Pressure Injury Management

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  Pressure Ulcer Risk in the Incontinent Patient

  Lachenbruch C | Journal of Wound, Ostomy & Continence Nursing | 2016

  This article is an analysis of incontinence and pressure ulcers from the International Pressure Ulcer Prevalence™ Survey. It concludes that incontinent patients had higher Braden Scale scores and higher overall and facility-acquired pressure ulcer prevalence. Incontinence was associated with an increased risk for all pressure ulcers, but especially full-thickness injuries.

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  Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness

  Chou R, et al. | Agency for Healthcare Research and Quality | 2013

  Pressure ulcers are a relatively common occurrence across all care settings, resulting in significant health burdens. However, risk-assement scales and preventive interventions can decrease the incidence or severity of pressure ulcers. 

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  Comparison of Air-Fluidized Therapy With Other Support Surfaces Used to Treat Pressure Ulcers in Nursing Home Residents

  Ochs RF, et al. | Ostomy Wound Management | 2005

  This retrospective pressure ulcer prevention and treatment study compared healing rates for different support surfaces in nursing home residents. Support surface types were categorized into 3 groups: static overlays and replacement mattresses (1); low-air-loss beds, alternating pressure, and powered/non-powered overlays/mattresses (2); and air-fluidized beds (3). Mean healing rates were as follows: 5.2 cm2/wk (Group 3); 1.8 cm2/wk (Group 2); 1.5 cm2/wk (Group 1) (P=0.007 comparing Group 3 to 1 and 2). Mean healing rates were also significantly greater for stage III/IV ulcers on Group 3 surfaces. Groups 1 and 3 had fewer hospitalizations and ER visits compared to Group 2 (P=0.01).

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  Air-Fluidized Therapy: Physical Properties and Clinical Uses

  Annals of Plastic Surgery | 2010

  This review describes the benefits and drawbacks of air-fluidized therapy compared to other support types in terms of factors known to impact skin breakdown: interface pressure, shear, friction, heat, and moisture. The clinical benefits of air-fluidized therapy include faster pressure ulcer healing, decreased rate of hospitalization and ER visits for long-term care pressure ulcer patients, and decreased mortality and increased comfort for patients with burns and inhalation injury.

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  The Effect of Using a Low-Air-Loss Surface on the Skin Integrity of Obese Patients: Results of a Pilot Study

  Pemberton V, et al. | Ostomy Wound Management | 2009

  This study assesses the impact of a new low-air-loss, continuous lateral rotation therapy bed in 21 obese, bariatric acute care patients. During this pilot study, pressure ulcers decreased in size from an average 5.2 cm2 to 2.6 cm2, and no new pressure ulcers developed.

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  Microclimate Management: So Much More Than Just Airflow

  Lachenbruch C | 2017

  This whitepaper discusses factors impacting the skin microclimate and describes the ideal combination of airflow, temperature, and surface material for preventing skin breakdown.

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  Pressure Ulcer Incidence and Progression in Critically Ill Subjects: Influence of Low Air Loss Mattress Versus a Powered Air Pressure Redistribution Mattress

  Black J, et al. | Journal of Wound, Ostomy & Continence Nursing | 2012

  This study evaluated the change in existing pressure ulcers and incidence of new pressure ulcers in surgical ICU patients using a new low-air-loss, weight-based, microclimate management (LAL-MCM) system compared to the standard SICU bed with an integrated, powered air pressure redistribution (IP-AR) surface. Incidence of supine pressure ulcers was 0% in the LAL-MCM group and 18% in the IP-AR group (P=0.046), despite more comorbidities in the patients in the LAL-MCM group.

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  Role of Bed Design and Head-of-Bed Articulation on Patient Migration

  Davis K, et al | Journal of Nursing Care Quality | 2015

  Repositioning patients in bed puts both patients and caregivers at risk.  Patients experience shear and friction which are risk factors for pressure ulcers, while caregivers who are repositioning patients are at risk for lower back injuries.  This study examined the influence of hospital bed design on patient migration. Over 180 trials, Bed A (Hill-Rom® Progressa® bed system) showed 85-86% (p< 0.001) less patient migration and 34% less torso compression compared to current alternatives.  Three in four subjects preferred the Hill-Rom® Progressa® bed system. The author concludes that optimal bed design should reduce patient migration which may lead to clinically significant reductions in health risks to patients and caregivers.

