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Eberhardt TD, Lima SBD, Pozzebon BR, Santos KPD, Silveira LBD, Soares RSDÁ, Alves PJ. Heel skin microclimate control: Secondary analysis of a self-controlled randomized clinical trial. J Tissue Viability 2024; 33:305-311. [PMID: 38553355 DOI: 10.1016/j.jtv.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE this study was undertaken to evaluate the efficacy of multilayer polyurethane foam with silicone (MPF) compared to transparent polyurethane film (TPF) dressings in the control of heel skin microclimate (temperature and moisture) of hospitalized patients undergoing elective surgeries. METHOD the study took of a secondary analysis of a randomized self-controlled trial, involving patients undergoing elective surgical procedure of cardiac and gastrointestinal specialties in a university hospital in southern Brazil, from March 2019 to February 2020. Patients served as their own control, with their heels randomly allocated to either TPF (control) or MPF (intervention). Skin temperature was measured using a digital infrared thermometer; and moisture determined through capacitance, at the beginning and end of surgery. The study was registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5. RESULTS significant difference in the microclimate variables were observed when the groups (intervention and control) and the timepoint of measurement (beginning and end of surgery) were compared. When assessing temperature, an increase (+3.3 °C) was observed with TPF and a decrease (-7.4 °C) was recorded with MPF. Regarding skin moisture, an increase in moisture (+14.6 AU) was recorded with TPF and a slight decrease (-0.3 AU) with MPF. CONCLUSIONS The findings of this study suggest that MPF is more effective than TPF in controlling skin microclimate (temperature and moisture) in heels skin of hospitalized patients undergoing elective surgeries. However, this control should be better investigated in other studies.
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2
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Martins de Oliveira AL, O'Connor T, Patton D, Strapp H, Moore Z. Sub-epidermal moisture versus traditional and visual skin assessments to assess pressure ulcer risk in surgery patients. J Wound Care 2022; 31:254-264. [PMID: 35199594 DOI: 10.12968/jowc.2022.31.3.254] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the predictive ability of subepidermal moisture (SEM) measurement versus traditional risk assessment and visual skin assessment (VSA) as means of detecting early pressure ulcer (PU) damage development among adults undergoing surgery. METHOD A non-experimental, comparative, descriptive cohort study design was used. Following ethical approval, participants who had given their informed written consent had their skin assessed over the areas that were weight-bearing during surgery, using VSA and the SEM measurement. Visual PUs were graded according to the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel ulcer grading system. Assessments took place preoperatively, then daily on the ward, beginning on day one postoperatively and continuing for three days or until discharge. RESULTS Of the 231 participants, who had a mean age of 57.50 years, 55.8% (n=129) were male. The most common comorbidity was cardiology/vascular (n=42; 18.2%). Just over half (52.4%; n=121) underwent orthopaedic surgery and 47.6% (n=110) underwent non-orthopaedic surgery; 70% (n=163) received a general anaesthetic and 43% (n=100) were in the supine decubitus position during surgery. PU incidence was 51% (n=116), according to SEM measurement, and 3% (n=7) according to VSA. Among the seven participants who developed a visual PU, 10 PUs at stage 1 developed (31%); some patients developed more than one PU. Of the participants who had assessments for three days postoperatively, 94% (n=61) had a persistently high SEM delta on day three. The variables that emerged as statistically significantly related to abnormal SEM measurement deltas among these participants were: surgery duration (p=0.038); having orthopaedic surgery (p=0.020); supine surgical position (p=0.003); spinal anaesthetic type (p=0.0001); and Waterlow and Braden mobility subscale day one postoperatively (p=0.0001). None of the variables had a statistically significant influence on abnormal VSA. CONCLUSION Surgical patients, because of immobility, are vulnerable to the action of compression and shear forces. These forces cause changes at a cellular level that trigger inflammation, which is a precursor to early tissue damage. SEM measurement can detect this tissue damage from the increase in the underlying tissue water content that results from inflammation. From the findings of this study, SEM measurement is very promising in the detection of early tissue damage in those at risk of PU development among the surgical population.
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Affiliation(s)
| | - Tom O'Connor
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,Lida Institute, Shanghai.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia
| | - Declan Patton
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Helen Strapp
- Tallaght University Hospital, Ireland.,SWaT Research Network, RCSI University of Medicine and Health Sciences, Ireland
| | - Zena Moore
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Lida Institute, Shanghai.,University of Wales, Wales.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia
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3
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Guzman S, Allegretti AL, Kormos RL, Brienza DM. A comparison of air-cell and gel surgical table pads and an evaluation of the influence of pressure distribution and other factors on pressure injury prevention. J Tissue Viability 2021; 30:9-15. [PMID: 33468340 DOI: 10.1016/j.jtv.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/01/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
Guidelines for pressure injury prevention consider the use of pressure-redistributing pads to prevent tissue deformation. However, limited research exists to assess the pressure distribution provided by the operating tables and the effectiveness of pressure-redistributing pads in preventing pressure injuries. In this study, we compared the pressure distribution properties of two surgical table pads and identified parameters influencing pressure injury outcomes after a lengthy surgical procedure. Twenty-seven patients undergoing left ventricular assist device implantation surgery participated in the study. Participants were randomly assigned to use either an air cell-based pad or a gel pad. Interface pressure was recorded during the surgery. We analyzed the effect of surgical table pad type, interface pressure distribution and pressure injury outcomes and analyzed what characteristics of the patients and the interface pressure are most influential for the development of pressure injuries. Comparing the interface pressure parameters between the air-cell group and the gel group, only the peak pressure index x time was significantly different (p < 0.05). We used univariate logistic regression analysis to identify significant predictors for the pressure injury outcome. The support surface was not significant. And, among patient characteristics, only age and BMI were significant (p ≤ 0.05). Among the interface pressure parameters, pressure density maxima, peak pressure index x time, and coefficient of variation were significant for pressure injury outcome (p ≤ 0.05). Peak pressure index, average pressure, and the surgery length were not statistically significant for pressure injury outcomes.
