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2.
J Tissue Viability ; 31(4): 575-578, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36175255

ABSTRACT

AIM: To develop a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). METHOD: A nominal group technique was used. Six experts with extensive knowledge of these types of injuries were selected for the group. All were nurses with a PhD in wound research and had more than 15 years of experience in wound care. The experts were asked only one question: In your opinion, what are the basic and indispensable aspects to differentiate a dependence-related skin injury (DR-SI) from a severe life-threatening skin injury (SLT-SI)? RESULTS: The experts identified three basic elements to differentiate DL-SI and SLT-SI (clinical situation, provision of care, and clinical characteristics of the lesions). A diagnostic algorithm was developed to differentiate the two types of skin lesions using the three basic elements identified, a literature review, and what was published in the two articles that define DR-SI and STL-SI. CONCLUSION: We developed a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). The algorithm also facilitates the identification of the subtypes of these injuries, depending on its location and characteristics.


Subject(s)
Soft Tissue Injuries , Humans , Diagnosis, Differential , Algorithms
4.
J Nurs Scholarsh ; 54(1): 72-80, 2022 01.
Article in English | MEDLINE | ID: mdl-34741398

ABSTRACT

PURPOSE: To create a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time. To name and classify these types of skin injuries. To describe the clinical features of the different types of skin injuries that may occur in terminally ill and/or dying patients. DESIGN: A sequential design with several different phases (a literature review, a nominal group, and a consensus conference) was used. METHODS: Six experts with extensive knowledge of these types of injuries were selected for the nominal group. The traditional eight-phase nominal group technique was followed. The consensus conference consisted of participants voting on different options based on the statements elaborated with the expert panel summarizing the best scientific evidence available. FINDINGS: Using all these elements, a conceptual framework was constructed to identify skin injuries associated with severe life-threatening situations (SI-SLTSs), defined as unpredictable and therefore unpreventable injuries indicating a serious threat to life or even imminent death. These injuries can occur in two forms: (a) as skin injuries associated with multiple organ dysfunction syndrome (SI-MODSs) or (b) as skin injuries associated with severe vasoconstriction (SI-ESVs). SI-MODSs develop very quickly and suddenly. They progress from superficial to deep stages abruptly, even within hours. The severity of the injuries does not reflect the care provided to the patient. Individuals suffering from these injuries have an irreversible clinical condition. SI-ESVs also appear in individuals who are in a very critical, even terminal, clinical condition. They are frequently treated in the ICU and may exhibit severe vasoconstriction due to their disease process (e.g., shock), sometimes exacerbated by vasoconstriction caused by various drugs (e.g., noradrenaline). CONCLUSIONS: We have developed a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time and have named them SI-SLTSs, distinguishing between SI-MODSs and SI-ESVs. CLINICAL RELEVANCE: This new conceptual framework may help clinicians understand the mechanisms and the pathophysiology of skin injuries that develop in terminally ill and/or dying patients associated with multi-organ failure. Through this new framework these injuries can be identified and differentiated from pressure injuries or other dependence-related skin lesions.

6.
J Wound Ostomy Continence Nurs ; 48(3): 239-250, 2021.
Article in English | MEDLINE | ID: mdl-33951713

ABSTRACT

Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.


Subject(s)
Concept Formation , Dermatitis/etiology , Fecal Incontinence , Urinary Incontinence , Consensus , Humans , Risk Factors , Skin Care
8.
Gerokomos (Madr., Ed. impr.) ; 31(3): 180-192, sept. 2020. graf, tab
Article in Spanish | IBECS | ID: ibc-197354

