including dressings and foam mattresses, while technology-centric therapies are not offered. The aim of this systematic review is to evaluate the effectiveness of any novel and high-grade technological PU interventions. Method The PubMed, Embase (via Ovid), Web of Science and CINAHL databases were electronically searched using free-text and MeSH search strings. Results evaluating the type of technological intervention, outcome measures and wound healing rates, duration of hospital stay, requirement for surgical debridement, infection and mortality rates were methodically assessed. Results An initial search identified 900 articles. Using the PRISMA guidance, 25 studies were included, encompassing 845 patients. 28 novel modalities of high-grade innovations were identified, with distinguished technologies including smart wireless bandages and 3D-printed wound repair scaffolds. Overall, 92.8% of devices demonstrated an improvement in wound healing (P &amp;lt; 0.05). A novel framework was created from the different innovations identified to approach adopting innovation in PU management. Conclusions The majority of high-technology innovations identified in this systematic review significantly improve PU healing, thus offering an additional pathway to standard care. Given the annual cost of PUs (£531 million), it is vital innovative technologies are considered as the NHS transitions into a digital age. Therefore, further studies are essential and recommended to evaluate the potential benefit of the promising, innovative technologies identified.

Knowledge and Practices of Student Nurses towards Prevention and Management of Pressure ulcers in Allied Hospitals of Rawalpindi Medical University

Introduction: Pressure ulcer is a common preventable complication of prolonged hospitalisation. Although debilitating, but preventable through timely assessment and proper management. This study was conducted to access student nurse’s knowledge and practices towards the prevention and management of pressure ulcers. Materials and Methods: A cross-sectional study was conducted at Nursing Schools of Holy Family Hospital and Benazir Bhutto Hospital Allied with Rawalpindi Medical University. A pre-tested self-designed questionnaire was filled by 264 students selected through the non-probability convenient sampling technique. Data were analysed using SPSS 21. P-value &lt;0.01 was considered significant.&#x0D; Results: Mean percentage of Student nurse’s knowledge and practices were 58.7% 69.62% respectively. 21.7% of first-year students, 34.1% of second-year students, and 60.2% of third-year students had good knowledge. Correspondingly, 10.89% of first-year students, 32.9% of second-year students, and 56.2% of third-year students had good practice. There was a significant correlation between knowledge and practices i.e. r value is 0.92, the p-value is &lt;0.000.&#x0D; Conclusion: Knowledge and Practices of Student Nurses towards the prevention and management of pressure ulcers was found to be average. The practices of students gradually improved as their knowledge improved throughout their years of education.

Chronic Osteomyelitis in Sacral Pressure Ulcers Management Review in QA Format

Most cases of reported osteomyelitis in stage 4 pressure ulcers are almost exclusively chronic and superficial (when depth is reported). Wound cultures or bone specimen cultures lack diagnostic sensitivity or specificity. Histopathological diagnosis is necessary to make an accurate diagnosis of osteomyelitis. Surgical debridement is the mainstay of treatment for chronic osteomyelitis. Duration of antibiotics in combination with surgical management is unclear but choice should consider bone and biofilm penetration. Shorter durations of antibiotics to treat the soft tissue infection should be considered in the absence of a concrete plan for wound coverage with primary closure or rotational flap.

Pressure ulcers microbiota dynamics and wound evolution

Bacterial species and their role in delaying the healing of pressure ulcers (PU) in spinal cord injury (SCI) patients have not been well described. This pilot study aimed to characterise the evolution of the cutaneous microbiota of PU in SCI cohort. Twenty-four patients with SCI from a French neurological rehabilitation centre were prospectively included. PU tissue biopsies were performed at baseline (D0) and 28 days (D28) and analysed using 16S rRNA gene-based sequencing analysis of the V3–V4 region. At D0, if the overall relative abundance of genus highlighted a large proportion of Staphylococcus, Anaerococcus and Finegoldia had a significantly higher relative abundance in wounds that stagnated or worsened in comparison with those improved at D28 (3.74% vs 0.05%; p = 0.015 and 11.02% versus 0.16%; p = 0.023, respectively). At D28, Proteus and Morganella genera were only present in stagnated or worsened wounds with respectively 0.02% (p = 0.003) and 0.01% (p = 0.02). Moreover, Proteus, Morganella, Anaerococcus and Peptoniphilus were associated within the same cluster, co-isolated from biopsies that had a poor evolution. This pathogroup could be a marker of wound degradation and Proteus could represent a promising target in PU management.

The influence of anaemia on pressure ulcer healing in elderly patients.