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Affiliation(s)
- Sandra Guzman
- University of Pittsburgh, School of Health and Rehabilitation Sciences, 6425 Penn Ave, Suite 401, Pittsburgh, PA, 15206, USA.
| | - Ana L Allegretti
- UT Health San Antonio, Department of Occupational Therapy, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Robert L Kormos
- University of Pittsburgh, Cardiothoracic Surgery, 802 Rough Hollow Drive, Austin, TX, 78734, USA.
| | - David M Brienza
- School of Health and Rehabilitation Sciences, Department of Rehabilitation Science and Technology, School of Engineering, Dept of Bioengineering, 6425 Penn Ave, Suite 401, Pittsburgh, PA, 15206, USA.
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4
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Eberhardt TD, de Lima SBS, de Avila Soares RS, Silveira LBTD, Rossarola Pozzebon B, Reis CR, Dos Santos KPP, Alves PJP. Prevention of pressure injury in the operating room: Heels operating room pressure injury trial. Int Wound J 2020; 18:359-366. [PMID: 33314605 PMCID: PMC8243998 DOI: 10.1111/iwj.13538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022] Open
Abstract
The objective was to evaluate the efficacy of multi‐layered silicone foam (intervention) compared with transparent polyurethane film (control) in preventing heel pressure injuries caused by surgical positioning of individuals undergoing elective surgery. It was designed an intra‐patient, open, parallel, randomised controlled trial was conducted in a university hospital in southern Brazil, from March 2019 to February 2020, with patients undergoing elective surgeries of cardiac and gastrointestinal specialties. The patients who met the selection criteria constituted, simultaneously, a single group receiving the intervention and active control, through paired analysis of the cutaneous sites (right heel and left heel). The outcome was the occurrence of PI, within the follow‐up period was 72 hours. Brazilian Registry of Clinical Trials: RBR‐5GKNG5. There was analysis of 135 patients/270 heels, with an overall incidence of 36.7%. The pressure injury incidence was significantly lower in the intervention group (26.7%), compared with the control group (P = .001); relative risk of 0.57. In the intervention group, the estimated pressure injury‐free time (survival) was 57.5 hours and in the control group, 43.9 hours. It was concluded that Multi‐layered silicone foam (intervention) is more efficacious than transparent polyurethane film (control) in the prevention of pressure injuries caused by surgical positioning of individuals undergoing elective surgery.
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Affiliation(s)
- Thaís Dresch Eberhardt
- Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.,Instituto de Ciências Biológicas, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | | | | | | | | | - Cassia Ribeiro Reis
- Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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5
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Gao L, Yang L, Li X, Chen J, Du J, Bai X, Yang X. The use of a logistic regression model to develop a risk assessment of intraoperatively acquired pressure ulcer. J Clin Nurs 2018; 27:2984-2992. [PMID: 29679411 DOI: 10.1111/jocn.14491] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To screen the factors of intraoperatively acquired pressure ulcer and establish a new risk assessment model of intraoperatively acquired pressure ulcer. DESIGN This is a prospective study. METHODS A total of 1,963 patients who received neurosurgery, orthopaedics, paediatric surgery and cardiac surgery therapy in Sichuan Academy of Medical Science and Provincial People's Hospital in China from October 2015-October 2016 were enrolled in the study, and their clinical parameters were collected. Multivariable logistic regression analysis and decision tree analysis were used to analyse and screen the factors of intraoperatively acquired pressure ulcer and establish the risk assessment model of intraoperatively acquired pressure ulcer. RESULTS The risk factors for intraoperatively acquired pressure ulcer included the application of external force during operation (β = 1.10, OR = 3.20), lean body mass (β = 1.08, OR = 2.95), time of operation ≥6 hr (β = 2.66, OR = 14.30), prone position operation (β = 1.13, OR = 3.10), cardiopulmonary bypass during operation (β = 1.72, OR = 5.59) and intraoperative blood loss (β = 0.67, OR = 1.95). The new risk assessment model showed that the AUC of ROC curve was 0.897 (p < .001). According to the maximum principle of Youden's index, the sensitivity, specificity and Youden's index J of the model were 0.81, 0.88 and 0.69, respectively, when the cut-off point was set at π = 0.025. CONCLUSIONS A new and relatively reliable assessment model for intraoperatively acquired pressure ulcer is established. RELEVANCE TO CLINICAL PRACTICE Pressure ulcers remain a challenge in clinical nursing. A new risk assessment model of pressure ulcers that is applicable to surgical patients is highly recommended.
