Pressureulcers are considered as a global healthcare problem according to thedetrimental effects that they have on the patients’ lives and thefinancial burden to the healthcare organizations (Coleman et.al2014). They are associated with illnesses and poor mobility resultingto the patients not being able to change positions to bed on theirown. Hospital associated pressure ulcers are defined as localizedinjury to the skin or the underlying tissue basically over a bonyprominence, due to pressure or its combination with shear. Differentconfounding factors which are not yet elucidated are also associatedwith pressure ulcers.
Pressureulcers are placed in various categories. Category 1 pressure ulcersare localized regions of intact skin with non-blanchable rednesswhile category two pressure ulcers involve partial thickness skinloss. Category 3 and four pressure ulcers include full thickness skinand tissue loss respectively. Other groups incorporated into theclassification system are unstageable (depth unknown: real depth ofulcer is obscured entirely by slough and eschar) and suspected deeptissue injury (depth unknown: damage of the underlying soft tissuefrom pressure causing blood-filled blisters or localized regions ofdiscolored skin). Pressure ulcers treatment is costly, and itsdevelopment can be prevented by the utilization of evidence-basednursing practice.
Evidence-based Measures to Prevent Pressure Ulcer
Riskassessment is considered as a cornerstone in the prevention ofpressure ulcers. Identifying patients who are highly predisposed toacquire pressure ulcers by looking at their risk factors might helpprevent the development of the lesions in clinical practice. The riskfactors include immobility, moisture, nutrition, pressure, advancedage, low blood pressure, the length of stay in the ICU, mechanicalventilation extent, and vasoactive medications (Cooper, 2013). Astructured approach should be used in conducting a risk assessmenttest to ensure consideration of all the relevant risk factors.However, additional factors such as perfusion and skin status shouldbe considered, and clinical judgment is also essential.
Skintissue assessment is also indispensable in the prevention of pressureulcers. Health professionals should be educated on how to conduct acomprehensive skin assessment that includes techniques foridentifying edema, localized heat, and blanching response. Stage 1pressure ulcers are under-detected in patients with darkly pigmentedskin. Each time a patient is repositioned, it’s an opportunity toconduct a brief skin assessment to identify early signs of pressuredamage, majorly over bony prominences. Recommendations for theprevention of skin damage include avoiding positioning of the patienton an area of erythema, keep the skin dry and clean, andimplementation of an individualized continence management plan.
Emergingtherapies such as microclimate control, prophylactic dressing andelectrical stimulation of the muscles in people with spinal cordinjury. In microclimate control use of specialized surfaces that comein contact with the skin can alter the microclimate by manipulatingthe moisture evaporation and heat dissipation rates from the skin.Heat decreases tolerance of the tissue for pressure induces sweatingand increase the metabolic rate. Prophylactic dressings are selectedaccording to their appropriateness for the patient and clinical use.A polyurethane foam dressing is applied to bony prominences toprevent pressure ulcer in anatomical places commonly subjected tofriction and shear. Electrical stimulation reduces the risk ofdevelopment of pressure ulcers at risk body parts by inducingintermittent tetanic muscle contradictions (PACIFIC, 2014).
Further,nutrition assessment and implementation by a nutritionist is alsoessential. Repositioning and early mobilization are also used toprevent heel pressure ulcers. Different repositioning techniques arerecommended to reduce the magnitude and duration of pressure in thevulnerable regions of the body. Support surfaces facilitate pressureredistribution to manage tissue loads and other therapeuticfunctions. Finally, regular use of olive oil based formulas is usefulin the prevention of pressure ulcers (Lupiañez-Perez et. al, 2015)
Barriers to Prevention of Pressure Ulcers in the Hospital
Preventionpractices are usually impaired by the lack of adequate staff inhospitals and lack of sufficient time. Many professional nursesreport a lack of enough time as the primary barrier. Severely illpatients were also hard to manage, and their conditions provided anobstacle in preventing. Further, lack of access to pressure relievingequipment is another obstacle. Devices such as the Ergo nurse device,heel lift device, partial bi-level positive airway pressure mask, andpadded cervical collar are not cheap and available to all thepatients especially those with low-income backgrounds. Finally, lackof knowledge on the various ways of preventing pressure ulcers suchas risk assessment, repositioning techniques among others is anotherbarrier in the prevention of pressure ulcers (Kaddourah, Abu-Shaheen,& Al-Tannir, 2016)
Hospital based pressure ulcers are a significant concern to thehealth sector today globally. Prevention of the disease is cheaperand easier when compared to treatment strategies which are costly.The area of health should work on various policies and implementationstrategies relevant in ensuring that the preventive measures arebeing used effectively. Ways of curbing the barriers preventing theimplementation should be developed and implemented too.
Coleman, S., Nixon, J., Keen, J., Wilson, L., McGinnis, E., Dealey,C., Nelson, E. A. (2014). A new pressure ulcer conceptual framework.Journal of Advanced Nursing, 70(10), 2222–2234.http://doi.org/10.1111/ja.12405
Cooper, K. L. (2013). Evidence-based prevention of pressure ulcers inintensive care units. Critical care nurse, 33(6),57-66.
Kaddourah, B., Abu-Shaheen, A. K., and Al-Tannir, M. (2016).Knowledge and the attitudes of the health professionals towardspressure ulcers at a rehabilitation hospital: a cross-sectionalstudy. BMC Nursing, 15, 17.http://doi.org/10.1186/s12912-016-0138-6
Lupiañez-Perez, I., Uttumchandani, S. K., Morilla-Herrera, J. C.,Martin-Santos, F. J., Fernandez-Gallego, M. C., Navarro-Moya, F. J.,Morales-Asencio, J. M. (2015). Topical Olive Oil Is Not Inferior tothe Hyperoxygenated Fatty Aids to Prevent Pressure Ulcer in High-RiskImmobilised Patients in Home Care. Results of the MulticentreRandomised Triple-Blind Controlled Non-Inferiority Trial. PLoSONE, 10(4),e0122238.http://doi.org/10.1371/journal.pone.0122238
PACIFIC, P. (2014). Prevention and Treatment of Pressure Ulcers:Quick Reference Guide. Emily Hasler (Ed.). Cambridge Media: OsbornePark, Australia.