Prevalence Of Pressure Sores Research Articles

173 Pressure Sores in Spinal Patients Admitted to Intensive Care - a Retrospective Observational Study

Abstract Aim Spinal patients in the intensive care unit (ICU) have a high risk of developing pressure sores due to factors such as immobilisation and collar use. In a collaboration between the spinal surgery department and the ICU at a tertiary care hospital, this study aimed to assess the prevalence of pressure sores in spinal patients in the ICU as well as potential risk factors, to establish any required changes to patient care. Method NHS-mandated DATIX reports for all pressure sores in ICU were cross-referenced with a list of all spinal patients admitted to ICU between January 2018 and August 2022 (4-and-a-half years). We included pressure sores such as occipital, sacral, clavicular, hips. Exclusions were sores categorised below Grade 2 and those caused by intubation such as lips or mouth. Results 97 patients were included and fifteen (15.5%) developed grade 2 or above pressure sores in ICU. Admission age, days spent in hospital and days in ICU were significantly greater in those who developed pressure sores compared to those who did not (all P < 0.05). Advanced respiratory support time was also greater in those who developed pressure sores (P < 0.05). Conclusions Just over 1 in 7 spinal patients in the ICU developed pressure sores and clinicians should be aware of the potential risks for mutual benefits of patient comfort and the NHS cost burden. However, in comparison to other studies reporting percentages of 19.1% and 37.5%, the department appears to be doing comparatively well in preventing pressure sores.

Investigation and analysis on status quo of pressure ulcer and other skin injuries among inpatients in Class III Grade A hospitals in Hainan province

Objective To investigate and analyze the prevalence of pressure ulcer and other skin injuries, and the implementation of pressure ulcer prevention measures among inpatients in Class Ⅲ Grade A hospitals in Hainan province. To provide basis for fomulating bundle of care model to prevent and intervent pressure ulcer, and establishing early warning management model on nosocomial pressure ulcer in Class Ⅲ Grade A hospitals in Hainan province. Methods A cross-sectional survey was conducted on inpatients from 7 Class Ⅲ Grade A hospitals in Hainan province. A investigation was performed by a self-designed inpatients′ questionnaire and qualified tools on pressure ulcer and other skin injuries. Statistical analysis of data using by SPSS19.0 software. Results The content validity index of the self-designed inpatients′ questionnaire and qualified tools on pressure ulcer and other skin injuries was 0.91, Cronbach α coefficient was 0.93. The prevalence of pressure sores was 2.28%(165/7 248), of which 66.06%(109/165) was family involvement, 30.30%(50/165) was hospital acquired, 3.03%(5/165) was community involvement,and 0.61%(1/165) was both from family and hospital acquired. Medical instrument related pressure ulcer accounted for 18.18%(30/165) of the total number of pressure ulcer. The most common site of pressure ulcer was the sacrococcygeal region, accounting for 47.94%(93/194). The proportion of pressure ulcer in stageⅡ was the highest (35.57%, 69/194). 52.01%(647/1 244) of patients at risk of pressure ulcer did not use the anti-pressure devices,and 81.40%(1 013/1 244) of patients′ main compression sites were not covered by dressings.35.50%(442/1 244) of patients did not according to plans or regularly turn over, only 56.19%(699/1 244) patients turned over every 2 hours. 61.57%(442/1 244) patients who have pressure ulcer did not have anti-pressure ulcer signs. Among other skin injuries: the prevalence of incontinence related dermatitis was 0.88%(64/7 248), and the prevalence of avulsion skin injury was 0.37%(27/7 248). Conclusions The incidence of acquired pressure ulcer in Class Ⅲ Grade A hospitals in our province is slightly higher than other domestic investigation results. The reasons may be that anti-pressure devices in hospital configuration are not enough, lack of the tailored bundle of prevention measures of pressure ulcer, and failure to establish an effective early warning management model on pressure ulcer etc. So prevention and treatment of pressure ulcer should have a further standard management. Instrument related pressure ulcer and incontinence related dermatitis should also attract the attention of clinical nurses and managers. Key words: Pressure ulcer; Skin injury; Investigation; Analysis