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Affiliation(s)
- Ling Gao
- Sichuan Academy of Medical Science and Provincial People's Hospital, Chengdu, Sichuan, China
| | - Lina Yang
- Sichuan Academy of Medical Science and Provincial People's Hospital, Chengdu, Sichuan, China
| | - Xiaoqin Li
- Sichuan Academy of Medical Science and Provincial People's Hospital, Chengdu, Sichuan, China
| | - Jin Chen
- Sichuan Academy of Medical Science and Provincial People's Hospital, Chengdu, Sichuan, China
| | - Juan Du
- Sichuan Academy of Medical Science and Provincial People's Hospital, Chengdu, Sichuan, China
| | - Xiaoxia Bai
- Sichuan Academy of Medical Science and Provincial People's Hospital, Chengdu, Sichuan, China
| | - Xianjun Yang
- Department of Health Statistics, Prevention and Control Centre of Disease of Chengdu Military Command, Chengdu, Sichuan, China
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6
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Yoshimura M, Ohura N, Tanaka J, Ichimura S, Kasuya Y, Hotta O, Kagaya Y, Sekiyama T, Tannba M, Suzuki N. Soft silicone foam dressing is more effective than polyurethane film dressing for preventing intraoperatively acquired pressure ulcers in spinal surgery patients: the Border Operating room Spinal Surgery (BOSS) trial in Japan. Int Wound J 2016; 15:188-197. [PMID: 27928911 DOI: 10.1111/iwj.12696] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 11/28/2022] Open
Abstract
Preventing intraoperatively acquired pressure ulcers (IAPUs) in patients undergoing spinal surgery in the prone position using a Relton-Hall frame is challenging. We investigated the efficacy of soft silicone foam dressings in preventing IAPUs. A prospective dual-center sham study was conducted among patients undergoing elective spinal surgery in a general hospital and a university hospital in Japan. The incidence of IAPUs that developed when soft silicone foam dressings and polyurethane film dressings were used was compared on two sides in the same patient. IAPUs developed on the chest in 11 of 100 patients (11%). Polyurethane film dressings were associated with a significantly higher rate of IAPUs than soft silicone foam dressings (11 versus 3, P = 0·027). A multivariate logistic regression analysis revealed that a diastolic blood pressure of <50 mmHg (P = 0·025, OR 3·74, 95% confidence interval [CI] 1·18-13·08) and the length of surgery (by 1 hour: P = 0·038, OR 1·61, 95% CI 1·03-2·64) were independently associated with the development of IAPUs. The use of soft silicone foam dressings reduced the risk of IAPUs (P = 0·019, OR 0·23, 95% CI 0·05-0·79) and was more effective than film dressings for preventing IAPUs in spinal surgery patients.
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Affiliation(s)
- Mine Yoshimura
- Department of Nursing, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Norihiko Ohura
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Junko Tanaka
- Department of Epidemiology Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shoichi Ichimura
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yusuke Kasuya
- Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Oruto Hotta
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yu Kagaya
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Takuya Sekiyama
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Mitsuko Tannba
- Department of Nursing, Kyorin University Hospital, Tokyo, Japan
| | - Nao Suzuki
- Department of Nursing, Tokyo Metropolitan Police Hospital, Tokyo, Japan
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7
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Tayyib N, Coyer F, Lewis P. Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: a prospective cohort study. Int Wound J 2016; 13:912-9. [PMID: 25662591 PMCID: PMC7949994 DOI: 10.1111/iwj.12406] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/09/2014] [Accepted: 12/04/2014] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to identify pressure ulcer (PU) incidence and risk factors that are associated with PU development in patients in two adult intensive care units (ICU) in Saudi Arabia. A prospective cohort study design was used. A total of 84 participants were screened second daily basis until discharge or death, over a consecutive 30-day period, out of which 33 participants with new PUs were identified giving a cumulative hospital-acquired PU incidence of 39·3% (33/84 participants). The incidence of medical devices-related PUs was 8·3% (7/84). Age, length of stay in the ICU, history of cardiovascular disease and kidney disease, infrequent repositioning, time of operation, emergency admission, mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU. According to binary logistic regression analyses, age, longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs, while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II-IV PUs. In conclusion, PU incidence rate was higher than that reported in other international studies. This indicates that urgent attention is required for PU prevention strategies in this setting.
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Affiliation(s)
- Nahla Tayyib
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Peter Lewis
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
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8
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Yoshimura M, Nakagami G, Iizaka S, Yoshida M, Uehata Y, Kohno M, Kasuya Y, Mae T, Yamasaki T, Sanada H. Microclimate is an independent risk factor for the development of intraoperatively acquired pressure ulcers in the park-bench position: A prospective observational study. Wound Repair Regen 2015; 23:939-47. [DOI: 10.1111/wrr.12340] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mine Yoshimura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Mikako Yoshida
- Department of Life Support Technology (Molten), Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yoko Uehata
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Michihiro Kohno
- Department of Neurosurgery; Tokyo Medical University; Tokyo Japan
| | - Yusuke Kasuya
- Department of Anesthesiology; Tokyo Women's Medical University; Tokyo Japan
| | - Tomoko Mae
- Department of Anesthesiology; Tokyo Metropolitan Police Hospital; Tokyo Japan
| | - Takashi Yamasaki
- Department of Anesthesiology; Tokyo Metropolitan Police Hospital; Tokyo Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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9
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Yoshimura M, Iizaka S, Kohno M, Nagata O, Yamasaki T, Mae T, Haruyama N, Sanada H. Risk factors associated with intraoperatively acquired pressure ulcers in the park-bench position: a retrospective study. Int Wound J 2015; 13:1206-1213. [PMID: 26043765 DOI: 10.1111/iwj.12445] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/22/2015] [Indexed: 11/28/2022] Open
Abstract
Patients undergoing surgery in the park-bench position are at high risk of developing intraoperatively acquired pressure ulcers (IAPUs). The purpose was to examine retrospectively risk factors associated with IAPUs in the park-bench position. This study was conducted at a general hospital during the period of September 2010 to September 2012. Twenty-one potential risk factors were evaluated using data obtained from the hospital database. IAPUs developed in 30 of 277 patients (11%). Perspiration was statistically found to be independently associated with IAPUs [OR 3·09, 95% confidence interval (Cl) 1.07-8·58, P = 0·037]. A length of surgery of more than 6 hours was identified to be likely associated with IAPUs (OR 2·64, 95% Cl 0·84-9·08, P = 0·095) compared with less than 6 hours. Furthermore, there was an interaction between the length of surgery and the core temperature; that is, when the length of surgery was more than 6 hours, a core temperature of more than 38·1°C at the end of surgery had a higher odds ratio (8·45, 95% Cl 3·04-27·46, P < 0·001) than that at a lower core temperature (3·20, 95% Cl 1·23-8·78, P = 0·017). These results suggest that perspiration and core temperature are preventable causative factors of pressure ulcers, even under conditions of prolonged surgery in the park-bench position.
