Role of Patient Specifics on Mechanical Risk and Load Relief During Support of Bony Prominences

2013 ◽  
Author(s):  
Ahmet Erdemir
Keyword(s):  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Region Of Interest ◽  
Clinical Effectiveness ◽  
Incidence Rates ◽  
Patient Specific ◽  
Support Surface ◽  
Load Relief ◽  
Bony Prominence ◽  
Pressure Ulcer Development

Prolonged mechanical loading of tissue in between a bony prominence and a support surface can lead to pressure ulcers. Despite recent initiatives to curb down incidence rates, the health care burden of pressure ulcer prevention remains significant [1]. Etiology of pressure ulcers are commonly attributed to interface pressures. As a result, interventions, e.g., support surfaces, routinely aim to reduce contact pressures. However, the clinical effectiveness of such an objective can be questionable [2]. Recent studies have shown that internal mechanics of the tissue can be associated with pressure ulcer development [3], potentially indicating the inefficacy of interventions targeted solely at contact pressure relief. Tissue characteristics at a bony prominence, e.g., tissue thickness and material properties, also influence load distribution within and on the surface of the tissue. Given the variability in patient populations and for a bony region of interest [4], it is possible that patient specific risk and load relief (with the use of support surface) may differ widely.

scholarly journals Analysis of epidemiological characteristics and surgical treatment of patients with pressure ulcer

2021 ◽  
pp. 93-93
Author(s):  
Dragana Petrovic-Popovic ◽  
Milan Stojicic ◽  
Maja Nikolic-Zivanovic
Keyword(s):  
Surgical Treatment ◽  
Pressure Ulcer ◽  
Traffic Accidents ◽  
Pressure Ulcers ◽  
Stage Iv ◽  
Clinical Center ◽  
Bony Prominence ◽  
The University ◽  
Epidemiological Characteristics ◽  
Reconstructive Methods

Introduction/Objective. A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and a major role in their treatment plays epidemiological and etiological aspects. Methods. A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated during a five-year period at the Clinic for Burns, Plastic and Reconstructive Surgery of the University Clinical Center of Serbia in Belgrade. Main data features used in the analysis were: gender, age, principal diseases, comorbidities and biochemical indicators of malnutrition. The patients' data was obtained from the existing patients? records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results. A total of 72 patients with pressure ulcers were included into this study with 54.7 ? 16.1 mean age. Three times more patients injured in traffic accidents were male (75% vs. 25%), while the most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of III or IV stage were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. The patient with pressure ulcer of stage IV was usually treated with partial osteotomy. Conclusion. A surgical reconstructive treatment with fasciocutaneous and myocutanaeous flaps represents a gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures.

Pressure injuries in the ageing population

2017 ◽  
pp. 401-408
Author(s):  
Cindy Kiely ◽  
Magdalena Pupiales
Keyword(s):  
Older Adult ◽  
Pressure Ulcers ◽  
Adult Population ◽  
Incidence Rates ◽  
Population Pressure ◽  
Ageing Population ◽  
Geriatric Population ◽  
Bony Prominence ◽  
Older Adult Population ◽  
The Impact

The prevalence of pressure ulcers has been reported to range from 4.1 to 32.2% in the older adult population. Pressure ulcers, also known as decubitus ulcers, bedsores, and pressure sores, are defined as localized injury to the skin and/or underlying structures, usually over a bony prominence as result of pressure or pressure in combination with shear. Within the geriatric population, prevalence and incidence rates tend to be high due to multifactorial risk factors such as comorbidities, changes in functional status, nutritional habits, medications affecting the skin, and physiological changes. The impact of pressure ulcers spans physical, emotional, social, and economic dimensions, and is of concern throughout the healthcare continuum. The aim of this chapter is to illustrate the aetiologic complexity of pressure ulcers in the geriatric population and summarize a comprehensive approach to prevention and management of pressure ulcers.

Effects of Using a High-Density Foam Pad Versus a Viscoelastic Polymer Pad on the Incidence of Pressure Ulcer Development During Spinal Surgery

2010 ◽  
Vol 13 (4) ◽  
pp. 419-424 ◽  
Author(s):  
Tsokuang Wu ◽  
Shin-Tien Wang ◽  
Pi-Chu Lin ◽  
Chien-Lin Liu ◽  
Yann-Fen C. Chao
Keyword(s):  
Pressure Ulcer ◽  
Spinal Surgery ◽  
Iliac Crest ◽  
Pressure Ulcers ◽  
Female Gender ◽  
High Density ◽  
Ulcer Formation ◽  
Viscoelastic Polymer ◽  
Significant Difference ◽  
Pressure Ulcer Development

