Risk Factors For Pressure Ulcers Research Articles

Nosocomial Pressure Ulcer Risk Factors in a Relatively Young Adult Population

Background: Pressure ulcers are considered to be a major health problem both in acute and community settings. Numerous studies have explored risk factors related to the development of pressure ulcers but not in a relatively younger population as in Jordan. Aim: The study explores risk factors associated with the development of hospital-acquired pressure ulcers. Design: A cross-sectional multicenter study was conducted. Setting and Sample: All patients matching the study selection criteria were recruited conveniently from three hospitals in Jordan. Statistical Analysis: Descriptive and univariate analysis was performed on the study variables. Multivariate analysis using a special algorithm (‘‘purposeful selection’’) was employed to explore the independent association between a number of risk factors and pressure ulcers. Results: Results from multivariate analysis showed that age, moisture, decreased mobility, presence of three chronic diseases or more, and hypoalbuminemia were independently associated with the development of pressure ulcers when the effect of all other variables in the study was statistically controlled for using logistic regression. Conclusion: This study is the first of its kind that was conducted in Jordan. Results from current work support the findings of previous studies showing that certain risk factors are associated with pressure ulcers. However, the current work also found pressure ulcers to be associated with a younger age (the age cohort above 40 years) than has been reported.

Characterization and risk factors for pressure ulcers in the hospitalized elderly

This study aimed to identify the socio-demographic and clinical characteristics; obtain the risk factors for pressure ulcers identified in hospitalized senior citizens. This is a prospective, descriptive, and quantitative study. The sample consisted of 215 hospitalized elderly people in a public hospital in Teresina, PI, Brazil, in orthopedic, neurological, medical, and surgical clinics, and Intensive Care Units from November/2012 to February/2013. Data collection happened through interviews, physical examinations, and medical records. The average age was 71.8 years old, most patients were female (55.3%), with low education, and married. The majority were taken into orthopedics (42.3%). For the length of hospital stay, the average was of 12.4 days. The most prevalent risk factors were hypertension, use of analgesics, antihypertensives, and anticoagulants. Eighty-seven senior citizens (40.5%) presented low risk. One highlights the importance of nursing care in the prevention and assessment of risk for pressure ulcers in order to reduce its incidence in hospitals.

Nutrition care-related practices and factors affecting nutritional intakes in hospital patients at risk of pressure ulcers.

Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group. The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses. Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed <50% of food provided at main meals. Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers.

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

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

Risk factors of pressure ulcers among traumatized patients

Abstract Critically ill patients are at a higher risk for pressure ulcers than patients in general care unites. Several factors increase the risk: severity of illness; increased length of stay; poor tissue perfusion due to hemodynamic instability, use of vasoactive medications, anemia; sensory impairment, skin maceration due to moisture; immobility; and poor nutritional status. Aim: the aim of this study is to assess the risk factors of pressure ulcers among traumatized patients. Design: descriptive research design was used to conduct this research. Setting: this study was carried out at Trauma ICU at Assiut University Hospitals. Subjects: sampleof this studyincluded 60 adult patients. Tools: two tools were used for data collection in this study. Results: The main results revealed that most of study sample aged between 41- 60 years old, and there was a significant difference between the age groups. Results also indicated a significant difference between the studied samples in relation to the different risk factors. There was a significance difference in the studied patients in relation to the temperature. As regard the Braden scale assessment, it was found a significance difference between the studied patients in relation to the sub items of the scale. Conclusion: proper assessment of the patients for pressure ulcer risk factors is very important for prevention.