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  The Demographics of Suspected Deep Tissue Injury in the United States: An Analysis of the International Pressure Ulcer Prevalence™ Survey 2006-2009

  VanGilder C, et al. | Advances in Skin & Wound Care | 2010

  This article reports data from the International Pressure Ulcer Prevalence™ survey 2006-2009 in patients with suspected deep tissue injury (sDTI). Overall and facility-acquired pressure ulcer prevalence was constant in 2006-2008 and decreased by about 1% in 2009 (P<0.001). The prevalence of pressure ulcers identified as sDTI increased to 9% of all observed ulcers in 2009, a 3-fold increase, while the proportion of stage I and II ulcers has decreased and stage III and IV ulcers remained constant. This increase may be due in part to education of staging definitions.

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  A Pilot Study of Pressure Ulcer Incidence and Healing of Pressure Ulcers Comparing Subjects Placed on the LAL-MCM Mattress Versus a Standard Bed SICU Mattress

  Black J, et al. | 2010

  This study evaluated the change in existing pressure ulcers and incidence of new pressure ulcers in surgical ICU patients using a new low-air-loss, weight-based, microclimate management (LAL-MCM) system compared to the standard SICU bed with an integrated, powered air pressure redistribution (IP-AR) surface. Incidence of supine pressure ulcers was 0% in the LAL-MCM group and 18% in the IP-AR group (P=0.046), despite more comorbidities in the patients in the LAL-MCM group.

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  The national cost of hospital-acquired pressure injuries in the United States

  Padula WV, Delarmente BA. | International Wound Journal

  Abstract

  Our objective was to estimate the US national cost burden of hospital‐acquired pressure injury (HAPI) using economic simulation methods. We created a Markov simulation to estimate costs for staged pressure injuries acquired during hospitalisation from the hospital perspective. The model analysed outcomes of hospitalised adults with acute illness in 1‐day cycles until all patients were terminated at the point of discharge or death. Simulations that developed a staged pressure injury after 4 days could advance from Stages 1 to 4 and accrue additional costs for Stages 3 and 4. We measured costs in 2016 US dollars representing the total cost of acute care attributable to HAPI incidence at the patient level and for the entire United States based on the previously reported epidemiology of pressure injury. US HAPI costs could exceed $26.8 billion. About 59% of these costs are disproportionately attributable to a small rate of Stages 3 and 4 full‐thickness wounds, which occupy clinician time and hospital resources. HAPIs remain a concern with regard to hospital quality in addition to being a major source of economic burden on the US health care system. Hospitals should invest more in quality improvement of early detection and care for pressure injury to avoid higher costs.

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  Relative contributions of interface pressure, shear stress, and temperature on ischemic-induced, skin-reactive hyperemia in healthy volunteers: a repeated measures laboratory study

  Lachenbruch C, Tzen YT, Brienza D, Karg PE, Lachenbruch PA | Ostomy Wound Manage | 2015

