TI S SUE VIAB I L I T Y


Taking the pressure off the NHS


Pressure ulcers present a huge burden for the NHS and, in light of the current global health crisis (COVID-19), it has led to growing concerns about the incidence of pressure ulcers, how their management could be affected and what this will mean for patient outcomes. So, how can the health service address the issue?


Pressure Ulcers (PUs) are one of the most common type of chronic wounds and are defined as localised damage to the skin or underlying tissue, as a result of pressure or pressure in combination with shear. Pressure injuries usually occur over a bony prominence but may also be related to a medical device or other object.1


Under


normal circumstances they exert a significant financial burden on the UK health system, costing the NHS £531 million.2 Pressure ulcers also have a negative impact on quality of life of patients by limiting their ability to perform daily activities.3


These wounds can cause


patients distress due to pain and fear of exudate leakage.4,5


occur in the elderly as comorbidities of other conditions such as cardiovascular disease and obesity.6


PUs most commonly The combination of an


increasing ageing population and long-term diseases has meant that more people will be immobile; immobility is a risk factor for the development of PUs.7


As population ageing is now a global issue, there is growing concern of the implications a fast ageing population will have on PU incidence, management and cost for the NHS as a significant amount of time is already dedicated to managing these wounds.6


virus, require the support of a mechanical ventilator.10


Patients who need ventilators usually remain in hospital for an average of 22 days.11


Long hospital stays have To add to these pre-existing


burdens, the global health crisis – COVID-19 – poses another significant challenge. A combination of its potential to increase the incidence of PUs, nurse shortages and redeployment into new clinical settings could have major implications on wound care in the future.8,9


Implications of COVID-19 on PUs Around 15% of critically ill COVID-19 patients with Acute Respiratory Disease (ARDS), the life-threatening symptom of the


AUGUST 2020


been shown to increase the risk of PU development, with studies reporting that PUs can develop in as little as 4-6 hours following sustained pressure.12


Clinical


guidelines recommend placing patients in the prone position (face down) for mechanical ventilation if no improvements in oxygenation are observed in the supine position (face up).13


that by alternating between prone and supine position for mechanical ventilation, patient outcomes can be improved.14


This suggests that critical COVID-19 patients mechanically ventilated in the supine position are at high risk of developing PUs. The older population are more at risk of becoming unwell from COVID-19 (a new study found that the median age of patients admitted to hospital with severe COVID-19 was 63).16


They are also likely to have at


least one comorbidity, such as hypertension, obesity and diabetes16


(also the risk factors Studies have suggested When


a patient is mechanically ventilated in the supine position, there is direct pressure exerted on the patient’s heels and sacrum.15


of PUs). Tissue viability nurse, Luxmi Dhoonmoon comments: “Though it is not widely reported, pressure ulcers will be on the rise in the COVID-19 wards. In my community setting for example, we have experienced an increase in PU incidence since the start of the epidemic and rapid deterioration in skin integrity despite all preventative measures in place.”


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