Predictors of pressure ulcer development in patients with vascular disease

Although pressure ulcer (PU) risk factors are well known in the general population, little research is available in hospitalized surgical patients admitted with vascular diseases. Using a retrospective medical records review, characteristics of hospitalized surgical patients with vascular diseases were assessed. Variables were based on literature review of PUs and availability of medical records and administrative data. Trained registered nurses collected data. Analyses included descriptive and comparative statistics, and multivariable modeling was used to determine predictors of PU. In 849 adult admissions, 18.9% had a PU; 11.8% were hospital-acquired PU (HAPU). Patients were more likely to be elderly, male (n=575; 67.7%), and Caucasian (n=704; 83.3%). Common diagnoses were aneurysms/embolisms (43.2%) and atherosclerosis (31.2%). Patients with HAPU were more likely to be discharged to a skilled nursing or other facility compared with home (P<.001). In univariate analyses, 12 patient characteristics were associated with HAPU presence: Female gender, non-married status, current smoker, non-Caucasian race, non-intensive care unit (ICU) stay, primary diagnosis of atherosclerosis, higher analgesic use, higher right ankle brachial index (ABI), lower Braden score, higher blood urea nitrogen (BUN) higher serum creatinine and higher total protein levels. In multivariate analyses, nine factors predicted HAPU: Lower right ABI and Braden score, an ICU stay, low and high hematocrit values, female gender, non-White race, atherosclerosis history, and higher BUN and body mass index (BMI). The concordance index for the nine-item model was 0.854. The rate of HAPU in hospitalized surgical patients with vascular diseases was greater than expected. Assessment of important HAPU factors and implementation of interventions are needed to decrease risk and improve clinical outcomes.

Exploring Pressure Ulcer Care in Jordan

Background A number of studies have been conducted on pressure ulcer (PU) risk assessment and prevention, and several sets of prevention guidelines have been produced. However, in Jordan, where no such research has previously been carried out, there appears to be a gap between nurses’ knowledge and practice in this area, which needs to be addressed. Aim The purpose of this study was to explore Jordanian nurses’ knowledge of PU risk factors and preventive modalities. In addition, their current reported preventive practice was investigated. Methods A cross-sectional study was carried out in three hospitals in Jordan. The registered and associate nurses working at these sites were requested to complete a self-administered questionnaire. Results The nurses’ knowledge of PU risk factors was good. Although there was a high level of agreement regarding the preventive methods judged as “always useful”, there was a lesser degree of agreement regarding those which should be used only in individual cases and those which should not be used. A significant number of nurses were unaware that some outdated methods such as “massage” were no longer used. Nurses applied such methods without enough prior knowledge about their usefulness. Conclusions Findings from this study suggest that the knowledge and practice of PU prevention among Jordanian nurses needs to be improved, particularly since some methods that are acknowledged to be harmful were still found to be in use. It is recommended that national PU prevention guidelines are adopted in Jordan, especially since nurses seem to rely on past practices that are not evidence based.

Incidence and Predicted Risk Factors of Pressure Ulcers in Surgical Patients: Experience at a Medical Center in Taipei, Taiwan

Purpose. To explore the context of incidence of and associated risk factors for pressure ulcers amongst the population of surgical patients. Methods. The initial study cohort was conducted with a total of 297 patients admitted to a teaching hospital for a surgical operation from November 14th to 27th 2006 in Taipei, Taiwan. The Braden scale, pressure ulcers record sheet, and perioperative patient outcomes free from signs and symptoms of injury related to positioning and related nursing interventions and activities were collected. Results. The incidence of immediate and thirty-minute-later pressure ulcers is 9.8% (29/297) and 5.1% (15/297), respectively. Using logistic regression model, the statistically significantly associated risk factors related to immediate and thirty-minute-later pressure ulcers include operation age, type of anesthesia, type of operation position, type of surgery, admission Braden score, and number of nursing intervention after adjustment for confounding factors. Conclusion. Admission Braden score and number of nursing intervention are well-established protected factors for the development of pressure ulcers. Our study shows that older operation age, type of anesthesia, type of operation position, and type of surgery are also associated with the development of pressure ulcers.

Pressure ulcer risk factors: There is no higher priority than prevention

Pressure ulcers, or PRUs, have affected humans for ages, and addressing the overall management of pressure ulcers is now a prominent national healthcare issue. Despite current interest and advances in medicine, surgery, nursing care, and self-care education, pressure ulcers remain a major cause of morbidity and mortality. This is particularly true for persons with impaired sensation, prolonged immobility, or advanced age. Research in the area of pressure ulcers, specifically in characterization, prevention, and treatment of pressure ulcers, is important in preventing secondary complications in persons with disabilities. As the standards of acute, post traumatic, and rehabilitation care improve, the population of persons with lifelong functional impairments continues to grow. Consequently, the prevention of secondary complications has become an increasingly prominent concern.

