A systematic review of prevalence and incidence of pressure ulcers/injuries in hospital emergency services

AimTo develop a systematic review on the prevalence and the incidence of pressure ulcers/injuries in adult patients in hospital emergency services.Materials and methodsSystematic review of prevalence and incidence studies developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols and the Joanna Briggs Institute methodology. The inclusion criteria were based on the CoCoPop mnemonic. The main variables of interest were the “prevalence” and/or the “incidence” of “pressure ulcers/injuries” (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The Systematic Review Protocol was registered in PROSPERO (CDR42021252906).ResultsThe pressure ulcer/injury (point) prevalence ranged from 5.2% (at admission) to 12.3% (at discharge) and the pressure ulcer/injury incidence ranged from 4.5% to 78.4%. Most of the pressure ulcers/injuries documented were category/stage I. The most problematic anatomical locations were the sacrococcygeal region and the heels. The preventive measures should be implemented as soon as possible and are important in patients older than 75 years, with multiple comorbidities, high C-Reative Protein levels, cervical spine immobilization, presented to hospital emergency service by ambulance or with hypotension at the time of admission.ConclusionsThe prevalence and incidence of pressure ulcers/injuries in hospital emergency services remains an understudied topic which could limit the generalization of our data. This systematic review highlighted that the management of pressure ulcers/injuries is a real and current challenge in hospital emergency services. It is important to identify the patients at (higher) risk to establish an (earlier) preventive care plan according to patients and emergency services’ characteristics.     

Prevalence and incidence of pressure ulcers/injuries in emergency services: A systematic review protocol

AimTo develop a systematic review protocol on the prevalence and/or the incidence of pressure ulcers/injuries in adult patients in emergency services.Materials and methodsThis protocol was developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the Joanna Briggs Institute (JBI) methodology for systematic reviews of prevalence and incidence studies. The inclusion criteria will be based on the CoCoPop mnemonic. The main variables of interest will be the “prevalence” and/or the “incidence” of “pressure ulcers/injuries” (Condition) reported in studies developed in emergency services (Context), with participants aged 18 or more (Population). This Systematic Review Protocol was registered in PROSPERO (CDR42021252906).ResultsIf meta-analysis is not possible, the syntheses of quantitative data will be presented in a narrative form to address the scope and objectives of this systematic review. Tables, graphs and/or figures will be designed to present the results of the prevalence and the incidence of pressure ulcers/injuries, their body locations and the respective categories/stages. The Systematic Review is currently ongoing.ConclusionsPrevalence and incidence systematic reviews are an emerging methodology in the field of evidence synthesis. We believe that the systematic review on prevalence and incidence of pressure ulcers/injuries in emergency services can provide useful information for healthcare professionals and policy makers about the dimension of this problem in a specific context. The standardized approach outlined in this systematic review protocol offers a rigorous and transparent method to conduct the review.     

Protective equipment-related pressure ulcers in healthcare workers during COVID-19 pandemic: A systematic review

AimThis systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions taken to prevent these injuries.MethodRelevant studies were retrospectively searched. Seven English keywords identified from MESH were used while searching. The search was carried out in five international databases by trying various combinations of these words during February 15–25, 2021. This systematic review was updated by rescanning databases on December 20, 2021 and a total of 611 studies were attained.Results17 studies which met the study inclusion criteria, which were conducted mostly through online survey method in different study designs and which included a total of 24,889 healthcare professionals were examined. The incidence of PPE-related pressure ulcers was found to be between 30% and 92.8%. Grade I pressure ulcers were the most common (44.1%–82%). The incidence of skin problems except PPE-related pressure ulcers such as itching, redness and dry skin was found to be between 42.8–88.1%. Risk factors that frequently played a role in the development of PPE-related pressure ulcers and other skin problems were longer use of PPE and sweating. PPE-related pressure ulcers and other skin problems were more frequent over the nose (nasal bone/nasal bridge), ears, forehead and cheeks. PPE-related itching, redness and dry skin mostly occurred. Several dressing applications were found to be effective in the prevention of PPE-related pressure ulcers and other skin problems that might develop especially on the facial region.ConclusionPPE-related pressure ulcers and other skin problems were found to be higher among healthcare professionals. Data regarding the sealing of dressing applications against viral transmission in the prevention of PPE-related pressure ulcers and other skin problems are limited. It is estimated that future studies will be performed to prevent device-related pressure ulcers in healthcare workers. It is suggested that there is a need to conduct studies with larger samples where expert researchers make observations for pressure ulcers in order to determine the prevalence and incidence of PPE-related pressure ulcers.     

