Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-27T01:21:24.825Z Has data issue: false hasContentIssue false

Chapter 39 - Pressure Injuries

Practical Considerations in Prevention and Treatment

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Barbara M. Bates-Jensen  and
Stephanie L. Woelfel
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Pressure injuries are a costly and complex global issue in all health-care settings. Morbidity and mortality are significant for persons who develop facility-acquired pressure injuries and they often fail to proceed through normal wound healing, stalling in the inflammatory phase of healing and remaining in a chronic inflammatory state. Prevention and treatment require multiple approaches and multidisciplinary team involvement for success. Prevention includes attention to risk assessment, daily skin assessment, tissue load management with offloading and support surfaces, mobility and activity interventions, nutrition assessment, and incontinence management. Treatment follows the TIMERS acronym: Tissue management including debridement and cleansing, Infection and inflammation control including management of bacterial biofilms, Moisture balance with use of moisture-retentive dressings, Epithelial edge advancement or frequent and consistent reassessment of healing, Repair and regeneration with use of advanced wound healing and adjunct therapies, and Social factors and those related to the individual.

Keywords

pressure injurypressure injury preventionpressure injury assessmentrisk assessmentdebridementmoisture-retentive dressings
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 477 - 492
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. The international guideline. Haesler, Emily (Ed.), EPUAP/NPIAP/PPPIA, 2019.Google Scholar
Hajhosseini, B, Longaker, MT, Gurtner, GC. Pressure injury. Annals of Surgery. 2020; 271(4):671–679.Google Scholar
Tubaishat, A, Papanikolaou, P, Anthony, D, Habiballah, L. Pressure ulcers’ prevalence in the acute care setting: A systematic review, 2000–2015. Clin Nurs Res. 2018; 27(6):643–659.Google Scholar
Zhaoyu, L, Frances, L, Lukman, T, Wendy, C. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. International Journal of Nursing Studies. 2020; 105:103–546.Google Scholar
Berlowitz, D, Lukas VanDeusen C, Parker, V, et al. Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care.Rockville, MD: Agency for Healthcare Research and Quality, 2011.Google Scholar
Graves, N, Birrell, F, Whitby, M. Effect of pressure injuries on length of hospital stay. Infect Control Hosp Epidemiol. 2005; 26:293–297.Google Scholar
Redelings, MD, Lee, NE, Sorvillo, F. Pressure injuries: More lethal than we thought? Adv Skin Wound Care. 2005 (Sep.); 18(7):367–372.Google Scholar
Thomas, DR, Goode, PS, Tarquine, PH, Allman, RM. Hospital-acquired pressure injuries and risk of death. J Am Geriatr Soc. 1996; 44:1435–1440.CrossRefGoogle ScholarPubMed
Sapico, FL, Ginunas, VJ, Thomhill-Joynes, M, et al. Quantitative microbiology of pressure sores in different stages of healing. Diagn Microbiol Infec Dis. 1986; 5:31–38.Google Scholar
Landis, SJ. Chronic wound infection and antimicrobial use. Adv Skin Wound Care. 2008; 21:531–540.CrossRefGoogle ScholarPubMed
Braga, IA, Pirett, CCNS, Ribas, RM, Gontijo Filho, PP, Diogo Filho, A. Bacterial colonization of pressure ulcers: Assessment of risk for bloodstream infection and impact on patient outcomes. Journal of Hospital Infection. 2013; 83(4):314–320.Google Scholar
Song, YP, Shen, HW, Cai, JY, Zha, ML, Chen, HL. The relationship between pressure injury complication and mortality risk of older patients in follow-up: A systematic review and meta-analysis. Int Wound J. 2019; 16(6):1533–1544.CrossRefGoogle ScholarPubMed
Bliss, DZ, Gurvich, O, Savik, K, et al. Are there racial-ethnic disparities in time to pressure ulcer development and pressure ulcer treatment in older adults after nursing home admission? J Aging Health. 2015; 27(4):571–593. doi: 10.1177/0898264314553895.Google Scholar
