Abstract

Pressure ulcers are a serious and costly health condition that occur in populations with limited mobility such as bedridden individuals or people confined to wheelchairs. This study reviews the academic literature to identify good practices to prevent pressure ulcers. There are strategies that can be employed to help prevent pressure ulcers in high-risk populations including specialized support surfaces, frequent turning or repositioning, consultations with dieticians to ensure good nutrition, and keeping the skin moist. Background: Limited mobility is a large risk-factor for developing pressure ulcers. A pressure ulcer occurs when the skin begins to breakdown due to prolonged pressure on one area of the body. Pressure ulcers are expensive to treat - a serious case can cost $70 000 - and are relatively common in high-risk populations such as the elderly, or those bed-ridden, or wheelchair-bound. The development of pressure ulcers is associated with reduced quality of life, poor overall prognosis, and premature mortality. There are strategies that can help prevent the development of pressure ulcers. This study reviews the academic literature to find the best evidence for preventing pressure ulcers.

Methods: A comprehensive search for research studies was undertaken to identify evaluations of different interventions for preventing pressure ulcers. Several details of each study were extracted and summarized including: 1) the exact intervention, 2) the effect of the intervention on the prevention of pressure ulcers, 3) the aspect of prevention that was addressed by the intervention (impaired mobility, nutrition, and skin health), and 4) the study setting (such as acute care or long-term care). An assessment of the quality of each research study was also conducted.

Findings: A total of 59 studies, published over the last 30 years, were found that examined the effect of specific interventions on the prevention of pressure ulcers. The majority of the studies (72%) examined interventions in the acute care setting, which is where the majority of pressure ulcers develop. Nearly 20% of the studies were conducted in long-term care, and the remaining studies took place in rehabilitation hospitals or mixed-care settings. The study designs and methods varied. Only three studies fulfilled all quality criteria.

Forty-eight of the 59 studies examined support devices to ensure that the skin was not being subjected to undue pressure. Specialized foam and sheepskin mattresses were found to reduce the number of pressure ulcers compared to regular hospital mattresses. Several different types of support surfaces with a wide range of costs were studied. Frequent turning or repositioning patients was also found to be an effective strategy. A common standard for turning frequency is every two hours: The authors found that there was insufficient evidence in the reviewed studies to change this current standard. Impaired nutrition appeared to be a factor in the formation of pressure ulcers in one study. Consultation with a dietician and ensuring adequate general nutrition were suggested to be promising interventions. Only three studies examined the strategy of ensuring the skin is kept moist. Although this intervention is attractive because it is inexpensive and unlikely to do harm, there was insufficient evidence to support the benefit of using simple generic moisturizers versus other specific agents.

Conclusions: Several strategies can be employed to help prevent pressure ulcers in high-risk populations. Specialized support surfaces are more effective than regular mattresses but are more costly. Frequent turning or repositioning is also effective. Both consultations with a dietician to ensure good nutrition and keeping the skin moist are also likely to prevent pressure ulcers, are easy to implement, and unlikely to be harmful. Long-term care facilities and home care workers could assess the feasibility of using these interventions for clients that must remain immobilized for prolonged periods.

Reference: M. Reddy, S.S. Gill, P.A. Rochon "Preventing Pressure Ulcers: A Systematic Review." Journal of the American Medical Association, 2006; 296 (8): 974-984.