Incidence of pressure injuries in fracture patients: A systematic review and meta-analysis

ObjectiveTo systematically evaluate the incidence of pressure injuries (PIs) in hospitalized fracture patients and to provide evidence for the prevention and treatment of PIs.MethodsA systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, China Knowledge Resource Integrated Database (CNKI), WanFang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched to collect cross-sectional studies and cohort studies related to PIs among hospitalized fracture patients. All electronic literature sources were searched from inception to March 2022, and a hand-search through references was also conducted to find relevant articles. Studies were evaluated independently by two researchers and audited by a third researcher. The data were extracted and presented in tables. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. All data analysis used Stata14.0. The I² statistic and random-effects model were used to determine the heterogeneity.ResultsA total of 7906 articles were screened, and 18 studies with 8956 patients were ultimately involved in this review. The pooled incidence of PIs in the fracture patients was 20.4% (95%CI: 14.9 to 25.8), and the incidence of PIs only in spinal and hip fracture patients was 23.9% (95%CI: 19.6 to 28.2). The incidence of PIs in 65 years old or over was significantly high (23.3% [95%CI: 15.3 to 31.2]). The most affected body sites were sacrococcygeal regions (56.7%) and heels (19.9%). The most common stages were stage 2 (62.2%) and stage 1 (17.4%).ConclusionThe overall incidence of PIs in fracture patients was as high as 20.4%, significantly higher than the average incidence of adults. We found that the potential for PIs in fracture patients increases with age. Hence, our discoveries recommended that healthcare givers should consider reducing the occurrence of PIs. Additionally, more research may be conducted to improve the understanding of characteristics of PIs among fracture patients and to identify PIs risk factors to prevent and treat them effectively.     

Investigation of the prevalence of pressure ulcers and patient-related risk factors in hospitals in the province of Erzurum: A cross-sectional study

BackgroundPressure ulcers are a significant health care problem all across the world due to their associated high mortality and morbidity rates and high health care costs. The prevalence of pressure ulcers serves as one of the most important indicators of the quality of nursing care.Study aimThis study aims to determine the prevalence of pressure ulcers and patient-related risk factors in inpatients receiving treatment in the province of Erzurum, located in the eastern part of Turkey.DesignThis is a cross-sectional study.Participantswhich included 832 inpatients hospitalized for at least 24 h after admission in five hospitals in the province of Erzurum. All of the study patients were 18 years of age or older and agreed to participate in the research. Patients hospitalized in the obstetric, emergency, and pediatric clinics were excluded from the study (due to the low probability of pressure ulcers in these clinics).InstrumentsFor the collection of data, the “Introductory Information Form” was used to learn the socio-demographic and clinical characteristics of the patients, and the “Braden Risk Assessment Scale” was used to determine the risk of pressure ulcers. The stage of the pressure ulcers of the patients was determined according to the classification of the National Pressure Ulcer Advisory Panel (NPUAP).MethodsSince the study was planned as a point prevalence study, research data were gathered by the researchers and interviewers on a single day designated for each hospital during the first week of October 2016.ResultsAmong the patients included in the study, 53.1% were male, mean age was 56.62 ± 17.95, 57.2% were treated in internal clinics, and the mean hospital stay was 9.02 ± 13.36 days. In terms of the patients' risk of pressure ulcers, it was determined that 28% were at risk. The overall prevalence of pressure ulcers was calculated to be 12.7% (for stages I-IV), with the overall prevalence decreasing by 6.7% when the patients with stage-I were excluded. Furthermore, it was found that 48.3% of the pressure ulcers were stage-I, and that the sacral region (37.3%) was the most affected region. According to the logistic regression analysis conducted to determine the factors, along with their weights, that affect the development of pressure ulcers, the age of the patient, the duration of the hospital stay, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to have an impact (p < 0.05).ConclusionIn this study, the prevalence of pressure ulcers was calculated to be 12.7%, with the highest prevalence found in intensive care clinics (35.3%). The age of the patient, the duration of the hospital stays, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to be effective in the development of pressure ulcers.     