Bliss, DZ, Gurvich, O, Savik, K, et al. Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Arch Gerontol Geriatr. 2017; 72:187–194. doi: 10.1016/j.archger.2017.06.009.CrossRefGoogle ScholarPubMed
Bergquist, S. Pressure ulcer prediction in older adults receiving home health care: Implications for use with the OASIS. Adv Wound Care. 2003; 16(3):132–139.CrossRefGoogle ScholarPubMed
Kirkland-Kyhn, H, Teleten, O, Joseph, R, Schank, J. The origin of present-on-admission pressure ulcers/injuries among patients admitted from the community: Results of a retrospective study. Wound Manag Prev. 2019; 65(7):24–29.Google Scholar
Corbett, LQ, Funk, M, Fortunato, G, OʼSullivan, DM. Pressure injury in a community population: A descriptive study. J Wound Ostomy Continence Nurs. 2017; 44(3):221–227.Google Scholar
Stevenson, R, Collinson, M, Henderson, V, et al. The prevalence of pressure ulcers in community settings: An observational study. Int J Nurs Stud. 2013; 50(11):1550–1557.Google Scholar
Margolis, DJ, Knauss, J, Bilker, W, Baumgarten, M. Medical conditions as risk factors for pressure injuries in an outpatient setting. Age Ageing. 2003; 32(3): 259–264.Google Scholar
Ferris, A, Price, A, Harding, K. Pressure ulcers in patients receiving palliative care: A systematic review [published correction appears in Palliat Med. 2020 (Jul.); 34(7):969]. Palliat Med. 2019; 33(7):770–782.Google Scholar
Artico, M, Dante, A, D’Angelo, D, et al. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review. Palliat Med. 2018; 32(1):299–307.CrossRefGoogle ScholarPubMed
Wang, H, Niewczyk, P, Divita, M, et al. Impact of pressure ulcers on outcomes in inpatient rehabilitation facilities. Am J Phys Med Rehabil. 2014; 93(3):207–216.Google Scholar
Sala, JJ, Mayampurath, A, Solmos, S, Vonderheid, SC, Banas, M, D’Souza, A, LaFond, C. Predictors of pressure injury development in critically ill adults: A retrospective cohort study. Intensive and Critical Care Nursing, 2021; 62: 102924.Google Scholar
Bates-Jensen, BM, Anber, K, Chen, M, et al. Natural history of pressure injury among ethnically, racially diverse nursing home residents: The pressure ulcer detection study. Journal of Gerontological Nursing. 2021; 47(3):37–46.CrossRefGoogle ScholarPubMed
Bergstrom, N, Smout, R, Horn, S, Spector, W, Hartz, A, Limcangco, MR. Stage 2 pressure ulcer healing in nursing homes. J Am Geriatr Soc. 2008; 56(7):1252–1258.Google Scholar
Lynn, J, West, S, Hausmann, D, Gifford, R, Nelson, P, McGann, P, Bergstrom, N, Ryan, JA. Collaborative clinical quality improvement for pressure ulcers in nursing homes. J Am Geriatr Soc. 2007; 55(10):1663–1669.CrossRefGoogle ScholarPubMed
Bolton, L, McNees, P, van Rijswijk, L, de Leon, J, Lyder, C, Kobza, L, Edman, K, Scheurich, A, Shannon, R, Toth, M, Wound Outcomes Study Group. Wound healing outcome using standardized assessment and care in clinical practice. J Wound Ostomy Continence Nurs. 2004; 31(2):65–71.CrossRefGoogle ScholarPubMed
Van Rijswijk, L, Polansky, M. Predictors of time to healing deep pressure ulcers. Ostomy Wound Manage. 1994; 40(8):40–42, 44, 46–48, passim.Google ScholarPubMed
Spilsbury, K, Nelson, A, Cullum, N, Iglesias, C, Nixon, J, Mason, S. Pressure ulcers and their treatment and effects on quality of life: Hospital inpatient perspectives. J Adv Nurs. 2007; 57(5):494–504.Google Scholar
Gorecki, C, Brown, JM, Nelson, EA, et al. Impact of pressure ulcers on quality of life in older patients: A systematic review. J Am Geriatr Soc. 2009; 57(7):1175–1183.Google Scholar
Pack, R, Chang, DS, Brevetti, LS, et al. Correlation of a simple direct measurement of muscle pO2 to a clinical ischemia index and histology in a rat model for chronic severe hindlimb ischemia. J Vasc Surg. 2002; 36:172–179.Google Scholar
