A Review on Pressure Ulcer: Aetiology, Cost, Detection and Prevention Systems

Pressure ulcer (also known as pressure sore, bedsore, ischemia, decubitus ulcer) is a global challenge for today’s healthcare society. Found in several locations in the human body such as the sacrum, heel, back of the head, shoulder, knee caps, it occurs when soft tissues are under continuous loading and a subject’s mobility is restricted (bedbound/chair bound). Blood flow in soft tissues becomes insufficient leading to tissue necrosis (cell death) and pressure ulcer. The subject’s physiological parameters (age, body mass index) and types of body support surface materials (mattress) are also factors in the formation of pressure ulcer. The economic impacts of these are huge, and the subject’s quality of life is reduced in many ways. There are several methods of detecting and preventing ulceration in human body. Detection depends on assessing local pressure on tissue and prevention on scales of risk used to assess a subject prior to admission. There are also various types of mattresses (air cushioned/liquid filled/foam) available to prevent ulceration. But, despite this work, pressure ulcers remain common.This article reviews the aetiology, cost, detection and prevention of these ulcers

System providing discomfort monitoring for people in wheelchairs

This article describes a project that aims to develop a system that provides people in wheelchair a relief to the level of the sensitive perception of discomfort, assuring greater independence, welfare, quality of life and the prevention of illnesses/wounds. The project is based on the development of textile and polymer applications (cushions, mattresses and mattresses overlays) with functions of pressure and humidity monitoring in the body’s areas contacting with the support surfaces. The same principle used in this work can be applied to other situations, such as people with serious motor function limitations that condition their mobility and/or deambulation, bed rest patients or patients under effect of sedatives or anesthesia during long surgeries (intra and post operative).The authors thank the Portuguese Foundation for Science and Technology – FCT (Grant PTDC/SAU-BEB/68678/2006) and the School of Engineering of The University of Minho (IN2TEC project)

Hybrid Equation/Agent-Based Model of Ischemia-Induced Hyperemia and Pressure Ulcer Formation Predicts Greater Propensity to Ulcerate in Subjects with Spinal Cord Injury

Pressure ulcers are costly and life-threatening complications for people with spinal cord injury (SCI). People with SCI also exhibit differential blood flow properties in non-ulcerated skin. We hypothesized that a computer simulation of the pressure ulcer formation process, informed by data regarding skin blood flow and reactive hyperemia in response to pressure, could provide insights into the pathogenesis and effective treatment of post-SCI pressure ulcers. Agent-Based Models (ABM) are useful in settings such as pressure ulcers, in which spatial realism is important. Ordinary Differential Equation-based (ODE) models are useful when modeling physiological phenomena such as reactive hyperemia. Accordingly, we constructed a hybrid model that combines ODEs related to blood flow along with an ABM of skin injury, inflammation, and ulcer formation. The relationship between pressure and the course of ulcer formation, as well as several other important characteristic patterns of pressure ulcer formation, was demonstrated in this model. The ODE portion of this model was calibrated to data related to blood flow following experimental pressure responses in non-injured human subjects or to data from people with SCI. This model predicted a higher propensity to form ulcers in response to pressure in people with SCI vs. non-injured control subjects, and thus may serve as novel diagnostic platform for post-SCI ulcer formation. © 2013 Solovyev et al

Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture

Malnutrition is very prevalent in geriatric patients with hip fracture. Nevertheless, its importance is not fully recognized. The objective of this paper is to review the impact of malnutrition and of nutritional treatment upon outcomes and mortality in older people with hip fracture. We searched the PubMed database for studies evaluating nutritional aspects in people aged 70 years and over with hip fracture. The total number of studies included in the review was 44, which analyzed 26,281 subjects (73.5% women, 83.6 ± 7.2 years old). Older people with hip fracture presented an inadequate nutrient intake for their requirements, which caused deterioration in their already compromised nutritional status. The prevalence of malnutrition was approximately 18.7% using the Mini-Nutritional Assessment (MNA) (large or short form) as a diagnostic tool, but the prevalence was greater (45.7%) if different criteria were used (such as Body Mass Index (BMI), weight loss, or albumin concentration). Low scores in anthropometric indices were associated with a higher prevalence of complications during hospitalization and with a worse functional recovery. Despite improvements in the treatment of geriatric patients with hip fracture, mortality was still unacceptably high (30% within 1 year and up to 40% within 3 years). Malnutrition was associated with an increase in mortality. Nutritional intervention was cost effective and was associated with an improvement in nutritional status and a greater functional recovery. To conclude, in older people, the prevention of malnutrition and an early nutritional intervention can improve recovery following a hip fracture