  Abstract

  Although the primary risk factors for pressure ulcer development - pressure, shear, skin temperature, moisture, and friction - have been identified for decades, the relative contribution of each to this risk remains unclear. To confirm the results of and expand upon earlier research into the relative contributions of interface pressures, shear stress, and skin temperature among 4 healthy volunteers, a study involving 6 additional healthy 40- to 75-year-old volunteers was conducted and results of the 2 studies were pooled. All 3 variables (interface pressures, shear stress, and skin temperature) were systematically and randomly varied. In the prone position, volunteers each underwent 18 test conditions representing different combinations of temperature (28˚ C, 32˚ C, 36˚ C), pressure (8.0 and 13.3 kPa), and shear (0, 6.7, and 14.0 kPa) using a computer-controlled indenter applied to the sacrum for 20 minutes exerting weights of 100 g and 200 g to induce 0.98 N and 1.96 N of shear force, respectively. Each condition was tested twice, resulting in a total of 360 trials. Magnitude of postload reactive hyperemia as an index of ischemia was measured by laser Doppler flowmetry. Fixed effects regression models were used to predict 3 different indices of reactive hyperemic magnitude. Friedman tests were performed to compare the reactive hyperemia among 3 different skin temperatures or shear stresses under the same amount of localized pressure. In all regression models, pressure and temperature were highly significant predictors of the extent of reactive hyperemia (P <0.0001 and P <0.0001, respectively); the contributions of shear stress were not statistically significant (P = 0.149). With higher temperature, reactive hyperemia increased significantly, especially at greater localized pressure and shear stress, and the difference was more profound between 32˚ C and 36˚ C than between 28˚ C and 32˚ C. These results confirm that, in laboratory settings, temperature is an important factor in tissue ischemia. Additional studies examining the relative importance of pressure, shear, and temperature and potential effects of lowering temperature on tissue ischemia in healthy volunteers and patients at risk for pressure ulcer development are warranted. Because deformation at weight-bearing areas often results in blood flow occlusion, actively lowering the temperature may reduce the severity of ischemia and lower pressure ulcer risk. In this study, shear did not appear to contribute to ischemia in the dermal tissues when assessed using laser Doppler; further work is needed to examine its effect on deeper layers, particularly with regard to nonischemic mechanisms.

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  Predictors of superficial and severe hospital-acquired pressure injuries: A cross-sectional study using the International Pressure Ulcer Prevalence™ survey.

  Kayser SA, VanGilder CA, Lachenbruch C | International Journal of Nursing Studies. | 2019

  Abstract

  BACKGROUND:

  Prevalence of hospital-acquired pressure injuries has declined over time. However, it is unknown if this decline is consistent for different stages of pressure injuries. It is also unknown if risk factors differ between superficial (stage 1 and 2) and severe (stage 3, 4, deep tissue, and unstageable) pressure injuries.

  OBJECTIVE:

  To examine changes in prevalence of superficial and severe hospital-acquired pressure injuries from 2011 to 2016. To evaluate differences between risk factors associated with superficial versus severe hospital-acquired pressure injuries.

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  A Laboratory Study Comparing Skin Temperature and Fluid Loss on Air-Fluidized Therapy, Low-Air-Loss, and Foam Support Surfaces

  Lachenbruch, Charles | Ostomy/Wound Management | 2010

  ABSTRACT

  To ensure appropriate fluid replacement, caregivers need to understand the effect of support surfaces on the rate of moisture loss from the body. A prospective study was conducted to 1) measure the rate of weight (fluid) loss on an air-fluidized therapy (AFT) surface; 2) determine the effect of bath temperature on weight loss; 3) compare weight loss and skin temperatures between foam and low-air loss (LAL) surfaces; 4) compare characteristics of individuals with high and low weight loss rates; and 5) compare weight loss rates to previously measured rates of support surface evaporative capacity. Eight healthy adult volunteers (three men, five women, average age 33 years, average body mass index 31.0 kg/m²) participated in eight 180-minute trials (one trial per day) on a foam, an LAL, and an AFT surface at five different bath temperatures (range: ~99.0 °F [hot] to ~88.0 °F [low]). Weight (± 10 g) was obtained before and after each trial and skin temperature (across the back) was recorded continuously. Using linear regression, weight loss rate on AFT was found to be strongly dependent upon bath temperatures: weight loss/day (g/m²-24 hours) = 53.9 x T (F) - 4030, where T is the mean skin temperature on the patient's back (also equal to bath temperature) in (F) Fahrenheit. Using this regression equation at mid-range (94 °F), fluid loss in an average woman (145 lb/64.5 inches/1.72 m² body surface area [BSA]) on AFT would be estimated to be 850 g/day higher than on foam. Compared with LAL, weight loss on AFT was estimated to be 700 g/day and 800 g/day higher for the typical woman and man, respectively (P < 0.05 at a mid-range bath temperature of 94 °F). Weight loss rates varied from 480 g/m²-24 hours to 3,470 g/m²-24 hours. Weight loss and mattress evaporative rates also suggest that moisture accumulation may occur on a foam but not on an LAL or AFT surface. However, fluid intake should be increased on AFT, particularly when bath temperature settings are high.

