Pressure sore prevalence: a national survey

? A cross-sectional nation-wide sample was used to determine the point prevalence and grading of pressure sores in patients in all hospitals in Iceland (22 hospitals). ? The pressure sore prevalence was 8.9% (n = 57 patients), 7.12% for women (n = 26) and 11.2% for men (n = 31); the mean age for both sexes with pressure sores was 78.4 years. ? Grade I sores were most frequently identified and Grade IV the least. Eighty-five per cent of pressure sores were located below the waist. ? `No dressings' and occlusive dressings were the treatment of choice for pressure sores. ? Results from this study are important for international comparisons.     

The Use of the Modified Norton Scale in Nursing-Home Patients

Patients in three nursing-home wards in Sweden were in 1991 assessed by the Modified Norton Scale (MNS). Of the 71 patients, 38 (49%) were considered to be at risk of developing pressure sores. Six of the patients had a total of eight pressure sores. Five sores were assessed as stage II, two sores as stage III and one sore as stage IV. Only two of the six patients with pressure sores had any preventive equipment in their beds. The nursing and medical documentation of the existing pressure sores was not satisfactory. Individual programs for skin care and routine assessment with a pressure sore prediction instrument, such as the MNS, would serve the dual purpose of directing the relevant measures to the patient groups at the greatest risk and would aid in assessing the efficacy of pressure sore treatment strategies.     

Monitoring the pressure sore problem in a teaching hospital

During 1989 and 1990 a senes of three prevalence surveys were undertaken in a West Midlands teaching hospital to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure relieving equipment A further survey was undertaken in January 1993 to examine any improvement in pressure sore prevention strategies and in the care of those with established pressure sores All in-patients were assessed using the Waterlow score Full details of all pressure sores and any pressure relieving equipment in use was recorded The findings were compared with those of the first survey in 1989 The prevalence for 1989 was 8 77%, and this had reduced slightly to 7 9% in 1993 There was no significant difference in these figures However, in 1989 35 patients had 64 pressure sores and in 1993 32 patients had 46 pressure sores There was a significant reduction in the actual numbers of pressure sores There was no significant difference in the grades of sores and the sacrum was the most frequent position in both surveys The survey showed an improvement in the management of established pressure sores There was little change in the patient populations with respect to the degree of risk of pressure sore development Using the Waterlow score, the numbers of patients found to be in the no risk, at risk, high risk and very high risk categories remained remarkably stable These surveys will continue to provide a basis for selecting pressure relieving equipment Measurement of pressure sore incidence is needed in the future to monitor the efficacy of the prevention programme     

Matching patient need for pressure sore prevention with the supply of pressure redistributing mattresses

The authors have conducted a series of pressure sore prevalence surveys within one health district over a 4-year period. Additional surveys of the availability and deployment of pressure redistributing (PR) bed mattresses have also been made within the same district. The prevalence of pressure sores increased from 6.8% (1986) to 14.2% (1989) while the available stocks of PR mattresses increased from 69 (1987) to 186 (1989). Our results appear to question the common assumption that successful pressure sore prevention can be achieved through expanding the stocks of PR mattresses. Five possible reasons why the increase in mattress provision was matched with an increased prevalence of pressure sores are forwarded. The use of measures of prevalence rather than incidence rates to monitor the effects of clinical initiatives is discussed.     

Prevention, treatment and healing of pressure sores in long-term care patients

ABSTRACT Of 515 consecutive patients newly admitted to the long-term medical ward, 16% already had skin lesions which were classified as pressure sores upon arrival in the ward, and 7.6% developed pressure sores during the observation period which was more than three days but not more than 26 weeks. The relation between the condition of the patient and the development of pressure sores and their prevention and treatment was followed with a modified Norton scale. Proportionally more sores progressed which were initially recorded as skin discoloration as compared with the other stages, i.e. epithelial damage, damage to the full thickness of the skin and lesion with a cavity. Preventive measures were not used to a greater extent in those patients who developed pressure sores as compared with those who did not. Preventive measures were used rather as treatment or secondary prevention after a patient had already developed a lesion. The treatment measures were used in many different combinations. In this study no healing effect could be proved for the various treatment measures which were undertaken.     

