Pressure Ulcer Prevention Research Articles

Barriers and facilitators to pressure ulcer prevention behaviours by older people living in their own homes and their lay carers: a qualitative study

ObjectiveTo identify barriers and facilitators to pressure ulcer prevention behaviours in community-dwelling older people and their lay carers.DesignTheoretically informed qualitative interviews with two-phase, deductive then inductive, thematic analysis.SettingThe study was...

Effects of predictive nursing interventions on pressure ulcer in older bedridden patients: A meta-analysis.

To evaluate the effect of predictive nursing interventions on pressure ulcers in elderly bedridden patients by meta-analysis. Applied computer searches of PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials (RCTs) on the effect of predictive nursing in preventing pressure ulcers in elderly bedridden patients from the database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on inclusion and exclusion criteria. Stata 17.0 software was utilised for data analysis. Eighteen RCTs involving 6504 patients were finally included. The analysis revealed the implementation of predictive nursing interventions had a significant advantage in reducing the incidence of pressure ulcers in elderly bedridden patients compared with conventional nursing (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.15-0.28, p < 0.001), while the patients' satisfaction with nursing care was higher (OR = 3.70, 95% CI: 2.99-4.57, p < 0.001). This study shows that the implementation of a predictive nursing interventions for elderly bedridden patients can effectively reduce the occurrence of pressure ulcers and significantly improve patients' satisfaction with nursing care, which is worthy of clinical promotion and application.

Aetiology, risk factors and treatment of typical and atypical pressure ulcers in patients with traumatic brain injury: A narrative review.

Pressure ulcers are one of the leading complications in bedridden patients that result in multiple burdens on healthcare systems and patients (11 billion dollars/year). The prevalence of pressure ulcers in traumatic brain injury patients is 1.5-fold compared with the other bedridden patients. Moreover, critical traumatic brain injury patients who are admitted to the intensive care unit experience severe pressure ulcers and further complications. The motor/sensory disabilities and low supplementation and oxygenation to the pressured side were the main mechanisms of the typical pressure ulcers. Intellectual evaluation is the first essential step to prevent the development of pressure ulcers in high-risk patients. Till now, different scales, including Injury Scale Score and Braden Scale Score, have been provided to assess the pressure ulcer. Since low stages of pressure ulcers heal rapidly, traumatic brain injury patients require a periodical assessment to prevent further developments timely. Alongside different procedures provided to prevent and treat any pressure ulcer, traumatic brain injury patients required additional specific protections. For the first line, fast and efficient rehabilitation repairs motor/sensory disabilities and decreases the chance of pressure ulcer. Our review indicated that pressure ulcer in traumatic brain injury had several complex mechanisms that demand special care. Therefore, further studies are required to address these mechanisms and prevent their progression to typical and atypical pressure ulcers.

Modeling and comfort analysis of arrayed air cushion mattress for pressure ulcer prevention and assisted repositioning

Assisting immobile individuals with regular repositioning to adjust pressure distribution on key prominences such as the back and buttocks is the most effective measure for preventing pressure ulcers. However, compared to active self-repositioning, passive assisted repositioning results in distinct variations in force distribution on different body parts. This incongruity can affect the comfort of repositioning and potentially lead to a risk of secondary injury, for certain trauma or critically ill patients. Therefore, it is of considerable practical importance to study the passive turning comfort and the optimal turning strategy. Initially, in this study, the load-bearing characteristics of various joints during passive repositioning were examined, and a wedge-shaped airbag configuration was proposed. The airbags coupled layout on the mattress was equivalently represented as a spring-damping system, with essential model parameters determined using experimental techniques. Subsequently, different assisted repositioning strategies were devised by adjusting force application positions and sequences. A human-mattress force-coupled simulation model was developed based on rigid human body structure and equivalent flexible springs. This model provided the force distribution across the primary pressure points on the human body. Finally, assisted repositioning experiments were conducted with 15 participants. The passive repositioning effectiveness and pressure redistribution was validated based on the simulation results, experimental data, and questionnaire responses. Furthermore, the mechanical factors influencing comfort during passive assisted repositioning were elucidated, providing a theoretical foundation for subsequent mattress design and optimization of repositioning strategies.

