The prevalence and incidence of pressure ulcers in hospitalised patients in the Netherlands: a prospective inception cohort study

BACKGROUND: Pressure ulcers frequently occur in hospitalised patients. The prevalence of pressure ulcers grade 2 or worse varies from 3% to 12% in hospitalised patients. Incidence figures are not frequently reported. While incidence and prevalence are both measures of disease frequency, they provide different perspectives on pressure ulcers. OBJECTIVES: To describe the incidence rate and prevalence of pressure ulcers in hospitalised patients. DESIGN: Prospective inception cohort study. SETTING: Two large hospitals, one general (530-beds) and one teaching (1042-beds), in The Netherlands. PARTICIPANTS: A non-selected, though not strictly random, sample of 1536 patients was eligible for inclusion in the study. One thousand four hundred and thirty one patients (93.2%) consented to participate. Eventually, 1229 patients (80%) had a complete follow-up. The sample consisted of patients admitted to the surgical, internal, neurological and geriatric wards for more than 5 days between January 1999 and June 2000. METHODS: Follow-up once a week until pressure ulcer occurrence, discharge or length of stay over 12 weeks. MAIN OUTCOME MEASURES: Occurrence of a pressure ulcer grade 2 or worse during admission to hospital, according to the classification of the European Pressure Ulcer Advisory Panel. RESULTS: One hundred and thirty four patients developed 172 pressure ulcers during follow-up. The overall weekly incidence rate was 0.06 per week (95% confidence interval 0.05-0.07 per week). Highest rates were observed for surgical patients and lowest for geriatric and neurologic patients (0.08 and 0.02, respectively). The week specific prevalence varied between 12.8% and 20.3%. CONCLUSIONS: Among patients hospitalised for more than 5 days overall one may expect 6% per week to develop pressure ulcers. It would appear that any preventive measures can only be effective if taken timely. Accordingly, preventive measures should be considered early, because pressure ulcers were observed already within the first week of admission.     

The prevalence of pressure ulcers in four paediatric institutions

Aim and objective. Pressure ulcers are a common nursing care issue in hospitals. They are associated with psychological and physical suffering, an increased morbidity and mortality rate and higher overall health care costs. The aim of the current study is to describe the frequency of pressure ulcers in a paediatric care setting and to identify the population at risk, as well as to assess the factors predisposing to the development of pressure ulcers. Design. A point prevalence study. Methods. The study was conducted in four paediatric hospitals in the German‐speaking part of Switzerland and included children from the age of 0–18 years. The method of data collection was a direct systematic inspection and assessment of the skin, taking into account the clinical condition of the patient for risk assessment. A valid risk assessment and data collection instrument was used and, each patient was assessed by a previously instructed rater pair. Results. Of all possible patients, 81% (n = 155) were included. An overall pressure ulcer prevalence of 27·7% (including grade 1) was registered. Thirty‐six patients (84%) had grade 1 ulcers, including many caused by external medical devices. Sixty‐five per cent (n = 100) of all patients were considered at risk (Braden score ≤ 20) of developing a pressure ulcer. Thirty‐five per cent of patients in the risk group were afflicted with one or more pressure ulcers. Conclusions. The prevalence of pressure ulcers in paediatric patients is greater then previously appreciated and the problem requires further exploration. The high percentage of grade 1 pressure ulcers caused by medical devices requires nursing interventions to prevent lesions for these patients. Relevance to clinical practice. The high prevalence rate in paediatric patients is disconcerting and requires further exploration in terms of interventions needed to improve outcomes for this patient group.     

The prevalence of myofascial trigger points in hip and thigh areas in anterior knee pain patients

BackgroundAnterior knee pain (AKP) is a widespread problem among young athletes and soldiers. There are many theories on the etiology of AKP but there is little reference to myofascial trigger points (MTrPs) as a possible contributor.AimTo evaluate the association between AKP and prevalence of active and latent MTrPs in the hip and thigh muscles in soldiers.MethodsA cross-sectional study was conducted in the Beer-Sheva military outpatient physical therapy clinic. Subjects were 42 men and 23 women referred for physical therapy, 33 with a diagnosis of AKP (cases) and 32 with upper limb complaints (without AKP, controls). All subjects underwent physical evaluation by an examiner blinded to their identity and medical condition. The following muscles were assessed bilaterally for active or latent MTrPs: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal).ResultsIn six out of eight areas, the cases had a higher prevalence of total active and latent MTrPs than the controls. When summarizing MTrPs by muscle, cases had significantly more MTrPs than controls in each muscle. The largest difference was found in vastus medialis and vastus lateralis; nearly half of the cases had MTrPs in these muscles.ConclusionsSubjects with AKP have a greater prevalence of MTrPs in their hip and thigh muscles than controls, indicating an association between MTrPs and AKP. Further research is necessary to determine whether MTrPs are the cause or the consequence of AKP.     

