Evaluation of Pressure Ulcer Among the Critically Ill Patients Admitted in a Tertiary Hospital

Background: All over the world pressure ulcer is a significant health care problem due to high morbidity and mortality rates and also high health care cost. This study was carried out with the objectives to identify the characteristics and associated factors of pressure ulcer among the critically ill patients admitted in a tertiary military hospital. Few studies have been conducted on pressure ulcer in Bangladesh and very few in military hospitals. Methodology: This was a cross sectional study conducted among purposively selected 53 critically ill admitted pressure ulcer patients in CMH Dhaka from 01 July 2018 to 31 December 2018 and data were collected by face to face interview and checklist. Results: Among the study population half (50.9%) were aged between 61-80 years with the mean age 69.13 years. The most common anatomical site of pressure ulcer were buttock (51.9%) followed by sacrum (38.5%) and 30.2% had multiple pressure ulcer. Among the critically ill patients, 81.1% had developed pressure ulcer after admission into hospital. The most common place of pressure ulcer was geriatric HDU (30.2%) and officers ward (18.9%). Among the pressure ulcer patients 79.2% were male. Most common stage of pressure ulcer were stage II (66.0%) followed by stage I (18.9%), stage III (13.2%) and stage IV (1.9%). All of them were bedridden and half (50.9%) were completely immobile. According to Braden Scale, about half (50.9%) had high risk for development of pressure ulcer followed by moderate risk (26.4%) and there were none beyond risk. About three fourth (73.6%) of pressure ulcer patients had hypertension & cerebrovascular diseases. Age group of 60-90 years, SSC & above educational group, male sex, immobility, low Braden score group patients are statistically significant (p < 0.05), and hypertensive and cerebrovascular diseased patients are not statically significant (p > 0.05) but having clear trends to be associate factors of pressure ulcer. Conclusion: The number of pressure ulcer were increasing with the increase of age. The higher age, male sex, immobilization, low Braden score, hypertension, and cerebrovascular diseased patients were more prone for development of pressure ulcer among the critically ill patients. J Bangladesh Coll Phys Surg 2022; 40: 23-30

FRAGILIDADES NO CONHECIMENTO DOS ENFERMEIROS SOBRE LESÃO POR PRESSÃO

O DESENVOLVIMENTO DE UMA LESÃO POR PRESSÃO É CONSIDERADO UM EVENTO ADVERSO QUE PROLONGA A RECUPERAÇÃO DO PACIENTE. A IDADE AVANÇADA CONSTITUI UM DOS FATORES DE RISCO INTRÍNSECOS AO SURGIMENTO DAS LP, ALÉM DA IMOBILIDADE, ALTERAÇÕES NA PERCEPÇÃO SENSORIAL E ESTADO NUTRICIONAL. ESTE ESTUDO TRATA-SE DE UMA REVISÃO INTEGRATIVA DA LITERATURA COM OBJETIVO DE REALIZAR UM LEVANTAMENTO SOBRE AS LACUNAS DO CONHECIMENTO DOS ENFERMEIROS RELACIONADAS A LP. FORAM SELECIONADOS 20 ARTIGOS NAS BASES DE DADOS BDENF, LILACS, MEDLINE, SCOPUS, GOOGLE SCHOLAR E WEB OF SCIENCE, UTILIZANDO A ESTRATÉGIA DE BUSCA EM PORTUGUÊS: (“LESÃO POR PRESSÃO” OR “ÚLCERA POR PRESSÃO” OR “ÚLCERA DE DECÚBITO” OR “ESCARA DE DECÚBITO”) AND ENFERMAGEM AND CONHECIMENTO, E, EM INGLÊS, (“PRESSURE ULCER” OR “BED SORE” OR “BED SORES” OR BEDSORE OR BEDSORES) AND NURSING AND KNOWLEDGE. VERIFICOU-SE QUE AS CLASSIFICAÇÕES DOS ESTÁGIOS 2 E 3 FORAM AS QUE APRESENTARAM MENOR NÚMERO DE ACERTOS NOS ESTUDOS. EVIDENCIOU-SE DEFICIÊNCIA DE CONHECIMENTO SOBRE DEFINIÇÃO DE CISALHAMENTO E A REDUÇÃO DE OFERTA DE OXIGÊNIO COMO FATOR DE RISCO PARA LP. AS MEDIDAS PREVENTIVAS QUE APRESENTARAM MAIOR FRAGILIDADE DO CONHECIMENTO REFEREM-SE AO ÂNGULO DA CABECEIRA DO LEITO E FREQUÊNCIA DE REPOSICIONAMENTO DE PACIENTES EM POSIÇÃO SENTADA. A IDENTIFICAÇÃO DAS LACUNAS DE CONHECIMENTO É UMA FERRAMENTA ESSENCIAL PARA O PLANEJAMENTO INSTITUCIONAL E MELHORIA NA QUALIDADE DA ASSISTÊNCIA.