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Affiliation(s)
- Mine Yoshimura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Nursing, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Osamu Nagata
- Department of Anesthesiology, Cancer Institute Hospital, Tokyo, Japan
| | - Takashi Yamasaki
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Tomoko Mae
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Naoko Haruyama
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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10
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Santamaria N, Gerdtz M, Sage S, McCann J, Freeman A, Vassiliou T, De Vincentis S, Ng AW, Manias E, Liu W, Knott J. A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J 2015; 12:302-8. [PMID: 23711244 PMCID: PMC7950350 DOI: 10.1111/iwj.12101] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/19/2013] [Indexed: 12/29/2022] Open
Abstract
The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex(®) Border Sacrum and Mepilex(®) Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer.
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Affiliation(s)
- Nick Santamaria
- Nursing Research, University of Melbourne & Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Marie Gerdtz
- Emergency Department, University of Melbourne & Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sarah Sage
- Nursing, Royal Park Hospital, Melbourne, VIC, Australia
| | - Jane McCann
- Nursing, Royal Park Hospital, Melbourne, VIC, Australia
| | - Amy Freeman
- Department of Podiatry, Western Health, Melbourne, VIC, Australia
| | - Theresa Vassiliou
- Emergency Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Ai Wei Ng
- Nursing, Royal Park Hospital, Melbourne, VIC, Australia
| | | | - Wei Liu
- Emergency Department, University of Melbourne & Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jonathan Knott
- Emergency Department, University of Melbourne & Royal Melbourne Hospital, Melbourne, VIC, Australia
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11
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Lumbley JL, Ali SA, Tchokouani LS. Retrospective review of predisposing factors for intraoperative pressure ulcer development. J Clin Anesth 2014; 26:368-74. [PMID: 25113424 DOI: 10.1016/j.jclinane.2014.01.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 12/30/2013] [Accepted: 01/10/2014] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To evaluate the comorbidities and surgical factors involved in the genesis of intraoperative pressure ulcers. DESIGN Retrospective chart review. SETTING Anesthesiology department of a university medical center. MEASUREMENTS The charts of 222 patients with varying illness, who underwent an operation of at least two hours' duration, were analyzed retrospectively. Data on surgery type, case length, comorbidities, intraoperative surgical position, and area of ulceration were recorded. MAIN RESULTS Risk factors for intraoperative pressure ulcer development include surgical times of 4 hours or longer; comorbidities affecting tissue perfusion (namely, diabetes, hypertension, and nonspecific cardiac issues); supine placement during surgery; and abdominal, noncardiac thoracic, and orthopedic operations. Regions of the body most at risk for ulceration include the coccygeal/sacral region, the buttocks, genitalia, and heels. CONCLUSIONS Pressure ulcers are a costly, debilitating, and avoidable complication of surgery.
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Affiliation(s)
- Joshua L Lumbley
- Department of Anesthesiology, Ohio State Univeristy (OSU) Wexner Medical Center, Columbus, OH 43210-1267, USA.
| | - Syed A Ali
- Department of Anesthesiology, Ohio State Univeristy (OSU) Wexner Medical Center, Columbus, OH 43210-1267, USA; Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Loic S Tchokouani
- Department of Anesthesiology, Ohio State Univeristy (OSU) Wexner Medical Center, Columbus, OH 43210-1267, USA; Ohio State University College of Medicine, Columbus, OH 43210, USA
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12
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Dealey C, Brindle CT, Black J, Alves P, Santamaria N, Call E, Clark M. Challenges in pressure ulcer prevention. Int Wound J 2013; 12:309-12. [PMID: 23786251 DOI: 10.1111/iwj.12107] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/01/2013] [Accepted: 05/05/2013] [Indexed: 11/28/2022] Open
Abstract
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?
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Affiliation(s)
- Carol Dealey
- Tissue Viability, University Hospital Birmingham NHSFT, Birmingham, UK
| | - C Tod Brindle
- Wound Care Team, Virginia Commonwealth University (VCU) Medical Center, Richmond, VA, USA
| | - Joyce Black
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paulo Alves
- Health Sciences Institute, Catholic University of Portugal, Porto, Portugal
| | - Nick Santamaria
- Nursing-Translational Research, University of Melbourne & Royal Melbourne Hospital AU, Melbourne, VIC, Australia
| | - Evan Call
- Department of Microbiology, Weber State University, Weber, UT, USA
| | - Michael Clark
- Faculty of Health, Birmingham City University, Birmingham, UK
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Moore Z, Cowman S. Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland. J Clin Nurs 2011; 21:362-71. [DOI: 10.1111/j.1365-2702.2011.03749.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carneiro GA, Leite RDCBDO. [Skin lesions in the intraoperative period of cardiac surgery: incidence and characterization]. Rev Esc Enferm USP 2011; 45:611-6. [PMID: 21710065 DOI: 10.1590/s0080-62342011000300009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 09/21/2010] [Indexed: 11/22/2022] Open
Abstract
The main objective of this exploratory, descriptive cohort study was to verify the incidence of patients submitted to cardiac surgery who developed skin lesions during the intraoperative period, and characterize the lesions. Data collection was performed at the Surgery Department of a public teaching hospital, of tertiary health care, mostly surgical, specialized in cardiology, and located in São Paulo. The study sample consisted of 182 patients. The study was performed with a significant p (<0.05) in nonparametric statistical tests. The incidence found for patients submitted to cardiac surgery who developed skin lesions due to the preoperative period was 20.9%. It was observed that 19.2% of lesions were Pressure Ulcers (PU) in stage I; 1.1% of lesions were abrasive; 1.1% incisive; 0.5% lacerative; 0.5% superficial electrical burns; and 0.5% PU in stage II.