Nutritional status as a predictor of the incidence of pressure injury in adults: A systematic review and meta-analysis

AimPressure injuries are a significant health care problem worldwide, and many factors influence their occurrence and development. The purpose of this systematic review and meta-analysis was to investigate the role of nutritional status in the development rate of pressure injuries as a potentially modifiable risk factor.MethodsStudy designs included cohort (prospective and retrospective), case-control, and RCTs if the association between nutrition status and pressure injuries was reported. Databases searched included: PubMed, CINAHL, Embase, Scopus, Web of Science, and Cochrane Library on April 20th, 2022. The data were analyzed using OR and random effect model in Revman5.3 and STATA 15 Software. Report this systematic review and meta-analysis according to the PRISMA 2020 statement.ResultsA total of 22 separate studies were retained in this systematic review. Of these, 16 articles were included in the meta-analysis. Three studies were assessed as low risk and sixteen as a moderate risk of bias. All RCTs were B quality. The odds ratio of the incidence of pressure injuries in malnourished and non-malnourished patients was 3.66(95% CI: 2.77–4.83). In the three RCTs studies(n = 870), the odds ratio of the incidence of pressure ulcers in patients with standard nutrition to those with specific nutritional interventions was 1.35(95%CI:1.02–1.78).ConclusionsThis systematic review and meta-analysis showed that nutritional status is significantly associated with pressure injuries. Malnutrition can increase the incidence of pressure injuries, and specific nutritional interventions can reduce the incidence of pressure injuries compared to standard nutrition.     

Location-dependent depth and undermining formation of pressure ulcers

Aim of the studyWe examined the location-specific properties of pressure ulcers, focusing on depth and undermining formation, which are often unfavorable factors for ulcer healing.MethodsWe conducted a retrospective observational study of 2 independent databases on pressure ulcers. Databases from a 200-bed hospital (database A) and a 300-bed hospital (database B) were collected during different time periods. Relationships between ulcer location, ulcer depth, and undermining formation were analyzed. All pressure ulcers were accurately diagnosed and classified according to their locations.ResultsA total of 282 pressure ulcers in 189 patients from database A and 232 pressure ulcers in 154 patients from database B were analyzed. It was found that pressure ulcers primarily developed over the sacrum. Ratio of stages III and IV pressure ulcers was high in pressure ulcers of the foot, ankle, and crus on the lower leg. Among the deep pressure ulcers, undermining formation was frequently observed on the greater trochanter, ilium, and sacrum. In contrast, pressure ulcers of the foot, ankle, and crus did not exhibit undermining formation.ConclusionOur results revealed marked differences in pressure ulcer properties depending on their location. Factors affecting depth and undermining of pressure ulcers appear to be related to anatomical and physical properties of the bone and subcutaneous tissue.     

Prevalence of pressure ulcers in the paediatric population and in primary health care: An epidemiological study conducted in Spain

AimThe primary goal of this study was to estimate the prevalence of pressure ulcers in the paediatric population cared for in primary health care.MaterialsThe data of this epidemiological study were extracted from the records of the 24 departments that attended to an approximate population of 1 million inhabitants between 0 and 18 years old from 2012 to 2015. The study included children requiring assistance to reduce pressure ulcer incidence. The paediatric population was categorised into neonates and infants (0–2 years), young child (3–6 years), child (7–12 years) and adolescents (13–18 years). The primary outcome was information on the prevalence of pressure ulcers. Secondary outcomes were classification of ulcers in terms of location and category. Other outcomes included the total number of consultations owing to pressure ulcers.ResultsThe sample included 65,359 children who attended 813 centres of primary health care. The prevalence of pressure ulcers was 1.72%. A higher prevalence was observed in children younger than 3 years (2.89%), with children at age 1 year showing the most prevalence (4.77%). The highest number of diagnosed ulcers was located in the lower back and heels, regardless of the age range.ConclusionOverall, the prevalence of pressure ulcers in the paediatric population attended to in primary health care is low when compared to that of hospitalised and acutely ill children. The figures advise that special attention should be paid to the care of the population younger than 3 years, because this population shows the highest prevalence.     

