Pressure ulcer dressings in critical patients: a cost analysis

Comparison of aloe vera gel dressing with conventional dressing on pressure ulcer pain reduction: a clinical trial

BACKGROUND

Aloe Vera has a strong analgesic and anti-inflammatory effect, and its use effectively controls pain. This study aimed to determine the effect of Aloe Vera gel versus saline on pain relief of pressure ulcers.

METHODS

This study is a double-blind, randomized clinical trial conducted in Valiasr Hospital in Arak, Markazi Province, in the center of Iran from May 2020 to April 2022. Using the available sampling method, 95 patients with pressure ulcers were assessed for eligibility, 64 patients were selected, 33 patients were placed in the experimental and 34 patients in control. For the experimental group, the ulcers were first cleaned with normal saline to remove the slough and then the already prepared Aloe Vera gel was evenly applied. For control groups, the ulcers were first washed with normal saline to remove off the slough and then covered with a sterile cotton gage, and the wound was tightly bandaged with a cotton roll to keep the "daily dressing" in place. A visual pain scale was used to assess the patient's pain level. Data analysis was done using SPSS 17. Descriptive statistics, ANOVA, and greenhouse tests were used. The significance level was 0.05.

RESULTS

The results showed that the average pain score in both groups had a downward trend; that is, both dressings effectively reduced pressure ulcer pain (P < 0.001). The greenhouse test results showed that the difference between the two groups was significant (P < 0.001).

CONCLUSION

The results showed the effect of Aloe Vera gel in reducing pressure ulcer pain. Dressing with Aloe Vera gel is preferable to reducing pain during dressing changes in patients with pressure ulcers.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20180715040478N2, 2021-08-17.

Moist dressings in the treatment of pressure injuries: A network meta-analysis

AIMS

The aim of this network meta-analysis is to analyze the difference in therapeutic effects between moist dressings and traditional dressings in the treatment of pressure injury (PI), explore the healing, healing time, direct cost, and number of dressing changes of different moist dressings for the management of pressure injuries.

BACKGROUND

The incidence of pressure injury is high and the burden of disease is high, but there is no consensus on how to choose moist dressing treatment.

DESIGN

A systematic review with network meta-analysis was performed.

DATA SOURCES

We searched the Chinese Biomedicine Literature Database and China National Knowledge Infrastructure, Wanfang Database, VIP database, PubMed, Web of Science, EMBASE.com, CENTRAL (Cochrane Central Register of Controlled Trials) and CINAHL to obtain randomized controlled trials (RCTs) on the treatment of PI with moist dressings.

REVIEW METHODS

R studio software and Stata 16.0 software were used to compare different moist dressings and traditional dressings.

RESULTS

41 RCTs of moist dressings in the treatment of PI were included. A total of seven kinds of moist dressings, Vaseline gauze and traditional gauze dressing were involved. All RCTs were at a medium to high risk of bias. Overall, moist dressings had more advantages than traditional dressings in terms of various outcome indicators.

CONCLUSION

The effect of moist dressings in treating PI is more advantageous than traditional dressings. However, in terms of direct cost and the number of dressings changes, more research is needed to improve the credibility of the network meta-analysis. The results of the network meta-analysis show that the silver ion dressing and alginate dressing are the best choices in the treatment of PI.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a network meta-analysis, which does not require the participation of patients and the public.

Nursing team knowledge assessment instruments about pressure injury: integrative review

Objectives: to identify in the scientific literature how the assessment of knowledge of the nursing team about pressure injuries is conducted, which instruments are used, and their psychometric properties. Methods: integrative review conducted with 44 scientific articles. The search was conducted between October and December 2021 in the following data sources: BDENF, Cinahl, Lilacs, MEDLINE, Scopus, Google Scholar, and Web of Science, using the strategy in Portuguese: ("lesão por pressão" OR "úlcera por pressão" OR "úlcera de decúbito" OR "escara de decúbito") AND enfermagem AND conhecimento, and, in English, ("pressure ulcer" OR "bed sore" OR "bed sores" OR bedsore OR bedsores) AND nursing AND knowledge. Articles published between 2012 and November 2021 were included, with text available in full, in open access, in English, Portuguese, or Spanish, resulting from original research related to care in the hospital area. Results: The most used knowledge assessment instrument was the P-PUKT and its versions, used in 50% of the studies, followed by the PUKAT and its versions. Three studies also used instruments constructed and validated by the authors, five qualitative studies, and four studies used non-validated instruments. Conclusion: Valid instruments to assess knowledge are essential to identify possible failures in patient care. Heterogeneity in the samples and in the classification criteria of the participants' level of knowledge made it impossible to compare the results obtained in the studies, constituting a limitation.