A Review of Intelligent Sensor-Based Systems for Pressure Ulcer Prevention

Pressure ulcers are a critical issue not only for patients, decreasing their quality of life, but also for healthcare professionals, contributing to burnout from continuous monitoring, with a consequent increase in healthcare costs. Due to the relevance of this problem, many hardware and software approaches have been proposed to ameliorate some aspects of pressure ulcer prevention and monitoring. In this article, we focus on reviewing solutions that use sensor-based data, possibly in combination with other intrinsic or extrinsic information, processed by some form of intelligent algorithm, to provide healthcare professionals with knowledge that improves the decision-making process when dealing with a patient at risk of developing pressure ulcers. We used a systematic approach to select 21 studies that were thoroughly reviewed and summarized, considering which sensors and algorithms were used, the most relevant data features, the recommendations provided, and the results obtained after deployment. This review allowed us not only to describe the state of the art regarding the previous items, but also to identify the three main stages where intelligent algorithms can bring meaningful improvement to pressure ulcer prevention and mitigation. Finally, as a result of this review and following discussion, we drew guidelines for a general architecture of an intelligent pressure ulcer prevention system.

Palestinian Experience in Stage Four Pressure Ulcer

Pressure ulcer (now called Pressure injury) happens when the bony prominence like the sacrum exposes to pressure for a long period and also can cause soft tissue injury. In order to prevent and cure pressure-induced wounds, continuous and attentive repositioning is necessary. Wound management begins with the identification and aggressive management of the modifiable factors, such as positioning, incontinence, spasticity, diet, devices, and medical comorbidity, which contribute to pressure injury formation. Initial interventions include washing, cleaning, and maintaining the surfaces of the wound. In certain cases, it may be sufficient to debride the non-viable or contaminated tissue; however, operational care in more severe cases or to encourage patient satisfaction may be necessary. Our patient is a 50-year-old overweighted man, nonsmoker, and confined to a wheelchair presented with a 20*20*8 stages 4 ulcers in the sacral area after multiple failed bedside debridement. When we use the fasciocutaneous we should consider the depth of the wound and fill dead space. Here we the local situation in Palestine as those patients are usually neglected and their management is restricted to bedside debridement, with no experience in flap reconstruction operations which would dramatically improve patients’ lives. We believe that further awareness is demanded for such procedures.

Prevention Effects of Chain Management on Pressure Ulcers of Hospitalized Patients

The study focused on the preventive effects of the chain management model on pressure ulcers in the operating room. Sqoop big data collection module is used to collect patient information from various hospital information systems in a distributed manner. The data were from the clinical data center of the Zhongshan Hospital Xiamen University General Hospital, and 268 patients were selected as the research subjects. A chain management model is constructed, concerning the preventive measures, the management of each link, the perioperative pressure ulcer management, and the reporting of pressure ulcers. Then, the two groups were compared for the SAS and SDS scores before and after nursing, the pressure ulcer sites, pressure ulcer reporting rate, pressure ulcer staging, and nursing satisfaction. The results show that it is not that more collection modules will lead to better cluster performance and that the execution delay is caused by MapReduce requiring the JAVA virtual machine, and after reaching a certain point, the increase in the number of tasks will slow down the process, and as data size increases, DataNote has an expanded capability to analyze data. After nursing treatment, the SAS and SDS scores of the two groups of patients were significantly lower than before treatment ( P < 0.05 ). The pressure ulcers were mainly distributed in the forehead, mandible, cheeks, front chest, and knees in the two groups, and the difference between the two groups was statistically significant ( P < 0.05 ). The total satisfaction of the observation group was 93.28%, and the total satisfaction of the control group was 92.54%. The patients’ satisfaction with the chain management model was higher than that of conventional nursing.

