Abstract: Background.  Pressure ulcers are common, costly and impact negatively on individuals. Pressure is the prime cause, and immobility is the factor that exposes individuals to pressure. International guidelines advocate repositioning; however, there is confusion surrounding the best method and frequency required. Design.  A pragmatic, multi-centre, open label, prospective, cluster-randomised controlled trial was conducted to compare the incidence of pressure ulcers among older persons nursed using two different repositioning regimens. Method.  Ethical approval was received. Study sites (n = 12) were allocated to study arm using cluster randomisation. The experimental group (n = 99) were repositioned three hourly at night, using the 30° tilt; the control group (n = 114) received routine prevention (six-hourly repositioning, using 90° lateral rotation). Data analysis was by intention to treat; follow-up was for four weeks. Results.  All participants (n = 213) were Irish and white, among them 77% were women and 65% aged 80 years or older. Three patients (3%) in the experimental group and 13 patients (11%) in the control group developed a pressure ulcer (p = 0·035; 95% CI 0·031-0·038; ICC = 0·001). All pressure ulcers were grade 1 (44%) or grade 2 (56%). Mobility and activity were the highest predictors of pressure ulcer development (β = -0·246, 95% CI = -0·319 to -0·066; p = 0·003); (β = 0·227, 95% CI = 0·041-0·246; p = 0·006). Conclusion.  Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30° tilt, reduces the incidence of pressure ulcers compared with usual care. The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines. Relevance to clinical practice.  An effective method of pressure ulcer prevention has been identified; in the light of the problem of pressures ulcers, current prevention strategies should be reviewed. It is important to implement appropriate prevention strategies, of which repositioning is one.
Abstract: Aims and objectives.  The aim of this study was to establish pressure ulcer prevalence and prevention in the long-term care setting. Background.  There is no information on pressure ulcers prevalence in care of the older person in Ireland; therefore, a prevalence study was undertaken to investigate key aspects related to current practices in pressure ulcer prevention. Design.  A cross-sectional survey design was employed. Method.  Ethical approval was received. Participants included 1100 older individuals residing in 12 long-term care settings. Data were collected using the Braden scale, the European Pressure Ulcer Advisory Panel minimum data set and pressure ulcer grading system. Results.  All participants were Irish and white, 70% were women, and 75% were aged 80 years or older. Prevalence was 9%, with 28% of pressure ulcers grade 1, 33% grade 2, 15% grade 3 and 24% grade 4, mainly located on the sacrum (58%) and the heel (25%). Seventy-seven per cent scored Braden low risk or not at risk; however, 53% were completely immobile/very limited mobility and 58% were chair/bedfast. There was a significant association between activity and mobility and pressure ulcer development (χ(2)  = 45·50, p < 0·001 and χ(2)  = 46·91, p = 0·0001, respectively). Fifty per cent had a pressure redistribution device in bed, and 48% had one in use on the chair; however, 9% had a repositioning regime planned for when in bed and 5% planned for when seated in the chair. Conclusions.  This paper reports on the first ever pressure ulcer prevalence survey conducted in long-term care in Ireland, and results provide significant insights into decision-making and use of resources in the prevention of pressure ulcers. Relevance to clinical practice.  Pressure ulcers are common, costly and impact negatively on individuals. Current practices in prevention show several areas for improvement, namely, risk assessment, care planning and documentation.
Abstract: Pressure ulcers are a largely preventable problem, but the incidence can impact negatively on the ability of the health service to deliver effective and quality care. Pressure ulcers commonly occur in the very old, the malnourished and those with acute illness. As pressure ulcers most commonly occur in the hospital setting, this can increase both length of stay and costs to the health service. As a result, prevention and management strategies should be core components in the strategic planning of healthcare services. This article discusses the importance of education and knowledge in pressure ulcers, and the onus of the nurse to put theory into practice in order to prevent this problem.
Abstract: Central venous catheters (CVC) continue to play a prominent role in haemodialysis vascular access with 46% to 70% of patients commencing haemodialysis via a CVC. CVC access is associated with catheter-related infections, increased patient hospitalisations and death due to infection. A variety of interventions are used to prevent CVC infection.
Abstract: Pressure, from lying or sitting on a particular part of the body, results in oxygen deprivation to the affected area. If a patient with an existing pressure ulcer continues to lie or bear weight on the affected area, the tissues become depleted of blood flow and there is no oxygen or nutrient supply to the wound, and no removal of waste products from the wound, all of which are necessary for healing. Patients who cannot reposition themselves require assistance. International best practice advocates the use of repositioning as an integral component of a pressure ulcer management strategy. This review has been conducted to clarify the role of repositioning in the management of patients with pressure ulcers.
Abstract: Eighteen per cent of patients in hospital have a pressure ulcer. These are often difficult to manage and are associated with significant morbidity and mortality. Wound cleansing is a routine part of managing these wounds. This article summarises the challenges associated with pressure ulceration and reviews evidence to guide nurses in selecting wound-cleansing fluids.
Abstract: Pressure ulcer risk assessment is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer. Use of a risk assessment tool is recommended by many international pressure ulcer prevention guidelines however it is not known whether using a risk assessment tool makes a difference to patient outcomes. A review was conducted to clarify the role of pressure ulcer risk assessment in clinical practice.
Abstract: The aim of this study was to use a Cochrane systematic review process to explore the effect of wound cleansing solutions and techniques on pressure ulcer healing.
Abstract: This article provides an overview of the European Wound Management Association's (2005) position document Identifying Criteria for Wound Infection and outlines its relevance and clinical applicability. The document is divided into four parts: understanding wound infection; clinical identification of wound infection--a Delphi approach; identifying criteria for pressure ulcer infection; and identifying surgical site infection in wounds healing by primary intention. Each part is discussed separately.
Abstract: There have been few systematic reviews and no meta-analyses of the clinical benefits of nutritional support in patients with, or at risk of developing, pressure ulcers. Therefore, this systematic review and meta-analysis was undertaken to address the impact of enteral nutritional support on pressure ulcer incidence and healing and a range of other clinically relevant outcome measures in this group.
Abstract: Pressure ulceration remains a significant cause of morbidity for patients and has a real economic impact on the health sector. Studies to date have estimated the cost of management but have not always given a breakdown of how these figures were calculated. There are no published studies that have estimated the cost of management of pressure ulcers in Ireland. A two-part study was therefore undertaken. Part one determined the prevalence of pressure ulcers in a 626-bed Irish acute hospital. Part two set out to derive a best estimate of the cost of managing pressure ulcers in Ireland.
Abstract: This article discusses the different aspects of classifying pressure ulcers. It aims to increase understanding of the grading methods used and how their reliability and validity may be assessed. In turn, this aims to increase the potential for nurses to enhance their assessment and pressure ulcer prevention skills.
Abstract: Pressure ulcers are not a plague of modern man; they have been known to exist since ancient Egyptian times. However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem.
Abstract: Despite the increased expenditure on pressure ulcer prevention strategies, incidence and prevalence is increasing. Exploring nurses' attitudes about these programmes offers an insight into why, in some cases, they are not working.
Abstract: Compression bandaging is the mainstay of conservative management of patients with venous ulceration. But debate is growing over what levels of pressure to apply and how to balance this with what patients can tolerate.
Abstract: Pressure ulcers adversely affect the quality of life of many patients and cause anxiety and distress for their families. Pressure ulcer prevention and management is an integral part of nursing practice, but despite numerous policies and guidelines, research, and improvements in equipment, the incidence and prevalence of pressure ulcers have not fallen. In this article, the author examines issues involved in promoting more effective pressure ulcer management.
