Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019

Kottner, Jan; Cuddigan, Janet; Carville, Keryln; Balzer, Katrin; Berlowitz, Dan R.; Law, Susan; Litchford, Mary Demarest; Mitchell, Pamela H.; Moore, Zena; Pittman, Joyce; Sigaudo‐Roussel, Dominique; Yee, Chang Yee; Haesler, Emily

doi:10.1016/j.jtv.2019.01.001

Cited by 233 publications

(215 citation statements)

References 30 publications

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“…In the HAPU group, 432 (58.8%) patients had information about their HAPU stages. According to the national guideline [14], HAPUs are classified into the following categories: Stage 1 means intact skin with nonblanchable redness, Stage 2 is partial thickness skin loss, Stage 3 is full thickness skin loss, Stage 4 indicates full thickness tissue loss, and Unstageable is depth unknown [14]. In the HAPU group, Stage 2 HAPUs were most frequent (46.8%), followed by Stage 4 (17.5%) and Stage 3 (14.3%) HAPUs.…”

Section: Discussionmentioning

confidence: 99%

“…A number of risk factors have been reported, such as history of vascular disease, mechanical ventilation, dopamine treatment, cardiovascular instability, and length of ICU stay [11-13]. However, these risk factors varied across the studies and the significance of the risk factors, and consequently, their relative importance has not yet been clarified [14].…”

Section: Introductionmentioning

confidence: 99%

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Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study

Hyun¹,

Moffatt-Bruce²,

Cooper³

et al. 2019

JMIR Med Inform

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Background A pressure ulcer is injury to the skin or underlying tissue, caused by pressure, friction, and moisture. Hospital-acquired pressure ulcers (HAPUs) may not only result in additional length of hospital stay and associated care costs but also lead to undesirable patient outcomes. Intensive care unit (ICU) patients show higher risk for HAPU development than general patients. We hypothesize that the care team’s decisions relative to HAPU risk assessment and prevention may be better supported by a data-driven, ICU-specific prediction model. Objective The aim of this study was to determine whether multiple logistic regression with ICU-specific predictor variables was suitable for ICU HAPU prediction and to compare the performance of the model with the Braden scale on this specific population. Methods We conducted a retrospective cohort study by using the data retrieved from the enterprise data warehouse of an academic medical center. Bivariate analyses were performed to compare the HAPU and non-HAPU groups. Multiple logistic regression was used to develop a prediction model with significant predictor variables from the bivariate analyses. Sensitivity, specificity, positive predictive values, negative predictive values, area under the receiver operating characteristic curve (AUC), and Youden index were used to compare with the Braden scale. Results The total number of patient encounters studied was 12,654. The number of patients who developed an HAPU during their ICU stay was 735 (5.81% of the incidence rate). Age, gender, weight, diabetes, vasopressor, isolation, endotracheal tube, ventilator episode, Braden score, and ventilator days were significantly associated with HAPU. The overall accuracy of the model was 91.7%, and the AUC was .737. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index were .650, .693, .211, 956, and .342, respectively. Male patients were 1.5 times more, patients with diabetes were 1.5 times more, and patients under isolation were 3.1 times more likely to have an HAPU than female patients, patients without diabetes, and patients not under isolation, respectively. Conclusions Using an extremely large, electronic health record–derived dataset enabled us to compare characteristics of patients who develop an HAPU during their ICU stay with those who did not, and it also enabled us to develop a prediction model from the empirical data. The model showed acceptable performance compared with the Braden scale. The model may assist with clinicians’ decision on risk assessment, in addition to the Braden scale, as it is not difficult to interpret and apply to clinical practice. This approach may support avoidable reductions in HAPU incidence in intensive care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study

Hyun¹,

Moffatt-Bruce²,

Cooper³

et al. 2019

JMIR Med Inform

View full text Add to dashboard Cite

show abstract

“…National and international guidelines indicate that simple preventive measures must be reinforced daily, such as: change of position at scheduled times, use of materials and therapies to provide pressure relief, predictive scales, adequate nutritional support, use of dressings, maintenance of the patient's and bed's hygiene, and health education not only for professionals, but also for family members (5)(6)(12)(13)(14) . The main concern of the clinical simulation scenarios is to ensure that the professional reproduces aspects of reality in an interactive and dynamic way, and also reflects on the solutions of care problems based on scientific evidence, so that the simulation promotes a positive impact for the clinical practice (15)(16)(17) .…”