ABSTRACT

OBJETIVOS: Describir la incidencia de lesiones por presión (LPP) en pacientes pediátricos atendidos en unidades de críticos, así como diferentes variables relacionadas con la metodología de su cálculo. INTRODUCCIÓN: Las LPP constituyen un serio problema de salud con importantes repercusiones en los pacientes que las sufren. Las UCI pediátricas (UCIP) y neonatales (UCIN) atienden a pacientes en alto riesgo para el desarrollo de LPP. Existen pocos datos sistematizados acerca de la incidencia y variables definitorias de LPP en UCIP y UCIN. MÉTODOS: Revisión sistemática de la literatura científica publicada entre el 1 de enero de 2000 y el 31 de diciembre de 2016, que incluía artículos que reportaban datos sobre incidencia en UCIP o UCIN. Se han incluido trabajos que notifican datos sobre LPP relacionadas con el apoyo, con o sin lesiones relacionadas con dispositivos sanitarios; se han excluido los artículos que incluían exclusivamente datos de lesiones relacionadas con dispositivos sanitarios. RESULTADOS: La revisión sistemática ha permitido identificar 27 artículos con un total de 53 reportes de incidencia con información sobre 15 587 pacientes. En el caso de las UCIP, la mediana de la incidencia de lesiones por presión es del 19,4% en los trabajos prospectivos que no incluyen de manera implícita lesiones por presión relacionadas con dispositivos sanitarios y del 16,97% en los que incluyen a la vez lesiones relacionadas con dispositivos sanitarios y lesiones por presión por apoyo de los pacientes. En el caso de las UCIN encontramos unos valores del 3,9% y del 23,58%. CONCLUSIONES: Los resultados del presente trabajo permiten definir el alcance de la incidencia de las LPP en pacientes críticos pediátricos y resaltan aspectos relacionados con la metodología utilizada para su cálculo


AIMS: To describe the incidence and main characteristics of pressure injuries in pediatric patients in intensive care units and some variables related to the methodology for pressure injury incidence calculation. BACKGROUND: Pressure injuries (PI) represent a serious health problem with major consequences for the patients affected. Neonatal and pediatric ICU (NICU) (PICU) care for patients at high risk of developing pressure injuries. There is a paucity of systematic data on the incidence and defining variables of injuries in PICU and NICU. METHODS: We conducted a systematic review of the literature published between January 1, 2000 and December 31, 2016, including articles reporting data on the incidence of these injuries in PICU or NICU. We included studies reporting data on pressure injuries related to position, with or without injuries related to medical devices; we excluded studies which only reported data on pressure injuries related to medical devices. FINDINGS: We identified 27 articles with a total of 53 reports on incidence and information on 15,587 patients. In the case of PICU, the mean incidence of PI was 19.4% in prospective studies that did not implicitly include PI related to medical devices, and 16.97% in those which included pressure injuries related both to medical devices and position. For NICU, we found values of 3.9% and 23.58% respectively. CONCLUSIONS: The results of this study shed light on the incidence of pressure injuries in pediatric intensive care patients and highlight aspects related to the methodology used for the calculation of PI incidence


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pressure Ulcer/epidemiology , Intensive Care Units, Pediatric/statistics & numerical data , Intensive Care Units, Neonatal/statistics & numerical data , Critical Care , Risk Factors , Child Health , Child Health Services/organization & administration
10.
Gerokomos (Madr., Ed. impr.) ; 30(4): 192-199, dic. 2019. graf, tab
Article in Spanish | IBECS | ID: ibc-188208

