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Leading the way in prevention

Despite the existence of prevention protocols, pressure ulcers are still one of the most common hospital-acquired conditions 

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Hospital-acquired pressure ulcers 

Pressure ulcer prevalence ranges between 7.3% and 23% in hospitals throughout Europe and North America    Pressure ulcers can occur at any point during a patient’s stay in hospital (e.g. emergency room, operating room, intensive care unit, aged care, paediatric care settings)    . High-risk areas for pressure ulcers include the sacrum, heel, back of the head, and underneath medical devices (e.g. face masks)    .

The causes of pressure ulcers

Pressure ulcers are caused by a complex interplay of factors – with pressure on a patient’s skin and subcutaneous tissues playing a major role. Extrinsic factors such as shear and friction, and increased skin temperature and humidity may also be involved    .

The burden of pressure ulcers

Pressure ulcers cause needless suffering, discomfort and pain for patients. And they lead to longer hospital stays, and increased demand on staff time and resources  . It all adds to a more expensive cost of care: For example, it has been estimated that the annual cost of treating pressure ulcers in the United States of America is about USD 11 billion  .

Preventing pressure ulcers

The cost of treating pressure ulcers is 3.6 times the cost of preventing them  . As the clinical, scientific and financial effectiveness of adopting proven pressure ulcer prevention protocols is well-established    , we focus on ways to build on best practice and support healthcare professionals with prevention. We also run educational events and provide expert support.

Key aspects of pressure ulcer prevention

Standard practices aimed at preventing pressure ulcers include:

  • Risk assessment to identify ‘at risk’ patients (this normally involves the use of a risk assessment tool (e.g. Braden Scale) in combination with a skin assessment)
  • Skin and tissue assessment to look for signs of early pressure damage
  • Preventive skin care to promote skin integrity and protect the skin from damage (keeping the skin clean and dry will help to control microclimate)
  • Use of support surfaces to reduce the magnitude of pressure
  • Keeping the head of the bed at or below 30 degrees elevation in order to reduce the risk of shear
  • Use of prophylactic dressings to areas frequently exposed to friction and shear (e.g. sacrum, heel)  
  • Turning and repositioning patients to reduce the duration of pressure 
  • Providing nutrition and hydration to maintain tissue tolerance for pressure    

Prophylactic dressings

Prophylactic dressings worn on high-risk areas are a key aspect of prevention protocols. An international clinical practice guideline    now recommends to consider applying a polyurethane foam dressing to high-risk areas for the prevention of pressure ulcers.

The results of several studies, including randomised controlled trials, show that these dressings are effective in preventing sacrum and heel pressure ulcers   . They help to combat the four extrinsic factors that contribute to pressure ulcers – by reducing shear, redistributing pressure, reducing friction and by maintaining an optimal microclimate       .

Turning and positioning systems

Patient repositioning is an important aspect of prevention protocols   . Several options are available to protect the head, sacrum and heel by holding the patient in position and redistributing pressure away from stress points, e.g.:

  • turning and positioning systems that make it easy for hospital staff to move their patients, reduce the physical effort required and reduce the risk of staff injuries   
  • fluidised positioners that are easily moulded to any shape and will hold the patient in the required position until the next scheduled repositioning   
  • heel boots designed specifically for positioning the high-risk heel area   

'References'

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