A Cross-sectional Descriptive Study of Pressure Ulcer Prevalence in a Teaching Hospital in China
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For ulcer staging, the 1989 NPUAP25 staging system was used where a Stage I ulcer was described as nonblanchable erythema of intact skin, Stage II involves the epidermis and possibly the dermal skin layers, Stage III extends into subcutaneous tissue layer, and Stage IV includes full-thickness skin loss with damage to muscle and possibly bone; when black eschar is present in the wound bed, the ulcer cannot be accurately staged and is labeled “unstageable”.24 The stage deep tissue injury was not used in this audit.
Procedures. The study was approved by the hospital ethical committee; before skin inspection, the patient or family member (if the patient could not communicate) was asked to provide oral informed consent. Patient identifying data were not collected. The data were collected by trained personnel, including hospital wound care clinicians, supervisors, head nurses, and graduate students. In total, 30 teams (each two-person team responsible for one to four units based on patient census) covering 61 units were assigned to collect the data.
Data collectors received 2 hours of training regarding the purpose of the audit, the data collection instrument, and specific instrument details such as proposed steps in the audit and PU definitions and staging. At the end of instruction, the trainees were asked to identify the stage of an ulcer from a picture provided by the instructor and were provided a question-and-answer opportunity. A session also was conducted on each unit level to explain the project and to enable data collectors to request assistance and cooperation in the activity. Head nurses were assured the results would not be taken as quality judgment.
Data collection was conducted and completed the morning after the training (March 10, 2009). Data collectors reviewed charts for patient demographic data and PU risk assessment and score and inspected each patient’s skin at bedside. During the data collection procedures, two leaders from the nursing department visited the units to ensure the plan was properly implemented, answer questions, and provide support when necessary.
Data analysis. All data were entered into Microsoft Excel spreadsheets and converted into SPSS 12.0 (Chicago, IL) by two research assistants. For descriptive purposes, means, standard deviation, and percentages were used. A t-test was used to compare the age of patients with and without PU and a chi-squared test was used to compare PU rates by Norton risk score (≤14 or >14).
Patient characteristics. On the morning of the study, there were 3,010 inpatients and audits of 2,913 (96.7%) were completed. The majority of the patients (1,648, 56.6％) were male; 1,265 (43.4%) were female. Average patient age was 43.91 (±21.20) years, range 1 to 94 years. The average age of persons with a PU (n = 52) was 63.48 (± 19.49) years and the average age of patients without a PU (n = 2,861) was 43.56 (± 21.06) (t = 7.369, P <0.001).
Pressure ulcer prevalence. Of the 2,913 patients audited, 52 had 79 PU for an overall point-prevalence of 1.8%. The nosocomial PU prevalence rate was 1.54%; the ulcers of seven patients were present on admission. Patients with PU were identified in 18 of 61 nursing units — the ICU had the highest prevalence rate (5 of 11, 45.5%), followed by the neurological (7 of 99, 7.1%), and geriatric units (12 of 176, 6.8%). No PU were found in patients under 18 years old. Nurses assessed risk of developing PU among 168 patients on admission using the Norton scale and found 95 patients considered as at risk (score ≤14) for PU development. The prevalence of PU among patients assessed as being at risk was 29.5% compared to 0.6% for patients not assessed as being at risk or whose chart did not contain a risk assessment (P <0.001) (see Table 1).
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