Anaemia is a common and multifactorial blood disorder in elderly individuals. This condition may be a significant barrier to pressure ulcers healing as it is associated with a decreased level of oxygen being supplied to body tissues. Some nutritional deficiencies such as iron, vitamin B12 and folate may also cause anaemia and have a negative impact on pressure ulcer healing. An increased iron demand in hard-to-heal pressure ulcers is a significant factor associated with the risk of anaemia of chronic disease in elderly patients. Anaemia screening and correction may need to be considered as well as iron supplementation if required in pressure ulcer prevention and management.

Nurses’ Management of Patients with Pressure Ulcers in Selected Health Facilities in Murang’a County, Kenya

Pressure ulcers are a common health problem in hospitalized patients, especially among patients with chronic illnesses and those with reduced mobility. The prevalence of pressure ulcers varies with health care settings and is highest in critically ill patients ranging between 15-20%. They affect the quality of life of patients and caregivers and have been associated with heavy financial burdens, extended hospital stays, higher morbidity and mortality. Inadequate prevention measures and lack of active management of pressure ulcers in early stages especially in high-risk patients result in recurrence and complicated pressure ulcers. In view of this, a descriptive cross-sectional study was conducted in Murang’a County, Kenya in selected health facilities with the objective of determining the management of patients with pressure ulcers. The study population was composed of one hundred and twenty-four (124) nurses working in medical and surgical wards in selected health facilities. Semi-structured questionnaires, observational checklists and focused group discussions were used to collect data. The qualitative data from the focus group discussions and observational checklist were transcribed and a summary written. The relationship between nurse’s knowledge, nurse-oriented factors and institutional factors affecting management of pressure ulcers among nurses were examined using Pearson correlation analysis and multiple regression analysis. The median age of the respondents was 37 years with at least 112 (90.3%) having diploma level of education, and 63 (50.9%) were from the medical department. The majority of the nurses (93.6%) agreed pressure ulcers can be avoided, while 58.1% preferred pressure ulcer risk assessment tools compared to 27.5% who preferred clinical judgment in the management of pressure ulcers. The majority of nurses (87.5%) who had adequate knowledge on the management of pressure ulcers mentioned immobility and bedridden patients, stroke, spinal injury, dry skin, stool and urine incontinence as major contributors to pressure ulcers. Regarding pressure ulcer risk assessment, 62.9% of nurses assessed patients for pressure ulcers though they relied on clinical judgement as 93.9% indicated there was no risk assessment scale in the wards and 5.1% were not sure. On institutional factors 61.3% of the nurses indicated that health facilities were lacking pressure ulcer reducing devices and those that had pillows and a few ripple mattresses. Regarding guidelines in the management of pressure ulcers, 75.8% of nurses indicated they were not available in the hospital. The study found an association between age and knowledge increasing the odds of effective management age (AOR = 6.83, p = 0.001); experience (AOR = 4.08, p = 0.01), and education (AOR = 22.9, p = 0.000). The nurse-oriented factors increasing the odds of effective management of pressure ulcers include nurse’s positive attitude on prevention of pressure ulcers (AOR = 2.3, p = 0.040) and nurse use of pressure ulcer risk assessment tool (AOR = 4.3, p = 0.010). On institutional factors, nurses trained on management of pressure ulcers were 4.47 times likely to effectively manage patients with pressure ulcers. Nurses who lack in-service training about pressure ulcers were less likely to effectively manage patients with pressure ulcers (AOR = 0.11, p = 0.000). The study concludes that the nurses had adequate knowledge in management of pressure ulcers, the nurses-oriented factors and institutional factors also influence the management of pressure ulcers

Nurses’ Knowledge and Practice on Pressure Ulcer Prevention and Management for Hospitalized Patients at Tertiary Level Hospital