Evaluation of the therapeutic efficacy of active specialistic medical dressings in the treatment of decubitus

INTRODUCTION

Treatment of decubitus ulcers is a grave medical problem. In many cases, it is difficult to cure a pressure ulcer, especially when it is deep and extensive, and prognosis is usually unfavourable. Treatment of decubitus ulcers requires new specialist dressings, which play an important role in the healing process.

AIM

To evaluate therapeutic efficacy of active specialist medical dressings in the treatment of decubitus.

MATERIAL AND METHODS

Research involved 40 patients - 18 (45%) women and 22 (55%) men, suffering from decubitus ulcers of different size and depth, localized in the sacral region, lasting from 1.5 to 30 months. Patients were randomly assigned to two research groups (20 people each), were treated for 4 weeks with 2 different specialist dressings. ATRAUMAN Ag, which contains silver ions, was used in the first group, while paraffin gauze of BACTIGRAS type was used in the second group. An assessment of pressure ulcers' healing progress was done with a planimetric method, which evaluates the wound surface area.

RESULTS

The analysis results showed a significant statistical decrease in an average decubitus ulcer surface area in both research groups: in the first group by 60.2% (p = 0.001), and in the second group by 32.95% (p < 0.001), which speaks in favour of dressings with silver ions as having better therapeutic effectiveness.

CONCLUSIONS

Using specialist dressings results in a significant decrease in the decubitus ulcer surface area, depending on the type of dressing and active substances contained within, while silver ions support curative effectiveness of the dressing used.

Comparison of polyurethane foam dressing and hydrocolloid dressing in patients with pressure ulcers: A randomized controlled trial protocol

BACKGROUND:

We conduct this randomized controlled trial protocol for the comparison of the influence of the hydrocolloid dressing and polyurethane foam dressing in the treatment of pressure ulcers (PUs) patients.

METHODS:

This study will be implemented from February 2021 to February 2022 at Hangzhou Geriatric Hospital. The experiment was granted through the Research Ethics Committee of Hangzhou Geriatric Hospital (C5259033). Criteria for inclusion: patients older than 18 years of age who have been diagnosed with PU. If the patient suffers from more than a PU, only the ulcer with largest diameter is evaluated. Criteria for exclusion: (1).. hypersensitivity or allergy to the substances in dressings; (2).. patients with diabetic foot or venous ulcers; and (3).. serious disease. The major result is rate of PU healing or ulcer epithelialization tissue. The secondary result is the changes in the area of ulcer in cm and cost-effectiveness. The analysis of all the data are conducted with the software of IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, NY).

RESULTS:

Table 1 will show the comparison of clinical outcomes between 2 groups.

CONCLUSION:

This study can develop an evidence-based protocol to identify optimal dressings for patients with PUs.

TRIAL REGISTRATION NUMBER:

researchregistry6294

Perfil clínico-epidemiológico dos pacientes com lesão por pressão no contexto hospitalar

Objetivo: descrever o perfil clínico-epidemiológico dos pacientes com lesão por pressão internados em um hospital universitário. Método: estudo descritivo com 122 pacientes com lesão por pressão internados em um hospital universitário, entre janeiro de 2018 e dezembro de 2019. Os dados foram coletados nos prontuários dos pacientes e no banco de dados do Serviço Assistencial de Cuidados com a Pele. Utilizou-se estatística descritiva para análise dos dados. Resultados: as lesões por pressão predominaram entre adultos e idosos, pardos, que estudaram até o ensino fundamental e não possuíam companheiro. Houve semelhança entre os sexos. Os pacientes possuíam, principalmente, doença infecciosa, uma ou mais comorbidades, alteração nutricional, incontinência mista e utilizavam terapia nutricional, mas não apresentavam dermatite associada à incontinência e histórico de tabagismo. A maioria dos pacientes foi classificada como risco alto de lesão por pressão. O estudo totalizou 237 lesões, sendo a maior parte adquirida antes da internação, não classificável, localizada na região sacrococcígea, tratada topicamente com hidrogel com alginato e hidrocoloide, e não cicatrizada no momento da alta hospitalar. Conclusão: o estudo descreveu aspectos importantes da caracterização das lesões por pressão, assim como das pessoas acometidas por esse grave problema de saúde, o que pode otimizar as ações de prevenção e tratamento.