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  Pressure ulcer incidence and progression in critically ill subjects: influence of low air loss mattress versus a powered air pressure redistribution mattress

  Black, Joyce; Berke, Christine; Urzendowski, Gail | ournal of Wound, Ostomy and Continence Nursing | 2012

  Abstract

  PURPOSE:

  The primary objective of this study was to compare facility-acquired pressure ulcer incidence and progression of pressure ulcers present on admission in critically ill patients, using 2 different support surfaces.

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  Factors associated with safe patient handling practice in acute care and its relationship with patient mobilization: A cross-sectional study

  Kayser S, Wiggermann N, Kumpar D | International Journal of Nursing Studies | 2019

  Background

  Mobilizing hospital patients is associated with improved outcomes and shorter length of stay. Safe patient handling and mobility programs that include mechanical lift use facilitate mobilizing patients and reduce the likelihood of musculoskeletal disorders in staff. However, there is little information on the prevalence of lift use or why some patients are more likely to have a lift used than others. Such information is needed to inform public policy, benchmark lift use over time, and contextualize barriers for lift use.

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  Incontinence-Associated Dermatitis and Immobility as Pressure Injury Risk Factors: A Multisite Epidemiologic Analysis

  Gray M, Giuliano KK. | J Wound Ostomy Continence Nurs. | 2017

  Abstract

  PURPOSE:

  The purpose of this study was to measure the prevalence of incontinence-associated dermatitis (IAD) among incontinent persons in the acute care setting, characteristics of IAD in this group, and associations among IAD, urinary, fecal, and dual incontinence, immobility, and pressure injury in the sacral area.

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  The Standardized Pressure Injury Prevention Protocol for improving nursing compliance with best practice guidelines.

  Padula WV, Black JM | Journal of Clinical Nursing. | 2018

  BACKGROUND
  
  Compliance with international best practice guidelines can effec-tively prevent most hospital-acquired pressure injuries (HAPIs) (Black et al., 2011; Padula et al., 2016) These guidelines include sev-eral nursing interventions that first were introduced in 1992 by the U.S. Agency for Healthcare Research & Quality (AHRQ), and have since been updated by the National Pressure Ulcer Advisory Panel (NPUAP) every 3–5 years (NPUAP, 2014; Panel on the Prediction and Prevention of Pressure Ulcers in Adults, 1992. AHCPR Publication No. 91-0047). Following admission, nurses should perform a daily skin check and risk assessment using a validated risk tool (Bergstrom, Braden, Laguzza, & Holman, 1987; Braden & Bergstrom, 1994). Patients determined to be high-risk receive additional measures: (a) repositioning every 2–4 hr; (b) managing skin care and incontinence; (c) improving nutrition; (d) using pressure-relieving support surfaces; and (e) reducing friction and shear (Agency for Healthcare Research and Quality, 2011; NPUAP, 2014). Many hospitals struggle to incor-porate these guidelines into a daily routine given the intense amount of nursing time, costliness to implement, uncertain clinical effective-ness, and competing patient demands and hospital priorities.

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  Time of Onset to Changes in Skin Condition During Exposure to Synthetic Urine: A Prospective Study.

  Phipps L, Gray M, Call E. | J Wound Ostomy Continence Nurs

  Abstract

  PURPOSE:

  The purpose of this study was to evaluate the impact of incontinence on epithelial-moisture barrier function and the subsequent risk for incontinence-associated dermatitis by exposing healthy volunteers to a premium incontinence pad wet with synthetic urine.

  DESIGN:

  Prospective, single-group study.