Gefen, A. Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 2. Nursing Standard. 2009; 23(46):40–44.Google Scholar
Stekelenburg, A, Strijkers, GJ, Parusel, H, Bader, DL, Nicolay, K, Oomens, CW. Role of ischemia and deformation in the onset of compression-induced deep tissue injury: MRI-based studies in a rat model. J Applied Physiology. 2007; 102(5):2002–2011.Google Scholar
Linder-Ganz, E, Yarnitzky, G, Yizhar, Z, Siev-Ner, I, Gefen, A. Real-time finite element monitoring of sub-dermal tissue stresses in individuals with spinal cord injury: Toward prevention of pressure injuries. Annals of Biomedical Engineering. 2009; 37(2):387–400.CrossRefGoogle Scholar
Peirce, SM, Skalak, TC, Rodeheaver, GT. Ischemia-reperfusion injury in chronic pressure ulcer formation: a skin model in the rat. Wound Rep Reg. 2000; 8:68–76.Google Scholar
Houwing, R, Overgoor, M, Kon, M, et al. Pressure-induced skin lesions in pigs: Reperfusion injury and the effects of vitamin E. J Wound Care, 2000; 9:36–40.Google Scholar
Miller, GE, Seale, J. Lymphatic clearance during compressive loading. Lymphology. 1981; 14:161–166.Google Scholar
Shaked, E, Gefen, A. Modeling the effects of moisture-related skin-support friction on the risk for superficial pressure ulcers during patient repositioning in bed. Front Bioeng Biotechnol. 2013; 14(1):9.Google Scholar
Zeevi, T, Levy, A, Brauner, N, Gefen, A. Effects of ambient conditions on the risk of pressure injuries in bedridden patients: Multi-physics modeling of microclimate. Int Wound J. 2018; 15(3):402–416.Google Scholar
Iaizzo, PA. Temperature modulation of pressure ulcer formation: Using a swine model. Wounds. 2004; 16:336–343.Google Scholar
Topman, G, Lin, FH, Gefen, A. The influence of ischemic factors on the migration rates of cell types involved in cutaneous and subcutaneous pressure ulcers. Ann Biomed Eng. 2012; 40:1929–1939.CrossRefGoogle ScholarPubMed
Gefen, A. The biomechanics of sitting-acquired pressure injuries in patients with spinal cord injury or lesions. Internatl Wound J. 2007; 4(3):222–231.Google Scholar
Loerakker, S, Oomens, CW, Manders, E, et al. Ischemia-reperfusion injury in rat skeletal muscle assessed with T2-weighted and dynamic contrast-enhanced MRI. Magn Reson Med. 2011; 66(2):528–537.CrossRefGoogle ScholarPubMed
Loerakker, S, Manders, E, Strijkers, GJ, et al. The effects of deformation, ischemia, and reperfusion on the development of muscle damage during prolonged loading. J Appl Physiol (1985). 2011; 111(4):1168–1177.Google Scholar
Berlowitz, DR, Brienza, DM. Are all pressure injuries the result of deep tissue injury? A review of the literature. Ostomy Wound Manage. 2007; 53(10):34–38.Google Scholar
Farid, KJ. Applying observations from forensic science to understanding the development of pressure injuries. Ostomy Wound Manage. 2007; 53(4):26–28, 30, 32, passim.Google Scholar
Bates-Jensen, BM, McCreath, HE, Kono, A, Apeles, NC, Howell, L, Alessi, C. Sub-epidermal moisture predicts erythema and stage I pressure ulcers in nursing home residents: A pilot study. Journal of the American Geriatrics Society. 2007; 55:1199–1205.Google Scholar
Lynn, J, West, S, Hausmann, D, Gifford, R, Nelson, P, McGann, P, Bergstrom, N, Ryan, JA. Collaborative clinical quality improvement for pressure ulcers in nursing homes. J Am Geriatr Soc. 2007; 55(10):1663–1669.Google Scholar
Bates-Jensen, BM, McCreath, HE, Pongquan, V. Subepidermal moisture is associated with early pressure ulcer damage in nursing home residents with dark skin tones: Pilot findings. J Wound Ostomy Continence Nurs. 2009 (May–Jun.); 36(3):277–284.Google Scholar
Gefen, A, van Nierop, B, Bader, DL, Oomens, CW. Strain-time cell-death threshold for skeletal muscle in a tissue-engineered model system for deep tissue injury. J Biomechanics. 2008; 41(9):2003–2012.Google Scholar
Coleman, S, Gorecki, C, Nelson, EA, et al. Patient risk factors for pressure ulcer development: Systematic review. Int J Nurs Stud. 2013; 50(7):974–1003.Google Scholar
