Improving quality care for patients with pressure ulcers resulted in a two-year intensive effort to educate staff, keep morale high, standardize care plans by stage of ulcer, and participate in a comparison study of two support surfaces (Thera-Pulse, Kinetic Concepts and Geo-Matt, SpanAmerica). When all pressure ulcers were considered, the analysis of covariance revealed no statistically significant difference in the healing of pressure ulcers with respect to type of support surface used (F[1, 78] = 0.35, p > .05). For patients with stage III and IV pressure ulcers, the proportion of patients improving more than 10cm2 was higher in the air-suspension group. There was relatively little difference in the Stage II ulcer patients.
This descriptive, comparative study examined the relationship between three body positions, body weight, and tissue interface pressure measurement on three support surfaces among residents who were 65 years of age or older. The support surfaces included the Sof. Care bed cushion, Biogard foam mattress, and hospital mattress. Subjects included 12 ideal body-weight and six less-than-ideal body-weight individuals from a long-term care facility in a Mid-western state. Results indicated no significant difference in sacral tissue interface difference between ideal body weight and less-than-ideal body weight subjects. However, the sacral measurements were significantly greater in the supine position than those taken in the Fowler's and semi-Fowler's positions. A significant interaction was found between position and support surface with subjects in Fowler and semi-Fowler positions on the Sof. Care Surface exhibiting the lowest mean tissue interface pressure at the sacrum.
The use of genuine sheepskin was compared to the use of synthetic sheepskin in two long term care institutions. Data for the control group of 44 residents placed on synthetic sheepskin were obtained by retrospective chart audit. Sixty-four residents were randomly placed on genuine merino sheepskin (WoolTec USA, Maspeth, NY). The two groups were similar in age, diagnosis, polypharmacy, and risk assessment score. In the control group 41% maintained skin integrity, 38% improved, and 21% deteriorated; in the study group 63% maintained skin integrity, 37% improved, and none deteriorated. The use of genuine sheepskin is recommended to reduce the risk factors of friction and shear.
To investigate the patient and healing characteristics related to full-thickness pressure ulcers, 119 consecutive patients admitted with ulcers in three acute care, four longterm care, and one rehabilitation agency were studied. Of the 119 patients with 153 pressure ulcers, only 48 (40%) had full-thickness ulcers. Compared to patients with partial-thickness ulcers, patients with full-thickness ulcers were more likely to have multiple ulcers, occasional incontinence of urine and feces, a compromised overall skin condition, and a less than optimal nutritional status at baseline. Full-thickness ulcers treated with a hydrocolloid dressing (DuoDERM Hydroactive) did not develop adverse reactions; clinicians perceived the dressing to be efficacious. Ulcers that healed during the study decreased 47% in area in two weeks. This distinguished ulcers that healed from those that did not heal. The findings suggest that ulcers that do not decrease in size within two weeks should be reevaluated for additional or alternate treatments.
Preventing Pressure Ulcers--A patient's guide was released by the Agency for Health Care Policy and Research (AHCPR) in May 1992. Using criteria suggested by Falvo (1985), Redman (1988), Ruzicki (1989), and others, the guide was critiqued to determine how it compared to existing criteria for evaluating written tools. The AHCPR guidelines does not meet all the criteria; suggestions for improvement are provided.
This study used two full-size pressure-sensitive mats to evaluate five patient support surfaces. The mats, containing 1,536 and 2,340 pressure measurement sites, respectively, made it possible to quantify the entire interface pressure distribution of each support surface. Measurements for groups of 64 and 32 subjects were obtained in supine positions of 0 degree, 30 degrees, at maximal head elevations (50 degrees-60 degrees), and at lateral recumbency. Several statistical descriptors were calculated to characterize the interface pressure distributions. The support surfaces tested included: a powered-air overlay (ACUCAIR Continuous-Air-flow System), a low-airloss bed (FLEXICAIR MC3 Low-Airloss Therapy), a continuous lateral-rotation low-airloss bed (RESTCUE Dynamic Air Therapy), an air-fluidized bed (CLINITRON II Air-Fluidized Therapy), and an integrated bed (prototype Advance 2000 Bed). An analysis of variance revealed that the interface pressure was significantly lower and weight-bearing area was significantly higher on the five surfaces, when compared to the standard hospital mattress.