The purpose of this study was to evaluate the effect of high-density foam (HDF) pads versus viscoelastic polymer (VP) pads in the prevention of pressure ulcer formation during spinal surgery and their cost-effectiveness. Subjects were 30 patients who underwent spinal surgery for more than 3 hr in a prone position. One side of the chest and iliac crest was padded with HDF pads and the other side was padded with VP pads. An Xsensor® pressure measuring sheet was placed between the pad and the patient. Bilateral chest and iliac crest points were observed for the presence of pressure ulcers at 30 min after the operation. Results showed that a pressure ulcer had occurred at 9 of 120 compression points (7.5% of the total), 30 min after the operation. Risk evaluation showed that female gender, weight <50 kg, and body mass index (BMI) <18 kg/m2 as well as location (the iliac crest) were all risk factors for development of pressure ulcers. The most significant factor was BMI <18 kg/m2. The average and peak pressures measured at the points padded with the VP pads were significantly lower than those padded with the HDF pads. However, there was no significant difference between the VP and the HDF pads regarding ulcer prevention. Because the cost of a VP pad is 250 times greater than that of an HDF pad of similar size, the VP pad should only be considered for use in high-risk patients.

scholarly journals The Design and Implementation of a Local Strategy to Increase the Accuracy of Pressure Ulcer Classification: The Pressure Ulcer Guidance (PUG) Tool

2017 ◽  
Vol 2 (4) ◽  
Keyword(s):  
Pressure Ulcer ◽  
Healthcare Professionals ◽  
Pressure Ulcers ◽  
Hospital Admissions ◽  
Healthcare Providers ◽  
Staging System ◽  
Initial Assessment ◽  
Skin Damage ◽  
Key Factor ◽  
Pressure Ulcer Development

Skin inspection should be seen as an essential part of patient assessment and therefore should be compulsory for all hospital admissions. Recognising this as a key factor of risk assessment can ensure healthcare professionals are providing the best possible care and protection for their patients. Identifying skin damage on initial assessment ensures appropriate and early intervention, thus minimising or even preventing the risk of damage to the skin and avoiding pressure ulcer development. Once a pressure has developed the patient is generally dependent on others to manage, treat and care for their ulcer. Healthcare providers need to recognise that a pressure ulcer is a crucial element in preventing a full recovery, it can lead to increased hospital stay, resulting in ongoing treatment which may take weeks, even months of nursing care. Patients may also experience pain and discomfort, which has serious consequences on a patient’s quality of life, as well as a very costly exercise for the National Health Service (NHS). Understanding the mechanism of how the skin can be damaged and identifying the different stages of pressure damage can help in reducing, or even avoiding hospital acquired pressure ulcers. However, failure to identify pressure ulcers correctly can lead to inaccurate reporting and consequently inappropriate management. This article aims to explain the development and introduction of a new strategy to aid healthcare professionals overcome the difficulties in classifying pressure ulcers and differentiating superficial pressure ulcers from moisture lesions. Using the European Pressure Ulcer classification guide (EPUAP 2014) a pressure ulcer guide wheel, or ‘PUG wheel/ tool’, was designed to help healthcare professionals understand pressure ulcer categories and differentiate between pressure ulcers and moisture lesions [1]. To test the accuracy regarding classification, a group of 20 Tissue Viability Link Nurses were tested using this new tool against various verified pressure ulcer and moisture lesion images. A supporting poster was also designed to help healthcare professionals understand the staging system.

scholarly journals Socioeconomic effects of pressure ulcer

2021 ◽  
Vol 64 (1) ◽  
pp. 11-15
Author(s):  
Jun-Ho Lee
Keyword(s):  
Pressure Ulcer ◽  
Outpatient Care ◽  
Complex Disease ◽  
Pressure Ulcers ◽  
Cost Effective ◽  
Treatment And Prevention ◽  
Medical Institutions ◽  
Bony Prominence ◽  
Hospitalization Period ◽  
Socioeconomic Burden

A pressure ulcer is defined as localized ischemic skin or soft tissue damage resulting from disruption of the blood supply by pressure over the bony prominence. However, it is not just a wound that causes pain to individuals, but also a complex disease that causes socioeconomic losses. In 2019, total 30,983 patients with pressure ulcers were treated at medical institutions in Korea, and 76 billion Korean won (KRW) was spent on this treatment. Inpatient care cost amounted to 65.5 billion KRW, whereas outpatient care cost amounted to 9.8 billion KRW. The average hospitalization cost per patient was 6,696,605 KRW, and the average hospitalization period was 57.4 days, averaging 116,707 KRW per patient per day. The average outpatient care cost per patient was 421,134 KRW, and the average period in the clinic was 8.9 days, calculated at 47,428 KRW per day. The development of pressure ulcers inevitably causes socioeconomic losses and puts strain on limited medical resources; therefore, the best socioeconomic solution is prevention. Prevention has been shown to be much more efficient in cost-effective studies on treatment and prevention. Therefore, investment of more resources to prevent the development of pressure ulcers is the best solution to reduce the related socioeconomic burden.

scholarly journals Using the braden and glasgow scales to predict pressure ulcer risk in patients hospitalized at intensive care units

2008 ◽  
Vol 16 (6) ◽  
pp. 973-978 ◽  
Author(s):  
Luciana Magnani Fernandes ◽  
Maria Helena Larcher Caliri
Keyword(s):  
Intensive Care ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
University Hospital ◽  
Major Health ◽  
Braden Scale ◽  
Hospital Patients ◽  
Patients At Risk ◽  
Pressure Ulcer Development ◽  
Critical Patients

Pressure ulcers remain a major health issue for critical patients. The purpose of this descriptive and exploratory study was to analyze the risk factors for the development of pressure ulcers in patients hospitalized at an intensive care unit of a university hospital. Patients were assessed through the Braden scale to determine the risk for the development of pressure ulcers and to identify individual risks, and the Glasgow scale was used to assess their consciousness. It was found that the risks associated with pressure ulcer development were: low scores on the Braden Scale on the first hospitalization day and low scores on the Glasgow scale. The results showed that these tools can help nurses to identify patients at risk, with a view to nursing care planning.

