PRESSURE ULCER PREVENTION & TREATMENT

Pressure Ulcer Prevention & Treatment

Pressure Ulcer Prevention & Treatment

Introduction

Pressure ulcers are common in acute and long-term care. The treatment and prevention of pressure ulcers consume large quantities of resources in terms of disposable equipment and nursing time (Defloor and Grypdonck, 2005). Moreover, pressure ulcers have been described as one of the most costly and physically debilitating complications in the 20th century (Burdette-Taylor and Kass, 2002 S.R. Burdette-Taylor and J. Kass, Heel ulcers in critical care unit: a major pressure problem, Critical Care Nursing 25 (2) (2002), pp. 41-53. View Record in Scopus | Cited By in Scopus (6)Burdette-Taylor and Kass, 2002). Pressure ulcers are the third most expensive disorder after cancer and cardiovascular diseases (A Health Council of the Netherlands: Pressure Ulcers, 1999). In addition, about 57-60% of all pressure ulcers occur within hospitals (Thomas, 2001). Up to 13% of patients develop pressure sores while being treated in an intensive care (Hunt, 1993). However, critically ill patients usually have multiple risk factors for the development of pressure ulcers (Peerless et al., 1999). The development of pressure ulcers entails a substantial morbidity of the critically ill and debilitated patients (Eachempati et al., 2001). Patients in many intensive care units (ICUs) are sedated and ventilated and therefore unable to move or care for themselves. Movement is a natural defense to pressure, but this defence is lost during a critical illness due to conditions such as anaemia, renal impairment, shock or vascular failure (Lowery, 1995).

Urinary and faecal incontinence have been cited as risk factors for pressure ulcers, with faecal incontinence being the better predictor of pressure ulcer formation (Clever et al., 2002). Additionally, patients with fecal incontinence have more than 20 times the risk of pressure ulcers than continent patients. Incontinence increases risk by causing chemical irritation and creating an excessively moist environment. Excoriation and maceration can occur even after a brief episode of incontinence (Calianno, 2000). Therefore, measures focusing on the skin care of patients with incontinence are recommended to reduce the incidence of pressure ulcers on sacrum and ischium (Lowery, 1995). Also, there is often confusion between a pressure ulcer and a lesion caused by moisture which can be a result of incontinence of urine and/or bowel. Therefore, the differentiation between the two lesions is clinically important because prevention and treatment protocols differ largely. Wound characteristics such as causes, shape, depth, edges and color are helpful to differentiate between a pressure ulcer and a moisture lesion (Defloor et al., 2005).

In order to determine the effect of risk factors or to evaluate the effectiveness of specific preventive intervention, incidence measurements are indicated (Halfens and Bours, 2002). Incidence has been defined as measuring the number of persons developing new pressure ulcers during a period of time (EPUAP, 2002). There are only few incidence studies concerning pressure ulcers in intensive care units in Germany, although it is a common problem in ICUs in various countries. In Texas, Fife et al. (2001) found a pressure ulcer incidence rate of ...