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  Identifying the Right Surface for the Right Patient at the Right Time - Generation and Content Validation of an Algorithm for Support Surface Selection

  McNichol L., et al. | Journal of Wound, Ostomy & Continence Nursing | 2015

  A consensus conference was held to fill the void in clinical literature as to the appropriate surface technology to prevent or treat pressure ulcers.  Although the literature is clear that technology may help, no specific guidance yet exists on which surfaces are appropriate for th right patient and the right time.  This article lays the foundation for how the expert consensus panel researched, deliberated and created an algorithm for support surface selection.  It provides the first known consenses based algorithm for pressure ulcer prevention and treatment in press.

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  Pressure Ulcers: Avoidable or Unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference

  Black J, et al. | Ostomy Wound Management | 2011

  The National Pressure Ulcer Advisory Panel (NPUAP) hosted a conference in 2010 to establish consensus on the avoidability of pressure ulcers. An overall 80% agreement was reached among representatives, with unanimous consensus reached for the following: most PrUs are avoidable; not all PrUs are avoidable; there are situations that render PrU development unavoidable, including hemodynamic instability that is worsened with physical movement and inability to maintain nutrition and hydration status and the presence of an advanced directive prohibiting artificial nutrition/hydration; pressure redistribution surfaces cannot replace turning and repositioning; and if enough pressure was removed from the external body the skin cannot always survive.

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  NPUAP and EPUAP Clinical Practice Guideline for Prevention of Pressure Ulcers

  National Pressure Ulcer Advisory Panel | 2014

  National Pressure Ulcer Advisory Panel (NPUAP) and European Pressure Ulcer Advisory Panel (EPUAP) evidence-based recommendations for the prevention of pressure ulcers for use by health care professionals throughout the world.

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  WOCN Guideline for Prevention and Management of Pressure Ulcers

  Wound Ostomy and Continence Nurses Society | 2016

  The Wound, Ostomy and Continence Nurses Society™ (WOCN®) guidelines are designed to support clinical practice by providing consistent research-based information with the goal of improving cost-effective patient outcomes as well as stimulating wound-related research.

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  NPUAP Pressure Injury Stages

  National Pressure Ulcer Advisory Panel | NPUAP Pressure Injury Stages

  The term “pressure injury” replaces “pressure ulcer” in the National Pressure Ulcer Advisory Panel Pressure Injury Staging System according to the NPUAP. The change also more clearly describes pressure injuries to both intact and ulcerated skin.

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  Identifying Gaps, Barriers, and Solutions in Implementing Pressure Ulcer Prevention Programs

  Jankowski I, et al. | Joint Commission Journal on Quality and Patient Safety | 2011

  This project identified 3 major barriers to pressure ulcer prevention program implementation: limitations in staff education and training, poor communication of at-risk status, and insufficient quality improvement evaluation of bedside practices. The study noted insufficient clarity for selecting and securing appropriate therapy surfaces. Guidelines were identified for addressing these barriers. 

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  Pressure Ulcer Prevention Toolkit

  Joint Commisson Resources | 2012

  This toolkit provides practical and effective strategies and tools for mitigating and preventing pressure ulcers. The toolkit includes examples of organizations who have demonstrated success in preventing and treating pressure ulcers and it’s purpose is to educate staff at other organizations to apply similar strategies and initiatives

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  Safe Skin® Program

  A full toolkit designed to help you design, implement and measure a pressure injury prevention and treatment program in your facility. 

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  Pressure Injury Staging Guide and Braden Risk Assessment

  This tool is designed to help caregivers classify pressure injuries as Stages 1-4, DTIs or unstageable. It includes images and descriptions as defined by the National Pressure Ulcer Advisory Panel (NPUAP).  It also includes the Braden Scale, a tool designed to help caregivers evaluate a patient's risk for developing a pressure injury.

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  WOCN® Surface Selection Algorithm - Web Tool

  The WOCN Society and Hill-Rom have teamed up to provide a web-based patient specific tool using the evidence-and consensus-based guidelines for pressure ulcer prevention and treatment.