Heel pressure ulceration: the perennial clinical and financial problem?

2021 ◽  
pp. 1-5
Author(s):  
Deborah Glover ◽  
Trevor Jones ◽  
Henning von Spreckelsen
Keyword(s):  
Cost Analysis ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Cost Savings ◽  
Shear Forces ◽  
Financial Problem ◽  
Pressure Ulcer Development ◽  
Hospital Acquired

The heel of the foot is particularly susceptible to pressure, friction and shear forces. In consequence, heel pressure ulcers account for approximately 18% of all hospital-acquired pressure ulcers in England. To ameliorate the effects of friction and shear forces, the use of heel protectors made from silk-like fabric is recommended. This article outlines how one such product, the Parafricta bootee (APA Parafricta), has facilitated a reduction in heel pressure ulcer development, resulting in both time and cost savings in an acute NHS trust over the course of 8 years and thousands of patients. A cost-analysis will also be detailed to show that if the products and processes pioneered by this trust were used throughout NHS England, over £300 million in resource savings could be achieved each year.

Pressure ulcers in patients receiving palliative care: A systematic review

2019 ◽  
Vol 33 (7) ◽  
pp. 770-782 ◽  
Author(s):  
Amy Ferris ◽  
Annie Price ◽  
Keith Harding
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Palliative Care ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Cochrane Library ◽  
Long Duration ◽  
Organ Failures ◽  
Pressure Ulcer Development ◽  
Inadequate Care

Background: Pressure ulcers are associated with significant morbidity and mortality as well as high cost to the health service. Although often linked with inadequate care, in some patients, they may be unavoidable. Aim: This systematic review aims to quantify the prevalence and incidence of pressure ulcers in patients receiving palliative care and identify the risk factors for pressure ulcer development in these patients as well as the temporal relationship between pressure ulcer development and death. Design: The systematic review is registered in the PROSPERO database (CRD42017078211) and conducted in accordance with the ‘PRISMA’ pro forma. Articles were reviewed by two independent authors. Data sources: MEDLINE (1946–22 September 2017), EMBASE (1996–22 September 2017), CINAHL (1937–22 September 2017) and Cochrane Library databases were searched. In all, 1037 articles were identified and 12 selected for analysis based on pre-defined inclusion and exclusion criteria. Results: Overall pressure ulcer prevalence and incidence were found to be 12.4% and 11.7%, respectively. The most frequently identified risk factors were decreased mobility, increased age, high Waterlow score and long duration of stay. Conclusion: The prevalence of pressure ulcers is higher in patients receiving palliative care than the general population. While this should not be an excuse for poor care, it does not necessarily mean that inadequate care has been provided. Skin failure, as with other organ failures, may be an inevitable part of the dying process for some patients.

Cytokine and Chemokine Release Upon Sustained Mechanical Loading of the Epidermis

2007 ◽  
Author(s):  
Debbie Bronneberg ◽  
Lisette H. Cornelissen ◽  
Cees W. J. Oomens ◽  
Frank P. T. Baaijens ◽  
Carlijn V. C. Bouten
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
Soft Tissue ◽  
Mechanical Loading ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Objective Measures ◽  
Subjective Measures ◽  
Non Invasive ◽  
Pressure Ulcer Development

Pressure ulcers are areas of soft tissue breakdown resulting from sustained mechanical loading of the skin and underlying tissues. These ulcers are painful, difficult to treat, and represent a burden to the community in terms of health care and money. Currently, pressure ulcer risk assessment is dominated by subjective measures and does not predict pressure ulcer development satisfactorily [1]. Objective measures are therefore needed for early, non-invasive detection.

scholarly journals Validation of two case definitions to identify pressure ulcers using hospital administrative data

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016438 ◽  
Author(s):  
Chester Ho ◽  
Jason Jiang ◽  
Cathy A Eastwood ◽  
Holly Wong ◽  
Brittany Weaver ◽  
...  
Keyword(s):  
Administrative Data ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Case Definition ◽  
University Hospital ◽  
Case Definitions ◽  
Discharge Abstract Database ◽  
Accurate Identification ◽  
Prevalence Studies ◽  
Pressure Ulcer Development

ObjectivePressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes.SettingA cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011.ParticipantsThere were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer.ResultsUsing pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay.ConclusionDAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other prevalence studies.

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