Determination of Risk Factors in the Development and Prevalence of Pressure Sores in Patients Hospitalized in a Cardiovascular and Thoracic Surgery Intensive Care Unit

Determination of Risk Factors in the Development and Prevalence of Pressure Sores in Patients Hospitalized in a Cardiovascular and Thoracic Surgery Intensive Care Unit

Determination of the risk factors that will play a role in the pressure sore prevalence and the development of pressure sore in patients hospitalized in a chest cardiovascular surgical intensive care unit

Determination of the risk factors that will play a role in the pressure sore prevalence and the development of pressure sore in patients hospitalized in a chest cardiovascular surgical intensive care unit

Pressure Ulcer Surveillance in Neurotrauma Patients at a Level One Trauma Centre in India.

Pressure ulcers are a multifactorial, prevalent, and preventable morbidity. They cause a burden both financially and emotionally, to the individual, their family and doctor, and to society as a whole. Pressure ulcers are extremely difficult to treat; therefore, prevention is key. We started a Wound Care Surveillance Program in 2012 involving nurses, physiotherapists, and doctors. We intended to prevent the occurrence of pressure ulcers, ensure early detection, and facilitate the healing process. The Braden scale was used to stratify patients' risk. The number of patients observed in our study was 2,974 over a one-year period. The pressure sore prevalence was 3.1%. Younger and middle-aged patients were most commonly affected; 27% of these patients did not survive. Mortality was not attributed to the pressure ulcer directly. The most common mode of injury was road traffic accidents. Most of our patients had just a single pressure area affected, most commonly the sacrum. Most patients were managed with debridement and dressings while 12% received surgical treatment. Of those with stage one ulcers, 29% healed completely at two months. In stage two and three patients, 17% and 6% healed in two months, respectively, and this number was zero in stage four patients. The Wound Care Surveillance Program has been a very effective strategy for the prevention and management of pressure ulcers. Stage two ulcers were the most common in our setup. Braden scoring, traditionally used to screen these ulcers, can be used as a predictive and prognostic tool to predict healing of pressure ulcers. Poor healing is expected in higher staged ulcers and patients with spinal injury and major solid organ injury and those who need a tracheostomy. Home-based care is not up to mark in our society and accounts for most of the cases in the follow-up.

Prevalence of pressure sores in EPHAD in Britanny

Prevalence of pressure sores in EPHAD in Britanny

What to Do When They Bash Your Nursing Home

What to Do When They Bash Your Nursing Home

British Ageing with SCI Study: Changes in Physical and Psychosocial Outcomes over Time

Aim: To present main physical and psychosocial changes experienced by the participants of the British Ageing with Spinal Cord Injury (SCI) study over a 16-year time period. Method: Interview and examination results collected between 1990 and 2006, in a sample of people injured more than 20 years prior to 1990, were analysed using mixed effects model analysis. Results: Out of the original 293 study participants, 122 completed the 2006 follow-up. Throughout the study, the most frequently reported problems were urinary tract infections, upper extremity pain, fatigue, pressure sores, constipation, and bowel accidents. Pressure sore prevalence remained stable. Use of suprapubic catheters and intermittent catheterization increased over time, as did manual bowel evacuation and colostomy methods. Depressive symptomatology increased, and Craig Handicap Assessment and Reporting Technique (CHART) mobility and occupation subscores worsened. However, CHART social integration subscores remained stable, as did scores on...