Application of Self-Adhesive Soft Silicone Common Foam Dressing in Reducing Intraoperative Pressure Ulcers in Elderly ICU Patients

Pressure ulcer (PU), also called pressure injury, is localized damage to the skin and underlying soft tissues, usually over bony prominences, as a result of sustained mechanical loads applied to the tissues. However, in many situations, complete off-loading of sacral PUs is not possible. Minimising the exposure of wounds and their surroundings to elevated mechanical loads is crucial for healing. We for the first time reported the application of Meipicang in the prevention and treatment of intraoperative pressure ulcers in elderly ICU patients with severe illness. We found that the pressure ulcer risk score ( 20.15 ± 2.17 ) in the dressing group after intervention was higher than that ( 17.42 ± 3.62 ) in the regular group. The incidence of pressure sores in the dressing group was 3.77% lower than the 18.88% in the regular group. The psychological concern score ( 31.41 ± 3.15 ) of the dressing group was higher than that ( 26.92 ± 3.43 ) of the regular group. The trust score ( 29.57 ± 2.61 ) of the dressing group was higher than the score ( 24.28 ± 2.29 ) of the regular group. The score of physiological problems in the dressing group ( 34.69 ± 3.82 ) is higher than that in the regular group ( 29.88 ± 3.54 ). The skin complication rate of the dressing group was 5.56% lower than that of the regular group (22.64%). The comfort score (92.46 ± 4.15) of the dressing group was higher than that ( 80.59 ± 5.43 ) of the regular group. The nursing satisfaction score ( 94.53 ± 3.72 ) of the dressing group was higher than that ( 81.79 ± 4.61 ) of the regular group. To conclude, in this study, we found that the Meipicang dressing can reduce the incidence of pressure ulcers in ICU patients with severe ICU and improve the comfort and nursing satisfaction of elderly ICU patients with severe ICU, which is worthy of promotion.

Assess the Level of Practice regarding Prevention of Pressure Ulcer in bedridden patients among Nurses

Background: Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and impose significant burden on patients, their relatives and caregivers. Now days, pressure ulcers are recognized worldwide as one of the five most common causes of harm to patients and preventable patient safety problem. It is also increasingly described as an indicator of the quality of care provided by health care organization. However, pressure ulcers are largely preventable. All patients who are identified as being at risk should have a management plan to prevent development of pressure ulcer, optimize healing, and prevent complications of existing pressure ulcer. Objectives: 1. To assess the level of practice regarding prevention of pressure ulcer in bedridden patients among nurses. 2. To determine the association between pre-test practice scores of nurses regarding prevention of pressure ulcer in bedridden patients with selected sample characteristics. Methodology: The research design used for this study was non – experimental descriptive design. The study was conducted at a tertiary hospital in Bengaluru, Karnataka, India. Population comprises of nurses (staff nurses and student nurses) working in a selected hospital. The sample size selected for this study consists of 60 nurses (staff nurses -24 and student nurses -36) who were working in medical, surgical wards and Intensive Care Units (ICUs). Nurses providing care to the patients who are bed ridden for more than 48 hours were included in the study. Non – probability purposive sampling technique was used to select the samples. The tool used in this study was socio-demographic profile of nurses (separate tool for staff nurses and student nurses) and observational checklist to assess the practice. Result: The overall practice scores of the 60 nurses revealed that 40(66.67%) had good practice, whereas 20(33.33%) samples had average practice and none of them had poor practice. Among of 24 staff nurses; 20(83.33%) had good practice, whereas 4(16.67%) had average practice and none of them had poor practice. Out of 36 student nurses; 20(55.56%) had good practice, whereas 16(44.44%) samples had average practice and none of them had poor practice. It was found that among socio-demographic variables none had association with the practice of staff nurses and student nurses too. Conclusion: The study concluded that continuing education programmes are needed to improve the practices of nurses. Nurses must be motivated to provide back care and position change every second hourly in bedridden patients.