Pressure ulcer risk factors: There is no higher priority than prevention

Pressure ulcer risk factors: There is no higher priority than prevention

The study of risk factors of pressure sore for elective orthopedic surgery patients

Objectives：The purposes of the study were to investigate the incidence of pressure ulcer of orthopedics patients undergoing selective operation, and to identify the risk factors of pressure ulcer.Methods: A prospective cohort study was employed in this study. Data were collected concerning the general characteristics as well as preoperative, intraoperative and postoperative indicators probable to induce pressure ulcer and then analyzed in view of the risk factors of pressure ulcer. Results: (1) Pressure ulcers developed in thirty five patients (10.1%) on day 0 and the first 3 days following surgery; (2) age, hemoglobin, lymphocyte and getting up late for the first time after surgery were significantly associated with the occurrence of pressure ulcers (odds ratio 1.068, 0.948, 0.293, 1.019, respectively).Conclusions: (1) Patients have higher risk of developing pressure ulcer after operation, the critical period beginning from the operation day to the 3rd day after operation. (2) The age older, the later getting up for the first time after surgery, the liable it is for the patients to develop pressure ulcer postoperatively.

Perioperative corticosteroids administration as a risk factor for pressure ulcers in cardiovascular surgical patients: a retrospective study

The aim of this study was to investigate the relationship between perioperative corticosteroids administration and the incidence of pressure ulcers (PUs) in cardiovascular surgical patients. A retrospective analysis was performed on data from consecutive patients who had cardiac surgery in 2012. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between perioperative corticosteroid administration and the incidence of surgery-related PU (SRPU). A total of 286 cardiac surgery patients were included in this study; of these, 47 patients developed 57 SRPUs, an incidence of 16·4% [95% confidence interval (CI): 12·3-21·2%). The SRPU incidence was significantly higher in corticosteroid-administered group compared with groups not receiving corticosteroids (43·8% versus 14·8%, Pearson's χ(2) = 9·209, P = 0·002). The crude odds ratio (OR) was 4·472 (95% CI: 1·576-12·694). After performing multivariate logistic regression analysis, the adjusted OR was 2·808 (95% CI: 1·062-11·769). This result showed that perioperative corticosteroid administration was an independent risk factor for PUs in cardiovascular surgical patients. Therefore, it is recommended that in order to prevent PU perioperative corticosteroids should be administered with caution to cardiovascular surgical patients.

Nutritional intakes of patients at risk of pressure ulcers in the clinical setting

ObjectiveMalnutrition is a risk factor for pressure ulcers. The aim of this study was to describe the energy and protein intakes of hospitalized patients at risk for pressure ulcers and to identify predictors of eating inadequately. MethodsAn observational study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients with restricted mobility were observed for 24 h, and information such as oral intake and observed nutritional practices was collected. A chart audit gathered other demographic characteristics, clinical, anthropometric, and dietary information. t Tests or one-way analysis of variances were used to identify differences in total energy and protein intakes. Univariate and multivariate regression analyses were conducted to determine predictors of eating inadequately (i.e., intake of <75% of estimated energy and protein requirements). ResultsMean energy and protein intakes of the 184 patients were 5917 ± 2956 kJ and 54 ± 28 g, respectively. Estimated energy and protein requirements were calculated for 93 patients. Only 45% (n = 42) and 53% (n = 49) met ≥75% of estimated energy and protein requirements, respectively. In multivariate analysis, patients on the renal ward were 4.1 and 4.6 times more likely to be eating inadequately for energy and protein, respectively (P < 0.05). Patients who consumed any amount of oral nutrition support were 5.1 and 15.5 times more likely be eating adequately for energy and protein, respectively (P < 0.05). ConclusionsRenal patients are more likely to be eating inadequately, although any consumption of oral nutrition support seems to increase likelihood of eating adequately.

Challenges in pressure ulcer prevention

Although this article is a stand-alone article, it sets the scene for later articles in this issue. Pressure ulcers are considered to be a largely preventable problem, and yet despite extensive training and the expenditure of a large amount of resources, they persist. This article reviews the current understanding of pressure ulcer aetiology: pressure, shear and microclimate. Individual risk factors for pressure ulceration also need to be understood in order to determine the level of risk of an individual. Such an assessment is essential to determine appropriate prevention strategies. The main prevention strategies in terms of reducing pressure and shear and managing microclimate are studied in this article. The problem of pressure ulceration related to medical devices is also considered as most of the standard prevention strategies are not effective in preventing this type of damage. Finally, the possibility of using dressings as an additional preventive strategy is raised along with the question: is there enough evidence to support their use?