Decubitus ulcer in the terminal phase: epidemiologic, medicolegal and ethical aspects

Pressure sores usually result from insufficient preventive measures. They are particularly omnipresent among dying persons in geriatric care. This study deals with prevalence, risk factors and the significance of the nursing environment. The prevalence of pressure sores among the dead was analysed in a prospective cross-sectional study based on 10,222 postmortem examinations in a crematorium in Hamburg. The overall prevalence of pressure sores from grades I to IV was 11.2% (grade I: 6.1%, grade II: 3%, grade III: 1.1%, grade IV: 0.9%). A final logistic regression model showed that pressure sores of Grade III or IV were associated with female gender, date of death in the summer, marasmus, stroke history, neurological disease in general, kidney disease, preceding traumatic events and nursery home residence at the time of death. More than half of all the grade IV cases were diagnosed among nursing home residents whereas those who had died in hospitals contributed to only 11.5% of all the grade IV cases (dead from private homes 34.4%). Nursing home residence was associated with female gender, marasmus and stroke history which predisposed to a higher rate of pressure sores. Nursing homes are confronted with the highest proportion of pressure sores among dying people when compared to hospitals or private home care. Failure to meet the standards of preventive action against pressure sores point to the shortfalls in the present public health sector and nursing home regulations as well as the medical responsibility for supervision of nursing care. Apart from established standards of care, medicolegal assessment of high-grade pressure sores should also take ethical considerations into account when considering maximum therapy goals among dying persons.

Comparison of two Dutch follow-up care models for spinal cord-injured patients and their impact on health problems, re-admissions and quality of care

Objective: To evaluate whether transmural care for people with spinal cord injury living in the community has more impact on health outcomes than traditional follow-up care within the Netherlands. Design: Quasi-experiment with 12 months of follow-up. Setting: Eight Dutch rehabilitation centres. Subjects: Thirty-one patients who received transmural care in two `experimental' rehabilitation centres were compared with a matched sample of 31 patients having received `usual follow-up care' in six other rehabilitation centres. Intervention: The core component of the transmural care consists of a transmural nurse, who `liaises' between former patients living in the community, primary care professionals and the rehabilitation team. The transmural care model provides activities to support patients and their family/partners and activities to promote continuity of care. Main measures: The prevalence of pressure sores and urinary tract infections; the number and duration of re-admissions to hospital and rehabilitation centre due to pressure sores, bladder and bowel problems; and the experienced quality of follow-up care. Results: The transmural care, as implemented, did not influence the health outcomes. The prevalence of pressure sores, urinary tract infections and the number of re-admissions (due to pressure sores, bladder and bowel problems) was respectively 13, 13 and 4 in the intervention group versus 14, 15 and 6 in the usual follow-up care group. Since the transmural care had been incompletely implemented and there were methodological and practical limitations, we formulated no final conclusions regarding its effectiveness. Conclusion: Implementing the transmural care model strictly according to protocol may improve its effectiveness.

L’escarre à l’hôpital en 2003 : enquête de prévalence un jour donné

To determine the prevalence of pressure sores in a university hospital and to assess the risk of developing a pressure sore. A one-day survey was performed in all hospitalized patients, day hospital excepted. The Garches scale was used to assess the severity of pressure sores and the Braden scale was used to measure the patient's risk for the development of pressure ulcers. One thousand six hundred and eleven patients were included, mean age was 62+/-23 years and 53.3% were over 65 years old. In hospitalized patients, 64% were in acute care, 29% in intermediate medicine and long-term care and 7% in intensive care units. We have found 675 pressure sores in 268 patients, mean age of 76 years; 263 decubitus ulcers were acquired during hospitalization. The most frequent sites were heels (46%) and sacrum (26%). Stage 1 pressure ulcers showed 33% of the total. The total prevalence was 16.6%, 95% CI (14.9-18.6), the hospital acquired pressure sores prevalence was 7.5%, all stages included. A Braden score less than or equal to 15 was found in 29.1% of hospitalized patients. Standard mattresses were used in 37% of patients with pressure sores. Multivariate analysis showed that age and a Braden score less than or equal to 15 were significantly associated with pressure sores. Pressure sores are still an important problem in hospital; occurrence must be considered as an iatrogenic event and management requires a multidisciplinary approach.

