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Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit
María Isabel González-Méndez1,2, Marta Lima-Serrano2, Catalina Martín-Castaño1
1UGC de Cuidados Intensivos, Hospital Virgen del Rocío, Seville, Spain.
Insights
This study found that pressure ulcer incidence in intensive care units was 8.1%, with in-hospital complications and prognosis scores as key risk factors. Surprisingly, longer immobilization appeared protective against pressure ulcers in critical care patients.
Area of Science:
- Critical care medicine
- Nursing
- Epidemiology
Background:
- Pressure ulcers are a common complication in clinical practice.
- Intensive care unit (ICU) patients face a higher risk of developing pressure ulcers, with reported incidence rates varying widely (3.3-39.3%).
Purpose of the Study:
- To determine the incidence, incidence rate, and risk factors of pressure ulcers in critical care patients.
- To identify key variables associated with pressure ulcer development in the ICU setting.
Main Methods:
- A prospective cohort study involving 335 adult ICU patients monitored for up to 32 days.
- Kaplan-Meier survival analysis and multivariate Cox regression were used to calculate incidence and identify risk factors, excluding patients with pre-existing pressure ulcers.
Main Results:
- The incidence of pressure ulcers was 8.1%, with an incidence rate of 11.72 per 1,000 ICU days.
- Most pressure ulcers were Stage I (40.6%) or Stage II (59.4%), primarily located on the sacrum.
- In-hospital complications and the SAPS III prognostic score were identified as significant risk factors, while length of immobilization was unexpectedly found to be protective.
Conclusions:
- The observed pressure ulcer incidence is lower than reported in some recent studies.
- In-hospital complications and prognosis scores are confirmed risk factors, but immobilization's protective role warrants further investigation.
- Identifying these risk factors aids nurses in developing targeted interventions to prevent pressure ulcers, improving quality of care in ICUs.
Aims And Objectives:
To determinate the incidence, incidence rate and risk factors of pressure ulcers in critical care patients.
Background:
Pressure ulcers represent one of the most frequent health problems in clinical practice. Specifically, critical patients who are hospitalised in intensive care units have a higher risk of developing a pressure ulcer, with an incidence that fluctuates between 3.3-39.3% according to previous studies.
Design:
Prospective cohort study.
Methods:
Three hundred and thirty-five adult patients (over 18 years old) who were hospitalised in intensive care units for at least 24 hr were monitored for a maximum of 32 days. They were excluded if they had a pressure ulcers at admission. The survival rate for pressure ulcers, from stages I-IV, was calculated using the Kaplan-Meier method. A multivariate Cox regression model was adjusted to identify the main risk factors for pressure ulcers: demographic, clinical, prognostic and therapeutic variables.
Results:
The incidence of pressure ulcers in critical patients was 8.1%, and the incidence rate was 11.72 pressure ulcers for 1,000 days of intensive care units stay; 40.6% of pressure ulcers were of stage I and 59.4% of stage II, mainly in the sacrum. According to the Cox model, the main risk factors for pressure ulcers were in-hospital complications, prognostic scoring system (SAPS III) and length of immobilisation.
Conclusions:
The incidence of pressure ulcers is lower than that shown in recent studies. Complications on the unit and the prognosis score were risk factors associated with pressure ulcers but, surprisingly, length of immobilisation was a protective factor.
Relevance To Clinical Practice:
Survival analysis of pressure ulcer allows for identification of risk factors associated with this health problem in the intensive care units. Identifying these factors can help nurses establish interventions to prevent pressure ulcers in this healthcare scenario, given that pressure ulcers prevention is an indicator of nursing quality.
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