Background: Pressure ulcers are areas of localized injury to the skin, underlying tissue or both, usually over a bony prominence, as a result of pressure or in combination with shear. There are common problem in health care and represent a significant burden on patients, their relatives and caregivers. Materials and Methods: This was a descriptive cross sectional study carried out to assess the level of nurses’ knowledge and practice on pressure ulcer prevention and management for hospitalized patients in DMCH & ShSMCH from January to December 2019. A total of 310 respondents (Senior Staff Nurse) were taken conveniently as sample. Relevant data were collected by using pre tested semi-structured questionnaire, an observation checklist was also utilized for physical verification and record keeping. Results: Findings represent that mean age of the respondents were 34±6.94 years. Among the respondents’ 85% were female, 73% of the respondents were Muslim, 72% respondents completed Diploma in Nursing, 54% respondents working experience in hospital is 5 years. About 71% mentioned high loading pressure main factor is responsible for formation of pressure ulcer, highest (60%) mentioned lower back/buttock is the common site, prolonged immobility (46%) main cause of formation of pressure ulcer. Unconscious patients (40%) mostly affected by pressure ulcer, partial skin loss, redness of the skin, blister (66%) are the sign of pressure ulcer, apply talcum powder (52%) appropriate method for skin care of pressure ulcer patients. In-service training on pressure ulcer prevention (86%) enhances competency of staff nurses in preventing pressure ulcer. Performing skin care as a routine work of the unit (90.9%), giving advice to the caregiver regarding pressure ulcer preventive before discharge the patients from a hospital (81.3%). About 55% had satisfactory knowledge, professional education and overall knowledge had strong association. Another also found between working experience and knowledge on common site of pressure ulcer. Highest (77%) had sometimes practice to prevent pressure ulcer. Another association also found between working experience and practice on prevention of pressure ulcer. Here p value is less than .05 that is .024. Conclusion: It was concluded that in-service training on pressure ulcer and set up pressure ulcer prevention protocol, are some of the important steps to improve nurses' knowledge and practice regarding prevention and management of pressure ulcer.

EFFICACY OF AUTOLOGOUS PLATELET RICH PLASMA IN THE MANAGEMENT OF PRESSURE ULCER IN PATIENTS WITH SPINAL CORD INJURY

EFFICACY OF AUTOLOGOUS PLATELET RICH PLASMA IN THE MANAGEMENT OF PRESSURE ULCER IN PATIENTS WITH SPINAL CORD INJURY

Role of 5% Tankana bhasma in Gomutra Arka as a Chemical Debridement agent in the Management of Pressure Ulcer - A Case Report

Background and Objective: Pressure ulcers regarded as preventable but occur in approximately 5% of all hospitalized patients (range of 3% to 12 % in published literature). It is more common in paraplegic patients. Only after the complete debridement of slough in grade 3 and grade 4 pressure sores the healing progresses and the infection can be controlled. A chemical solution of 5%Tankana in Gomutra Arka was reviewed in the management of a case of pressure ulcer. Presentation of Case: A 26 year old male hemiplegic patient presented with a wound in the sacral region which was diagnosed as a Grade 4 pressure ulcer measuring 12x13 cm. Manual Debridement of ulcer was associated with bleeding. Methodology: There after the solution of 5% Tankana in Gomutra Arka was applied upon the wound by soaking a gauge with the above solution. A regular passive movement of the lower part of the body was done to prevent further development of new Ulcer. Result: After 3 days of dressing 90 % or slough was reduced, discharge from the ulcer reduced and progression of infection had stopped. Discussion: Pressure ulcers impose an economic burden on the patient and common problem amongst bed ridden patients. Grade 4 pressure ulcers have a poor prognosis. Manual slough removal is usually associated with bleeding. Chemical debridement not only helps us in avoiding instances of bleeding but also is more effective in its reach and action. Conclusion: In this case 5% Tankana bhasma in Gomutra Arka was found to be very effective in slough removal which in turn reduced the total duration of management. Use of Chemical debriding agents in a grade 4 ulcer had hastened the process of slough removal and improves the overall rate of recovery. Mixture of Tankana and Gomutra Arka seemed to complement each other’s action on Vrana Shodhana.

Reactive Oxygen Species and Pressure Ulcer Formation after Traumatic Injury to Spinal Cord and Brain.

Traumatic injuries to the nervous system, including the brain and spinal cord, lead to neurological dysfunction depending upon the severity of the injury. Due to the loss of motor (immobility) and sensory function (lack of sensation), spinal cord injury (SCI) and brain injury (TBI) patients may be bed-ridden and immobile for a very long-time. These conditions lead to secondary complications such as bladder/bowel dysfunction, the formation of pressure ulcers (PUs), bacterial infections, etc. PUs are chronic wounds that fail to heal or heal very slowly, may require multiple treatment modalities, and pose a risk to develop further complications, such as sepsis and amputation. This review discusses the role of oxidative stress and reactive oxygen species (ROS) in the formation of PUs in patients with TBI and SCI. Decades of research suggest that ROS may be key players in mediating the formation of PUs. ROS levels are increased due to the accumulation of activated macrophages and neutrophils. Excessive ROS production from these cells overwhelms intrinsic antioxidant mechanisms. While short-term and moderate increases in ROS regulate signal transduction of various bioactive molecules; long-term and excessively elevated ROS can cause secondary tissue damage and further debilitating complications. This review discusses the role of ROS in PU development after SCI and TBI. We also review the completed and ongoing clinical trials in the management of PUs after SCI and TBI using different technologies and treatments, including antioxidants.