The economic impact of pressure ulcers among patients in intensive care units. A systematic review

BackgroundThe incidence and prevalence of pressure ulcers in critically ill patients in intensive care units (ICUs) remain high, despite the wealth of knowledge on appropriate prevention strategies currently available.MethodsThe primary objective of this systematic review was to examine the economic impact of pressure ulcers (PU) among adult intensive care patients. A systematic review was undertaken, and the following databases were searched; Medline, Embase, CINAHL, and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used to formulate the review. Quality appraisal was undertaken using the Consensus on Health Economic Criteria (CHEC)-list. Data were extracted using a pre-designed extraction tool, and a narrative analysis was undertaken.ResultsSeven studies met the inclusion criteria. Five reported costs associated with the prevention of pressure ulcers and three explored costs of treatment strategies. Four main PU prevention cost items were identified: support surfaces, dressing materials, staff costs, and costs associated with mobilisation. Seven main PU treatment cost items were reported: dressing materials, support surfaces, drugs, surgery, lab tests, imaging, additional stays and nursing care. The overall validities of the studies varied between 37 and 79%, meaning that there is potential for bias within all the included studies.ConclusionThere was a significant difference in the cost of PU prevention and treatment strategies between studies. This is problematic as it becomes difficult to accurately evaluate costs from the existing literature, thereby inhibiting the usefulness of the data to inform practice. Given the methodological heterogeneity among studies, future studies in this area are needed and these should use specific methodological guidelines to generate high-quality health economic studies.     

Incidence and prevalence of pressure injuries in children patients: A systematic review and meta-analysis

BackgroundPressure injuries presently has been a serious healthcare problem all over the world. Children were recognized as the high-risk population of pressure injuries in the latest prevention and treatment of pressure injuries clinical practice guideline. However, the estimates of incidence, and prevalence of pressure injuries in hospitalized children patients vary considerable in relevant published studies.ObjectiveTo systematically quantify the incidence and prevalence of pressure injuries (PIs) in hospitalized children and the most affected PIs sites.MethodsA systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Electronic databases searches of the Cochrane Library, Pubmed, Web of Science, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP), and hand-search through references were conducted to find relevant articles. Studies were evaluated independently by two researchers and audited by a third researcher. The data were extracted and presented in tables. The risk of bias was assessed using Hoy's tool. The I² statistic and random-effects model were used to assess the heterogeneity. Meta-regression analysis and subgroup analysis were conducted to examine between-study heterogeneity.ResultsA total of 6, 672 articles were screened, and 30 studies with 251, 501 participants were ultimately included in this review. The pooled incidence of PIs for 3, 205 children was 13.5% (95% CI: 10.5–16.5); and the pooled prevalence of PIs for 4, 639 children was 12.2% (95% CI: 8.0–16.3). The most affected body sites were occiput, ears, and nose. Meta-regression and subgroup analysis showed that the inpatient ward, and region were the sources of heterogeneity.ConclusionsThe incidence and prevalence of PIs was significantly higher than the adults. Our discoveries recommended that healthcare givers ought to pay more consideration to diminish the happens of PIs. Additionally, more research may be needed to improve our understanding of the characteristics of PIs among children and to identify PIs risk factors to prevent and treat it in children effectively.     

Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review

AimsThe main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect.BackgroundPressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum.DesignQuantitative systematic review.MethodsData sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms. Study eligibility criteria: Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication. Participants: patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion.ResultsThirteen studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies.ConclusionsThere is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation.Prospero idPROSPERO International prospective register of systematic reviews: CRD42017071459.     

Nurses’ attitude on pressure injury prevention: A systematic review and meta-analysis based on the pressure ulcer prevention instrument (APuP)

BackgroundPrevention of pressure ulcers (PU) is one of the most important indicators of the quality of patient care that may be influenced by the attitude of nurses. Nurses are responsible for maintaining the integrity of the skin and preventing its complications. The aim of this study was to assess the overall attitude of nurses on PU prevention based on their scores on the Attitude towards Pressure ulcer Prevention instrument (APuP).MethodsIn this systematic review and meta-analysis, databases including Web of Science, Science Direct, PubMed, and Scopus were searched, using the following keywords: Pressure Ulcer, Pressure injury, Bedsore, Pressure Sore, Decubitus Ulcer, Attitude, and their possible combinations. Heterogeneity of studies was assessed with I² index and Cochrane-Q test. Based on heterogeneity between the studies, the data were analyzed using a random effects model. All the analyses were performed using STATA v.16 software.ResultsTwelve studies with a sample size of 7824 people were analyzed. The overall score of attitude towards pressure ulcer prevention was 70.84% (95% CI: 66.34–75.35) and the highest and lowest scores were related to the dimensions of individual priority (78.83%, 95% CI: 74.69–82.97) and competence (70.11%, 95% CI: 67.24–72.94), respectively. The percentage of the total score of attitude towards pressure ulcer prevention in nurses was higher than nursing students (72.15%, 95% CI: 67.10–77.20 vs. 67%, 95% CI: 53.80–80.20). Sensitivity analysis confirmed the stability of the results. Publication bias was significant (p = 0.036).ConclusionThe attitude of nurses and nursing students towards the prevention of pressure ulcers was moderate, and providing the necessary training to these groups was essential.     