ABSTRACT

Objetivos: Obtener las cifras de prevalencia de las lesiones por presión (LPP) y otros tipos de lesiones cutáneas relacionadas con la dependencia (LCRD) en centros residenciales para mayores y centros sociosanitarios (CSS) españoles. Analizar las características demográficas y clínicas de las personas con LCRD y de las lesiones. Metodología: Estudio observacional, transversal, tipo encuesta epidemiológica (5º Estudio Nacional de Prevalencia), dirigido a residencias de mayores y CSS en España. Recogida de datos entre noviembre y diciembre de 2017 mediante formulario seguro on-line. Variables: características de los centros, número de pacientes con cada tipo de LCRD, medidas de prevención, clasificación de cada lesión, tamaño y tiempo de evolución. Se calculó la prevalencia cruda y su intervalo de confianza del 95%. Resultados: Se han obtenido datos de 43 CSS y residencias de mayores de 6 comunidades autónomas españolas. Solo un 7% de los centros declararon no tener ninguna persona con LCRD atendida en el momento de obtener los datos. La prevalencia global de LCRD fue del 6,24% (IC 95% 5,51-7,07%), y la de cada tipo de lesión: presión, 4,03%; humedad, 2,19%; fricción, 0,80%; combinadas, 1,01%, y desgarros cutáneos, 1,31%. Para las LPP, la prevalencia fue mayor en centros concertados (8,12%) y privados (4,40%) que en los centros públicos (2,96%). No hay diferencias entre tipos de centros para las otras lesiones. Las LCRD eran de origen nosocomial (originadas en instituciones residenciales u hospitales) en el 92,4% de los casos y solo un 7,6% se originaron en los domicilios. Conclusiones: La prevalencia de LCRD en residencias de mayores y CSS es la más baja en este tipo de centros en la serie histórica de estudios realizado en España por el GNEAUPP. Debido a la menor participación de centros en el estudio, esta menor prevalencia podría explicarse por mayor representación de centros más motivados en la prevención de LCRD, pero también por una mejora en los programas de prevención implementados. Hay diferencias estadísticamente significativas entre la prevalencia de LCRD en función de la titularidad de los centros, siendo las más bajas en los públicos y las más elevadas en los concertados. El perfil, los tipos de lesiones, severidad y localización de las LCRD son similares a las descritas en atención primaria de salud y hospitales


Aims: To obtain figures on the prevalence of pressure injuries (PI) and other types of dependence-related skin lesions (DRSL) in Spanish nursing homes and residential care centres. To analyse the demographic and clinical characteristics of people with DRSL and the characteristics of the lesions. Methods: Observational, cross-sectional, epidemiological study through a survey (5th National Prevalence Study), aimed at nursing homes and residential centres in Spain. Data collection between November and December 2017 using a secure on-line form. Variables: characteristics of the centres, number of patients with each type of DRSL, prevention measures, classification of each lesion, size and time of evolution. The crude prevalence and its 95% confidence interval were calculated. Results: 43 nursing home and residential care centres participated, from 6 Spanish autonomous communities. Only 7% of the centres stated that they did not have any person with DRSL attended at the time of collecting the data. The overall prevalence of LCRD was 6.24% (95%CI: 5.51 7.07%) and that of each type of lesion: pressure 4.03%, humidity 2.19%, friction 0.80%, combined 1.01% and skin tears 1.31%. For PI, the prevalence was higher in subsidised (8.12%) and private (4.40%) centres than in public (2.96%) ones. There are no differences between types of centres for the other injuries. DRSL were of nosocomial origin (originating in residential institutions or hospitals) in 92.4% of cases and only 7.6% originated at home. Conclusions: The prevalence of DRSL in nursing homes and residential centres is the lowest in this type of settings in the historical series of studies carried out in Spain by GNEAUPP. Due to the fact that the participation of centres has been much lower than that of previous studies, this lower prevalence could be explained by a higher representation in the sample of those centres more motivated toward DRSL prevention; but also by an improvement in preventive programmes. There are statistically significant differences between the prevalence of SLRD according to the funding of the centres, with the lowest in the public centres and the highest in the subsidised centres. The profile, types of injuries, severity and location of the DRSL are similar to those described in primary care or hospitals


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Skin/injuries , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Pressure Ulcer/epidemiology , Wound Healing , Cross-Sectional Studies , Spain , Confidence Intervals
11.
Gerokomos (Madr., Ed. impr.) ; 30(3): 134-141, sept. 2019. tab
Article in Spanish | IBECS | ID: ibc-185321

