Literature Review
A pressure ulcer or a hospital acquired ulcer is one of the rising concern in healthcare. It is a condition characterized by damage in the skin or the underlying tissue due to unwanted pressure, friction, or moisture applied on the skin. More commonly, patients get this health condition when they are unable to move, when they have delicate and brittle skin while hospitalized, or when certain equipment is used on them making them more susceptible to pressure ulcer . A hospital acquired pressure ulcer is sometimes referred as bedsore in layman’s term. Pressure ulcer became a major concern in healthcare because of the added burden it brings to the patient. Also it incurs additional treatment cost which also lead to reimbursement issues in healthcare providers.
For this this literature review, I searched for peer-reviewed scientific articles that deal with the nature, causes, and treatment of hospital acquired pressure ulcer. The articles I chose dated from 2010 to 2015 in order to get the most recent updates.
The professional affiliations that contributed to the article were the UCSF Medical Center, The Centers for Medicare and Medicaid Services, and Centers for Disease Control (CDC) and Prevention. The UCSF Medical Center gives a strict regulation regarding the prevention of pressure ulcer. This institution also conducts pressure ulcer prevalence study. Their results are submitted to the National Database of Nursing Quality Indicators for comparison with other hospitals in order to better assess the status of occurrence and prevention of pressure ulcer in hospitals. The Centers for Disease Control is an institution devoted to preventing and managing different health concerns. The Centers for Medicare and Medicaid Services is an institution that oversees and administers Medicare and Medicaid programs.
Significant Conclusions
Pressure ulcers occur more commonly on bony prominences such as the sacrum, heels, and the tailbone. When there is pressure, friction or moisture in these areas, pressure ulcer is quick to develop. Pressure puts strain on the small blood vessels which hampers the supply of oxygen and limits the dispose of metabolic wastes in these areas. These metabolic wastes causes vasodilation which causes edema and ischemia, which then promotes tissue death. Friction and moisture make the skin more vulnerable to the effect of pressure, hastening the damage to the skin and the tissue. .
Certain medical devices also causes ulcers. According to survey, around 10% of pressure ulcer cases are caused by devices. For instance, when patients are intubated, they may develop ulcer in the endotracheal region. Another device that causes ulcer is the cervical collar. Prolonged use of cervical collar increases the risk for the development of pressure ulcer. When cervical collars are worn by a patient for more than 5 days, the risk of developing ulcer increases from 38% to 55%. To help lower the risk, padded collars are recommended. Transfer boards that are rigid also contributes to the risk of developing pressure ulcer .
Another technique used to prevent or manage pressure ulcer is to determine the modifiable and non-modifiable risk factors. Modifiable risk factors include turning the patient every two hours, inspecting the skin and making sure it is kept dry. Non-modifiable risk factors include the inability of the patient to turn or move and having a constantly wet tissue (such as in the cases of weeping wounds). Doing these simple measures decreased the incidence rate of pressure ulcer from 1.89 to 0.86 in 1000 patient- days .
Another important aspect in preventing and managing pressure ulcer is by stressing the importance of proper nutrition and vitamins. Hospitals also became more conscious of the type of beds they use as well as the mattresses, sheets and overlays. Other hospitals also started using special creams and barriers in order to prevent pressure ulcers .
Outlook
In order to manage and prevent the development of pressure ulcers in hospitalized patients, health care providers should come up with methods and procedures that would be both effective and cost-efficient. Future studies need to look at what the hospitals are currently applying and how effective are they in preventing and controlling the occurrence of pressure ulcer. It is also an aim of this study to raise awareness of this health condition and eventually protect the patients from this disease.
References
Cooper, K. L. (2013). Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit. Critical Care Nurse, 57-66.
Mallah, Z., Nassar, N., & Badr, L. K. (2015). The Effectiveness of a Pressure Ulcer Intervention Program on the Prevalence of Hospital Acquired Pressure Ulcers: Controlled Before and After Study. Applied Nursing Research, 106-113.
UCSF Medical Center. (n.d.). Hospital-Acquired Pressure Ulcers. Retrieved from UCSF Medical Center: https://www.ucsfhealth.org/about/pressure_ulcers/
Zaratkiewicz, S., Whitney, J. D., Lowe, J. R., Taylor, S., O’Donnell, F., & Minton-Foltz, P. (2010). Development and Implementation of a Hospital-Acquired Pressure Ulcer Incidence Tracking System and Algorithm. Journal for Healthcare Quality, 44-51.
