Which factors are associated with higher prevalence rates of pressure ulcers?

Updated: Apr 24, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Zubin J Panthaki, MD, CM, FACS, FRCSC  more...
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Answer

Milne et al reported the outcome of a long-term acute care hospital's program to reduce the incidence of pressure ulcers. [45] The facility used a failure mode and effects analysis to determine where improvements in care were most needed. The hospital determined that its ulcer prevalence rates, which were believed to be above average, were associated with such problems as "a lack of 1) wound care professionals, 2) methods to consistently document prevention and wound data, and 3) an interdisciplinary wound care team approach." After the hospital addressed these issues, it saw the incidence of facility-acquired pressure ulcers drop from 41% (the baseline figure) to an average of 4.2%, over a 12-month period.

Table 2. Staging Pressure Ulcers (Open Table in a new window)

Stage

Definition

Appearance

Appropriate topical treatment

Average healing time (d)

I

Nonblanchable erythema of intact skin

Pink skin that does not resolve when pressure is relieved; discoloration; warmth; induration

DuoDerm q2-3d

14

II

Partial-thickness skin loss involving epidermis and/or dermis

Cracking, blistering, shallow crater, abrasion

Cleanse with saline; DuoDerm/Tegaderm dressing

45

III

Full-thickness skin loss into subcutaneous fatty tissues or fascia

Distinct ulcer margin; deep crater (in general, 2.075 mm or deeper [the thickness of a nickel])

Debride; irrigate with saline; apply DuoDerm/Tegaderm

90

IV

Full-thickness skin loss with extensive tissue involvement of underlying tissues

Extensive necrosis; damage to underlying supporting structures, such as muscle, bone, tendon, or joint capsule

Surgically debride; irrigate with saline (possibly under pressure); apply advanced topical dressings; consider antibiotics

120

*When the overlying skin is necrotic, the staging cannot be accurate until debridement is performed.


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