Nurses' assessment of pain in hospitalised patients.

This study compared the incidence of pain reported by hospitalised patients with that recorded by nurses, correlated patients' and nurses' ratings of pain intensity and explored the relative importance nurses placed on various criteria in pain assessment. Patients (n = 115) in a university teaching hospital rated pain intensity on a visual analogue scale (VAS) and indicated its source and duration. Nurses (n = 115) caring for them rated their pain intensity on a VAS and ranked the importance of 12 factors in their assessments. Seventy-two patients (63%) reported pain and 97 nurses (84%) indicated that their patients had pain (X2 = 13.94, p less than 0.001). Patients' and nurses' VAS ratings were poorly correlated (rs = 0.35, p less than 0.001). The highest ranked factors in nurses' assessments were: what the patient said; the patient's report of the severity of pain; the patient's facial expression and the patient's posture. It was concluded that the prevalence of pain was high and that nurses' judgements were poor.     

The prevalence of pressure ulcers in community settings: An observational study

Background

Changes in healthcare and ageing populations have led to an increasing emphasis on the provision of healthcare in the community. Quality initiatives in healthcare have led to a focus upon pressure ulcer rates. However, published data on pressure ulcer prevalence in a community setting is currently very limited.

Objective

The objective of this cross-sectional observational study was to determine the prevalence of patients with pressure ulcers in a community setting in the United Kingdom.

Design

A cross-sectional observational study.

Setting

Two community settings in the North of England.

Participants

Patients in the community who were aged 18 years or older at the time of the pressure ulcer prevalence audit were included. There were no exclusion criteria and consent was not a requirement.

Methods

Each site used a different method to collect the data as per their usual method of prevalence data collection. Site 1 assessed all patients on the community nursing caseload: patients in residential homes, rehabilitation units, specialist palliative care units and all nursing homes in the locality, whether they were known to have a pressure ulcer or not. Site 2 assessed only those on the community nursing caseload who were known to have a pressure ulcer. Site 1 collected data between 8th February and 2nd April 2010 and site 2 between 12th April and 7th May 2010.

Results

In site 1, 185 patients were assessed as having a pressure ulcer Grade ≥1, a prevalence rate of 0.77 per 1000 adults. In Site 2 102 patients were assessed as having a Grade ≥1 pressure ulcer, a prevalence rate of 0.40 per 1000 adults. Removing patients in nursing homes from the calculation gives a prevalence of 0.38 per 1000 adults for site 1 and 0.39 per 1000 adults for site 2.

Conclusions

This study provides prevalence data in a community setting which can be used to assess resource allocation and staff training. This study has highlighted that differences in methodology can affect prevalence results, and this should be taken into account in future research.     

湖北省住院患者压疮现患率的调查研究

目的 :对湖北省住院患者压疮现患率的基线资料进行调查。方法 :采用横断面调查法获取湖北省26家综合医院住院患者的压疮现患率。结果 :本次调查总人数为23 443人,发生压疮299例,现患率为1.28%;其中院内压疮62例,院内压疮现患率为0.26%;排除I期压疮后,现患率为0.91%。结论 :首次获得湖北省住院患者压疮现患率的信息,能够为今后压疮管理工作提供参考。     

Factors associated to pressure ulcers in patients at adult Intensive Care Units

The objective of this a cross-sectional analytical study was to estimate the occurrence of pressure ulcers and their associated factors in adult ICUs in the city of Belo Horizonte, Brazil. The sample consisted of 142 patients aged 18 or older, admitted before midnight of the day prior to data collection, from a total of 316 beds distributed in 22 ICUs. Presence of at least one pressure ulcer per patient was 35.2% (CI 95% = 27.4-47.7). Of the 99 ulcers identified, the ones in the sacral region were most frequent (36.0%), followed by those in the calcaneus (22.0%). We observed that the presence of sepsis (OR = 6.04, CI 95% = 1.09-33.53), period of stay > or = 10 days (OR = 7.61, CI 95% = 2.92-19.82) and being high risk and very high-risk in the Braden scale (OR = 4.96, CI 95% = 1.50-16.50) were independent factors significantly associated with the presence of pressure ulcers. Results suggest that sepsis, length of stay, and having high and very high risk" in the Braden scale are factors potentially associated to the development of ulcers in bedridden patients.     