ABSTRACT

Objetivos: Obtener indicadores epidemiológicos actualizados para las lesiones por presión (LPP) y otras lesiones cutáneas relacionadas con la dependencia (LCRD) en centros de Atención Primaria de Salud (APS) españoles, tanto globales como ajustados. Analizar las características demográficas y clínicas de las personas con LCRD y de las lesiones. Metodología: Estudio observacional, transversal, tipo encuesta epidemiológica (5º Estudio Nacional de Prevalencia) (ENP), dirigido a centros de APS. Recogida de datos mediante formulario en línea seguro. Variables: características de los centros, número de pacientes con cada tipo de LCRD, clasificación de cada lesión, tamaño y tiempo de evolución. Se calcularon tres valores de prevalencia: prevalencia cruda poblacional, en mayores de 65 años y en personas en programas de atención domiciliaria. Resultados: Se han obtenido datos de una población de casi 763.000 personas atendidas en 98 centros de APS españoles. Un 14,3% de los centros declararon no tener ninguna persona con LCRD atendida en el momento de obtener los datos. En el grupo de personas en programas de atención domiciliaria (ATDOM), la prevalencia de LCRD fue del 6,11%. Según tipo de lesiones fueron: presión, 4,79%; humedad, 1,39%; fricción, 1,81%; combinadas, 1,05%, y desgarros cutáneos, 1,05%. Las lesiones se originaron en el mismo domicilio del paciente en un 83,3% de los casos, y solo un 16,7% eran de origen nosocomial. Conclusiones: La prevalencia de LCRD en pacientes atendidos en programas de ATDOM fue del 6,11%, siendo las LPP las lesiones más frecuentes, con un 4,79% de prevalencia (cifras similares a las del 3er ENP y suponen un ligero descenso sobre las encontradas en el 4º ENP). Tanto las LPP como el resto de LCRD son mayoritariamente producidas en el domicilio, a diferencia de la situación en hospitales en los que predominan las de origen nosocomial. La prevención de las LCRD en personas atendidas en ATDOM debe ser una prioridad


Aims: To obtain updated, global and adjusted epidemiological indicators for pressure injuries (PI) and others dependence-related skin lesions (DRSL) in Spanish primary healthcare (PHC) centres. To describe the clinical features of both people with DRSL and the lesions. Methods: Observational, cross-sectional study through a survey (5th National Prevalence Study), aimed to PHC in Spain. Data collected through a secure on-line form. Variables: characteristics of the centres, number of patients with each type of DRSL, classification of each lesion, size and time of evolution. Three prevalence values were calculated: crude population prevalence; in people over 65 years of age; and in people in home care programs (HCP). Results: Data have been obtained for a population of almost 763,000 people attended at Spanish PHC in 98 centers. 14.3% of the centres stated that they did not have any person with DRSL attended at the time of obtaining the data. In the group of persons in home care programmes, the prevalence of DRSL was 6.11%. According to the type of lesions: pressure 4.79%, moistureassociated lesions (MAL) 1.39%, friction 1.81%, combined 1.05% and skin tears 1.05%. The lesions originated in the patient's own home in 83.3% of cases, and only 16.7% were of nosocomial origin. Conclusions: The prevalence of DRSL in patients treated in was 6.11%, with PI being the most frequent lesion. Prevalence value is similar to that found in 2009 and slightly lesser than that of 2014. Both the PI and others DRSL are mostly developed in the home, unlike the situation in hospitals, where hospital-acquired injuries are predominant. So, prevention of DRSL in people in home care programmes should be a priority


Subject(s)
Humans , Male , Female , Aged, 80 and over , Skin/injuries , Pressure Ulcer/epidemiology , Primary Health Care , Primary Nursing , Pressure Ulcer/therapy , Cross-Sectional Studies , Health Surveys , Surveys and Questionnaires , Data Analysis , Risk Assessment
12.
Gerokomos (Madr., Ed. impr.) ; 30(2): 76-86, jun. 2019. graf, tab
Article in Spanish | IBECS | ID: ibc-183946