Nixon, J, Cranny, G, Bond, S. Skin alterations of intact skin and risk factors associated with pressure ulcer development in surgical patients: A cohort study. Int J Nurs Stud. 2007; 44(5):655–663.Google Scholar
Halfens, RJG, Bours, GJJW, van Ast, W. Relevance of the diagnosis “stage 1 pressure ulcer”: An empirical study of the clinical course of stage 1 ulcers in acute care and long-term hospital populations. J Clin Nurs. 2001; 10(6):748–757.Google ScholarPubMed
Vanderwee, K, Grypdonck, M, Defloor, T. Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: A randomized-controlled trial. J Clin Nurs. 2007; 16(2):325–335.Google Scholar
Bates-Jensen, BM, McCreath, HE, Nakagami, G, Patlan, A. Subepidermal moisture detection of heel pressure injury: The Pressure Ulcer Detection study outcomes. International Wound Journal. 2018; 15(2):297–309.CrossRefGoogle ScholarPubMed
Langemo, DK, Brown, G. Skin fails too: Acute, chronic, and end-stage skin failure. Adv Skin Wound Care. 2006; 19(4):206–211.Google Scholar
Sibbald, RG, Krasner, DL, Lutz, J. SCALE: Skin changes at life’s end – Final consensus statement, October 1, 2009. Adv Skin Wound Care. 2010; 23(5):225–238.CrossRefGoogle Scholar
Kennedy, KL. The prevalence of pressure injuries in an intermediate care facility. Decubitus. 1989; 2(2):44–45.Google Scholar
Coleman, S, Nixon, J, Keen, J, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014; 70(10):2222–2234.Google Scholar
Coleman, S, Gorecki, C, Nelson, EA, et al. Patient risk factors for pressure ulcer development: Systematic review. Int J Nurs Stud. 2013; 50(7):974–1003.Google Scholar
Lindgren, M, Unosson, M, Fredrikson, M, Ek, AC. Immobility: A major risk factor for development of pressure injuries among adult hospitalized patients – A prospective study. Scand J Caring Sci. 2004; 18(1):57–64.CrossRefGoogle Scholar
Nixon, J, Cranny, G, Bond, S. Skin alterations of intact skin and risk factors associated with pressure ulcer development in surgical patients: A cohort study. Int J Nurs Stud. 2007; 44(5):655–663.Google Scholar
Banks, M, Bauer, J, Graves, N, Ash, S. Malnutrition and pressure ulcer risk in adults in Australian health care facilities. Nutr Clin Pract. 2010; 26(9):896–901.Google Scholar
Citty, SW, Cowan, LJ, Wingfield, Z, Stechmiller, J. Optimizing nutrition care for pressure injuries in hospitalized patients. Adv Wound Care (New Rochelle). 2019; 8(7):309–322.Google Scholar
Baumgarten, M, Rich, SE, Shardell, MD, et al. Care-related risk factors for hospital-acquired pressure ulcers in elderly adults with hip fracture. J Am Geriatr Soc. 2012; 60(2):277–283.CrossRefGoogle ScholarPubMed
Demarre, L, Verhaeghe, S, Van Hecke, A, Clays, E, Grypdonck, M, Beeckman, D. Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: Secondary analyses of a multicentre randomised controlled trial. J Adv Nurs. 2015; 71(2):391–403.Google Scholar
Dhandapani, M, Dhandapani, S, Agarwal, M, Mahapatra, AK. Pressure ulcer in patients with severe traumatic brain injury: Significant factors and association with neurological outcome. J Clin Nurs. 2014; 23(7–8):1114–1119.Google Scholar
Hatanaka, N, Yamamoto, Y, Ichihara, K, et al. A new predictive indicator for development of pressure ulcers in bedridden patients based on common laboratory tests results. J Clin Pathol. 2008; 61(4):514–518.Google Scholar
Bates-Jensen, B. Incontinence management. In: Parish, LC, Witkowski, JA, Crissey, JT, eds. The Decubitus Ulcer in Clinical Practice. Berlin: Springer-Verlag, 1997, pp. 189–199.Google Scholar
Berg, RW, Milligan, MC, Sarbaugh, FC. Association of skin wetness and pH with diaper dermatitis. Pediatr Dermatol. 1994; 11:18–20.Google Scholar
Zimmerer, RE, Lawson, KD, Calvert, CJ. The effects of wearing diapers on skin. Pediatr Dermatol. 1986; 3:95–101.Google Scholar
Cowan, L, Broderick, V, Alderden, JG. Pressure injury prevention considerations for older adults. Crit Care Nurs Clin North Am. 2020; 32(4):601–609.Google Scholar