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Moore Z, Cowman S, Conroy RM. A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers. J Clin Nurs 2011; 20:2633-44. [PMID: 21702861 DOI: 10.1111/j.1365-2702.2011.03736.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Zena Moore
- Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland.
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Physical therapists' perceptions of ease of care in patients receiving 2 forms of analgesia after total hip arthroplasty. Phys Ther 2010; 90:707-13. [PMID: 20299408 DOI: 10.2522/ptj.20080323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain management modalities that facilitate patient mobility may contribute to recovery after total hip replacement (THR) surgery. OBJECTIVE The aim of this study was to evaluate the impact of morphine intravenous (IV) patient-controlled analgesia (PCA) and the fentanyl iontophoretic transdermal system (fentanyl ITS) on physical therapists' ability to complete care tasks for patients after THR. DESIGN The data were from an open-label, randomized, multicenter, active-control phase IIIb clinical trial. METHODS The settings were 52 US-based teaching and community hospitals. The patients were >or=18 years of age (mean [SEM]: 62.8 [0.6] years in the fentanyl ITS group and 62.9 [0.6] years in the morphine IV PCA group); had an American Society of Anesthesiologists physical status of I, II, or III; and were scheduled to undergo primary unilateral THR surgery. The patients were randomized to receive analgesia for up to 72 hours via the fentanyl ITS (40 microg of fentanyl over 10 minutes for up to 6 doses per hour for 24 hours or 80 doses per system, whichever occurred first) or morphine IV PCA (1-mg bolus doses [with a 5-minute lockout interval between doses] for up to 10 doses per hour for 24 hours). All patients received the usual treatment administered by physical therapists. After each therapy session, physical therapists completed a validated Physical Therapist Ease-of-Care Questionnaire, which included time efficiency and convenience subscales (lower scores indicated more positive responses) and a satisfaction subscale (a higher score indicated a more positive response). Therapists whose average scores were <or=2 on all items of the time efficiency and convenience subscales or >or=4 on both items of the satisfaction subscale were considered responders. RESULTS Higher percentages of physical therapists were responders for the fentanyl ITS than for morphine IV PCA on the subscales that assessed time efficiency (84.9% and 59.1%, respectively), convenience (86.6% and 71.2%, respectively), and satisfaction (54.3% and 30.5%, respectively). Higher percentages of physical therapists favored the fentanyl ITS than favored morphine IV PCA. Limitations The trial was limited by its open-label design, and physical therapists were more familiar with IV PCA than with the fentanyl ITS. CONCLUSIONS The findings demonstrate benefits to physical therapists of using the fentanyl ITS over morphine IV PCA in terms of time efficiency, convenience, and satisfaction.
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Pennington P, Caminiti S, Schein JR, Hewitt DJ, Nelson WW. Patients' Assessment of the Convenience of Fentanyl HCl Iontophoretic Transdermal System (ITS) Versus Morphine Intravenous Patient-Controlled Analgesia (IV PCA) in the Management of Postoperative Pain After Major Surgery. Pain Manag Nurs 2009; 10:124-33. [DOI: 10.1016/j.pmn.2007.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 08/06/2007] [Accepted: 09/25/2007] [Indexed: 11/26/2022]
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Sayar S, Turgut S, Doğan H, Ekici A, Yurtsever S, Demirkan F, Doruk N, Taşdelen B. Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. J Clin Nurs 2008; 18:765-74. [PMID: 19077014 DOI: 10.1111/j.1365-2702.2008.02598.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine incidence of pressure ulcers in patients at risk according to the Waterlow scale in intensive care units and to evaluate the effects of risk factors in critically ill patients. BACKGROUND Pressure ulcers continue to be an important health problem that increases the risk of illness and death, extends patients' length of hospital stay and increases healthcare expenses. DESIGN The study was conducted as a descriptive and prospective study. METHOD The sample consisted of 140 patients. Data were collected using a data collection form, the skin assessment instrument and the Waterlow scale. RESULTS The incidence of pressure ulcers in intensive care unit patients was found to be 14.3%. The majority of pressure ulcers (74%) were grade I. The mean length of time for pressure ulcer development was found to be 10.4 (SD 1.85) days. A statistically significant difference was found in the patients for pressure ulcer development according to their level of consciousness, activity, cooperation, length of stay, Waterlow scale score and C-reactive protein level. In the multiple stepwise logistic regression analysis, the most influential factors for pressure ulcer development were determined to be length of stay and activity level. CONCLUSIONS Extra care needs to be taken to prevent pressure ulcer development in intensive care unit patients who have an extended length of stay, are dependent for activities, have high Waterlow scores, are unconscious and are not cooperative. RELEVANCE TO CLINICAL PRACTICE This study determined the incidence of and factors that can affect the development of pressure ulcers in intensive care unit patients who are in a high risk group for the development of pressure ulcers and presented the importance of having Turkish nurses implement interventions directed at these factors.
