Prevention of pressure ulcers

B. Braun celebrates the worldwide Pressure Injury Prevention Day 2019

With the Worldwide Pressure Injury Prevention Day which is celebrated this year on Nov, 21th, the EPUAP (European Pressure Ulcer Advisory Panel) wants to raise awareness on pressure ulcer prevention.

The risk of developing pressure ulcers 

Patients mostly develop pressure ulcers if they have to stay immobile in bed or in wheelchair for a long time without the possibility to change position. Typically in the intensive care unit (ICU), where the patient very often has respiratory equipment, urinary catheters, sequential compression devices, multiple intravenous catheters for continuous administration of e.g. vasoactive agents for hypotension, it is impossible to change the patient's position, thus resulting in an increased risk of pressure ulcers development.  

Pressure ulcers develop when the blood supply of the skin and the underlying tissues is compromised for prolonged periods of time due to mechanical compression of the local vasulature, with ensuing hypoxia and tissue necrosis. Most of the time pressure ulcers have a significant impact on patient morbidity, mortality and quality of life. 1 to 4 out of 10 hospitalised patients have pressure ulcers(*). It has been shown that the costs of pressure ulcer treatment is 2.5 times higher than prevention(1) and, most importantly, that 95% of all pressure ulcers are preventable.(2)

Preventing the development of pressure ulcers 

In some cases, pressure ulcers can develop very fast - sometimes it can occur within only one hour.

In order to prevent pressure ulcers, different measures can be adopted(3), such as:

  • Pressure ulcer risk assessment

Whenever a patient enters a ward and the risk of pressure ulcer development cannot be excluded and must be a priority. It must be properly assessed with a validated pressure ulcer risk assessment tool such as e.g. the Braden scale. According to the level of risk, appropriate preventive measures must be implemented in due course.

  • Changing the position frequently

Being able to change the bed lying position as much as possible is one of the best way to prevent pressure ulcers. It is highly recommended to change position and alternate between back and sides at least every 2 hours. Most of the time, pillows are used to elevate the parts of the body which are highly exposed to the development of pressure ulcers such as heels, ankles or even the knees. However, if the patient has already a pressure ulcer, it must be avoided to lie or sit on it as it could worsen the ulcer.(4)  If the patient is not able to turn themself, she must be assisted by a healthcare professional. Wheelchair-bound patients are recommended to change their position at least every 15 to 30 minutes. 

  • Skin assessment

A regular skin assessment must be performed so as to check any sign of pressure ulcer development. Every skin change must be documented in order to prevent a pressure ulcer formation.(4) 

  • Nutrition and hydration monitoring

It is important to check the patient’s weight and monitor any changes. Having a well-balanced diet  can help to reduce the risk of developing pressure ulcers. For patients who have already developed pressure ulcers, they will have to consume food with high calories such as eating cheese, fish meat and eggs in order to heal more easily.  If necessary, patients must consult a dietician in order to solve out some nutrition, chewing and swallowing problems as well as to find a balanced diet routine.(4)(5) 

  • Pressure ease, prevention of frictions and adequate local moisture management

We recommend a combination of our soft, cushion-like dressings Askina® DresSil® Sacrum and Askina® Heel with Askina® Barrier Cream and Linovera® oil.

 

Incontinence and moisture management

An appropriate management of incontinence, perspiration or exudate must be ensured. Most of the time, skin barrier products are used so as to manage the level of moisture next to the skin in conjuction with a skin care routine to keep the skin clean and dry. It is essential to wash the skin with a non-perfumed soap with a natural pH balanced and to avoid oil based creams if the patient must use continence products as they can affect the level of absorption of the product.(4)(5)

In order to provide an effective prevention of skin breakdown which is associated with incontinence, the Askina® Barrier Cream is indicated. It acts as a lasting protective barrier on skin of incontinent patients who are highly exposed to the irritating effect of urine and stools. When applied, it is quickly absorbed, leaving an invisible breathable water repellent layer, resistant to wash-off. It efficiently moisturises very dry skin. 

Skin repair and prevention

In order to protect patients’ skin against external agents, improve their skin resistance and to restore their capillary circulation, Linovera® is indicated. Linovera® is a solution of hyper oxygenated fatty acids used in the prevention and treatment of Stage I pressure ulcers. Due to the high percentage of linoleic acid, its repairing action is increased. The vegetable extracts – aloe vera and centella asiatica – have a major protecting and healing effect on the skin.

In a prospective study, none of the high risk patients preventively treated with Linovera® oil developed pressure injuries(6).

With Askina® Heel and Linovera® oil in combination with full risk assessment and evidence-based pressure ulcer prevention, B. Braun offers a concept that prevents and treats heel pressure ulcers. In a group of 26 patients for whom this protocol had been applied, all lesions resolved satisfactorily within 6 weeks.(7)

With Askina® DresSil® Sacrum, you can prevent and treat pressure ulcers at the sacrum level. It can be used in combination with Askina® Barrier Cream that is also indicated to use on intact skin and acts as a protectant and moisture barrier against maceration caused by incontinence or body fluids. Askina® Barrier Cream protects sensitive, fragile and severely dry skin, including periwound areas and finally prevent skin irritation.

Askina® DresSil® Sacrum and Askina® Heel can both be used also in case of wounds as they provide a moist environment that is conducive to natural healing conditions.

 

References:

*) Range varies among settings and classification method. 

  • Bereded DT, Salih MH, Abebe AE. Prevalence and risk factors of pressure ulcer in hospitalized adult patients; a single center study from Ethiopia. BMC Res Notes. 2018;11(1):847. Published 2018 Nov 29. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267874/
  • Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract. 2007;13(2):227-35. (https://www.ncbi.nlm.nih.gov/pubmed/17378869)
  • Barrois B, Labalette C, Rousseau P, et al. A national prevalence study of pressure ulcers in French hospital inpatients. J Wound Care. 2008;17(9):373-6, 378-9. (https://www.ncbi.nlm.nih.gov/pubmed/18833894)
  • Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nurs Crit Care. 2008;13(2):71-9 (https://www.ncbi.nlm.nih.gov/pubmed/18289185)
  • Vangilder C, Lachenbruch C, Algrim-boyle C, Meyer S. The International Pressure Ulcer Prevalence™ Survey: 2006-2015: A 10-Year Pressure Injury Prevalence and Demographic Trend Analysis by Care Setting. J Wound Ostomy Continence Nurs. 2017;44(1):20-28.(https://www.ncbi.nlm.nih.gov/pubmed/27977509)

1) Chapter 12- Pressure Ulcers: A Patient Safety Issue (2008), Agency for HealthCare Research and Policy (US).

2) Downie, F. & Sandoz, Heidi & Gilroy, P. & Royall, Dawn & Davies, S.. (2013). Are 95% of hospital-acquired pressure ulcers avoidable?. Wounds UK. 9. 16-22. 

3) http://www.internationalguideline.com/static/pdfs/NPUAP-EPUAP-PPPIA-PUQuickReferenceGuide-2016update.pdf

4) www.stopthepressure.com

5) Quick Guide: Pressure ulcer prevention and management, Wounds International

6) López-Pérez, R. Gutiérrez Ibañez, B.: Incidence of pressure ulcer (bed scores) in patients on treatment with hyperoxygenated fatty acids. (Asturias, Spain). Unpublished.

7) Data on file.