Section: Introductionmentioning

confidence: 99%

“…In view of the epidemiological context of PIs, preventive measures to limit the spread of infections associated with injuries, the increase in hospital stay, financial costs, morbidity and mortality in health institutions generate quality indicators and reinforce the need to avoid adverse events ensuring patient safety ( 6 - 9 ) . The nurse has scientific and technological knowledge for an accurate assessment of wounds, being able to critically point out the risks and adverse events resulting from the failure to maintain the patient’s skin integrity ( 6 , 10 - 11 ) .…”

Section: Introductionmentioning

confidence: 99%

“…National and international guidelines indicate that simple preventive measures must be reinforced daily, such as: change of position at scheduled times, use of materials and therapies to provide pressure relief, predictive scales, adequate nutritional support, use of dressings, maintenance of the patient’s and bed’s hygiene, and health education not only for professionals, but also for family members ( 5 - 6 , 12 - 14 ) . Although the guidelines reinforce the use of preventive measures, in the clinical practice most of the health professionals do not adequately and rigorously provide care for the prevention of PIs.…”

Section: Introductionmentioning

confidence: 99%

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Application of the educational method of realistic simulation in the treatment of pressure injuries

Baracho

Chaves

Lucas

2020

Rev. Latino-Am. Enfermagem

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Objective: to evaluate the use of realistic simulation as a strategy to promote teaching about pressure injuries. Method: This is a quasi-experimental study. A modified and translated version of the Pieper Pressure Ulcer knowledge test was applied. Kappa statistical analysis was used to assess the professionals’ knowledge in the realistic simulation using the SPSS software. A p-value <0.05 was considered significant. Results: Seventy-seven nursing professionals participated in the realistic simulation, the majority (72.7%) being nursing technicians. Regarding the knowledge of primary and secondary coverage techniques, the Kappa index went from 0.56 (p=0.002) in the pre-test to 0.87 (p=0.001) in the post-test. As for the sterile dressing technique, there was a variation from 0.55 (p=0.002) in the pre-test to 0.91 (p=0.001) in the post-test. Regarding the cleaning of pressure injuries, there was a variation from 0.81 (CI: 0.62-0.84) in the pre-test to 0.91 (0.85-0.97) in the post-test. The knowledge about the use of a sterile spatula to distribute the dressing in the wound increased from an agreement index from regular to good. Conclusion: The introduction of the realistic simulation in the clinical practice has created quality assessment indicators for the prevention and treatment of pressure injuries.

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Updates on Recent Clinical Assessment of Commercial Chronic Wound Care Products

Sharma

Zhao

2023

Adv Healthcare Materials

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Impaired wound healing after trauma, disorders, and surgeries impact millions of people globally every year. Dysregulation in orchestrated healing mechanisms and underlying medical complications make chronic wound management extremely challenging. Besides standard‐of‐care treatments including broad spectrum antibiotics and wound‐debridement, novel adjuvant therapies are clinically tested and commercialized. These include topical agents, skin substitutes, growth factor delivery, and stem cell therapies. With a goal to overcome factors playing pivotal role in delayed wound healing, researchers are exploring novel approaches to elicit desirable healing outcomes in chronic wounds. Although recent innovations in wound care products, therapies, and devices are extensively reviewed in past, a comprehensive review summarizing their clinical outcomes is surprisingly lacking. Herein, this work reviews the commercially available wound care products and their performance in clinical trials to provide a statistically comprehensive understanding of their safety and efficacy. The performance and suitability of various commercial wound care platforms, including xenogeneic and allogenic products, wound care devices, and novel biomaterials, are discussed for chronic wounds. The current clinical evaluation will provide a comprehensive understanding of the benefits and drawbacks of the most‐recent approaches and will enable researchers and healthcare providers to develop next‐generation technologies for chronic wound management.

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Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019

Cited by 233 publications

References 30 publications

Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study

Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study

Application of the educational method of realistic simulation in the treatment of pressure injuries

Updates on Recent Clinical Assessment of Commercial Chronic Wound Care Products

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