Investigation of the prevalence of CKD in 13,383 Chinese hospitalised adult patients

BACKGROUND: There is an increase prevalence of chronic kidney disease (CKD)worldwide. However, the exact incidence of CKD in China is still uncertain. In this cross-sectional study, we retrospectively investigated the prevalence and distribution of CKD in Chinese hospitalised adult patients. METHODS: Totally, 13,383 adults patients who were hospitalised at our hospital were included in this study. They included 6215 males and 7168 females. Patients' gender, age, blood pressure, serum creatinine, blood urea nitrogen, uric acid, triglyceride, total cholesterol, albumin, hemoglobin, hemotocrit, urine protein, and history of hypertension, diabetes, and smoking were investigated. CKD was defined as eGFR<60 ML/ MIN PER 1.73 m(2) and/or proteinuria, GFR was estimated by using of the simplified MDRD equation. RESULTS: The prevalence rate of CKD was 14.82% in our group, which was respectively distributed from 1 to stage 5 at the following percentage, 3.33% (stage 1), 2.49% ( stage 2), 7.07% (stage 3), 1.08% (stage 4), and 0.86% (stage 5). Elderly patients (age >65 y) accounted for 53.07%, which had a higher CKD prevalence (29.47%) than middle and young-aged patients (9.49%). It was noted that 39.06% patients at stage 1-3 were undiagnosed with CKD during their hospitalization. The common etiology for CKD was hypertension (29.49%), diabetes (11.64%) and primary glomerulonephritis (4.39%). Hypertension, diabetes and ages were main associated factors for CKD. CONCLUSIONS: CKD is a very common disease among the hospitalised patients in China. With the increasing of aging population, elderly people will be the highest risk group for CKD. More strategies have to be made for its early detection and prevention.     

Adverse effects prevalence study: pressure ulcers in an acute hospital

ObjectiveThe pressure ulcers (PU) are one of the adverse effects associated with hospitalisation. The aims of this study are, to determine the prevalence of PU in patients admitted to a tertiary hospital, to describe the characteristics of the injuries, to find out the frequency of use of special surfaces for managing pressure (SSMP), and to establish lines of action for their prevention.MethodThis is a cross-sectional study of adults patients admitted to hospital between May 11 and 15, 2009. Collected variables are: demographic data, number of PU, admission unit, risk level (measured by modified Gosnell′s scale), stage, location, cause, origin of the injury and SSMP.ResultsA total of 683 patients were studied, of which 70 (10.3%) of them had at least one wound. The risk of developing PU in patients evaluated as high risk, is more than those patients evaluated as no or low risk (OR: 6.26; 95% CI; 3.54–11.08; p<0.001).Most of the wounds they were stage i (39.1%) and stage ii (35.2%), located mostly in the heel and sacrum, and (83.8 %) of the PU were of hospital origin. Only 28.1% of the available SSMP were used.ConclusionsThe overall percentage of PU is greater than that reported in other studies, but with less severe injuries. Patients at risk need to be identified and early preventive measures applied. In our hospital the use of SSMP is low in relation to the number of patients at risk.     

Predicting and preventing pressure ulcers in surgical patients

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PRESSURE ULCERS, regardless of their origin, represent negative outcomes for patients, including pain, additional treatments and surgery, longer hospital stays, disfigurement or scarring, increased morbidity, and increased costs.

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THE OR IS A HIGH-RISK environment for the development of pressure ulcers. Preoperative identification of patients at risk for pressure ulcer development is imperative if cost-effective, evidence-based preventive measures are to be implemented.

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THIS ARTICLE PRESENTS a review of the literature pertaining to pressure ulcer development in surgical patients. Recommendations for future research and implications for practice are provided. AORN J 81 (May 2005) 986-1006.

     

综合性医院压疮现患率多中心联合调研

目的:获得综合性医院住院成人患者的压疮现患率和医院获得性压疮发生率,为下一步预防策略的制定提供依据。方法:采用统一的调研时间、工具、方法、流程及判断标准,组织统一培训合格的护士457名对12所综合性医院≥18岁的住院患者实施横断面调研,统计压疮现患率和医院获得性压疮发生率,采用SPSS16.0统计软件进行描述性统计分析。结果:压疮现患率为1.579%,医院获得性压疮发生率为0.628%。压疮现患率排序前三位科室分别为ICU、老年科、神经内科,医院获得性压疮发生率排序前三位科室分别为ICU、老年科、内科;前三位年龄分别为>89岁、80～89岁、70～79岁;前三位压疮部位分别为骶尾部、足跟部、髂嵴;前三位发生时段为不清楚发生时间、8∶00-12∶00和2∶00-8∶00。结论:本研究所获得的压疮现患率和发生率可代表我国部分地区住院患者的基线值。≥70岁者是压疮预防的重点对象;骶尾部、足跟部和髂嵴部是压疮重点防护部位;ICU、老年科和内科是重点预防科室;8∶00-12∶00和2∶00-8∶00是重点预防时段,值得注意的是有76.545%的压疮发生时段不清楚,因此需要加强护士的压疮预防意识并严格执行交接班制度,按要求检查皮肤。     