Gazineo, D, Chiari, P, Chiarabelli, M, et al. Predictive factors for category II pressure ulcers in older patients with hip fractures: A prospective study. J Wound Care. 2019; 28(9):593–599.Google Scholar
Chiari, P, Forni, C, Guberti, M, Gazineo, D, Ronzoni, S, D’Alessandro, F. Predictive factors for pressure ulcers in an older adult population hospitalized for hip fractures: A prognostic cohort study. PLoS One. 2017; 12(1):e0169909.Google Scholar
Ranzani, OT, Simpson, ES, Japiassú, AM, Noritomi, DT; Amil Critical Care Group. The challenge of predicting pressure ulcers in critically ill patients: A multicenter cohort study. Ann Am Thorac Soc. 2016; 13(10):1775–1783.Google Scholar
Cremasco, MF, Wenzel, F, Zanei, SS, Whitaker, IY. Pressure ulcers in the intensive care unit: The relationship between nursing workload, illness severity and pressure ulcer risk. J Clin Nurs. 2013; 22(15–16):2183–2191.Google Scholar
Woelfel, S, Gibbs, KA. Academy of Clinical Electrophysiology and Wound Management white paper. “The Role of Physical Therapists in Wound Management: An Update,” 2017.Google Scholar
Lim, E, Mordiffi, Z, Chew, HSJ, Lopez, V. Using the Braden subscales to assess risk of pressure injuries in adult patients: A retrospective case-control study. Int Wound J. 2019 (Jun.); 16(3):665–673. doi: 10.1111/iwj.13078. PMID: 30734477.CrossRefGoogle ScholarPubMed
Sardo, PMG, Guedes, JAD, Alvarelhão, JJM, Machado, PAP, Melo, EMOP. Pressure ulcer incidence and Braden subscales: Retrospective cohort analysis in general wards of a Portuguese hospital. J Tissue Viability. 2018 (May); 27(2):95–100.Google Scholar
Defloor, T, DeBacquer, D, Grydonck, MH. The effects of various combinations of turning and pressure reducing devices on the incidence of pressure injuries. Int J Nurs Stud. 2005; 42(1):37–46.Google Scholar
Vanderwee, K, Grypdonck, MHF, De Bacquer, D, Defloor, T. Effectiveness of turning with unequal time intervals on the incidence of pressure ulcer lesions. J Adv Nurs. 2006; 57(1):59–68.Google Scholar
Moore, Z, Cowman, S, Conroy, RM. A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers. J Clin Nurs. 2011; 20(17–18):2633–2644.Google Scholar
Bergstrom, N, Horn, SD, Rapp, MP, Stern, A, Barrett, R, Watkiss, M. Turning for ulcer reduction: A multisite randomized clinical trial in nursing homes. J Am Geriatr Soc. 2013; 61(10):1705–1713.Google Scholar
Paulden, M, Bergstrom, N, Horn, SD, et al. Turning for Ulcer Reduction (TURN) study: An economic analysis. Ont Health Technol Assess Ser. 2014; 14(12):1–24.Google Scholar
Pechlivanoglou, P, Paulden, M, Pham, B, Wong, J, Horn, SD, Krahn, M. Turning high-risk individuals: An economic evaluation of repositioning frequency in long-term care. J Am Geriatr Soc. 2018; 66(7):1409–1414.CrossRefGoogle ScholarPubMed
Manzano, F, Colmenero, M, Pérez-Pérez, AM, et al. Comparison of two repositioning schedules for the prevention of pressure ulcers in patients on mechanical ventilation with alternating pressure air mattresses. Intensive Care Med. 2014; 40(11):1679–1687.Google Scholar
Bååth, C, Engström, M, Gunningberg, L, Muntlin Athlin, Å. Prevention of heel pressure ulcers among older patients: From ambulance care to hospital discharge – A multi-centre randomized controlled trial. Appl Nurs Res. 2016; 30:170–175.Google Scholar
Santamaria, N, Gerdtz, M, Kapp, S, Wilson, L, Gefen, A. A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. Int Wound J. 2018; 15(3):482–490.Google Scholar
Nixon, J, Cranny, G, Iglesias, C, Nelson, EA, Hawkins, K, Phillips, A, et al. Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure injuries: PRESSURE (pressure relieving support surfaces) trial. Br Med J. 2006; 332(7555):1413.Google Scholar
Nixon, J, McElvenny, D, Mason, S, Brown, J, Bond, S. A sequential randomized controlled trial comparing a dry visco-elastic polymer pad and standard operating table mattress in the prevention of post-operative pressure sores. Int J Nurs Stud. 1998; 35(4):193–203.Google Scholar