ABSTRACT

Objetivo: Obtener indicadores epidemiológicos actualizados para las lesiones por presión (LPP) y otras lesiones cutáneas relacionadas con la dependencia (LCRD) en unidades de hospitalización de adultos de hospitales españoles, tanto globales como ajustados. Analizar las características demográficas y clínicas de las personas con LCRD y de las lesiones. Metodología: Estudio observacional, transversal, tipo encuesta epidemiológica (5º Estudio Nacional de Prevalencia), dirigido a todos los hospitales en España. Recogida de datos mediante formulario seguro online. Variables: características de los hospitales y de las unidades, pacientes ingresados, pacientes con cada tipo de LCRD, clasificación de cada lesión, tamaño y tiempo de evolución. Se estimó la prevalencia bruta global y ajustada por hospitales y por tipo de unidades. Resultados: Participaron 554 unidades de hospitalización de adultos pertenecientes a 70 hospitales de todo el territorio nacional. La prevalencia global de LCRD fue del 8,7%. Según tipo de lesiones, las prevalencias fueron: lesiones por presión (LPP) 7,0%; por humedad 1,4%; por fricción 0,9%; combinadas 1,5%; laceraciones 0,9%. Para las LPP, las unidades con prevalencias más altas fueron: cuidados paliativos (16,7%), UCI (14,9%) y unidades posquirúrgicas y reanimación (14,0%). La mayoría de las lesiones son de origen nosocomial (p. ej., el 72,2% de las LPP), producidas en hospitales o residencias de mayores. Se ha encontrado alta variabilidad en la prevalencia de LCRD y de LPP tanto a nivel de hospitales como de unidades de hospitalización. Conclusiones: La prevalencia de LPP es similar a la de estudios anteriores en hospitales españoles. Por primera vez se han obtenido datos de prevalencia de otros tipos de LCRD. Puesto que la mayoría de las lesiones son producidas en los propios hospitales y otras instituciones, como residencias de mayores, se evidencia la necesidad de mejorar la prevención de las LCRD en estos entornos


Aims: To obtain updated epidemiological indicators for pressure injuries (PI) and other dependence-related skin lesions (DRSL) at adult hospitalization units of Spanish hospitals, both global and adjusted. To analyse both the demographic and clinical characteristics of people with DRSL and the characteristics of the lesions. Methods: Observational, cross-sectional study, as an epidemiological survey (5th National Prevalence Study), focused to all the hospitals in Spain. Data were collected by an on-line secure form. Variables: characteristics of the hospitals and the units, number of patients admitted, number of patients with each type of DRSL, lesions classification, size and time. The crude prevalence was calculated, both overall and adjusted by hospitals and units. Results: In this study have participated 554 units from 70 Spanish hospitals. Overall, the prevalence for DRSL of any kind, was 8,7%. By type of lesion, the prevalence was: pressure injuries (PI), 7,0%; moisture associated lesions, 1,4%; friction, 0,9%; combined lesions, 1,5%; and skin tears, 0,9%. For PI, the units with highest prevalence were: palliative care (16,7%), intensive care (14,9%) and post-surgery and reanimation units (14,0%). Most of the lesions were nosocomial (e.g. 72,2% of the PI), that is, produced at hospitals or nursing homes. This study has shown a high variability in the figures of prevalence of DRSL and PI, both at hospitals and units levels. Conclusions: The prevalence of PI is similar to that of previous studies at Spanish hospitals. This is the first time that the prevalence of other types of DRSL has been calculated. Since most of the dependence-related skin lesions were produced inside the hospitals and other facilities, such nursing homes, there is a need to improve the prevention of these lesions in these settings


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Pressure Ulcer/epidemiology , Epidemiologic Studies , Skin Ulcer/epidemiology , Skin Ulcer/classification , Cross-Sectional Studies , Health Surveys/methods , Health Surveys/statistics & numerical data , Palliative Care/statistics & numerical data , Hospitalization/statistics & numerical data , Lacerations/epidemiology
13.
Gerokomos (Madr., Ed. impr.) ; 28(3): 151-157, sept. 2017. ilus, graf
Article in Spanish | IBECS | ID: ibc-169000

ABSTRACT

A través de una revisión narrativa, los autores revisan elementos clave relacionados con la historia de las úlceras por presión y su contexto, desde la Edad Antigua, el Renacimiento, el siglo xix hasta la edad moderna


Through a narrative review, the authors review key facts related with the history of pressure ulcers and their framework, from ancient age, Renaissance, xix's century up to the modern age


