Wound digest: Leg ulcers


n There were no unique risk factors that would enable early identification of patients at risk for MDR PU, and no differences between the risks for MDR and traditional PU. Patients with medical devices were, however, 2.4 times more likely to develop a PU of any kind (p=0.10, 95% CI = 1.2-4.8)


n MDR PU were found in some unusual sites including lips (from endotracheal tubes), hands (from splints) and arms (from arterial line tubing)


n The number of hospital-acquired MDR PUs decreased when continuous quality initiatives were implemented, including skin protection under oxygen tubing and changes to pulse oximeter use policy


n The authors recommend that more frequent and thorough skin and neurovascular assessments need to be made in patients with medical devices. They identify patients with, or at risk of, oedema as being at particular risk, as well as individuals with sensory deficits.


Black JM, Cuddigan JE, Walko MA, Didier LA, Lander MJ, Kelpe MR. Medical device related pressure ulcers in hospitalized patients. Int Wound J 2010; 7: 358–65.


2


Risk factors for pressure ulcer in vulnerable neonates identified


Readability Relevance to daily practice Novelty factor


n This multisite, prospective cohort study was designed to assess the incidence of, and risk factors for, pressure ulcers in vulnerable infants treated in seven neonatal intensive care units (NICUs) in Japan


n NICU patients treated in incubators are recognised to be at increased risk of pressure ulcers for a number of reasons including skin immaturity, the warm and humid conditions in the incubator and the use of interventions restricting body movement, such as high- frequency ventilation


n The study included all babies nursed in incubators in the participating centres between January and November 2006, who did not have skin breakdown at the start of the study


n Skin examination of each infant was performed daily by nurses, and risk factors based on literature review noted. Medical and nursing records were reviewed three times a week by a single researcher. The incidence, location and stage of pressure ulcers were noted, and risk factors for pressure ulcers were determined using univariate and multivariate analysis. Assessment included calculation of Braden Q score, Apgar score and the Dubowitz neonatal maturation assessment scale


n Data were analysed from 81 newborns (39 male, 42 female). A total of 14 pressure ulcers occurred in 13 infants during the 11-month study period; the incidence was 0·01 persons per day and cumulative incidence rate was 16·0%. Eight of the 13 infants with pressure ulcers had a gestational age of less than 33 weeks


n Half of all pressure ulcers were located on the infant’s nose. Six pressure ulcers occurred within one week and three occurred over three weeks. Most pressure ulcers were classified as stage II (n = 11, 78·6%); the remainder were stage I (n = 3, 21·4%)


n Pressure ulcer risk factors found to be significant (P < 0·05) were birthweight, skin texture, incubator temperature, incubator humidity, support surface, limited number of position changes and use of endotracheal intubation


n Two key risk factors for pressure ulcers were identified by multivariate analysis: skin texture as associated with a skin texture score of 1 point or lower on the Dubowitz neonatal maturation assessment scale (odds ratio 7·6; 95% confidence interval (CI) 1·58 –36·71, P = 0·012) and endotracheal intubation (odds ratio 4·0; 95% CI 1·04–15·42, P = 0·042)


n The authors state that this is the first ever study to focus on incidence and risk factors of pressure ulcers in the NICU


n Given that the two key risk factors of skin condition and endotracheal intubation have now been identified, the authors conclude that it will be desirable to establish preventative care as well improving endotracheal intubation materials to suit various skin conditions.


Fujii K, Sugama J, Okuwa M, Sanada H, Mizokami Y. Incidence and risk factors of pressure ulcers in seven neonatal intensive care units in Japan: a multisite prospective cohort study. Int Wound J 2010; 7: 323–8.


3


Knowledge and use of water-filled gloves for prevention of pressure ulcers


in Nigeria


Readability Relevance to daily practice Novelty factor


n This cross sectional descriptive survey was performed at University College Hospital, Idaban, the first teaching hospital to be established in Nigeria, in order to assess nurses’ knowledge, perception and practice in using water-filled gloves as an aid to preventing heel pressure ulcers


n Low-tech pressure relieving measures are especially useful and practical in conditions of nursing shortage and resource limitation. Water-filled gloves offer


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