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Affiliation(s)
- Serap Sayar
- Mersin Universitesi Tip Fakültesi Araştirma Hastanesi, Yara Bakim Unitesi, Zeytinlibahçe Sk Eski Otogar Yani, Mersin, Turkey
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Baumgarten M, Margolis DJ, Localio AR, Kagan SH, Lowe RA, Kinosian B, Abbuhl SB, Kavesh W, Holmes JH, Ruffin A, Mehari T. Extrinsic risk factors for pressure ulcers early in the hospital stay: a nested case-control study. J Gerontol A Biol Sci Med Sci 2008; 63:408-13. [PMID: 18426965 DOI: 10.1093/gerona/63.4.408] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about the impact of extrinsic factors on pressure ulcer risk. The objective of this study was to determine whether risk of pressure ulcers early in the hospital stay is associated with extrinsic factors such as longer emergency department (ED) stays, night or weekend admission, potentially immobilizing procedures and medications, and admission to an intensive care unit (ICU). METHODS A nested case-control study was performed in two teaching hospitals in Philadelphia, Pennsylvania. Participants were medical patients age > or =65 years admitted through the ED. Cases (n = 195) had > or =1 possibly or definitely hospital-acquired pressure ulcers. Three controls per case were sampled randomly from among noncases at the same hospital in the same month (n = 597). Pressure ulcer status was determined by a research nurse on the third day of hospitalization. Pressure ulcers were classified as preexisting, possibly hospital-acquired, or definitely hospital-acquired. Information on extrinsic factors was obtained by chart review. RESULTS The odds of pressure ulcers were twice as high for those with an ICU stay as for those without (adjusted odds ratio [aOR] 2.0, 95% confidence interval [CI], 1.2-3.5). The aOR was 0.6 (95% CI, 0.3-0.9) for use of any potentially immobilizing medications during the early inpatient period. CONCLUSIONS Many of the procedures experienced by patients in the ED and early in the inpatient stay do not confer excess pressure ulcer risk. Having an ICU stay is associated with a doubling of risk. This finding emphasizes the importance of developing and evaluating interventions to prevent pressure ulcers among patients in the ICU.
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Affiliation(s)
- Mona Baumgarten
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, USA.
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Agam L, Gefen A. Pressure ulcers and deep tissue injury in wheelchair users: A bioengineering perspective. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.2.28192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Wheelchair users are highly susceptible to deep tissue injury. Interface pressures are unlikely to predict this, and an alternative assessment approach is needed that can easily monitor internal mechanical stresses and deformations. This review aims to provide clinicians with a comprehensive perspective of the biomechanical aspects of pressure ulceration in wheelchair users.
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Affiliation(s)
- L Agam
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel,
| | - A Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
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Nakagami G, Sanada H, Konya C, Kitagawa A, Tadaka E, Matsuyama Y. Evaluation of a new pressure ulcer preventive dressing containing ceramide 2 with low frictional outer layer. J Adv Nurs 2007; 59:520-9. [PMID: 17681081 DOI: 10.1111/j.1365-2648.2007.04334.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This paper is a report of an evaluation of the effectiveness of a newly developed dressing for preventing persistent erythema and pressure ulcer development and improving the water-holding capacity without increasing the skin pH in bedridden older patients. BACKGROUND Shear forces and skin dryness play important roles in persistent erythema and pressure ulcer development. To eliminate these risks, we developed a dressing to reduce shear forces and improve the water-holding capacity. However, the effects of this dressing in clinical settings remain unknown. METHOD An experimental bilateral comparison study was conducted at a hospital in Japan in 2004 with 37 bedridden older patients at risk of pressure ulcer development. The dressing was randomly applied to the right or left greater trochanter for 3 weeks. No dressing was applied to the opposite side as a control. The skin was monitored weekly during the 3-week application for persistent erythema and pressure ulcer development. Skin hydration and pH were also assessed during the intervention and for 1 week after dressing removal. FINDINGS The incidence of persistent erythema was significantly lower in the intervention area than the control area [P = 0.007, RR 0.18 (95% CI: 0.05-0.73) and NNT 4.11 (2.50-11.63) ]. No pressure ulcers occurred in either the intervention or control area. Skin hydration increased significantly during dressing application and remained high after removal (P < 0.001) relative to the control area. Skin pH decreased significantly during the application (P < 0.001) but returned to control levels after removal (P = 0.38). CONCLUSION This safe and effective dressing can be used for patients with highly prominent bones and dry skin to prevent pressure ulcers.
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Affiliation(s)
- Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Japan Society for the Promotion of Science [corrected] Tokyo, Japan.
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Agam L, Gefen A. Pressure ulcers and deep tissue injury: a bioengineering perspective. J Wound Care 2007; 16:336-42. [DOI: 10.12968/jowc.2007.16.8.27854] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- L Agam
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - A Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Papanikolaou P, Lyne P, Anthony D. Risk assessment scales for pressure ulcers: A methodological review. Int J Nurs Stud 2007; 44:285-96. [PMID: 17141782 DOI: 10.1016/j.ijnurstu.2006.01.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 12/19/2005] [Accepted: 01/10/2006] [Indexed: 10/23/2022]
Abstract
Much is written about risk-assessment scales (RASs) for pressure ulcers (PU) and their properties demonstrating that they are of limited value. Less is known about the reasons for these limitations and the scope for improvement. This review examines issues such as structure and scoring for the Norton, Waterlow and Braden scales, showing that the equal-weighting technique behind the current RASs is too simplistic and leads to limitations. It concludes that properly trained, experienced nurses should conduct PU risk assessments, whilst more robust data-driven RASs should be developed using the differential weighting scoring method together with advanced statistical techniques.
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Affiliation(s)
- Panos Papanikolaou
- Nursing, Health and Social Care Research Centre, School of Nursing and Midwifery Studies, University of Cardiff, 35-43 Newport Road, Cardiff CF24 0AB, UK.