Subject(s)
Humans , History, Ancient , History, 16th Century , History, 19th Century , History, 20th Century , Pressure Ulcer/epidemiology , Pressure Ulcer/history , Wounds and Injuries/epidemiology , Wounds and Injuries/history , Frail Elderly/statistics & numerical data
14.
Gerokomos (Madr., Ed. impr.) ; 28(2): 83-87, jun. 2017. tab
Article in Spanish | IBECS | ID: ibc-165743

ABSTRACT

Las lesiones por presión son un importante problema de salud con una gran repercusión epidemiológica y un gran impacto a nivel de salud y calidad de vida que genera importantes costes para las personas, instituciones y sistemas de salud. A pesar de la importancia económica del problema de las lesiones por presión, prácticamente no existe información sistematizada acerca de las diferentes dimensiones de su coste. Para cubrir esta falta de información se planteó la realización de una revisión integrativa acerca de la dimensión económica del problema de las lesiones por presión. Se han identificado y analizado 89 documentos con información económica acerca del problema de las lesiones por presión. La información se ha sistematizado basándose en los siguientes apartados: tiempo necesario para la cicatrización, impacto en las estancias hospitalarias, costes relacionados con la seguridad de los pacientes, impacto en los grupos relacionados de diagnóstico, coste total, coste por episodio, por tipo de tratamiento, de las complicaciones, de las demandas legales, de los años de vida ganados ajustados a calidad de vida, en pacientes lesionados medulares y con otras condiciones, y los costes de medidas preventivas


Pressure Lesions are an important health problem with a great epidemiological impact that affects the health status and quality of life producing important expenses for persons, healthcare institutions and health systems. There is not available systematized information about the different cost components of pressure lesions although the important economic dimension of such problem. In order to cover this lack of systematized information we performed an integrative review about the economic dimension of pressure lesions. We have identified and analyzed 89 documents with economic information about pressure lesions problem. Information has been systematized according with the next categories: time for healing, cost of additional hospital stays, costs related with safety of patients, DRG costs, total cost of treatment, episode’s cost, by type of treatment, related with complications, QALYs, costs in spinal cord patients and in patients with other conditions and global prevention costs


Subject(s)
Humans , Pressure Ulcer/epidemiology , Health Care Costs/statistics & numerical data , Length of Stay/statistics & numerical data , Risk Factors , Wound Healing , Patient Safety/economics , Quality-Adjusted Life Years , Health Evaluation/methods
15.
Gerokomos (Madr., Ed. impr.) ; 27(4): 161-167, dic. 2016. tab, graf
Article in Spanish | IBECS | ID: ibc-160108

ABSTRACT

Hoy en día, la seguridad de los pacientes es una prioridad para los sistemas de salud. Las úlceras por presión son un importante problema de salud que produce daño en los pacientes y que son evitables en un alto porcentaje de casos. Se revisan en el presente artículo aspectos conceptuales y metodológicos acerca de las úlceras por presión como problema de seguridad de los pacientes, su impacto entre los diferentes eventos adversos, así como diferentes iniciativas institucionales acerca de estas dentro del contexto de la seguridad de los pacientes y los eventos adversos


Nowadays patient’s safety is a priority for Healthcare Systems. Pressure Ulcers are an important health problem that produce harm in patients and are avoidable in a high percentage of cases. We review in the current paper conceptual and methodological issues related with pressure ulcers as a safety problem in patients, their impact between the different adverse events as well as different institutional approaches about pressure ulcers in the framework of the safety of patients and adverse events


Subject(s)
Humans , Pressure Ulcer/epidemiology , Long Term Adverse Effects/epidemiology , Patient Safety , Risk Factors , Safety Management/organization & administration , Pressure Ulcer/prevention & control
17.
J Wound Care ; 25(1): 26, 28-32, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26762495

ABSTRACT

A new theoretical framework on the development of pressure ulcers and other dependence-related lesions requires continued in-depth analysis of their conceptual bases. This study reports the historical background, definitions, and production mechanisms of these lesions, describing the differential pathognomonic features of pressure and/or shear ulcers, moisture-associated skin damage, and lesions from rubbing or friction. It also discusses the combined/multifactorial lesions that can be found in the clinical setting. Finally, it presents the new classification of these lesions proposed by the Spanish Pressure Ulcers and Chronic Wounds Advisory Panel.