Oe, M, Sasaki, S, Shimura, T, Takaki, Y, Sanada, H. Effects of multilayer silicone foam dressings for the prevention of pressure ulcers in high-risk patients: A randomized clinical trial. Adv Wound Care (New Rochelle). 2020; 9(12):649–656.Google Scholar
Santamaria, N, Liu, W, Gerdtz, M, et al. The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: A within-trial analysis of the Border Trial. Int Wound J. 2015; 12(3):344–350.Google Scholar
Padula, WV, Chen, YH, Santamaria, N. Five-layer border dressings as part of a quality improvement bundle to prevent pressure injuries in US skilled nursing facilities and Australian nursing homes: A cost-effectiveness analysis. Int Wound J. 2019; 16(6):1263–1272.Google Scholar
Cai, JY, et al. Use of a hydrocolloid dressing in the prevention of device-related pressure ulcers during noninvasive ventilation: A meta-analysis of randomized controlled trials. Wound Manag Prev. 2019 65(2):30–38.Google Scholar
Brienza, DM, Karg, PE, Bertolet, M, et al. A randomized clinical trial of wheeled mobility for pressure injury prevention and better function. J Am Geriatr Soc. 2018; 66(9):1752–1759. doi: 10.1111/jgs.15495.CrossRefGoogle ScholarPubMed
Clever, K, Smith, G, Bowser, C, Monroe, K. Evaluating the efficacy of a uniquely delivered skin protectant and its effect on the formation of sacral/buttock pressure injuries. Ostomy Wound Manage, 2002; 48(12):60–67.Google Scholar
Bates-Jensen, BM, McCreath, HE, Harputu, D, Patlan, A. Reliability of the Bates-Jensen Wound Assessment Tool for pressure injury assessment: The pressure ulcer detection study. Wound Repair Regen. 2019 27(4):386–395.Google Scholar
Bates-Jensen, B, McNees, P. The wound intelligence system: Early issues and findings from multi-site tests. Ostomy/Wound Management Supplement. 1996; (42)7A:1–7.Google Scholar
Stechmiller, JK, Cowan, L, Whitney, JD, et al. Guidelines for the prevention of pressure injuries. Wound Rep Reg. 2008; 16:151–168.Google Scholar
Gould, L, Stuntz, M, Giovannelli, M, Ahmad, A, et al. Wound healing society 2015 update on guidelines for pressure ulcers. Wound Rep and Reg. 2016; 24:145–162.Google Scholar
Moore, ZE, Cowman, S. Wound cleansing for pressure ulcers. Cochrane Database Syst Rev. 2013; 3:CD004983. doi: 10.1002/14651858.CD004983.pub3.Google Scholar
Percival, SL, Mayer, D, Malone, M, Swanson, T, Gibson, D, Schultz, G. Surfactants and their role in wound cleansing and biofilm management. J Wound Care. 2017; 26(11):680–690. doi: 10.12968/jowc.2017.26.11.680.Google Scholar
AMDA: The Society for Post Acute and Long Term Care Medicine. Pressure Ulcers and Other Wounds in the Post-Acute and Long-Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA, 2017.Google Scholar
Souliotis, K, Kalemikerakis, I, Saridi, M, Papageorgiou, M, Kalokerinou, A. A cost and clinical effectiveness analysis among moist wound healing dressings versus traditional methods in home care patients with pressure ulcers. Wound Repair Regen. 2016; 24(3):596–601. doi: 10.1111/wrr.12433.Google Scholar
Kloeters, O, Unglaub, F, de Laat, E, van Abeelen, M, Ulrich, D. Prospective and randomised evaluation of the protease-modulating effect of oxidised regenerated cellulose/collagen matrix treatment in pressure sore ulcers. Int Wound J. 2016; 13(6):1231–1236. doi: 10.1111/iwj.12449.Google Scholar
Zeppetella, G, Ribeiro, MD. Morphine in intrasite gel applied topically to painful ulcers. J Pain Symptom Manage. 2005; 29(2):118–119. doi: 10.1016/j.jpainsymman.2004.12.006.Google Scholar
Cereda, E, Neyens, JCL, Caccialanza, R, Rondanelli, M, Schols, JMGA. Efficacy of a disease-specific nutritional support for pressure ulcer healing: A systematic review and meta-analysis. J Nutr Health Aging. 2017; 21(6):655–661.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×