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These guidelines provide an easy-to-follow format for patients and their families to be active in preventing pressure ulcers. The definition of pressure ulcers, where they form, and risk factors are described. Key steps in prevention of each risk factor and care to be expected for each risk factor are presented along with additional resources.

The purpose of this study was to compare the clinical outcomes of pressure ulcers treated on a low-air loss bed and a foam mattress with loose-fitting top cover. The two-group, non-randomized study design consisted of a convenience sample of 20 subjects: 10 subjects treated on the low-air loss bed and 10 subjects treated on the foam mattress with loose-fitting top cover. Subjects were selected from among patients located in the medical/surgical, critical care, and the skilled nursing units of a metropolitan public teaching hospital. Descriptive data, laboratory data, pressure ulcer transparency drawing, and pressure ulcer photographs were obtained on each subject every seven days from two to four weeks. A one-way analysis of variance indicated that there was no statistically significant difference in the pressure ulcer outcomes of subjects treated on the low-air loss bed (Mediscus) compared to the pressure ulcer outcomes of subjects treated on the foam mattress with loose-fitting top cover (Comfortex). Analysis of covariance further indicated no statistically significant difference in the pressure ulcer outcome of subjects treated on either pressure-relieving surface according to the subjects': a) age, percent ideal body weight, presence of pressure ulcer infection; b) leukocyte count, total lymphocyte count, and albumin level; and c) level of sensory perception, moisture, activity, mobility, nutrition, friction, and shear. Results from this study indicate that the low-air loss bed and foam mattress with loose-fitting top cover provide comparable pressure ulcer outcomes. Implications for nursing and recommendations for further study are included in the text.

The purpose of this study was to evaluate the effect of a preferential shift toward increased use of muscle flap coverage for surgically treated Stage IV pelvic pressure ulcers. Patients treated from 1979-1990 were studied since 1979. Muscle flap use increased from 57% to 100% of surgically treated cases. Over this same period the number of operations per ulcer declined from 1.9 to 1.1 and the time to complete healing dropped from 12.8 to 4.8 weeks. While other factors (including advances in supportive care) have also played a role, increasing use and familiarity with muscle flap has been largely responsible for these improvements.

Pressure ulcer prevention and maintenance strategies at a 650-bed tertiary care hospital with a high risk population of patients have resulted in a low prevalence of pressure ulcers (3% to 5%). The steps in achieving a reduction in pressure ulcers were: 1) identification of high risk patients in the institution; 2) updating of knowledge through literature review and attendance at conferences; 3) adoption of a risk assessment scale; 4) standardization of protocols concerning pressure reducing support surfaces, nutritional support, and incontinence strategies; and 5) periodic audits for continuous quality management. This portrait of practice may be similar to other hospitals throughout the country. The future pressure ulcer projects will be enhanced by the recent establishment of an Institute of Nursing Research and Education.

A survey of 788 patients on a specialty support surface, Pegasus Airwave System, in 119 hospitals or hospices in the United Kingdom during February and March 1991 provided the largest database on the current pattern of use of any pressure-relieving mattress. Fifty-four percent (n = 428) of the patients had established pressure ulcers. Seventy-nine percent (n = 261) of the patients on the specialty support surface for longer than five days showed visible signs of improvement. Nurses and patients expressed satisfaction with the support surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Pressure ulcer management is an increasingly serious problem for the healthcare industry. It is necessary for acute care facilities to examine the benefits of developing a comprehensive skin care protocol for pressure ulcer management. Increased and continuous staff awareness produces quality patient care and cost effectiveness. The description of the development, use, and auditing of a skin care protocol by Western Reserve Care System is representative of many institutions across the country.