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Imanishi K, Morita K, Matsuoka M, Hayashi H, Furukawa S, Terashita F, Moriya E, Kanesaki U, Kinukawa N, Nose Y, Moroi Y, Urabe K, Furue M. Prevention of postoperative pressure ulcers by a polyurethane film patch. J Dermatol 2006; 33:236-7. [PMID: 16620238 DOI: 10.1111/j.1346-8138.2006.00057.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Karadag M, Gümüskaya N. The incidence of pressure ulcers in surgical patients: a sample hospital in Turkey. J Clin Nurs 2006; 15:413-21. [PMID: 16553754 DOI: 10.1111/j.1365-2702.2006.01369.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This research was conducted for the purpose of determining the incidence of surgery-related pressure ulcer formation. BACKGROUND Patients undergoing surgery are prone to develop pressure ulcers during surgery. Pressure ulcer incidence in surgery population is reported between 3.5% and 29.5%. Some of these factors that occur during surgery are being under pressure for a long time, remaining wet, and metabolic and circulatory changes related to the surgery and anaesthesia. DESIGN The research was conducted as a prospective-analytic-descriptive study with 84 patients who agreed to participate in the study and who were 20 years old or older, having elective surgery, having a surgical procedure lasting two or more hours under general anaesthesia, and who had no risk for pressure ulcer development before surgery according to the Braden Pressure Ulcer Risk Assessment Scale. Research data were obtained using a Data Collection Form that has places for pre-, intra- and postoperative factors that may be related to surgery-related pressure ulcer development; a Body Mass Index Data Form and the Braden Pressure Ulcer Risk Assessment Scale. The Braden Pressure Ulcer Risk Assessment Scale was used to determine that patients had no risk for pressure ulcer development pre- and postoperatively and it was used for the purpose of establishing the patients risk status and areas at risk. Patients were monitored for pressure ulcers until the sixth postoperative day and risk status and areas at risk were determined. Data obtained in the research were analysed using percentage, chi-squared, McNemar and Cohen's Kappa tests for reliability between dependent groups. RESULTS At the conclusion of the research, the findings obtained showed that 54.8% of the patients (n = 46) were observed to have Stage 1 pressure ulcers. A total of 41.3% of the patients had pressure ulcers in more than one region and 56.5% of these were of the erythema type. During the six-day postoperative monitoring, 97.9% of the pressure ulcers were observed in the first three days. CONCLUSION The study made clear that surgery-related pressure ulcers are an important problem. RELEVANCE TO CLINICAL PRACTICE (i) Determining the incidence of pressure ulcers during surgery in Turkey; (ii) For nurses to be able to prevent surgery-related pressure ulcers, it is necessary for them to direct their care by knowing factors that have a role in the development of pressure ulcers during surgery therefore this study will be to call Turkish nurse's attention to pressure ulcers during surgery.
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Ersser SJ, Getliffe K, Voegeli D, Regan S. A critical review of the inter-relationship between skin vulnerability and urinary incontinence and related nursing intervention. Int J Nurs Stud 2005; 42:823-35. [PMID: 16084927 DOI: 10.1016/j.ijnurstu.2004.12.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Revised: 12/06/2004] [Accepted: 12/09/2004] [Indexed: 11/19/2022]
Abstract
The literature reveals there has been limited critical discussion of the inter-relationship between urinary incontinence, the vulnerability of the skin and the clinical implications. This paper critically re-examines the literature to identify and apply relevant scientific principles and evidence to inform effective intervention. It includes background on the structure, function and disruption to the skin's barrier. The implications for fundamental and largely taken-for-granted nursing practices, such as washing the skin, are examined. The current state of knowledge is analysed, specifying the types of evidence available and its weaknesses, highlighting implications for a research agenda.
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Affiliation(s)
- S J Ersser
- Living with Chronic Health Needs Research Group, School of Nursing and Midwifery, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
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Abstract
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. 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. 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.
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Affiliation(s)
- Alyce Schultz
- University of California Davis Medical Center, Center for Nursing Research, Sacramento, Calif., USA
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Lindgren M, Unosson M, Fredrikson M, Ek AC. Immobility--a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scand J Caring Sci 2004; 18:57-64. [PMID: 15005664 DOI: 10.1046/j.0283-9318.2003.00250.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify risk factors associated with pressure ulcer development among adult hospitalized medical and surgical patients. DESIGN A prospective comparative study including 530 adult patients from medical and surgical wards. Registered Nurses made the data collection on admission and once a week for up to 12 weeks. The risk assessment scale used was the Risk Assessment Pressure Sore (RAPS) scale, including the following variables; general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin. RESULTS Sixty-two (11.7%) patients developed 85 pressure ulcers. The most common pressure ulcer was that of nonblanchable erythema. Patients who developed pressure ulcers were significantly older, hospitalized for a longer time, had lower scores on the total RAPS scale, had lower weight and lower diastolic blood pressure than nonpressure ulcer patients did. In the multiple logistic regression analyses using variables included in the RAPS scale immobility emerged as a strong risk factor. When adding remaining significant variables in the analyses, mobility, time of hospitalization, age, surgical treatment and weight were found to be risk factors for pressure ulcer development. CONCLUSION It is confirmed that immobility is a risk factor of major importance for pressure ulcer development among adult hospitalized patients. The results also indicate that the RAPS scale may be useful for prediction of pressure ulcer development in clinical practice.