  Get the WOCN Consensus Statement

  Read the WOCN press release

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  Microclimate Management: So Much More Than Just Airflow

  Lachenbruch C | 2017

  This whitepaper discusses factors impacting the skin microclimate and describes the ideal combination of airflow, temperature, and surface material for preventing skin breakdown.

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  Prevalence and Incidence: Implications for Clinical Practice

  Goldberg M, et al. | 2016

  Inconsistency in measuring prevalence and incidence prevents facilities from benchmarking prevalence within their own facility against facilities of similar size and patient acuity.  A lunch session sponsored by Hill-Rom at WOCN 2016 focused on the importance of benchmarking prevalence and incidence, implementation strategies related to these data in the clinical setting, and how these strategies empower the WOC Nurse.

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  Pressure Ulcer Overview: A National Problem

  This course provides an overview of the incidence, prevalence and cost of pressure ulcers in the US, and reviews some clinical guidelines and initiatives that have been developed to help health care professionals reduce or prevent the occurrence of pressure ulcers. Additionally, the course discusses common barriers to implementing these guidelines.

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  Skin Basics: Anatomy & Physiology, Skin Assessment and Pressure Ulcer Staging

  This course covers the basics of skin anatomy and physiology, the components of a skin assessment, and pressure ulcer staging using the National Pressure Ulcer Advisory Panel (NPUAP) classification system.

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  Safe Skin: Pressure Injury Risk Assessment

  This course covers pressure injury risk assessment, including formal validated risk scales to quantitatively assess pressure injury risk.

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  The Science of Support Surfaces: Nomenclature, Design for Performance and Selection

  This course covers the science of support services, particularly nomenclature and engineering design choices that impact surface performance.  The course also discusses surface selection guidelines and criteria.

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  Ayello, Elizabeth. FILE DOWNLOAD of Webinar on Advancing Safe Skin Across the Care Continuum

  Ayello E | 2013

  FILE DOWNLOAD of webinar presented by Elizabeth Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN designed to provide you with up-to-date information on best practices for prevention and treatment of pressure injuries. Includes latest statistics on national problem of pressure injuries and how to address this through use of skin and risk assessments as well as the science behind surface selection

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  sDTI Challenges and Solutions

  Zulkowski K | 2013

  During the 2013 WOCN conference held in Seattle, WA, Dr. Karen Zulkowski presented a 15 minute presentation at Hill-Rom's booth featuring the latest information on suspected Deep Tissue Injury(sDTI).  This brief presentation features an overview of the February 2013 NPUAP biennial conference dedicated to sDTI state of the science, highlights sDTI IPUP trend data, and features a published sDTI case study where patients experienced less tissue breakdown than expected on the Clinitron Air Fluidized Therapy surface.

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  2006-2015 International Pressure Ulcer Prevalence Survey Overall Results: 10 year trends (US Only)

  VanGilder C, et al. | 2016

  Pressure Ulcer (PU) prevalence allows benchmarking within and across facilities. The International Pressure Ulcer Prevalence™ (IPUP) Survey is unique as it includes a variety of care settings and participants include community and larger teaching facilities. The purpose of this study is to present 10 years of US prevalence data and demographic data (2006-2015) by care setting.

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  Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence™ Survey*

  Lachenbruch C, et al. | 2016

  This poster is an outline of incontinence and hospital-acquired pressure ulcer findings from the International Pressure Ulcer Prevalence™ Survey (IPUP). It concludes that even patients at low pressure ulcer risk by Braden risk score have increased likelihood of pressure ulcers if they are incontinent. Incontinence was associated with an increased risk for all pressure ulcers, but especially full-thickness injuries.