Escarres dans un hôpital universitaire de court séjour: Prévalence, facteurs de risque et modalités e prise en charge

To determine the prevalence of pressure sores, their risk factors, and the responsible microbial agents in an acute-care hospital and to evaluate their management.A prevalence survey was conducted from 5 July through 9 July 2004. Investigators completed a standardized questionnaire for each hospitalized patient, including demographic data (age, sex, previous hospitalizations, etc.) and Braden scale risk factors (sensory perception, humidity, activity, mobility, nutrition, and friction and shear). Two experts in skin care detected pressure sores by physical examination of the patients. Each pressure sore was swabbed and inoculated on selective media. Management was evaluated by reviewing the clinical charts of each patient with a pressure sore.The study included 535 adult patients (aged 59 +/- 19 years): 75 ulcer sores were observed in 37 patients (prevalence=6.9%). Stage I sores accounted for 24% of the total, stage II for 29%, stage III 31%, and stage IV 16%. The most frequent site was the heel (41%), followed by the sacrum (20%), elbow (11%), back (7%) and ischial tuberosities (7%). Sixty (80%) were acquired while hospitalized. Age-adjusted multivariate analyses found that the risk factors significantly associated with pressure sores were Braden score< or =15 (OR=5.9, 95% CI: 2.4-13.7, p<0.0001) and previous pressure sores (OR=5.0 95% CI: 2.2-11.6, p<0.0001). Eleven sores (24.5%), mostly stage III and IV, were colonized by multiple-drug-resistant bacteria (i.e., methicillin resistant Staphylococcus aureus, extended spectrum beta-lactamase Enterobacteriaceae). Seven (9.3%) of the 75 ulcers were diagnosed only during the survey, by the experts; of the 68 diagnosed before the survey, 57 (83.8%) had been under treatment. Treatment was considered inappropriate according to French guidelines in 31.6% of the cases.This prospective prevalence study resulted in better awareness of the patients at risk for pressure sores. It also made the recently created mobile geriatrics unit better known within the hospital.

Prevalence of pressure sores in a community sample of spinal injury patients.

To estimate the point prevalence of pressure sores in a community sample of spinal cord injured patients who were followed up by a spinal injuries unit and to evaluate whether self-management strategies were associated with decreased risk of pressure sores. A regional spinal injuries unit, UK. Postal questionnaire survey. Presence of pressure sores. All patients who were being followed up on a regular basis by the unit. Out of 760, 520 replied to the questionnaire; 472 were eligible for analysis. Point prevalence of pressure sores was 23% (99). Failure to inspect the skin daily for pressure damage was associated with decreased prevalence of pressure sores (odds ratio (OR) 0.5; 95% confidence interval (CI) 0.2-0.83). Those who inspected their skin daily, however, had a higher proportion of stage I pressure sores, but this was not statistically significant. Smoking (OR 1.8; 95% CI 1-3.3) and pre-existing medical problems (OR 1.8; 95% CI 1-3) were associated with increased prevalence of pressure sores. Regular lifting of weight at least once in an hour while seated, age, gender, neurological level, employment status, living alone and faecal and urinary incontinence were not significant predictors of pressure sores. Nearly one-quarter of participants had pressure sores at the time of the survey. Periodic weight lifts and daily inspection of skin for pressure damage were not associated with decreased prevalence of pressure sores in this sample. However, those who inspected skin daily tended to detect pressure damage early.

Pressure sore prevalence within a public health services area

Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure-sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. The most frequently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures. There was no statistical difference in pressure-sore prevalence when compared with a similar study from 1980. Patients were, however, older in 1995.

Pressure sores: epidemiology, medico-legal implications and forensic argumentation concerning causality

