WOUND MANAGEMENT WITH GRADE 4 PRESSURE ULCER

Wound management on a patient with grade 4 pressure ulcer

Wound management on a patient with grade 4 pressure ulcer

Introduction

One of the many exceptional features about being human is that most of us are bipedal - able to sit or stand to carry out activity or functions. For those who are unable to stand or walk, for whatever reason, seating becomes the sole position which is adopted for the majority of the day. The numbers of persons seated for the purposes of mobility remains poorly understood. A report by the Royal College of Physicians dating back to 1995 estimate there to be about 650,000 seated individuals in the UK, of which 500 000 were thought to have a permanent disability . In 2001 one regional UK wheelchair service in the Midlands, serving a population of 559 000, estimated the number of clients in receipt of at least one wheelchair (many have two chairs: one electric, one manual) to be 10 500.

Although it is difficult to speculate on the generalisability of the figures from this particular service they suggest that approximately 1.8% of the population of the UK may be in receipt of a wheelchair. The prevalence of pressure ulcers in seated persons is poorly understood. Figures range widely: Sugarman suggested that up to half of all seated persons with complex impairments would develop a pressure ulcer at some time during their life time. Stockton in a study of 48 seated persons reported a prevalence of 60%. Inam and Firth reported a prevalence of 4.9% in a study of over 1000 community patients and more recently Stockton and Parker reported an overall prevalence of up to 58%.

From the clinical experience of the authors of this paper, pressure ulcers are a frequent and distressing aspect of the management of persons with complex physical disability. Studies suggest the cost of pressure ulcers is high in both human and financial terms:'A pressure sore can cause pain, systemic illness, reduced self-esteem, altered body image and can sufficiently delay rehabilitation measures to preclude return to independence'.

Pressure ulcers can result in long hospital stays, surgery, and prolonged bed rest at home, an increase in secondary disabilities such as contractures from bed rest and in extreme cases death from septicaemia. In a study by the first author it was found that ten regular wheelchair users with pressure ulcers spent 1231 days or 3.37 years in hospital for ongoing treatment of pressure ulcers. A study by Inam and Firth found the average time spent by a district nurse on the treatment of one pressure ulcer was 3.4 hours per week and on prevention was 1.3 hours per week.

The causes of pressure ulcers are well researched, and they are known to be the result of a complex set of interactions; for example pressure, friction, shear, nutritional status, mobility, incontinence and acute illness are known to be of particular importance. These factors can be usefully categorised as either intrinsic (those from ...