Subject(s)
Practice Guidelines as Topic , Pressure Ulcer/classification , Pressure Ulcer/diagnosis , Wound Healing , Advisory Committees , Humans , Observer Variation , Spain
19.
Gerokomos (Madr., Ed. impr.) ; 25(4): 162-170, dic. 2014. ilus, tab
Article in Spanish | IBECS | ID: ibc-134305

ABSTRACT

Objetivos: 1) establecer la prevalencia de úlceras por presión (UPP) en hospitales, centros sociosanitarios (CSS) y atención primaria en España; 2) determinar la frecuencia de UPP nosocomiales (generadas durante la estancia en hospitales o CSS), y 3) describir las características de los pacientes y de las lesiones identificadas. Métodos: encuesta epidemiológica, transversal, mediante cuestionario dirigido a profesionales que trabajen en centro sanitarios y sociosanitarios, públicos o privados, en España. Realizada entre el 1 de marzo y el 31 de mayo de 2013. Variables: descripción de los centros, población ingresada o atendida y pacientes con UPP, características demográficas y clínicas de los pacientes. Se calcula prevalencia bruta y prevalencia media para cada uno de los tres niveles asistenciales. Resultados: se obtuvieron 509 cuestionarios válidos, un 66,7% son de hospitales, un 21,6% de atención primaria y un 16,7% de CSS. Las cifras de prevalencia obtenidas son: en hospitales, en adultos 7,87% (IC 95%: 7,31-8,47%); en unidades pediátricas de hospitales, 3,36% (IC 95%: 1,44-7,61%); en CSS, 13,41% (IC 95%: 12,6-14,2%), y en atención primaria, 0,44% (IC 95%: 0,41-0,47%) entre mayores de 65 años y 8,51% (IC 95%: 7,96-9,1%) entre pacientes en programas de atención domiciliaria. La prevalencia es más alta en unidad de cuidados intensivos (UCI), llegando al 18%. Son UPP nosocomiales un 65,6% del total y solo un 29,4% se han producido en los domicilios. El mayor porcentaje de las lesiones es de categoría 2, con un tiempo de evolución de 30 días (mediana) y un área de 6 cm2 (mediana). Conclusiones: la prevalencia de UPP en España no ha disminuido en 2013 respecto a años anteriores, e incluso se ha duplicado en los CSS. En hospitales, las UCI son las unidades con mayor prevalencia. En los CSS, hay una prevalencia más alta en los privados frente a los públicos. Casi dos tercios de todas las UPP son de origen nosocomial (hospitales o CSS), lo que indica un fallo en la prevención de estas lesiones


Aim: 1) To determine the prevalence of pressure ulcers (PU) at hospitals, nursing homes (NH) and the community in Spain; 2) To determine the frequency of nosocomial PU (those acquired during patients’ stay at hospital or NH), y 3) To describe the characteristics of the patients and ulcers. Methods: Cross-sectional survey with a questionnaire aimed to nurses working at hospitals, nursing homes and primary care, both publics and privates, in Spain. Date: from 1st March to 31th May in 2013. Variables: Description of the centres, number of in-patients or residents at NH and number of patients with PU, demographic and clinical characteristics of the patients. For each one of the 3 settings, crude prevalence and average prevalence was calculated. Results: 509 valid questionnaires were obtained; 66.7% from hospitals; 21.6% from community care and 16.7% from nursing homes. Prevalence percentages: at hospitals, adults: 7,87% (CI95%: 7,31-8,47%); paediatric units, 3,36% (CI95%: 1,44-7,61%); nursing homes 13,41% (CI95%: 12,6-14,2%); and community care, 0,44% (CI 95%: 0,41-0,47%) among older than 65 years and 8,51% (CI95%: 7,96-9,1%) among people in home care programs. The Intensive Care Units (ICU) have the highest prevalence, reaching the 18%. On the whole, 65.5% of the PU are nosocomials and only the 29.4% were developed at homes. The majority of the lesions are classified in category 2. The duration of 30 days (as median) and the area was of 6 cm2 (median). Conclusions: In Spain, the prevalence of PU is not decreasing, from previous studies; and even it has doubled in nursing homes. At hospitals, the ICU are the places with highest prevalence. When considering the nursing homes, the private ones have higher prevalence than the public ones. Two-thirds of the PU has a nosocomial origin (hospitals or nursing homes), what could mean a failure in prevention