Nursing Staff Optimizing Elder Care

Older adults, 65 years and older, make up more than 50% of the acute care patient population at a Southwest Michigan critical access hospital. This DNP capstone project was implemented for nursing staff members in a small rural hospital to assist with improving knowledge and perceptions of caring for older adults. Realized outcomes from this educational initiative were not meant to create new information but instead to focus on clinical issues and apply best practice for the purpose of determining evidence based solutions. The project’s design implemented to assess outcomes was a quantitative, descriptive, quasi-experimental, non-randomized approach. The plan included a pre and post intervention survey using the Geriatric Institutional Assessment Profile (GIAP) from the Nurses Improving Care for Healthsystem Elders (NICHE) Program. Education was provided after the pre intervention survey was completed via classroom presentations, hand-outs, and informational emails. The GIAP survey was repeated post educational intervention. Thirty nursing staff members participated in the pre intervention survey and seventeen completed the post intervention survey. Independent samples t-test on measures related to knowledge and attitudes revealed compelling percent changes representing statistical significance between pre and post GIAP survey responses with a p value of ˂ .05 in all areas measured

Comparison of Nutritional Status Assessment Using MST (Malnutrition Screening Tool) and SGA (Subjective Global Assessment) in Assessing Nutritional Status Against the Injury Occurrence in the Patient in the Intensive Care Unit (ICU) Room Achmad Mochtar Hospital

 Patients in intensive space have the right to get special attention due to metabolic changes that have an impact on nutritional status. Critical patients will experience an increase in metabolism as the body's response to disease. Assessment of nutritional status must be carried out routinely in the hospital, including in the ICU. The Council of Europe 2001, that there are no nutritional assessment standards that can be used for all patients treated. The assessment must be early, simple, based on current science and can be adapted in the clinical environment. The American Society of Parenteral and Enteral (ASPEN) recommends assessing nutritional status or nutritional screening tools in patients treated by using Subjective Global Assessment (SGA). Another measure of nutritional status assessment that can be used is the Malnutrition Screening Tools (MST). MST is a nutritional status assessment tool that has been used by the General Intensive Care Unit (ICU) in Achmad Mochtar Bukittinggi Hospital. This study aims to analyze the differences in the accuracy of MST and SGA in assessing nutritional status as well as differences in sensitivity of MST and SGA as indicators of the incidence of pressure sores in patients in the ICU of the Achmad Mochtar Bukittinggi Hospital. The type of this research is this research is quantitative research with comparative hypothesis type and cross-sectional research design. The results of this study indicate that SGA is more accurate in assessing nutritional status in patients in intensive rooms

Risk Factors Associated With Pressure Injury in Pediatric Congenital Heart Disease Patients

Pediatric congenital heart disease (CHD) patients have unique risk factors associated with the pathophysiology of abnormal heart function. This vulnerable population is likely at an increased risk of acquiring a pressure injury during hospitalization. There are limited studies that include congenital heart disease patients and more specifically, factors unique to these patients. The purpose of this study was to identify risk factors associated with development of pressure injury in pediatric CHD patients. This retrospective study used a convenience sample from hospital-acquired data including subjects with congenital heart disease. The results demonstrated an association between pressure injury development and variables both known in literature and those specific to the population. Corticosteroid and anticoagulation use were most likely to result in the development of a pressure injury. The study findings inform nursing practice and demonstrate a need to implement further prevention practices

Evaluation of the bacterial diversity of Pressure ulcers using bTEFAP pyrosequencing

<p>Abstract</p> <p>Background</p> <p>Decubitus ulcers, also known as bedsores or pressure ulcers, affect millions of hospitalized patients each year. The microflora of chronic wounds such as ulcers most commonly exist in the biofilm phenotype and have been known to significantly impair normal healing trajectories.</p> <p>Methods</p> <p>Bacterial tag-encoded FLX amplicon pyrosequencing (bTEFAP), a universal bacterial identification method, was used to identify bacterial populations in 49 decubitus ulcers. Diversity estimators were utilized and wound community compositions analyzed in relation to metadata such as Age, race, gender, and comorbidities.</p> <p>Results</p> <p>Decubitus ulcers are shown to be polymicrobial in nature with no single bacterium exclusively colonizing the wounds. The microbial community among such ulcers is highly variable. While there are between 3 and 10 primary populations in each wound there can be hundreds of different species present many of which are in trace amounts. There is no clearly significant differences in the microbial ecology of decubitus ulcer in relation to metadata except when considering diabetes. The microbial populations and composition in the decubitus ulcers of diabetics may be significantly different from the communities in non-diabetics.</p> <p>Conclusions</p> <p>Based upon the continued elucidation of chronic wound bioburdens as polymicrobial infections, it is recommended that, in addition to traditional biofilm-based wound care strategies, an antimicrobial/antibiofilm treatment program can be tailored to each patient's respective wound microflora.</p