Improvements in pain relief,handling time and pressure ulcers through internal audits of hip fracture patients

The aim of this project was to improve the outcome of hip fracture patients by optimizing preoperative pain relief, diminishing the time from admission to operation and reducing the occurrence of pressure ulcers. A retrospective study of all medical records of hip fracture patients from the last 4 months in 1998 was compared with prospective registrations during the same period in 1999 and 2000 after the introduction of quality improvements. The number of patients who waited for more than 1 hour to get pain relief was almost halved after improvements. In 1998, close to half of the patients had to wait more than 24 hours for an operation. After attention was given to quality improvements, 36% of the patients in 1999 and 34% of the patients in 2000 had to wait more than 24 hours. In addition, 18% of the patients in 1999 and 24% of the patients in 2000 vs. 11% in 1998 were operated on within 12 had to wait more than 24 hours. Pressure ulcers were considerably reduced. In total, 19% of the patients in 1998, 8% in 1999 and 4.5% in 2000 had pressure ulcers at discharge from the hospital. The outcome for hip fracture patients was improved through attention to quality improvements with all staff involved and focused on these patients.     

Differences in prevalence of pressure ulcers between the Netherlands and Germany--associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes

Aim. This study compares pressure ulcer prevalence and prevention activities in nursing homes and hospitals within two European countries. Background. Over three years stable differences have been found between the Netherlands (NL) and Germany (GER) with higher pressure ulcer rates in the NL. As previous analyses have shown, the differences cannot be entirely explained by differences in the population’s vulnerability to pressure ulcers because they still remain after risk adjustment. Therefore, the differences in prevalence must be caused by other factors. The purpose of this study is to analyse if any potential differences in preventive activities can account for the varying occurrence of pressure ulcers. Method. In both countries, nation-wide surveys were conducted annually using the same standardised questionnaires. Trained nurses examined all consenting patients of the voluntarily participating facilities. This examination included a skin assessment of the entire body. Data regarding risk factors, prevention and details about wounds were then collected. Results. In-patients of 29 German (n = 2531) and 71 Dutch (n = 10 098) nursing homes and 39 German (n = 8515) and 60 Dutch (n = 10 237) hospitals were investigated. The use of pressure-reducing devices was more common in the NL than in GER, but all other interventions were more frequently provided to German risk patients than to their Dutch counterparts. The pressure ulcer prevalence was significantly higher in the Dutch sample. After adjusting for gender, age, Braden Score and prevention, the probability of having a pressure ulcer was 8·1 times higher for Dutch nursing home residents than for German residents. Conclusion. Some of the variance in pressure ulcer prevalence between the two countries can be explained by varying pressure ulcer prevention. However, some remarkable differences still remain unexplained. Relevance to clinical practice. The extent of pressure ulcer prevention, especially repositioning and nutrition intervention provided to patients at risk, is not in accordance with international guidelines.     

The prevalence of post-traumatic stress disorder in chronic pain patients

Several of the more common causes of chronic pain include traumatic events such as motor vehicle accidents and workrelated incidents. Therefore, it is not unusual for patients presenting with chronic pain to also describe significant levels of distress including post-traumatic symptomatology and, in the more severe cases, post-traumatic stress disorder (PTSD). Throughout the past few decades, the literature relating to chronic pain and PTSD has become progressively more sophisticated, resulting in well-supported theories and treatments for sufferers. However, only a handful of studies have specifically attended to the co-occurrence of these two disorders. This review presents a summary of the literature relating to the two disorders in terms of symptoms, prevalence, and comorbidity. It also briefly describes the main empirically supported psychologic theories of chronic pain and PTSD and briefly reviews the evidence regarding what factors maintain the disorders. Treatment implications and issues for future research are considered.     

Prevention and management of pressure ulcers in critical patients

The Taiwan Join Commission on Hospital Accreditation identified pressure ulcers as an important clinical care indicator in 2011. Pressure ulcers are a particularly critical medical care issue in hospital intensive care units. Pressure ulcers can influence patient physiology in terms of greater perceived pain, elevated infection and sepsis incidence, increased unplanned surgical treatments, and reduced activities of daily living (ADL). Pressure ulcers can also affect psychology through induced depression, stress, and anxiety. They can also increase patient and societal costs and prolong hospital stay length. This article explores the prevention and management of pressure ulcer in serious illness patients and introduces effective assessment and management techniques. We hope this article raises clinical nurse awareness of this critical issue and helps decrease the incidence of pressure ulcer-related complications in order to enhance overall quality of care.