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pressure Ulcer/epidemiology , Frail Elderly/statistics & numerical data , Spain/epidemiology , Epidemiologic Studies , Primary Health Care/statistics & numerical data , Homebound Persons/statistics & numerical data
20.
Gerokomos (Madr., Ed. impr.) ; 25(4): 171-177, dic. 2014. ilus, tab
Article in Spanish | IBECS | ID: ibc-134306

ABSTRACT

Objetivo: conocer las opiniones de las enfermeras sobre la variabilidad en el abordaje y manejo de las heridas crónicas, así como los factores que la causan. Métodos: cumplimentación voluntaria de un cuestionario por enfermeras de los tres niveles asistenciales. El cuestionario incluía ítems sociodemográficos, nivel asistencial, nivel de formación en heridas, implicación en investigación y si consideraban que existe variabilidad en el abordaje de las heridas crónicas. Resultados: porcentaje de respuesta del 14%. El 90% consideraba que existía variabilidad. Enumeraron 202 razones para explicar esa variabilidad, que se clasificaron en diez causas. Un porcentaje elevado considera que tiene formación específica en heridas; sin embargo, más de la mitad de los encuestados (65,5%) señala que la variabilidad está relacionada con un déficit de formación. Otras causas reflejadas fueron el "estilo de práctica profesional" (41%), la "discontinuidad de cuidados" (24,5%) y el "exceso/escasez de productos" (14%). El análisis inferencial no mostró ninguna relación significativa entre las variables estudiadas y la respuesta de la existencia o no de variabilidad. Conclusión: Aunque las guías de práctica clínica reflejan recomendaciones basadas en la evidencia en el abordaje de las heridas crónicas, el estudio muestra que un alto porcentaje de las encuestadas consideran que existe variabilidad en el tratamiento de aquellas. A pesar del nivel de formación que dicen tener un gran número de encuestadas, una de las principales causas de la existencia de variabilidad es el déficit de formación, además del estilo de práctica profesional, la discontinuidad de cuidados y el exceso-escasez de productos


Objective: The aim of the study was to know the opinions of nurses on the variability in the approach and management of chronic wounds, and the factors that cause it. Methods: Voluntary fulfillment of a questionnaire by nurses from the three care levels. The questionnaire included demographic items, care level, training level in injuries, involvement in research and whether they considered the existence of variability in the approach of chronic wounds. Results: Response rate of 14%. The 90% considered that there was variability. They listed 202 reasons trying to explain this variability, which were classified in ten causes. A high percentage considered they have specific training in wounds, however more than half of respondents (65.5%) indicated that the variability is related to lack of training. Other causes reflected were "practice style" (41%), "care discontinuity" (24.5 %) and "excess/shortage of products" (14%). The inferential analysis showed no significant relationship between the studied variables and the response of the existence or not of variability. Conclusion: Even though the clinical practice guidelines reflect the evidence-based recommendations on the management of chronic wounds, the observational, cross-sectional study shows that a high percentage of respondents consider that variability exists. In spite of the training level that a larger number of respondents say to have, one of the main causes of the existence of variability is the lack of training, together with practice style, care discontinuity and excess/ shortage of products


Subject(s)
Humans , Skin Ulcer/nursing , Pressure Ulcer/nursing , Nursing Diagnosis/methods , Nursing Assessment/methods , Nursing Care/methods , Evidence-Based Practice/methods
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