Pressure ulcers in the adult intensive care unit: a literature review of patient risk factors and risk assessment scales

Background : Critically ill patients are at high risk for pressure ulcer (PrU) development due to their high acuity and the invasive nature of the multiple interventions and therapies they receive. With reported incidence rates of PrU development in the adult critical care population as high as 56%, the identification of patients at high risk of PrU development is essential. This paper will explore the association between PrU development and risk factors. It will also explore PrU development and the use of risk assessment scales for critically ill patients in adult intensive care units. Method : A literature search from 2000 to 2012 using the CINHAL, Cochrane Library, EBSCOHost, Medline (via EBSCOHost), PubMed, ProQuest and Google Scholar databases was conducted. Key words used were: pressure ulcer/s; pressure sore/s; decubitus ulcer/s; bed sore/s; critical care; intensive care; critical illness; prevalence; incidence; prevention; management; risk factor; risk assessment scale. Results : Nineteen articles were included in this review; eight studies addressing PrU risk factors, eight studies addressing risk assessment scales and three studies overlapping both. Results from the studies reviewed identified 28 intrinsic and extrinsic risk factors which may lead to PrU development. Development of a risk factor prediction model in this patient population, although beneficial, appears problematic due to many issues such as diverse diagnoses and subsequent patient needs. Additionally, several risk assessment instruments have been developed for early screening of patients at higher risk of developing PrU in the ICU. No existing risk assessment scales are valid for identification high risk critically ill patient, with the majority of scales potentially over-predicting patients at risk for PrU development. Conclusion: Research studies to inform the risk factors for potential pressure ulcer development are inconsistent. Additionally, there is no consistent or clear evidence which demonstrates any scale to better or more effective than another when used to identify the patients at risk for PrU development. Furthermore robust research is needed to identify the risk factors and develop valid scales for measuring the risk of PrU development in ICU.

Intraoperative Positioning of Patients Under General Anesthesia and the Risk of Postoperative Pain and Pressure Ulcers

Intraoperative positioning is a crucial component of perianesthesia care and can lead to postoperative complications. Therefore, this study explored risk factors for postoperative positioning pain and pressure ulcers that were associated with supine positioning in patients undergoing general anesthesia. In this prospective cross sectional exploratory study, 86 ASA I-II, normal BMI patients undergoing elective surgery in the supine position from February to May 2009 were included. Seven different risk factors were examined to detect possible associations between intraoperative positioning and the development of postoperative positioning pain or pressure ulcers. Only one variable was found to be a significant risk factor for postoperative positioning pain, preoperative pain (P = .017) with an odds ratio of 13.1 (95% CI 1.4-23.9). There were no associations found between positioning pain or pressure ulcers and gender, age, duration of surgery, surface of the operation room bed, and number of monitoring devices. Four patients suffered from pain in their heels; of these, two had bilateral Grade I pressure ulcers. Five patients suffered from arm pain and three patients from neck and back pain. In conclusion, the risk for positioning pain seems to be greater in patients suffering from preoperative pain. Routine documentation and follow-up of a patient's preoperative pain, intraoperative positioning and overall postoperative pain experience are emphasized.

Microclimate and development of pressure ulcers and superficial skin changes

This study aims to evaluate the microclimate and development of pressure ulcers and superficial skin changes. A prospective cohort study was conducted in an acute care ward in Indonesia. Risk factors for pressure ulcers and superficial skin changes were identified based on the Bergstrom Braden conceptual model. Microclimate data were collected every 3 days for 15 days while the development of pressure ulcers and superficial skin changes was observed every day. Pressure ulcers and superficial skin changes were developed in 20 of the 71 participants. Total mean difference in skin temperature was higher for patients with pressure ulcers and superficial skin changes (0·9 ± 0·6°C) compared with controls (0·6 ± 0·8°C) (P = 0·071). Binary logistic regression predictor values for pressure ulcers and superficial skin changes were 0·111 for type of sheet and 0·347 for Braden Scale results. In conclusion, difference in skin temperature seems to be a predictor for pressure ulcer development and superficial skin changes, while synthetic fibre sheets are able to maintain a beneficial microclimate.

