TISSUE VIABILITY
Tackling the problem of pressure ulcers
Currently 20-25% of hospital beds are occupied each day by pressure ulcer patients, and 60-80% of these patients acquired their ulcer in hospital. A new consensus document has highlighted the important role of dressings in pressure ulcer prevention.
A new consensus document, the first of its kind, published by the World Union of Wound Healing Societies (WUWHS), has outlined the key role that dressings can have in helping to prevent pressure ulcers. At a time when NHS budgets are stretched and hospitals are coming under increasing financial pressure, this intervention is a timely example of how small changes in practice can lead to large savings – and most importantly, better outcomes for patients. Pressure ulcers are one of the biggest patient safety challenges faced by the NHS, placing a burden on both finances and staff. Just under 187,000 newly acquired pressure ulcers develop in hospitals each year in the UK,1
of between £1,214 to £14,1082
and with treatment costs this puts
significant pressure on the annual NHS healthcare budget. Pressure ulcer treatment costs £2.1bn which comprises 4.5% of the total budget.3
Aside from the enormity of the
financial burden on the NHS, the devastating effect of pressure ulcers on patients should not be underestimated. Pressure ulcers reduce quality of life for already vulnerable patients, increasing pain
and discomfort and decreasing mental wellbeing as a result.4
They can also be
debilitating for patients and can lead to life threatening complications, compounding an already distressing situation. Acquiring a pressure ulcer in a hospital setting unnecessarily lengthens a patients’ hospital stay by five to eight days and delays their recovery time.5
The financial and personal
cost of pressure ulcers is undeniable.3,4 Pressure ulcers are not just a UK problem, they are the scourge of hospitals across the world. Globally, pressure ulcers affect 15.3% of patients,6-10
and in
Europe the situation is severe with 20% of patients in acute settings developing a pressure ulcer while in hospital.11
A new consensus
This year WUWHS, supported by an educational grant from Mölnlycke Health Care, published a consensus document outlining the role dressings can have, alongside standard pressure ulcer preventive measures. The document tackles a number of myths on how pressure ulcers should be prevented, most notably rejecting the idea
that dressings used for open wounds are not suitable for use in pressure ulcer prevention, and that dressings are too thin to have an impact on the
factors that lead to pressure ulcers.12 There are four factors that lead to pressure ulcers: pressure, shear, friction, and microclimate (moisture). The consensus document makes clear how dressings can help to modify the factors and prevent an ulcer developing: l Pressure: a dressing which is very thick due to a lot of padding, or containing air, will prevent pressure as it will cushion the area. Additionally, a dressing with a large area will lessen pressure in a particular area by redistributing it.
l Shear: a dressing which is sufficiently adhesive to the skin, and which supports lateral movement between dressing layers, will absorb and redistribute shear forces.
l Friction: a dressing which is smooth on the outer surface will reduce friction on the skin.
l Microclimate: a dressing which is absorbent and therefore able to keep perspiration away from the skin, or has
Anatomical areas (1-6) at risk of pressure ulcer development. The sacrum (4) and heel (6) are the areas where a patient is most at risk of developing a pressure ulcer.
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WWW.CLINICALSERVICESJOURNAL.COM
MARCH 2017
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