Pressure ulcer prevention

Ulcer history

By: Mölnlycke Health Care, December 8 2011Posted in: Pressure ulcer prevention

Pressure ulcers are not a new phenomenon. The first reports in literature dates back thousands of years. During recent decades the body of knowledge and research has been growing fast, leading to practice guidelines, risk assessment tools and preventative programmes. Learn more about pressure ulcers.



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Introduction to Pressure Ulcers

Mölnlycke Health Care recognises the challenges faced by healthcare practitioners in treating and preventing pressure ulcers (PU). The information contained within this pressure ulcer section is designed to help you develop your knowledge on pressure ulcers and also share with you some of the solutions that Molnlycke Health Care offer to help you treat and prevent pressure ulcers within your patient population.

A pressure ulcer may be defined as a “localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear.
A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors has yet to be elucidated”1

Pressure ulcers are not a new phenomenon – literature reports the presence dating back thousands of years however recent decades have seen growing body of knowledge and research leading to development of practice guidelines, risk assessment tools and preventative programmes. For example there has been a 960% increase in publications focusing on pressure ulcers between 1990-2008.2

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Extent of pressure ulcers

The sacrum is usually reported as the most common location for pressure ulcers in most care settings, the heel often reported as second most common location; recent trend data suggests that incidence of heel ulcers is rising. More recently an emerging topic has been that of medical device related pressure ulcers with one report3 stating that:

  • 1.4% patients had a Medical Device Related (MDR) PU
  • Out of 113 PU’s 39 (34.5%) were MDR
  • Patients with medical devices were 2.4 times more likely to develop a PU

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Pressure Ulcer occurrence

Pressure Ulcer occurrence is usually measured in one of two methods4,5

  • Prevalence- most commonly used method; may be regarded as the number of a given population with a specific condition at a specific point in time. Note this means that it would include patients with a pressure ulcers on admission and those who have acquired one since admission
  • Incidence – may be regarded as the number of new cases of a specific condition over a given period of time. A more complex methodology, time period usually measured in terms of weeks or months
  • The two terms are often used in an incorrect manner – as they have very different meanings it is important that they are correctly applied
  • Health care acquired – this refers to pressure ulcers that occur after admission to the specific health care environment. This may be a more relevant measure if assessing impact of prevention programmes



Pressure ulcer prevalence varies according to country and is often reported to be higher in specific specialties such as critical care or elderly care.

Pressure Ulcer Prevalence

  • 5 European countries
    including 5947 patients6
    – 18.1% prevalence
  • USA: 651 facilities including
    85838 patients7
    – 14.8% prevalence
  • Canada: national prevalence8
    – 26%
  • Australia: various published reports9
    – 4.5- 27%
  • China – survey of 2913 patients10
    – 1.8% prevalence
  • South Korea11
    – .44-.49% acute care incidence
    – 47.4% home care
    – 21.7-45.5% ICU

References

  1. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009
  2. Bibliometric Analysis of Pressure Ulcer research. JWOCN; 37(6); 627-632; Hong-Lin Chen et al; 2010
  3. Medical Device related pressure ulcers in hospitalised patients. International Wound Journal; 7(5); 358-365; Black J M et al; 2010
  4. WOCN Society. Professional Practice Manual 3rd Edition, Appendix D Prevalence and Incidence: A Toolkit for Clinicians, Mt. Laurel NJ; 2005 3. Dressing related pain in patients with chronic wounds: an international patient perspective. Price P et al. International Wound Journal; 2008
  5. International Guidelines: Pressure ulcer prevention: prevalence and incidence in context. A consensus document. London: MEP Ltd, 2009
  6. Pressure Ulcer Prevalence Monitoring Project: Summary report on the Prevalence of Pressure Ulcers. EPUAP Review; Volume 4, Issue 2, 2002
  7. Results of nine international pressure ulcer surveys: 1989-2005. Ostomy Wound Management; 54(2). Vangilder C et al; 2008
  8. Prevalence of pressure ulcers in Canadian healthcare settings. Ostomy/Wound Management. 50(10):22-38. Woodbury MG, Houghton PE; 2004
  9. Prentice JL, Stacey MC. Pressure ulcers: the case for improving prevention and management in Australian health care settings. Primary Intention 2001; 9: 111-12027
  10. A Cross-sectional Descriptive Study of Pressure Ulcer Prevalence in a Teaching Hospital in China Zhao G, Ostomy Wound Manage. 2010 Feb;56(2):38-42
  11. Factors affecting healing of Pressure ulcers in Korean Acute Hospital. Sung Y.H et al. WOCN January 2011
  12. Description of pressure ulcers pain at rest and at dressing change. Szor JK. JWOCN. 26(3):115–120; 1999
  13. Pressure ulcer pain suffering; issues in a multi centre pain prevalence, Nixon J et al. Oral presentation at EPUAP Annual Conference, Birmingham, UK. 2010
  14. Reaching for the moon: achieving zero pressure ulcer prevalence. J Wound Care 18(4): 137–44 Bales I, Padwojski A ;2009
  15. The cost of pressure ulcers in the UK: Age and Ageing; 33: 230–235; Bennett G et al; 2004
  16. Legal Issues in the Care of Pressure Ulcer Patients: Ket Concepts for Healthcare Providers – A Consensus Paper from the International Expert Wound Care Advisory Panel. 23(11):493-507, November; Fife C et al; 2010
  17. Centers for Medicare & Medicaid Services. Proposed Fiscal Year 2009 Payment, Policy Changes for Inpatient Stays in General Acute Care Hospitals. Available at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3045&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500. Accessed May 13, 2008.
  18. Centers for Medicare & Medicaid Services. Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Proposed Collection of Information Regarding Financial Relationships Between Hospitals and Physicians; Proposed Rule. Federal Register. 2008;73(84):23550. Available at: http://edocket.access.gpo.gov/2008/pdf/08-1135.pdf
  19. Hospitalisation related to pressure ulcers among adults 18 years and over. Agency for Healthcare Research and Quality; Statistical Brief #64. 2006
  20. Interprofessional Management of Complex Continuing Care Patient Admitted with 18 Pressure Ulcers. Baker T et al. Ostomy Wound Management; Feb 2011
  21. Pressure Ulcer Classification; Differentiation between pressure ulcers and moisture lesions. EPUAP Review 6(3); Defloor T., et al ;2005
  22. Wound Dressing Shear Test Method (Bench) Providing Results Equivalent to Humans.Bill B et al. Poster Presentation at the EPUAP Congress, Oporto, 2011
  23. Wound Dressings, Measuring the Microclimate They Create, Call E. Oral Presentationat the EPUAP Congress, Oporto, 2011
  24. Dressings can prevent pressure ulcers :fact or fallacy? The problem of pressure ulcer prevention. Wounds UK;5(4) pg 61-64; Butcher M et al; 2009
  25. Journal of Wound, Ostomy and Continence Nursing: May/June 2007 - Volume 34 - Issue 3S - p S67 doi: 10.1097/01.WON.0000271036.00057.f8 Scientific and Clinical Abstracts From the 39th Annual Wound, Ostomy and Continence Nurses Annual Conference, Salt Lake City, Utah, June 9-13, 2007:Research Abstracts: Wound-Evidence-Based Interventions
  26. Shear A contributory factor in pressure ulceration. A presentation aimed at clinicians and associated professional. www.npuap.org; accessed 14/12/09
  27. Temperature-modulated pressure ulcers: a porcine model. Arch Phys Med Rehabil. 76(7):666-73; Kokate J.Y et al; 1995
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