Fourth national pressure ulcer prevalence survey.

The fourth national pressure ulcer prevalence survey was conducted on November 9, 1995, with stuff at 265 acute-care hospitals surveying 39,874 patients for the presence of pressure ulcers. Data were collected on patient demographics, ulcer site, ulcer stage, and support surface. The goal was to determine the aggregate prevalence of pressure ulcers and to compare the results to those of the previous three surveys. The overall prevalence was 10.1% (range 1.4% to 36.4%), with the sacrum and heels the most common pressure ulcer sites. The predominant age group of patients with pressure ulcers was 71 to 80 years. Seventy-four percent of pressure ulcers were superficial (i.e., Stages I and II). The national pressure ulcer prevalence has remained relatively constant throughout the four surveys, despite the many changes in health care over the past 7 years.

Pressure ulcers. Physical, supportive, and local aspects of management.

Pressure ulcers are a common and serious problem predominately among elderly persons who are confined to bed or chair. Additional factors associated with pressure ulcer development include cerebrovascular accident, impaired nutritional intake, urinary or fecal incontinence, hypoalbuminemia, and previous fracture. Implementation of preventive measures, such as an in-depth assessment for mobility, a pressure-relieving device combined with adequate repositioning, and thorough evaluation for nutritional status and urinary incontinence, significantly reduce pressure ulcer incidence. If the pressure ulcer is a partial thickness (stage II) wound, the causative factors are probably friction or moisture. If the ulcer is full thickness (stage III and IV), it is secondary to pressure or shearing forces. The development of wound infection is the most common complication in the management approach. Osteomyelitis is not an uncommon occurrence and must be initially ruled out in all full thickness pressure ulcers. Surgical debridement of necrotic tissue is necessary prior to further treatment and assessments. Antibiotic therapy is indicated only upon evidence of infection (cellulitis, osteomyelitis, leukocytosis, bandemia, or fever). Topical pharmacologic agents may be used to prevent or treat infection but must be carefully controlled to avoid such adverse effects as toxicity to the wound, allergic reaction, and development of resistant pathogens. Proper use of occlusive dressings increase patient comfort, enhance healing, decrease the possibility of infection, save time, and reduce costs. A patient presenting an ulcer that fails to improve or, because of its size, will take a great deal of time to heal should be evaluated for surgical closure.