Biomarkers for the early detection of pressure injury: A systematic review and meta-analysis

BackgroundPressure injury imposes a significant burden for patients and healthcare systems and the majority of pressure injuries are preventable. The early identification of pressure injury is critical for its prevention. As an objective measure, biomarkers have preliminarily shown the potential to identify individuals at risk for developing pressure injury before it is visually observed to occur. However, these results have not been synthesized.ObjectiveTo assess and synthesise the predictive effect of different biomarkers in the early detection of pressure injury formation.DesignA systematic review and meta-analysis.Data sourcesPubMed, EMBASE, CINAHL Complete and the Cochrane Library were comprehensively searched for articles up to June 2021. No restrictions were applied to study design type, language, country, race or date of publication.Review methodsTwo reviewers independently extracted data from all original eligible studies using a specified data extraction form, resolved disagreements through discussion and the involvement of an additional reviewer. Methodological quality of all included studies was independently appraised by two authors with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Newcastle-Ottawa Quality Assessment Scale (NOS). Heterogeneity of each study was estimated using the I² statistic, and the data was synthesized using StataSE15.ResultsEight observational studies involving 10595 participants were included. The overall pooled area under curve (AUC) and the 95% confidence intervals (CIs) of Serum albumin (Alb) was 0.66(0.62–0.70), and the Serum haemoglobin (Hb) was 0.67(0.60–0.74). The AUC and 95% CI of C-reactive protein (CRP) was 0.62(0.50–0.74), Braden score was 0.56 (0.429–0.691), Waterlow score was 0.729(0.654–0.803), Alb with Waterlow was 0.741(0.694–0.787), and the combination of Hb, CRP, Alb, Age and Gender was 0.79(0.682–0.898). Besides, the chemokine interferon-γ-induced protein of 10kd/CXCL10, cytokine interferon-α, tumor necrosis factor-alpha (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-15 (IL-15) and combination of creatine kinase (CK), myoglobin (Mb), heart-type fatty acid binding protein (H-FABP) and CRP may prove potential for detecting pressure injury.ConclusionThe findings suggest the combination of Hb, CRP, Alb, Age and Gender is superior to other biomarkers. However, the predictive effect of biomarkers needs to be confirmed by more researches and patient-level data.     

Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review

ObjectiveTo systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings.MethodsA systematic literature review of quantitative, qualitative, and mixed methods research was undertaken using PubMed, MEDLINE, Embase, CINAHL, and Cochrane Library. Studies that reported barriers or/and facilitators to pressure injury prevention in the acute care settings and published in English from 2008 to 2022 were included. Studies were excluded if they were conducted in residential care facilities and nursing homes, or other long-term community care settings. Two authors independently screened articles against the inclusion and exclusion criteria. Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Reported results were mapped to the Theoretical Domains Framework to identify the barriers and facilitators to pressure injury prevention.ResultsA total of 78 studies were included. There were 65 quantitative studies, 11 qualitative studies, and two mix-methods studies. The most salient Theoretical Domains Framework domains identified in this review were “Knowledge”, “Skills”, “Environmental Context and Resources”, “Optimism”, “Social/Professional Role and Identity”, and “Social influences”.ConclusionThe barriers and facilitators to pressure injury prevention in hospital settings identified in this systematic review were diverse, and included issues at both individual and organizational level. Healthcare organizations can address the barriers and facilitators from the influential Theoretical Domains Framework domains. Future research is required to investigate the effectiveness of behaviour change interventions that specifically target these barriers and facilitators to pressure injury prevention.     