Pressure ulcer point prevalence, classification, locations, and preventive measures: Insights from a Norwegian nursing home survey.

To report data from a point pressure ulcer (PU) prevalence survey on prevalence, PU categories, locations and preventive interventions at one Norwegian nursing home. A cross-sectional research design was used. One nursing home in Norway participated in the prevalence survey in 2020. The data were collected on one selected day. A total of 74 out of 88 residents (84.1%) participated. Descriptive statistical analyses were run. The overall prevalence of PUs was 27% amongst all participants in the nursing home, who together had a total of 57 PUs categorised as category I-III. One major finding was that the most common site of the PUs was on the residents' toes. Interestingly, the prevalence of PUs in the residents' sacrum was considerably low. The most frequently used PU preventive interventions were foam chair cushions, nutritional supplements and pressure-reducing heel protection. This study identified a high prevalence of PUs, predominantly on residents' toes. Although preventive strategies were implemented, their application appeared limited. Implementing obligatory care packages and annual nationwide PU surveys might be worth considering in municipalities.

Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay.

Hospital-acquired pressure ulcers are an important indicator of the quality of care. Most pressure ulcers are avoidable with a robust protocol for prevention, but prevention activities often have a low priority for senior management because the true costs to the hospital are not visible. Our aim was to raise awareness of the value of pressure ulcer prevention by estimating the excess length of inpatient stay associated with hospital-acquired pressure ulcers, and by assessing whether additional costs are covered by increased reimbursement. National activity data for hospitals in Germany are available through the InEK Data Browser. Data were extracted covering discharges from German hospitals between January 1 and December 31, 2021. Cases were selected according to the presence of a pressure ulcer diagnosis using ICD-10-GM codes L89.0-L89.3. Information was extracted for the ten most common German Diagnosis-Related Group (G-DRG) codes in patients with a secondary pressure ulcer diagnosis on mean length of stay and average reimbursement. Ulcer-associated excess length of stay was estimated by comparing cases within the same G-DRG with and without a pressure ulcer diagnosis. Mean length of stay was higher in patients with a pressure ulcer than in patients with no ulcer by between 1.9 (all ages) and 2.4 days (patients aged ≥65) per case. In patients aged ≥65 years, 22.1% of cases with a pressure ulcer had a length of stay above the norm for the DRG. In the German system length of stay above the norm is not normally reimbursed. Excess length of stay between 1.9 and 2.4 days leads to a potential cost to a hospital of between 1,633€ and 2,074€ per case. Hospital-acquired pressure ulcers represent an important source of cost for a hospital which highlights the potential value of effective prevention.

Nutritional interventions for preventing and treating pressure ulcers.

Nutritional interventions for preventing and treating pressure ulcers.

Integrated Machine Learning Approach for the Early Prediction of Pressure Ulcers in Spinal Cord Injury Patients.

(1) Background: Pressure ulcers (PUs) substantially impact the quality of life of spinal cord injury (SCI) patients and require prompt intervention. This study used machine learning (ML) techniques to develop advanced predictive models for the occurrence of PUs in patients with SCI. (2) Methods: By analyzing the medical records of 539 patients with SCI, we observed a 35% incidence of PUs during hospitalization. Our analysis included 139 variables, including baseline characteristics, neurological status (International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI]), functional ability (Korean version of the Modified Barthel Index [K-MBI] and Functional Independence Measure [FIM]), and laboratory data. We used a variety of ML methods-a graph neural network (GNN), a deep neural network (DNN), a linear support vector machine (SVM_linear), a support vector machine with radial basis function kernel (SVM_RBF), K-nearest neighbors (KNN), a random forest (RF), and logistic regression (LR)-focusing on an integrative analysis of laboratory, neurological, and functional data. (3) Results: The SVM_linear algorithm using these composite data showed superior predictive ability (area under the receiver operating characteristic curve (AUC) = 0.904, accuracy = 0.944), as demonstrated by a 5-fold cross-validation. The critical discriminators of PU development were identified based on limb functional status and laboratory markers of inflammation. External validation highlighted the challenges of model generalization and provided a direction for future research. (4) Conclusions: Our study highlights the importance of a comprehensive, multidimensional data approach for the effective prediction of PUs in patients with SCI, especially in the acute and subacute phases. The proposed ML models show potential for the early detection and prevention of PUs, thus contributing substantially to improving patient care in clinical settings.