压疮高危患者临床特征及危险因素分析

目的分析压疮高危患者的临床特征、管理现状及高危患者压疮发生的影响因素,探讨切实的压疮预防对策。方法采用压疮危险因素评估表筛选压疮高惫患者,并对其临床特征、压疮发生的危险因素和管理现状进行分析。结果2007年3-12月共有315例压疮高危患者,以ICU分布最多,占32．4％,其次为神经外科,占18．74％;初评分（16．91±2．29）分;压疮高危期持续时间（13．00±18．00）d;315例压疮高危患者中共发生压疮19例。高危期持续时间是高危患者发生压疮的危险因素,意识清醒、扶助行走、体温正常和压疮终评分是发生压疮的保护因素。压疮高危患者管理中仍存在忽视高危患者家属教育及预防措施落实、记录不全等问题。结论重视ICU等压疮高危高发科室和压疮高危持续期长患者的管理,根据压疮发生的危险因素科学定义难免压疮,建立护理会诊制度和压疮护理指南等规范压疮高危患者的过程管理,可有效预防和减少压疮的发生。     

贝复济治疗压疮的疗效观察

目的探讨重组牛碱性成纤维细胞生长因子(贝复济)喷涂给药法治疗压疮的有效性,为缩短压疮治愈时间、降低医疗费用,提供压疮护理方面的参考。方法应用随机双盲对照法,将32例62处Ⅱ期、Ⅲ期压疮患者分为实验组和对照组。实验组Ⅱ期采用重组牛碱性成纤维细胞生长因子喷涂暴露治疗,Ⅲ期采用重组牛碱性成纤维细胞生长因子喷涂加碘伏纱布包扎治疗;对照组Ⅱ期采用碘伏消毒包扎,Ⅲ期采用碘伏消毒后用雷佛奴尔湿敷治疗,每天换药1次。结果Ⅱ、Ⅲ期压疮痊愈率实验组明显高于对照组,且愈合时间明显缩短。结论重组牛碱性成纤维细胞生长因子治疗压疮经济、方便、有效,尤其适用于Ⅱ期、Ⅲ期压疮患者。     

非长期卧床患者发生压疮原因分析及对策

目的总结分析临床非长期卧床患者被动发现压疮的原因,并提出针对性对策。方法回顾性分析2003年4月-2007年8月在本院住院的17例非卧床发生压疮患者的临床资料,应用Norton量表对压疮进行评分,分析发生压疮的原因。结果Norton量表评分轻度危险11例、中度危险5例、重度危险1例,通过局部清创、全身营养等支持治疗和护理,除1例患者病情恶化死亡外,其他患者压疮均得到有效控制或治愈。结论加强压疮相关知识培训,以《压疮危险因素评估表》为依据,对患者做好连续评估和分期护理,重视特殊部位皮肤交接班,可以及时、主动发现压疮,积极干预,及时控制患者压疮的发展,减少患者的痛苦。     

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective:To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions.Methods:A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature.After being examined and validated by experts,the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital.Among the 47 patients enrolled into the study,the 14 who developed nosocomial pressure sores were allocated to the pressure sore group,and the remaining33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group.Univariate and multivariate logistic regression analyses were employed to examine the differences in22 indicators between the two groups in an attempt to identify the risk factors for pressure sores.Results:According to the univariate analyses,the maximum value of lactic acid in the arterial blood,the number of days of norepinephrine use,the number of days of mechanical ventilation,the number of days of blood purification,and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group(P0.05).The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores(P0.05).Conclusions:The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock.The adoption of measures specific to high-risk patient groups and risk factors,including the active control of primary diseases and the application of decompression measures during the treatment of the patients,are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.     

Pressure sores in intensive care: defining their incidence and associated factors and assessing the utility of two pressure sore risk assessment tools.