The aim of the present investigation was to identify the frequency and grading of pressure sores in a large series of unselected consecutive deceased subjects before cremation and to discuss aspects of the forensic argumentation concerning causality. A total of 10,222 corpses were examined prospectively over a 1-year-period (1998) for the occurrence, localization and grading of pressure sores. Epidemiological aspects (e.g. age, sex, underlying and contributing causes of death, place of death etc.) were taken from the death certificate. The mean prevalence of pressure sores was 11.2% (87.1% isolated sores; predominant localization of advanced grades on the sacrum in 69.6%). There was a positive correlation between the prevalence of sores and advanced age resulting in a clear female predominance in the age group of 80 years and over because of differences in life expectancy. A significant correlation was found between the prevalence of pressure sores and certain underlying diseases, e.g. trauma, senile dementia, neurological diseases, apoplexy and marasmus. Pressure sores of all grades were more frequently found in the deceased when a senior citizen's or nursing home was given on the death certificate as the domicile in the last period of life. The forensic argumentation for the causal relationship of a pressure sore as the focus of fatal infectious complications or septicemia has to be based on the results of clinical expertises and forensic investigations (evaluation of the institutional documentation of the patient's course, autopsy findings, histology, immunohistochemistry). The vast majority of physicians seem to pay only little attention to the potentially fatal outcome of pressure sores and fatalities associated with this condition are clearly underreported. From the point of view of social medicine, the prevalence of pressure sores in a defined population can be seen as a parameter for the quality of nursing and medical care. In bringing these fatalities to light, the field of legal medicine contributes to a general quality control of standards of nursing and medical care.

Setting the standard for pressure sore prevention on a trauma orthopaedic ward

This article describes an innovation used to tackle the problem of high prevalence and severity of pressure sores on an orthopaedic trauma ward. Simple data from the pressure sore prevalence survey were used to build the case and provide the rationale for action. Actions taken included targeting the elderly with hip fractures and having the prevention strategy start in Accident and Emergency (A&E) Department. A standard with a monitoring tool was devised at ward level to review and monitor our practice in pressure sore prevention. This has resulted in the reduction of the prevalence rate of pressure sores on the ward from 21% to 8% over four years. The severity of pressure sores also decreased.

The limits of pressure sore prevention.

Pressure sore prevalence and incidence were assessed in 275 patients who were admitted to a well-staffed internal medicine ward during a 12-month study period or who were present on day 1. Pressure sore risk was assessed by use of the Braden scale and patients scoring 16 or less were provided with intensive preventive care. During the study period 5.1% (95% confidence interval 2.7-7.8) of 275 patients had pressure sores (prevalence) and 4.4% (1.9-6.9) developed sores (incidence). None of the 239 patients who were assessed as not being at risk developed a sore. 36 patients were assessed as being at risk at some time during the study and 12 of these developed sores despite receiving high-quality preventive care. The results suggest that not all pressure sores can be prevented in severely ill patients. We believe that the 4.4% incidence of sores in this study approaches the current limit of prevention.

Pressure sore prevalence: a national survey.

A cross-sectional nation-wide sample was used to determine the point prevalence and grading of pressure sores in patients in all hospitals in Iceland (22 hospitals). The pressure sore prevalence was 8.9% (n = 57 patients), 7.12% for women (n = 26) and 11.2% for men (n = 31); the mean age for both sexes with pressure sores was 78.4 years. Grade I sores were most frequently identified and Grade IV the least. Eighty-five per cent of pressure sores were located below the waist. 'No dressings' and occlusive dressings were the treatment of choice for pressure sores. Results from this study are important for international comparisons.

Pressure sore survey Part 2: nurses' knowledge

This is the second of a three-part article which investigates the prevalence of pressure sores and nurses' knowledge and attitudes in one NHS trust. This study was designed to explore the assumption that lack of knowledge might be a contributory factor to pressure sore formation. A cross-section of trained and untrained staff over several areas of work in the acute and community settings were represented. Overall, the differences in awareness and opinions among staff were not indicative of major deficits in knowledge that could account for failure to prevent pressure sores. It is suggested that the problem may well be one of individual or organisational motivation.

Pressure sore survey. Part 2: Nurses' knowledge.

This is the second of a three-part article which investigates the prevalence of pressure sores and nurses' knowledge and attitudes in one NHS trust. This study was designed to explore the assumption that lack of knowledge might be a contributory factor to pressure sore formation. A cross-section of trained and untrained staff over several areas of work in the acute and community settings were represented. Overall, the differences in awareness and opinions among staff were not indicative of major deficits in knowledge that could account for failure to prevent pressure sores. It is suggested that the problem may well be one of individual or organisational motivation.