Clinical-epidemiological profile of patients with pressure injuries in the hospital context

Objective: describe the clinical-epidemiological profile of patients with pressure injuries admitted to a university hospital. Method: descriptive study with 122 patients with pressure injuries admitted to a university hospital between January 2018 and December 2019. Data were collected from patients’ medical records and from the Serviço Assistencial de Cuidados com a Pele (Skin Care Assistance Service) database. Descriptive statistics were used for data analysis. Results: pressure injuries predominated among adults and the elderly, browns, who studied up to elementary school and had no partner. There was a similarity between the sexes. The patients had, mainly, infectious disease, one or more comorbidities, nutritional alteration, mixed incontinence and used nutritional therapy, but did not present dermatitis associated with incontinence and smoking history. Most patients were classified as high risk of pressure injury. The study totaled 237 lesions, most of which were acquired before admission, not classifiable, located in the sacrococcygeal region, treated topically with hydrogel with alginate and hydrocolloid, and not healed at the time of hospital discharge. Conclusion: the studydescribed important aspects of the characterization of pressure injuries, as well as the people affected by this serious health problem, which can optimize prevention and treatment actions.

Pressure injury associated with mechanical restraint: a cross-sectional study

Objective: To verify the association of the practice of mechanical restraint with pressure injury (PI) in hospitalized patients. Method: A cross-sectional study of 111 patients from medical, surgical and intensive care units at a public hospital in the state of Rio de Janeiro, Brazil. To analyze the association between variables, the [odds ratio (OR)] was adopted. Results: It were found 57 patients in mechanical restraint (51.4%). In the group of patients contained, the occurrence of PI was estimated in 43.9% and in the group of patients not contained in 5.6%. The chance of the contained patient to present PI was 13 times higher than in patients not contained. The location of the injury was more frequently in the sacral region, classified as stage 2 (21.1%) and stage 3 (12.3%), followed by trochanter (15.8%) and calcaneus (10.5%). Conclusion: It is recommended the adoption of nursing practices of suppression or reduction of the time in the use of mechanical restraint, adopting educational measures and prevention of PI.

Lesão por pressão associada à contenção mecânica: estudo transversal

Objetivo: Verificar associação da prática de contenção mecânica com lesão por pressão (LP) em pacientes hospitalizados. Método: Estudo transversal realizado com 111 pacientes de unidades de clínica médica, cirúrgica e de terapia intensiva em um hospital público do estado do Rio de Janeiro, Brasil. Para analisar a associação entre as variáveis, adotou-se a razão de chances [odds ratio (OR)]. Resultados: Encontraram-se 57 pacientes em contenção mecânica (51,4%). No grupo de pacientes contidos, a ocorrência de LP foi estimada em 43,9% e, no grupo de não contidos, em 5,6%. A chance de o paciente contido apresentar LP foi 13 vezes maior do que em pacientes não contidos. A localização da lesão foi mais frequentemente na região sacra, classificada em estágio 2 (21,1%) e estágio 3 (12,3%), seguida de trocânter (15,8%) e calcâneo (10,5%). Conclusão: Recomenda-se a adoção de práticas de enfermagem de supressão ou redução do tempo no uso da contenção mecânica, adotando medidas educativas e de prevenção da LP.

Conhecimento do enfermeiro da atenção primária à saúde sobre a indicação de coberturas especiais

Objetivo: Identificar o conhecimento dos enfermeiros da atenção primária à saúde de um município sobre indicação de coberturas especiais. Método: Estudo exploratório, descritivo, com abordagem quantitativa realizado com 101 enfermeiros em 109 unidades de saúde da atenção primária em saúde por meio de instrumento estruturado. Os dados foram analisados estatisticamente com a distribuição de frequência, percentis, média, mediana, desvio padrão, coeficiente de variação, intervalo de confiança, p-valor e teste de igualdade de duas proporções para comparar o grupo que tem capacitação/aperfeiçoamento na área com o grupo que não tem. Resultados: Sobre a indicação da cobertura, 79,2% referiu que se destina a controlar o exsudato e o tecido não viável, e a indicação com maior porcentagem de acertos para utilização em feridas foi a cobertura hidrofibra de prata e hidrocoloide com prata. Conclusão: Enfermeiros da atenção primária com cursos de capacitação/aperfeiçoamento não têm conhecimento suficiente para indicação das coberturas.

Knowledge of nurses in primary health care about the indication of special coverage

Objective: To identify the knowledge of nurses in primary health care in a municipality about the indication of special coverage. Method: An exploratory, descriptive study with a quantitative approach performed with 101 nurses in 109 health units of primary health care through a structured instrument. The data were statistically analyzed with frequency distribution, percentiles, average, median, standard deviation, coefficient of variation, confidence interval, p-value and two-proportion equality test to compare the group that has qualification/improvement in the area with the group do not have. Results: About the indication of the coverage, 79.2% reported that it is intended to control exudate and non-viable tissue, and the indication with the highest percentage of correct answers for use in wounds was the silver hydrofibra coverage and hydrocolloid with silver. Conclusion: Primary care nurses with qualification/ improvement courses do not have enough knowledge to indicate the coverage.