Patients in intensive care units (ICU) are at high risk of developing pressure sores and the use of pressure sore risk tools has been advocated as a means of identifying patients at risk. A prospective multi-site observational study was conducted to define the incidence of pressure sores, assess two pressure sore risk scales and to define risk factors relevant to intensive care. Patients (n = 534) were assessed for the presence of pressure sores. The Waterlow and Jackson/Cubbin risk scales were completed each day for 314 and 188 of these patients respectively. A total of 75 pressure sores were recorded. Of these, 34 were present on admission. Of the remaining 41, 16 were classified as Grade 1 and 24 as Grade 2 sores. The pressure sore (PS) incidence was 5.2 per cent. Expressed as PS/1000 patient days there were 18.48 pressure sores per 1000 patient days. The ability of the risk scores to predict pressure sores was tested using a Receiver Operating Characteristic (ROC) analysis. The association of risk score with pressure sores was analysed using a survival function (Kaplan Meier) and variables compared using a logrank test (Mantel-Cox). Factors associated with pressure sore occurrence were developed and tested using a survival regression model. Both risk scales were poor predictors of pressure sores (ROC curve area approximately 70 per cent for both). The factors, coma/unresponsiveness/paralysed & sedated and cardiovascular instability were significantly associated with pressure sores with relative risks of 4.2 and 2.5 respectively. Risk increased as a function of time such that the cumulative risk was 50 per cent at 20 days.     

The surveillance system of decubital lesions of the University Polyclinic in Udine: results of an incidence study

A retrospective study of the incidence of pressure sores was one of the principal component of the ad hoc program of surveillance, prevention and treatment of pressure sores started in 1996 at University Hospital of Udine. Data were collected from the nursing records of patients defined at risk according to the Waterlow scale and admitted during 1998-99. Aims of the study were to quantify the number of patients who developed a pressure sore while in hospital and their risk level; stage of the lesions; to qualify the main risk factors and the management strategies adopted (i.e. mattresses, medications). Overall, 151 subjects (20.7% of those recruited) developed a pressure sore the greatest majority (96%) were classified as transient and reactive redness or superficial sore, while 14 patients (4%) developed a severe sore. For 50.4% of the lesions a regression to a lower risk level or healing were documented.     

Setting the standard for pressure sore prevention on a trauma orthopaedic ward

This article describes an innovation used to tackle the problem of high prevalence and severity of pressure sores on an orthopaedic trauma ward. Simple data from the pressure sore prevalence survey were used to build the case and provide the rationale for action. Actions taken included targeting the elderly with hip fractures and having the prevention strategy start in Accident and Emergency (A&E) Department. A standard with a monitoring tool was devised at ward level to review and monitor our practice in pressure sore prevention. This has resulted in the reduction of the prevalence rate of pressure sores on the ward from 21% to 8% over four years. The severity of pressure sores also decreased.     

卧床老年患者压疮危险因素评估及护理措施

目的:评估老年住院患者压疮危险因素,探讨有效预防压疮的方法,最大限度降低压疮的发生率。方法:采用B raden量表对302例卧床老年患者压疮危险因素进行评估,根据评估结果采取相应措施。结果:302例患者中无危险199例,轻度危险58例,中度危险18例,高度危险17例,极度危险10例。301例未发生新发压疮,1例出现新发压疮。结论:运用B raden量表可以评估卧床老年患者压疮危险,采取相应护理措施可以显著降低压疮的发生率。     

低位截瘫患者难愈性压疮的康复护理

目的探讨早期的康复介入在低位截瘫患者难愈性压疮治疗中的作用和成效。方法对15例低位截瘫患者压疮创面予改良封闭式负压引流技术处理的同时予康复介入,进行肢体功能锻炼、膀胱功能训练、肠道功能训练,增强患者心理社会的调适能力。结果15例低位截瘫患者的难愈性压疮全部治愈,半年回访无再发压疮。结论早期的康复介入可以提高截瘫患者的生活自理能力,提高患者的个人皮肤照顾能力,加快截瘫患者压疮的愈合速度,减少压疮的再发。     

低位截瘫患者难愈性压疮的康复护理

目的 探讨早期的康复介入在低位截瘫患者难愈性压疮治疗中的作用和成效.方法 对15例低位截瘫患者压疮创面予改良封闭式负压引流技术处理的同时予康复介入,进行肢体功能锻炼、膀胱功能训练、肠道功能训练,增强患者心理社会的调适能力.结果 15例低位截瘫患者的难愈性压疮全部治愈,半年回访无再发压疮.结论 早期的康复介入可以提高截瘫患者的生活自理能力,提高患者的个人皮肤照顾能力,加快截瘫患者压疮的愈合速度,减少压疮的再发.     