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Affiliation(s)
- Margareta Lindgren
- Department of Medicine and Care, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Gould D, Goldstone L, Kelly D, Gammon J. Examining the validity of pressure ulcer risk assessment scales: a replication study. Int J Nurs Stud 2004; 41:331-9. [PMID: 14967190 DOI: 10.1016/j.ijnurstu.2003.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2003] [Revised: 08/13/2003] [Accepted: 10/09/2003] [Indexed: 11/21/2022]
Abstract
Risk assessment scales (RASs) intended to identify patients most at risk of developing pressure ulcers have been widely used for many years. Numerous studies have evaluated their predictive validity but potential bias has been inherent in the design of all. To overcome these problems a simulation study was conducted in which clinical nurses were asked to identify the degree of risk experienced by four patients employing the three RASs discussed most frequently in the literature (Norton, Braden and Waterlow Scores). These findings were compared with nurses' clinical judgment rated on a visual analogue scale. The simulations consisted of high-resolution photographs accompanied by case studies of the patients. The nurses' scores were compared to estimates of risk generated by an expert panel. Nurses' clinical judgment agreed much more closely with expert opinion than any of the RASs. A replication study was undertaken to confirm these findings. One hundred and fifteen nurses participated in replication. Again the nurses' clinical judgment matched expert opinion much more closely than the results of the RASs. Replication also drew attention to a number of methodological issues which deserve consideration when using simulation to test the effectiveness of clinical tools and the need to establish adequate measures of external validity whenever use of this method is contemplated.
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Russell LJ, Reynolds TM, Park C, Rithalia S, Gonsalkorale M, Birch J, Torgerson D, Iglesias C. Randomized Clinical Trial Comparing 2 Support Surfaces. Adv Skin Wound Care 2003; 16:317-27. [PMID: 14652518 DOI: 10.1097/00129334-200311000-00015] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether a viscoelastic polymer (energy absorbing) foam mattress was superior to a standard hospital mattress for pressure ulcer prevention and to analyze the cost-effectiveness in comparison with standard hospital mattresses. DESIGN Unblinded, randomized, prospective trial. SETTING Elderly acute care, rehabilitation, and orthopedic wards at 3 hospitals in the United Kingdom. PARTICIPANTS 1168 patients at risk of developing pressure ulcers (Waterlow score, 15 to 20), with a median age of 83 years (25th to 75th percentile range, 79-87). INTERVENTIONS Participants were allocated to either the experimental equipment (CONFOR-Med mattress/cushion combination) or a standard mattress/cushion combination; all were given standard nursing care. Pressure areas were observed daily. MAIN OUTCOME MEASURE Development of nonblanching erythema. RESULTS A significant decrease in the incidence of blanching erythema (26.3% to 19.9%; P =.004) and a nonsignificant decrease in the incidence of nonblanching erythema occurred in participants allocated to the experimental equipment. However, when the survival curve plots were analyzed at 7 days, both categories showed statistically significant decreases (P =.0015 and P =.042, respectively). Participants on standard equipment had a relative odds ratio of 1.36 (95% confidence interval [CI], 1.10-1.69) for developing blanching erythema or worse and 1.46 (95% CI, 0.90-1.82) for developing nonblanching erythema or worse. To prevent nonblanching erythema, the number needed to treat (NNT) was 41.9 (95% CI, -82.6-15.3). To prevent any erythema (blanching or nonblanching), the NNT was 11.5 (95% CI, 41.6-9.3). Participants with blanching or nonblanching erythema were significantly less mobile than participants with normal skin and more likely to have worsening mobility (P <.001). For participants with similar pressure ulcer status, mattress type was not associated with difference in mobility. CONCLUSIONS Regardless of prevention routine, pressure ulcers occur. In this study, the experimental equipment showed statistical significance to standard equipment for prevention of blanching erythema; significance was not achieved for nonblanching erythema. Trend and survival analysis show that a larger study is required to determine whether this nonsignificant difference is genuine.
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Risk Factors Associated with Pressure Ulcer Development at a Major Western Australian Teaching Hospital from 1998 to 2000. J Wound Ostomy Continence Nurs 2002. [DOI: 10.1097/00152192-200209000-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lindgren M, Unosson M, Krantz AM, Ek AC. A risk assessment scale for the prediction of pressure sore development: reliability and validity. J Adv Nurs 2002; 38:190-9. [PMID: 11940132 DOI: 10.1046/j.1365-2648.2002.02163.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice. AIM To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale. METHODS The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re-modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value. RESULTS Two variables were excluded as a result of low item-item and item-total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0.83, respectively. The factor analysis gave three factors, with a total variance explained of 65.1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards. CONCLUSION The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.
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Affiliation(s)
- Margareta Lindgren
- Department of Medicine and Care, Division of Nursing Science, Faculty of Health Sciences, Linköping, Sweden.
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35
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Scott EM, Leaper DJ, Clark M, Kelly PJ. Effects of warming therapy on pressure ulcers--a randomized trial. AORN J 2001; 73:921-7, 929-33, 936-8. [PMID: 11378948 DOI: 10.1016/s0001-2092(06)61744-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Postoperative pressure ulcers are a common and expensive problem. Intraoperative hypothermia also is a common problem and may have a connection with impaired tissue viability. Researchers in this study hypothesized that intraoperative control of hypothermia may reduce the incidence of postoperative pressure ulcers. A randomized clinical trial (n = 338) was used to test the effects of using forced air warming therapy versus standard care. Results indicated an absolute risk reduction in pressure ulcers of 4.8% (i.e., 10.4% to 5.6%) with a relative risk reduction of 46% in patients who received warming therapy. Although not reaching statistical significance, the clinical significance of almost halving the pressure ulcer rate is important. A correlation between body temperature and postoperative pressure ulcers was established.
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Affiliation(s)
- E M Scott
- North Tees and Hartlepool NHS Trust, Stockton, England, United Kingdom
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