Effect of the "aSSKINg" Model in Reducing Pressure Ulcer Risk: A Comparative Study Using the Braden Risk Assessment Score.

Pressure ulcer is considered a common and costly problem in the care of patients. Prevention and management of pressure ulcer are very important due to the high cost of treatment and the adverse consequences of pressure ulcer. This study aimed to evaluate the effect of implementing "aSSKINg" model in reducing pressure ulcer risk. This study used a before- and after-intervention quasi-experimental design. This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. The data collection tool was a 3-part sheet (Braden scale, skin health assessment, and Pressure ulcer assessment). The incidence of pressure ulcer was 19 (60.0%) in the control group versus 9 (30.0%) in the study group with statistical significant differences. The most common site of pressure ulcer was coccyx (6 [31.6%]) in the control group and Heel (3 [33.3%]) in the study group. The application of "aSSKINg" model in the patients with pressure ulcers is effective in reducing the incidence and severity of pressure ulcers.

A budget impact analysis of a powered hybrid mattress to prevent pressure ulcers in the Austrian inpatient setting: An original research.

Pressure ulcer is a considerable health problem and is associated with an increased hospital length of stay (LOS), nursing effort, costs, and reduced quality of life. The aim of this analysis is to compare the economic, clinical, and nursing benefit after the implementation of the powered hybrid mattress Dyna-Form Mercury Advance SMARTcare® in 2019 with the situation in 2017 (rental systems Arjo BariAir® and Arjo TheraKair Visio®, and purchased foam mattresses Arjo Simuflex®) using a single center. In the framework of a budget impact analysis, a difference-in-difference approach was used to compare pre-implementation longitudinal data (2017) with post-implementation data (2019). The longitudinal data comprise the mattress resource use, patient characteristics, and LOS. The care effort was gathered based on a full survey of all 75 members of the nursing staff using the online tool "LimeSurvey." In this survey, the resource use of the different mattress systems was identified in terms of time (minutes or days). This analysis was performed from the hospital perspective and included direct costs of mattress systems, Austrian diagnostic-related group costs for the hospital stay and nursing staff costs for 2019. Based on 1253 patients "at-risk," the total yearly costs implementing the powered hybrid mattress amounts to 654,248€ compared with 901,469€ when using Arjo products. The budget impact shows a cost advantage of 247,221€. Furthermore, the powered hybrid mattress system leads to fewer nursing-staff time in minutes per year (-1,031,097 min [1,993,204 vs. 3,024,302]); 242€ are saved per patient. Compared with the Arjo products, fewer inpatient cases of pressure ulcers (-44 cases [0 vs. 44]) were documented. Despite the higher total outlay of costs associated with the powered hybrid mattress, the long-term savings potential showed a significant cost advantage per annum for the single center. Therefore, the use of the hybrid mattress leads to considerable economic, clinical, and nursing benefits.

Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis

BackgroundHospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region.MethodsThis study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064).ResultsA total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05).ConclusionThis systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.

Pressure ulcer prevention: family caregiver training effectiveness

ObjectiveTo determine the effectiveness of pressure ulcer prevention training for the relatives of palliative care inpatients.MethodsThis study had a pretest–post-test design with parallel groups and a randomised control group, and...

Development of a multifunctional nursing bed system for in-bed position recognition and automatic repositioning

Bedridden elderly need to be repositioned at regular intervals to prevent pressure ulcers. However, repositioning, being one of the most physically demanding tasks in nursing, faces many challenges, including work-related injuries and limited manpower. To address these problems, we have developed a multifunctional nursing bed system. This system not only assists in repositioning and transitioning positions but also features in-bed position recognition, enabling automatic repositioning based on recognition results. In this paper, the repositioning process was analysed, and the nursing bed mechanism and its control design were developed. An algorithmic framework for in-bed position recognition, including preprocessing and convolutional neural networks, is proposed. The experimental results demonstrate that the nursing bed system facilitates comfortable repositioning and position transition for subjects. In a short-term experiment, the system demonstrated an accuracy rate of 96.83% for in-bed position recognition. Meanwhile, in a long-term experiment, it achieved a success rate of 93.89% for automatic repositioning. These findings indicate that the proposed system demonstrates substantial potential in nursing care, particularly in pressure ulcer prevention.

Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis

BackgroundHospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region.MethodsThis study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064).ResultsA total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6–29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05).ConclusionThis systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.

Prevalence of methicillin-resistant Staphylococcus aureus in residents who died with pressure ulcers in residential aged care facilities

Background: As mobility in the elderly declines, dependence on care increases, and that care involves preventing pressure ulcers (PUs). PUs may become colonized with methicillin-resistant Staphylococcus aureus, causing cross-infection problems and leading to sepsis and death. Aims and Objectives: The aim of this paper was to examine the prevalence of methicillin-resistant S. aureus in residents with PUs and consider regulations. Materials and Methods: A retrospective review of 80 records of residents aged ≥65 years from eight residential aged care facilities (RACFs) in Australia was undertaken. Records were reviewed for sex, age at death, source of admission, Stage of PU, and colonization with methicillin-resistant S. aureus. Results: A third of residents, 34% (95% confidence interval [CI] 25%–44%, 27/80), had PUs in the last week of life. Of residents admitted from hospital 13% (95% CI 9%–32%, 7/40) had PUs. Most (63%, 95% CI 44–78%, 17/27) residents with a PU had been admitted from hospital, and most PUs (78%, 95% CI 59–89%, 21/27) were open wounds, stages 2–4. Half of all residents with a PU (48%, 95% CI 30–67%, 13/27) were colonized with methicillin-resistant S. aureus, and a third of residents with stages 2–4 PUs (31%, 95% CI 13–58%, 4/13) were colonized with methicillin-resistant S. aureus. Conclusion: Nearly half of all PUs were colonized with methicillin-resistant S. aureus, suggesting PUs may be a reservoir for methicillin-resistant S. aureus. Regulations that could reduce PUs in RACFs “an air mattress appropriate to each care recipient’s condition” are not being utilized. If PUs were prevented, reservoirs for methicillin-resistant S. aureus would be eradicated.

The impact of consistent pressure ulcer prevention practice on nursing staff's pressure ulcer prevention knowledge: A quasi-experimental intervention study

Nursing staff's pressure ulcer (PU) prevention knowledge in long-term older people care (LOPC) varies. In particular, more evidence is needed to improve the knowledge of nursing staff with a lower level of education with context-tailored interventions. The aim of this study was to evaluate the impact of intervention on nursing staff's PU prevention knowledge. The intervention, a consistent PU prevention practice for nursing staff based on international guidelines, was developed and implemented using the OMEBP model. The data were collected in two LOPC facilities from 253 registered and practical nurses using the Pressure Ulcer Prevention Knowledge test. In the intervention facility, knowledge improved in three PU prevention areas and in the total sum. Context-tailored PU prevention practice interventions focusing on nursing staff in LOPC facilities should be developed and these aspects should also be included in lower-level nursing staff's education.

Organizational development and management factors involved in the prevention and effective therapy of pressure ulcers: The results of the national survey conducted among Hungarian public hospitals.

The prevention of pressure ulcer (PU) or pressure injury (PI) wounds is of public health importance in developed countries, including Hungary. The study aimed to assess the PU/PI prevention and care practices of Hungarian public hospitals and identify organizational and management factors. In 2022, a national, questionnaire-based survey of inpatient institutions relevant to PU/PI care was conducted, providing a picture of the practices of 86 hospitals for the year 2019. The questionnaire was processed using descriptive statistics and regression analysis. The survey results show that good practices in Hungary are isolated, the reporting system is inhomogeneous, and documentation is not uniform across our institutional system. Of the 86 institutions, 71.0% operate a PU prevention team, 64.0% use prophylactic dressings, and 88.3% use an anti-decubitus mattress, with an average ratio of 26.1% to the number of beds. Less than half of the institutions reported the incidence of hospital acquired pressure injuries (HAPIs). In this sample, we found no significant association between hospital type and hospital size with the incidence of full-thickness HAPIs (stage III and IV wounds). Developing a comprehensive PU/PI reporting system and updating the national PU/PI prevention and care guidelines are essential in Hungary.