Despite ongoing efforts to improve the prediction, prevention, and treatment of pressure ulcers, clinicians continue to face an overwhelming array of confusing, and sometimes conflicting, information about the technologies used to lower pressure. The purpose of this article is to explain the fundamental differences among units of pressure measurement and those pressures (capillary closing, tissue interface, internal cushion, and hydrostatic) that are commonly described in research as well as sales literature. A clearer understanding of these parameters will help clinicians make informed evaluations of distinct technologies, set realistic expectations for different products, and achieve desired outcomes cost-effectively.
The validity of an instrument is another important issue for the clinician to consider when selecting a tool for use in data collection. Broadly defined, validity refers to the extent to which an instrument measures what it is supposed to be measuring. Although validity is a unitary concept, this article explores three common categories of validity: content, criterion-related, and construct validity.
Shear stress and shear strain of human tissue were calculated in vivo using measurements derived from pelvic CT scans of three subjects lying upon three depths of foam mattress overlays and an air mattress overlay commonly used in the prevention of pressure ulcers. The air mattress overlay plus three-inch foam had the lowest degree of tissue shear when compared with the foam overlays both quantitatively and qualitatively. In addition, it was found that the contouring air mattress overlay plus three-inch foam provided the greatest area of contact between surface support and subject when compared to the foam overlays, resulting in a greater distribution of applied load and ultimately decreasing tissue shear.
Because of their angular conformation, short hair, and thin skin, greyhounds are particularly subject to development of pressure ulcers. Greyhounds, therefore, can serve as a model to study pressure ulcers, either naturally occurring pressure ulcers or induced dermal pressure lesions. A method for inducing dermal pressure lesions was developed using a short-limb walking cast on one pelvic limb of the dog. Physical characteristics, dermal thromboxane B2 concentrations, and histopathologic changes were used to determine the severity of the lesions. Different lesion severities can be induced over the calcaneal tuberosity depending upon the amount of padding in the cast and the length of time the cast is in place. The technique for inducing a mild dermal pressure lesion is described.
It is assumed that during their basic preparation, nurses are provided with the knowledge and skills to predict and prevent pressure ulcers. A review of five fundamentals of nursing and five medical-surgical nursing textbooks revealed that a nursing student may be exposed to as few as 200 lines of text and 10 tables, charts, or illustrations related to pressure ulcers during a program of studies. The information contained in the textbooks tended to be dispersed over three to seven chapters, incomplete, and sometimes inaccurate.
One of the goals of the Agency for Health Care Policy and Research (AHCPR) is to improve the quality of medical care by developing and disseminating clinical practice guidelines. One indication of the effectiveness of a clinical guideline is the relationship between the costs of current practice and the costs of using the guideline. Using four model cases of patients at high risk for pressure ulcers, the costs of implementing the appropriate prevention and treatment procedures for each model were identified and compared to current practice costs. On the average, the overall cost of implementing the guideline is not much different from that of current practice.
The use of computers by healthcare educators is expanding rapidly because computer-assisted instruction reduces learning time, can be accessed at any time, and is cost-effective. How to evaluate their cost-effectiveness and suggestions for use are presented in detail. The advantages and disadvantages of computer-assisted instruction (CAI) and interactive videodisc (IVD) technologies are reviewed. Several CAI and IVD programs of interest to wound care clinicians are described.
To compare the efficacy and the cost-effectiveness of moist gauze dressings and a hydrocolloid wafer dressing (DuoDERM CGF), 70 patients with 97 pressure ulcers that were stage II and/or stage III were randomly assigned to one of two treatment methods: moist gauze dressings or hydrocolloid dressings. Efficacy was defined as the number of ulcers that completely healed. In this debilitated, poorly nourished group of patients, one ulcer completely healed in the moist gauze dressing group, and 11 healed in the hydrocolloid group. The per diem cost of the moist gauze dressing was $12.26; the per diem cost of the hydrocolloid dressing was $3.55.
Odor is a major problem with some pressure ulcers and other wounds. This article presents a comprehensive list of references and a case study of 13 patients who were treated with one topical product (metronidazole gel) to eliminate odor. All wounds had large amounts of malodorous drainage when initially assessed and had not previously responded to a variety of odor-reducing interventions. A wound care protocol was established using 0.75% topical metronidazole gel applied to the wound surface. Odor was assessed daily for nine days by a scale adapted from Baker and Haig. Malodor associated with each of 13 wounds was decreased following the initial treatment with topical metronidazole.
