Prevention of pressure ulcers

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B. Braun celebrates the worldwide Pressure Injury Prevention Day 2017

With the Worldwide Pressure Injury Prevention Day celebrated on Nov, 16th 2017, the NPUAP (National Pressure Ulcer Advisory Panel) wants to raise awareness on pressure ulcer prevention.

Also B. Braun has decided to celebrate this international awareness day with a special focus on two of its dressings whose soft, cushion-like design is dedicated to prevent pressure ulcers in the sacrum area and on the heels: Askina® DresSil® Sacrum and Askina® Heel.

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. Only in the USA, 3 million of people are affected by 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 ! (4)

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, such as:

  • Pressure ulcer risk assessment

Whenever a patient enters a ward and the risk of pressure ulcer development cannot a priori be excluded, 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.(2)  If the patient is not able to turn himself, he 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 changes must be documented in order to prevent a pressure ulcer formation. (2) 

  • 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 conjunction 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 neutral 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. (2) (3)

  • 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. (2)(3) 

  • Using B. Braun dressings

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.(5) With Askina® DresSil® Sacrum, you can prevent and treat pressure ulcers at the sacrum level. In case of the presence of wounds, Askina® DresSil® Sacrum and Askina® Heel can both be used as the provide a moist environment that are conducive to natural healing conditions.

References:

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

2. www.stopthepressure.com

3. Quick Guide: Pressure ulcer prevention and management, Wounds International

4. Are 95% of hospital-acquired pressure ulcers avoidable?, F.Downie et al. 2003

5. Data on file