TI S SUE VIAB I L I T Y
Early detection of pressure injury/ulcer risk
Caroline Fallon provides an insight into the risk factors for pressure injuries/ ulcers, current guidance on prevention and management, as well as the importance of early detection. She argues that technology can help assist healthcare practitioners in this task, which could ultimately lead to improved outcomes and reduced costs for the healthcare sector.
As patients age and acuity levels continue to rise, increasing frailty, complex underlying chronic diseases and rising obesity can add to the daily challenges faced by clinicians. These challenges include pressure injuries/ ulcers (PI/PU); wounds characterised by localised injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure, or pressure in combination with shear.1
Pressure injuries/ulcers can
have a significant impact on patients, they can cause suffering and morbidity2 quality of life3
and pain.4
For carers, over 90% of the cost of treating pressure injuries/ulcers is nursing time.5
For healthcare organisations the treatment of pressure injuries/ulcers can
, reduce
increase length of stay in hospital up to 5-8 days6
and is estimated to cost the NHS £3,800,000 a day.7 In Ireland, it was
estimated to cost the HSE €250 million across all healthcare settings per annum8 – which, when broken down per day, is approximately €684,000. Pressure injuries/ulcers prevalence reports
vary across the UK and Ireland. In Ireland, prevalence is estimated to be 16%9 Wales 8.9%.10
and A national prevalence study
undertaken in England, in its first cohort report, indicated a prevalence of 10.2%11 which is higher than previously reported prevalence (for example, the NHS safety thermometer shows a national prevalence of 4.9% in March 2020).12
report that the rate of pressure injuries/ulcers is higher in patients with darker skin tones in comparison to lighter skin tones.13, 14, 15 More recently, data from a large healthcare centre in New York has shown that the prevalence of PI/PUs among confirmed COVID-19 patients who required intensive care was more than three-times greater than the PU prevalence among patients without COVID-19 who similarly needed intensive care.16
While cost and Several studies
prevalence cannot be directly compared, it is clear that pressure injuries/ulcers remain a burden to our patients, carers and healthcare organisations. Improving quality of care outcomes related to the reduction of pressure injuries/ ulcers is high on national healthcare agendas across Ireland and the UK. Commonalities include optimising patient experiences, optimising patient safety, reducing harm, optimising cost and clinical efficiencies in patient care. Despite advances in surface technologies, education, guidelines and facility-based continuous improvement programmes, pressure ulcer prevalence and incidence remain high in many care settings.
How pressure ulcers develop In order to effectively avoid pressure injuries/ulcers, understanding the aetiology of pressure injuries/ulcers relies on the importance of reducing exposure to prolonged tissue deformation and early detection of tissue damage.
Figure 1: Technology for early detection of pressure injuries/ulcers MAY 2021
As a result of the internal reaction to body weight forces or external mechanical load, pressure injuries/ulcers develop, the causes being pressure and shear. While pressure may be applied directly to the skin, the effects of pressure are frequently exacerbated by lateral shear forces. Damage, along with the ability of the individual tissues to withstand
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