Quantification of Patient Migration in Bed

The study objective was to quantify the movement of hospital bed occupants relative to the bed in typical bed articulations. Movement of a patient in bed results in two common adverse events: (a) increase in shear and friction forces between the patient and bed, which are extrinsic pressure ulcer risk factors, and (b) musculoskeletal injuries to nurses, resulting from repositioning patients who have migrated down in bed. The study involved 12 participants who lay supine in three hospital beds, which were articulated to common positions. Body movement relative to the bed was quantified with the use of motion capture. Cumulative movement, net displacement, and torso compression (shoulder to trochanter distance) were calculated for different bed types and bed movements. Bed design and bed movement had a significant effect on most of the dependent variables. Bed design (e.g., type) influenced cumulative movement by up to 115%, net displacement by up to 70%, and torso compression by about 20%. Bed movement (e.g., knee elevation) reduced cumulative migration by up to 35%. The quantification of patient migration provides a metric for evaluating the interaction between body and bed surfaces. Overall, the measures were sensitive to design changes in bed frames, bed articulations, and mattress inflation. Documentation of the cumulative movement, net displacement, and torso compression provides hospital bed designers quantifiable measures for reducing migration and potentially shear and friction forces when designing bed frames, bed articulations, and mattresses. Optimization of these metrics may ultimately have an impact on patient and caregiver health.

Nutrition and skin ulcers

Skin ulcerations cause significant morbidity and mortality, while driving up healthcare utilization and costs. Interventions to prevent ulcers and improve wound healing times are needed to reduce the burden on patients and healthcare systems. It has been well established that weight loss, protein-calorie malnutrition, and dehydration are risk factors for pressure ulcers. Many nutritional interventions have been studied, with studies being of variable quality and producing mixed results. This review aims to clarify the current evidence and highlights the recent advances in the area of nutrition for the prevention and management of skin ulceration. Markers for assessing nutritional status will be reviewed first, followed by a discussion on the theoretical benefit of various nutritional interventions on wound healing. Recommendations for nutrient repletion are also included. Finally, the most recent or important literature will be highlighted and the risks and benefits of supplementation are debated. There is mixed evidence for most nutritional interventions, with most studies being of poor quality with variable study designs, lack of control groups, small sample sizes, and short study lengths. Long-term randomized trials of individual nutrients and clinically relevant endpoints are needed to definitively show the benefit of additional nutritional supplementation over dietary interventions. Until those studies become available, best evidence suggests the importance of screening for malnutrition, calculating resting energy expenditure and caloric needs, and monitoring dietary intake of essential nutrients.

Investigate on pressure ulcer risk factors of orthopedic patients

Objective To discuss the risk factors for pressure ulcer of orthopedic patients and provide reference for prevention and treatment of pressure ulcer.Methods Risk factors for pressure ulcer of 201 orthopedic patients were evaluated by using logistic regression and BP neural network respectively,with Braden rating scale as evaluation standards.Results There was no significant difference of Braden rating among patients of different levels of consciousness,different surgical situations,diabetes or not and different plaster immobilizations (P ＞ 0.05).There were significant differences of Braden rating among patients of different ages,nutritional status,traction situations,surgical outcomes,smoking habits,hemiplegic paralysis,paraplegia,serum albumin,fecal incontinence,urinary incontinence,external fixation,and anti-spin shoes (x2 =21.82,13.32,39.53,8.08,6.97,14.25,31.82,23.26,5.83,15.46,27.76,9.40,respectively ; P ＜0.05).Logistic regression analysis showed that the total correct rate of discrimination of the Braden classifications was 86.1％ (x2 =133.3t,P ＜0.01),while BP neural network' s total correct rate was 90％ (x2 =155.67,P ＜0.01).Conclusions Logistic regression analysis combined with BP neural network shows,age,hemiplegia,external fixation and bone traction have a linear relationship with the logarithm advantage of the Braden classifications and the others have a non-linear relationship. Key words: Risk factor; Pressure ulcer; Logistic regression; BP neural network; Braden rating scale