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  High Pressure Ulcer Risk Patients and Specialty Surface Utilization: Data From the 2010 International Pressure Ulcer Prevalence™ Survey

  Lachenbruch C, et al. | 2011

  This study evaluated current practice trends in surface utilization for patients at high risk for developing pressure ulcers. Surface types used for high-risk patients were powered static air (28%), foam (21.7%), low air loss (16%), self-adjusting technology (8%), alternating pressure (5.2%), nonpowered static air (2.0%), and air-fluidized therapy (1.8%), demonstrating that high-risk patients were most often placed on surfaces that are inferior to specialty surfaces with regard to pressure ulcer development and breakdown. 

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  2010 International Pressure Ulcer Prevalence™ Survey: Canadian Results

  VanGilder C, et al. | 2011

  This study collected data on pressure ulcer prevalence and risk score, surface type, and other parameters from facility-performed IPUP surveys. Overall pressure ulcer prevalence in the acute care, LTAC, LTC, and rehab settings decreased in 2009-2010. Significant decreases in facility-acquired prevalence were found in all settings except rehab.

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  Pressure Ulcer Prevalence in Bariatric Patients – Data From the International Pressure Ulcer PrevalenceTM Survey 2009

  VanGilder C, et al. | 2009

  This study of data from the 2009 IPUP survey focused on pressure ulcer prevalence by BMI and weight distribution revealed the following: the percentage of extremely obese patients increased from 18.3% to 20.6% in 2008-2009, 36% of survey patients have a BMI >30, and pressure ulcer prevalence is higher in patients weighing >300 lbs

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  Results of the 2010 International Pressure Ulcer PrevalenceTM Survey

  VanGilder C, et al. | 2010

  This International Pressure Ulcer Prevalence (IPUP) survey of pressure ulcer prevalence revealed that overall prevalence, facility-acquired prevalence, prevalence excluding stage I, and facility-acquired prevalence excluding stage I have decreased significantly during 2009-2010. An estimated 8% to 10% of patients in ICUs developed a facility-acquired pressure ulcer. Facility-acquired pressure ulcer prevalence is highest in pediatric ICUs, burn units, ICU, and CCU, and SICU.

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  Results of the 2008-2009 International Pressure Ulcer PrevalenceTM Survey and a 3-Year, Acute Care, Unit-Specific Analysis

  VanGilder C, et al. | Ostomy Wound Management | 2009

  This observational study evaluated the prevalence of pressure ulcers in acute care facilities. In 2008 and 2009, overall prevalence was 13.5% and 12.3%, respectively. Facility-acquired prevalence was 6% and 5%, respectively. Overall prevalence was highest in long-term acute care, while facility-acquired prevalence was highest in ICUs. Overall and facility-acquired prevalence were lower in 2008-2009 compared to 2006-2007. However, in 2009 approximately 10% of all ulcers were device related. 

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  International Pressure Ulcer Prevalence (IPUP) Survey™

  The International Pressure Ulcer Prevalence (IPUP) Survey™ is conducted annually within a 3-day period to help facilities assess their pressure ulcer prevalence and in turn, identify trends and opportunities for improvement.There is a flexible data collection window – choose the 24  hour period that best fits your needs! 

  Participation is free to facilities and includes a customized, detailed report including prevalence and facility-acquired prevalence benchmarks. Benchmarking your facility’s performance is the first step to achieving a better outcome.

  The link below brings you to the main IPUP website where all current materials are found.

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  Body Mass Index, Weight, and Pressure Ulcer Prevalence: An Analysis of the 2006–2007 International Pressure Ulcer Prevalence™ Surveys

  VanGilder C, et al | Journal of Nursing Care Quality | 2009

  This report analyzed data from the US 2006 and 2007 IPUP surveys and revealed an overall decrease in pressure ulcer prevalence from 2004-2005 to 2006-2007 and a higher pressure ulcer prevalence in patients with low BMI and with both low and high weights; 10% of patients were extremely obese.