Diabetic foot ulcers: Retrospective comparative analysis from Sicily between two eras

Aim: The aim of this study was to analyze changes in the incidence, management and mortality of DFU in Sicilian Type 2 diabetic patients hospitalized between two eras, i.e. 2008-2013 and 2014-2019. Methods: We compared the two eras, era1: 2008-13, era2: 2014-19. In era 1, n = 149, and in era 2, n = 181 patients were retrospectively enrolled. Results: In the population hospitalized for DFU in 2008-2013, 59.1% of males and 40.9% of females died, whilst in 2014-2019 65.9% of males and 34.1% of females died. Moderate chronic kidney disease (CKD) was significantly higher in patients that had died than in ones that were alive (33% vs. 43%, p &lt; 0.001), just as CKD was severe (14.5% vs. 4%, p &lt; 0.001). Considering all together the risk factors associated with mortality, at Cox regression multivariate analysis only moderate-severe CKD (OR 1.61, 95% CI 1.07-2.42, p 0.021), age of onset greater than 69 years (OR 2.01, 95% CI 1.37-2.95, p &lt;0.001) and eGFR less than 92 ml/min (OR 2.84, 95% CI 1.51-5.34, p 0.001) were independently associated with risk of death. Conclusions: Patients with DFU have high mortality and reduced life expectancy. Age at onset of diabetic foot ulcer, eGFR values and CKD are the principal risk factors for mortality

Laserterapia en úlcera por presión: evaluación por la Pressure Ulcer Scale for Healing y nursing outcomes classification

OBJETIVODescrever o processo de cicatrização de úlcera por pressão em paciente crítico tratado com terapêutica convencional de curativo acrescida de laserterapia de baixa intensidade avaliada pela Pressure Ulcer Scale for Healing (PUSH) e pelo resultado Cicatrização de Feridas: segunda intenção, da Nursing Outcomes Classification (NOC).MÉTODOEstudo de caso norteado pelo processo de enfermagem realizado com paciente de unidade de terapia intensiva. Os dados foram coletados com instrumento contendo a PUSH e o resultado da NOC. Na análise utilizou-se a estatística descritiva, considerando-se as pontuações obtidas no instrumento.RESULTADOSObservou-se redução nas dimensões da lesão de 7cm para 1,5cm de comprimento e de 6cm para 1,1cm de largura, além do aumento do tecido epitelial e de granulação, diminuição da secreção e odor.CONCLUSÃO:Houve melhora no processo de cicatrização da lesão tratada com terapia adjuvante e o uso da NOC permitiu uma avaliação mais detalhada e precisa do que da PUSH.OBJECTIVETo describe the pressure ulcer healing process in critically ill patients treated with conventional dressing therapy plus low-intensity laser therapy evaluated by the Pressure Ulcer Scale for Healing (PUSH) and the result of Wound Healing: Secondary Intention, according to the Nursing Outcomes Classification (NOC).METHODCase report study according to nursing process conducted with an Intensive Care Unit patient. Data were collected with an instrument containing the PUSH and the result of the NOC. In the analysis we used descriptive statistics, considering the scores obtained on the instrument.RESULTSA reduction in the size of lesions of 7cm to 1.5cm of length and 6cm to 1.1cm width, in addition to the increase of epithelial tissue and granulation, decreased secretion and odor.CONCLUSIONThere was improvement in the healing process of the lesion treated with adjuvant therapy and the use of NOC allowed a more detailed and accurate assessment than the PUSH.OBJETIVODescribir el proceso de cicatrización de úlcera por presión en paciente crítico tratado con terapéutica convencional de curativo agregada a la laserterapia de baja intensidad evaluada por la Pressure Ulcer Scale for Healing (PUSH) y el resultado Cicatrización de Heridas por segunda intención, de la Nursing Outcomes Classification (NOC).MÉTODOEstudio de caso orientado por el proceso de enfermería llevado a cabo con paciente de unidad de terapia intensiva. Los datos fueron recogidos con instrumento conteniendo la PUSH y el resultado de la NOC. En el análisis se utilizó la estadística descriptiva, considerándose las puntuaciones obtenidas en el instrumento.RESULTADOSSe observó reducción en las dimensiones de la lesión de 7cm a 1,5cm de largo y de 6cm a 1,1cm de ancho, además del aumento del tejido epitelial y de granulación, y la reducción de la secreción y el dolor.CONCLUSIÓNHubo mejora en el proceso de cicatrización de la lesión tratada con terapia adyuvante, y el uso de la NOC permitió una evaluación más detallada y precisa que la PUSH