Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

Abstract

T he development of hospital-acquired pressure ulcers is a great concern in health care today. Pressure ulcer treatment is costly, and the development of pressure ulcers can be prevented by the use of evidence-based nursing practice. In 2008, the Centers for Medicare and Medicaid Services announced that they will not pay for additional costs incurred for hospital-acquired pressure ulcers.1 The development of a stage III or IV pressure ulcer is now considered a "never event."2 This change has resulted in an increased focus on preventive strategies and institutional scrutiny of pressure ulcers that develop in patients after hospital admission. The cost of 1 stage III or IV pressure ulcer may be between $5000 and $50000. 2The actual cost of pressure ulcers is not known because it is unclear what costs were included in estimates, such as nursing care costs, material costs, and added acute care days related to the development of a pressure ulcer. 3 In the intensive care unit (ICU), patients have multiple factors that increase the risk of pressure ulcers developing. Typically the patient has respiratory equipment, urinary catheters, sequential compression devices, multiple intravenous catheters, and the infusion of vasoactive agents for hypotension that may contribute to inability to turn patients and increase the risk of pressure ulcer development. This article discusses the multiple risk factors present in critical care for the development of pressure ulcers, current practices, and evidence for interventions aimed at preventing pressure ulcers.

Pressure ulcer dressings in critical patients: a cost analysis

“…Being bedridden reduces the ability to relieve pressure on bony prominences, maintaining pressure intensity and duration (13) , even with the use of pneumatic mattresses with pressure redistribution surfaces that reduce the probability of ulcer formation (17) . It is worth mentioning the importance of position changes according to patients' clinical conditions, 30º backrest elevation, daily skin assessment and the use of dietary supplements in PU prevention and treatment (10,18) . There was a considerable reduction in PUSH scores and mean wound surface area between the first and last assessments.…”

Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit

“…In critically ill patients, the prevention of pressure ulcers is complex because the severity of illness is high and preventive measures may be contraindicated or limited. 2,3 NPUAP reported on trends in HAPU development from 2000 to 2010, and the incidence of HAPUs in intensive care units (ICUs) remains high, from 5.2% to 41%. 2 The numbers can vary widely, depending on the number of patients being examined, the type of ICU, risk assessment, and overall research methods.…”

“…2 The numbers can vary widely, depending on the number of patients being examined, the type of ICU, risk assessment, and overall research methods. [3][4][5][6][7][8][9][10] For example, in a cohort study, 6 surgical ICUs had a higher incidence of HAPUs than coronary care units did. A small unit of 10 patients might appear to have a high HAPU rate when compared with a larger unit.…”

Knowledge of Pressure Ulcer Management among Nurses

“…Nursing research is invaluable and an integral part of nursing care, which aids in shaping and delivering quality care regarding prevention and treatment of pressure sores 13 .…”