Prevention of pressure injuries in critically ill children: A preliminary evaluation

AimsTo evaluate a prevention strategy implemented to reduce incidence and severity of positioning related pressure injuries affecting pediatric patients in a pediatric critical care unit. Secondary objective was to evaluate compliance with preventive recommendations.BackgroundThe skin in infants or children has important physiological and anatomical differences compared with adults. Further, factors such as the immaturity of the skin and limited activity and mobility in pediatric critical care unit, along with the pressure exerted by medical devices, increases the risk of pressure ulcers in infants and children. The most effective preventive measures specific to this intensive care population need to be evaluated.Material and methodsQuasi-experimental before-after study with consecutive sampling. The effectiveness of the care bundle implementation was evaluated based on the latest evidence (intervention group) versus the application of non-standardized care (control group). Pediatric patients up to 14 years old at risk of suffering from pressure injuries and who were admitted more than 48 h in a pediatric intensive care unit (level III) participated. For the collection of data, two computer programs and the hospital clinical records of each participant were consulted. The data collection period was 6 months per group (pre and post intervention).ResultsA sample of 110 patients was obtained (50 control group and 60 intervention group). The cumulative incidence in pediatric patients exposed to the risk of pressure injuries was reduced from 16% to 13.3%; and in the subgroup of patients with prolonged stay (≥28 days), the incidence was reduced from 55.55% to 20%. In the intervention group, category III and IV pressure ulcers were completely reduced. In addition, the total number of pressure injuries decreased by 21.43%. The care bandle recommendations with the highest level of adhesion recorded were: skin inspection, application of hyperoxygenated fatty acids and use of a special support surface. The main risk factor found during the study was the prone position (p < 0.05).ConclusionsThe application of a care bundle for prevention can be an effective solution to reduce the number and severity of LPPs in an intensive care unit. The most vulnerable subgroup of patients may benefit from the application of these resources.     

Necrotizing soft tissue infections developing from pressure ulcers

Aim of the studyNecrotizing soft tissue infections (STIs) are serious complications that may arise from pressure ulcers. However, there are few studies on this important issue. In addition, diagnostic criteria for necrotizing STIs developing from pressure ulcers and infected pressure ulcers are not well established.MethodsWe defined necrotizing STIs developing from pressure ulcers based on clinical findings. Based on the definition, we retrospectively analyzed the medical records of 24 elderly patients with this condition to determine patient age, gender, comorbid disease, laboratory findings, wound location, bacteriology, and treatment outcomes.ResultsIn the examined population, necrotizing STIs developed primarily from pressure ulcers over the sacrum. Dementia and diabetes mellitus were also frequently observed in patients with necrotizing STIs. The average Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was relatively low. Bacterial cultures from the debrided deep tissues exhibited mixed infections of gram-positive cocci and gram-negative bacilli, except 1 case. Anaerobic pathogens were isolated from 18 patients (72%), and 7 patients (29%) developed bacteremia. None of the cases were preceded by wounds dominated by granulation tissue. Surgical intervention, combined with antibacterial therapy involving intravenous carbapenem or cephem, was successfully used in most cases.ConclusionNecrotizing STIs arising from pressure ulcers are generally caused by mixed pathogens and exhibit symptoms that are milder than those of necrotizing fasciitis caused by group A Streptococcus.     

The epidemiology of skin conditions in the aged: A systematic review

BackgroundThe human population is aging. A systematic summary of the epidemiology of skin diseases in the aged is lacking.MethodsA systematic review was conducted including electronic database searches in MEDLINE, Embase, SCOPUS and Web of Science. The eligibility criteria were primary incidence and prevalence studies or secondary data analysis, English or German language, subjects being 65+ years and reported skin problems or diseases. Data extraction was conducted using a standardized data collection form and the methodological quality of included studies was assessed.ResultsAfter screening of 1491 records, 74 records were included reporting data for more than 20 skin conditions. The majority of prevalence and incidence figures was identified for hospital and long-term care settings. The most prevalent skin diseases were fungal infections (14.3%–64%), dermatitis (1%–58.7%), xerosis (5.4%–85.5%) and benign skin tumors (1.7%–74.5%). Additionally, pressure ulcer prevalence ranged from 0.3% to 46% and incidence from 0.8% to 34%.ConclusionSkin conditions and diseases in aged populations are frequent. Health care practitioners should pay attention to those, although skin conditions might not be the primary reason for seeking care. Epidemiological data are lacking especially for home care and community settings although this can be regarded as the most important from a public health and prevention point of view. The methodological quality and reporting of epidemiological studies in the aged populations must be improved.Systematic review registration numberCRD42014014553 (PROSPERO).