Investigating the incidence of pressure ulcers in patients at risk based on the Braden scale and predicting factors related to its occurrence in selected educational and medical centers of Rasht in 2010-2011

Dissertation

To obtain a master's degree in nursing (special care field)

Abstract

Introduction: A pressure ulcer is a tissue damage caused by pressure and can involve skin, muscle, connective tissue, cartilage and bone. Pressure ulcer is a painful, debilitating process and endangers a person's health by increasing mortality and morbidity in terms of length of hospitalization, increasing the rate of infection and increasing the need for surgical procedures. Today, pressure ulcer is considered the third most expensive disease after cancer and cardiovascular diseases.

. Objective: The purpose of this study is to determine the incidence of pressure ulcer in patients at risk based on the Braden scale and prediction.

Materials and methods: This research is a descriptive-analytical cross-sectional study, sampling was done gradually on 350 patients hospitalized in orthopedics, ICUs, internal neurology departments in selected medical training centers in Rasht city.  The data collection tool in this research included a 3-part questionnaire. The first part, the registration form of personal-social and medical characteristics, the second part, the registration form of common places for the occurrence of pressure ulcers, the third part, the Braden predictor scale. The data were statistically analyzed through t-tests, chi-square, Fisher and logistic regression.

Results: Out of 350 patients studied, 221 patients were male and 129 were female patients. And the average age of the patients It was 20.54 + 49.77. The incidence rate of pressure ulcer in this study was 22.6%. The highest incidence of pressure ulcers was in patients hospitalized in ICU departments. The most common places for pressure ulcers were the heel (8%), buttock (5.7%), and sacrum (3.4%). In the logistic regression analysis, the probability of pressure ulcer formation in patients with edema was 4.16 times, in patients with a lower average level of consciousness, 0.81 times, in patients with chronic diseases, 2.31 times, in patients with Traction was increased by 2.24 times in patients with fecal incontinence by 2.71 times, by 0.4 times in patients with urinary incontinence, by 1.17 times in patients with longer hospitalization, and by 1.02 times in older patients. The chance of forming a pressure ulcer was increased by 1.71 times in "completely" limited sensory perception compared to no sensory disturbance and 3.59 times in slightly limited sensory perception. The chance of forming a pressure ulcer in very limited movement was increased by 3.82 times compared to no restriction in mobility and 19.97 times compared to "completely" immobile. The chance of pressure ulcer formation in the subgroup of friction potential problem increased by 2.47 times compared to no problem in friction and in the problem subgroup by 6.51 times.

Conclusion: The incidence rate of pressure ulcers in Iran is similar to other countries, using a standard method of patient evaluation and paying attention to factors causing pressure ulcers before hospitalization can have a significant effect on identifying patients at risk and reducing the incidence of pressure ulcers.

Key words: hospitalized patients, bed sores, risk factors.

Field of research:

It is the largest body tissue and accounts for about 15% of body weight. The skin has a complex structure and performs many basic functions in the body, including physical and chemical protection, sensory function, fluid balance, temperature regulation, urticaria and sensitivity reactions and inflammation, vitamin D production.  The skin plays a role in the expression of emotions and also interferes in the concept of self and the mental image of one's body. So having healthy skin is very important from different aspects. Changes in the integrity of the skin are dangerous and can be life-threatening. This is important in elderly people, immobile people, people with chronic problems and people hospitalized in acute care units. Pressure ulcers are the most common cause of skin integrity disorders (1).

Pressure ulcers are a common and costly problem in patient care. It is associated with mortality and morbidity (2).

Pressure ulcers are a problem.

Pressure ulcers are a problem that has existed for a long time, and pressure ulcers and their treatment are as old as human life. The ancient Egyptians were familiar with the problem of pressure sores.  The oldest existing manuscript about pressure ulcers belongs to Fabricus Hildanus[1]. In this 5000-year-old papyrus, an Egyptian physician described a pressure ulcer in a spinal cord injury patient as a wound that would not heal. In Egyptian mummies, there are evidences of pressure wounds that were covered with a piece of animal skin, and some of these wounds even had signs of healing. In Europe in the 16th century, the French surgeon Ambrose Parr [3] described pressure ulcers as an incurable disease that only rest, exercise and a good diet can be effective in improving (3). Pressure ulcers were incorrectly called bedsores for many years, but after understanding the effect of pressure in the development of pressure ulcers, the term pressure ulcers is used instead of the word bedsores (4). Today, pressure ulcers are the third most expensive disease after cancer and cardiovascular diseases (5). Any lesion caused by continuous pressure, stretching, frictional force and leading to damage to the skin and underlying tissues is called a pressure ulcer (6). Pressure ulcer is a painful, debilitating process and endangers a person's health by increasing mortality and morbidity in terms of increasing the duration of hospitalization, increasing the rate of infection and increasing the need for surgical procedures (7). The scientific approach to pressure ulcers began in the 19th century (8).

Every year in America, more than 1.3 million adults suffer from pressure ulcers. Its prevalence is variable and depends on clinical conditions. Its prevalence is 4-38% in hospitals, 2.2-23.9% in long-term care, and 0-17% in home care. The prevalence of pressure ulcers in the elderly is between 3-11% (5). The prevalence of pressure ulcers in America is 13.6% for patients with short hospitalization and 42.1% for patients with long hospitalization (9). In 2002, the prevalence of pressure ulcers in European hospitals was estimated at 18.1%. And grade 2, 3 and 4 pressure ulcers are estimated at 3-11% in American hospitals and 7.6-11.8% in Dutch hospitals (5) More than other patients are at risk of developing pressure ulcers (4).

Morbidity and mortality have a significant relationship with pressure ulcers. The death rate in patients with pressure ulcers is 2-6% more than patients without ulcers. The most common cause of death in patients with chronic pressure ulcers is kidney failure and amyloidosis [4], and in people with acute pressure ulcers, the presence of concomitant diseases or sepsis [5] (11). In patients with a history of pressure ulcers, the incidence of repeated pressure ulcers increases by 26% during a period of 6 months. Healing of pressure ulcers in patients with chronic diseases has taken a year in some cases (4). In the study of Reyhani Kermani and Haghiri (2006), the incidence of pressure ulcers in the special care department of Neurosurgery and Spine Surgery of Bahnar Kerman Hospital was 22.7% (12). Approximately 57-60% of pressure ulcers in the hospital occur in the first two weeks of hospitalization, and 70% of them occur in people over 70 years old. 95% of pressure ulcers occur in the lower limbs. 36% of pressure ulcers are formed in the sacrum [6] and 30% in the heel (5). In developed countries, where life expectancy has increased, the incidence of pressure ulcers has also increased (13).

Patients hospitalized in special departments are prone to develop pressure ulcers due to inactivity and frequent contact with risk factors related to the development of pressure ulcers (14). Special care: For every day connected to a mechanical ventilation device, the risk of developing a pressure ulcer increases by 4.2% (15).