美皮康敷料治疗老年患者一、二期压疮疗效观察

目的观察美皮康敷料治疗老年患者一、二期压疮的效果。方法对2010年发生一、二期压疮的123例老年患者随机分为对照组和观察组。对照组使用传统的压疮治疗方法,观察组应用美皮康敷料治疗,比较两组患者压疮治疗有效率和压疮治愈时间。结果观察组压疮治疗有效率（98．28％）高于对照组（84．62％）,且观察组患者一期压疮治愈时间较对照组缩短,差异有统计学意义（P〈0．05）。结论美皮康敷料能显著提高老年患者一、二期压疮治疗效果。     

脊柱后路手术中压疮预防的对照研究

[目的]探讨脊柱后路手术中预防压疮的措施及效果,并调查脊柱后路手术中病人发生压疮的危险因素,为完善手术中压疮的评估方法提供依据。[方法]选取行脊柱后路手术的病人100例,随机分为两组,实验组使用康惠尔透明贴和泡沫敷料预防压疮;对照组使用手术室常规防护措施,术后0h、24h、72h对病人进行压疮评估。[结果]术前血红蛋白、年龄、术中出血量是术中压疮发生的危险因素（P〈0.05）,对照组病人术后发生压疮5例,实验组病人术后发生压疮2例,两组比较有统计学意义（P〈0.05）。[结论]康惠尔透明贴和泡沫敷料对于脊柱后路手术中压疮的预防有一定作用。     

负压封闭引流技术治疗溃疡期压疮的效果观察

[目的]探讨负压封闭引流技术治疗溃疡期压疮的临床疗效.[方法]采用非同期对照研究,将2007年8月-2008年4月我科18例(38处压疮)院外带入溃疡期压疮的病人设为对照组,2008年5月-12月从他院、他科转入我科因地震致脊髓损伤而发生溃疡期压疮病人18例(40处压疮)设为实验组.在清创处理后实验组采用负压封闭引流技术,对照组采用外科普通换药方法;对创面肉芽组织生长和愈合效果进行动态观察,评价临床疗效.[结果]经治疗后两组创面愈合总体效果、肉芽组织生长情况和病人满意度比较,差异均有统计学意义(P＜0.05),实验组总有效率明显高于对照组.[结论]负压封闭引流技术治疗溃疡期压疮效果优于外科普通换药,缩短了创面愈合时间,提高了病人满意度,操作简便,省时省力,且无不良反应.     

Psychosocial factors associated with pressure sores.

To determine if psychosocial factors, not purely mechanical aspects, play an important part in the incidence of pressure sores, 141 subjects were tested on 3 psychosocial measures. Results indicate that differences exist among groups in pressure sore history and psychosocial measures. Contrary to the expectations of a mechanical skin problem model, quadriplegics as a group (rather than paraplegics) had a history of fewer pressure sores. Two variables, the subject's responsibility in skin care (RESPON) and his satisfaction with the activiities of life (SATIS), were significantly associated with the incidence of decubitus ulcers. The combination of RESPON, SATIS, and the total positive score from the Tennessee Self-Concept Scale in multiple linear regression accounted for (1) 26% of the pressure sore history in the total sample, (2) 40% in the paraplegic group, (3) 69% in the paraplegic with help group, and (4) 41% in the paraplegic without help group. The histories in the quadriplegic groups and subgroups did not show reliable associations with the 3 variables. SATIS contributed most in accounting for the incidence of pressure sores. The level of injury and these psychosocial factors are thus related to the incidence of pressure sores.