Pressure Injury Knowledge and Attitudes of Senior Nursing Students.

To describe the pressure injury (PI) knowledge and attitudes of senior nursing students (SNSs). This study used a descriptive and cross-sectional design. The study population consisted of SNSs involved in a nursing program in the Aegean region of Turkey. The authors collected data using a student information form, the Turkish version of the Attitude towards Pressure Ulcer Prevention instrument, and the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument. One hundred seventy SNSs were included; 50% had experience preventing PI, 14.1% had provided care to patients with PIs, and 21.2% had staged PIs. The SNSs' average PI prevention knowledge score was 13.06 ± 2.94 (50.3% correct), and only 20.5% (n = 35) of the SNSs answered questions at an acceptable proficiency level (60%). The mean Attitude towards Pressure Ulcer Prevention score of the SNSs was 39.38 ± 2.73 (75.7% correct). The results of the research indicated that the SNSs' knowledge about preventing PI was insufficient, although their attitudes toward PI prevention were positive. Because adequate training on PI is important for patient care, students' knowledge deficiencies regarding PIs should be identified and addressed.

Adoption of Information and Technology Communication in Ulcer Pressure Prevention: A Narrative Review

Patients who have immobilization and bedrest prone to have poor blood circulation to the area that contact the bed. This condition is triggering pressure ulcer that may impact on patients’ recovery process, burden, and conformity. In 4.0 industry, information, and communication technology (ICT) has implemented in many healthcare activities, including in the prevention of pressure ulcer. ICT provides a solution to prevent this unwanted condition in bedrest patients through many forms, but has not been mapped yet, especially for nursing. The purpose of this study is mainly to synthesize previous findings related to the adoption of ICT in pressure ulcer preventions. This study is a literature review which using several databases, namely Pubmed, Google Scholar, JMIR, IEEE, and Sage Journals. We used the PRISMA framework as a guideline to select the eligible articles that must be included to our study. We implemented Mixed Method Appraisal Tool to ensure the quality of articles in this review. Then, the data is synthesized and visualized in tabular. We gathered 2,081 articles from literature searching and obtained 12 eligible articles to be synthesized. Our Findings revealed that ICT adoption in ulcer pressure prevention was further than expected which the implementation of artificial intelligence (AI) was dominated in our findings. We also found that several technologies, such internet of things (IoT), were also implemented to send the patient’s data related to pressure ulcer periodically and provided the information for healthcare provider to formulate preventive interventions. Detection of pressure ulcer among patients may be done precisely by tomography technique in one study. Various ICT implementations in pressure ulcer prevention were promising to be adopted by healthcare providers, including nurses.

Nurses’ perceptions on barriers for implementing pressure ulcers preventive measures among critically ill patients at a tertiary teaching hospital, Tanzania

ObjectivesTo explore nurse’s perceptions on barriers for Implementing Pressure Ulcers Preventive Measures among critically ill patients. Research DesignAn exploratory qualitative study design was employed. In-depth interviews were conducted with 15 nurses to explore their perceptions on barriers for preventing pressure ulcers among critically ill patient. Qualitative thematic analysis approach was used to analyze data. Study settingsMedical high dependent unit, surgical high dependent unit, medical Intensive Care unit and surgical intensive care units at tertiary teaching hospital. FindingsSeven themes emerged that describes nurses’ perceptions on barriers for implementing pressure ulcers preventive measures among patients with critical illness. The themes are: Restrictions from therapeutic interventions and severity of patient condition; Shortage of staff and equipment for pressure ulcer prevention; Unbalanced shift staffing and competing need for patient care; health care providers’ incompetence and carelessness; Lack of guidelines on implementing best practice for pressure ulcer prevention; Lack of accountability measures for negligence; and Minimal management’s commitment for PUs prevention. ConclusionThis study reveals contextual based barriers for effective prevention of ppressure ulcers among critically ill patients. Nurses should be continuously empowered with competence for pressure ulcers prevention. This should go along with staffing and equipping critical care settings for pressure ulcers prevention. Managerial oversight is required for effective implementation of pressure ulcer preventive measures. This should include development of guidelines and policies, establishing accountability measures for negligence, malpractice as well as initiating clinical audit for reflective learning purpose.