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  Overall Results from the 2011 International Pressure Ulcer Prevalence™ Survey

  VanGilder C, et al | 2012

  The 2011 IPUP survey included 104,266 patients, and demonstrated a significant decrease in Overall Prevalence (OP) beginning in 2007 and Facility Acquired Prevalence (FAP) beginning in 2008. However, at present one in ten patients has an ulcer and nearly one in 20 develop one. Acute Care and Rehab had decreased OP and FAP, while LTC remained steady and LTAC OP and FAP increased in 2011. Prevalence by Age increases dramatically after age 60. By stage, severe ulcers as a proportion of all ulcers, have remained constant, and sDTI’s are now 11% of all identified ulcers

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  Comparison of Pressure Ulcer Patients and Outcomes by Care Setting from the 2011 IPUP Survey

  VanGilder C, et al | 2012

  This report from the International Pressure Ulcer PrevalenceTM Survey evaluates US care setting data from (Acute Care, LTC, LTAC, REHAB) and acute care unit types (ICU, Med Surg, Telemetry/Stepdown) for overall and facility acquired prevalence. It also evaluates risk factors such as Braden Score, Fecal and Urinary incontinence, and linen layers by care setting/unit type.

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  Initial Acute Care Field Evaluation Results for the Envella™ Bed System

  2017

  This paper describes the acute care evaluation of the brand new Envella™ Air Fluidized Therapy (AFT) bed system.  It shares Saint Joseph's Hospital's support surface algorithm specific to AFT, and describes some of the patients for whom the bed was appropriately used for using that algorithm in the acute care environment

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  Mary Lanning Healthcare Reduces Overall Pressure Injury Prevalence by 77%

  2017

  This whitepaper describes the impact of quality improvement process changes, including staff training, education, and surface evaluation; as well as incorporating the use of pressure-redistributing  and low air loss mattresses on improving the rates of facility-acquired pressure injuries.  

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  In the Critically Ill Patient, What Is the Effect of Air-Fluidized Therapy in Comparison to the Standard of Care on Preventing the Deterioration of Deep Tissue Injuries?

  Magliato B, et al. | Journal of Wound Ostomy & Continence Nursing | 2014

  This study evaluated the effects of immediately treating a developing hospital acquired deep tissue injury with medical honey dressing and air-fluidized therapy, in addition to routine preventative care. Examining 41 DTIs over the course of 18 months, only 4.4% deteriorated to unstageable full thickness wounds, while 46.3% of DTIs were resolved or only progressed to Stage II. Utilization of this protocol resulted in a net savings of approximatley 3 million dollars related to the 39 DTIs that did not deteriorate. 

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  Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients

  Jackson M, et al. | Critical Care Nurse | 2011

  Air-fluidized therapy beds were provided for patients who required vasopressors and mechanical ventilation for at least 24 hours postoperatively. While on therapy beds, only 1 of 27 patients developed a stage I ulcer versus 40 ulcers developed in 25 patients prior to therapy bed implementation despite already being a high-risk population for the development of pressure ulcers due to severity of illness.

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  Saint Thomas Health Services (STHS): Clinical Outcomes; People, Process and Technology - Combining the Best of Each to Improve Clinical and Financial Outcomes

  2011

  This study evaluated the effects of a program converting to Hill-Rom® bed systems on the incidence of adverse events. Overall, the incidence of adverse events was reduced by the following percentages: pressure ulcers (19%), VAP (91.9%), and falls (27.7%).

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  Confidence in your Surface Selection Process

  McNichol L | 2015

  In this complimentary, on-demand webinar, internationally recognized WOC nurse and lecturer Laurie McNichol discusses the benefits of using the right support surface at the right time to prevent and treat pressure ulcers. She highlights her discussion with the WOCN Evidence and Consensus-based Support Surface Algorithm and provides attendees with a demonstration of the WOCN algorithm tool.

   

  Next, Hill-Rom Chief Scientist, Charlie Lachenbruch, discusses NPUAP definitions and measurements of surfaces the algorithm reccommends.

   

  Finally, you will be introduced to the Hill-Rom Safe Skin® Program, tools, and support for implementation of a pressure ulcer management program.

   

  At the conclusion of the webinar, participants will be able to demonstrate increased awareness and knowledge of and be able to use the WOCN Society's Evidence and Consensus Based Support Surface Algorithm.

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