Prevalence and Incidence Studies of Pressure Ulcers in Two Long-Term Care Facilities in Canada
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Index: Ostomy Wound Manage 2001;47(11):28–34
Prevalence is a cross-sectional count of the number of cases of a medical condition at a specific point in time. Incidence is the number of new cases occurring over a given time period. A prevalence and incidence study is a combination of two studies that, when done consecutively, provides a facility with key statistics on patients with an existing medical condition and on those who acquire that condition during their stay.
Wide variation exists in the prevalence and incidence rates of pressure ulcers reported in the medical and nursing literature. The reasons for the variation in the rates are multiple; they include differences in the population of patients studied, differences in data collection and study methodology, and differences in the quality of care provided. Data collected from patients in tertiary care hospitals may not be comparable with data from residents in long-term care facilities (LTCFs).
The prevalence of pressure ulcers in the hospital setting ranges from 3.5% to 29.5%.1-5 The fourth National Pressure Ulcer Prevalence Survey recorded an overall prevalence of 10.1% (range 1.4% to 30.4%) in acute care hospitals. The authors noted that the prevalence had remained relatively constant throughout the four surveys that had been completed.5 However, other studies on hospital subpopulations have shown much higher prevalence rates for pressure ulcers that were as high as 60% in quadriplegic patients.6 Among people in long-term care settings, the prevalence of pressure ulcers ranges from 2.4% to 28%.7-12
The incidence of pressure ulcers in the hospital setting ranges from 2.7% to 29.5%.13-15 Higher incidence rates have been found in hospital subpopulations, such as elderly patients with femoral fractures where a 66% incidence was present.16 The incidence of pressure ulcers in the long-term care setting ranges from 4% to 24%.8,12,17-19 In a summary of data from studies of pressure ulcers in nursing homes, the incidence of pressure ulcers over a 4-week follow-up ranged from 10.8% to 13.3% for Stage II and greater ulcers, and rose to 28% when Stage I ulcers were included.11
Pressure ulcers predominate in the long-term care setting.20 Residents of LTCFs have high risk factors for developing pressure ulcers, such as decreased mobility, advanced age, decreased activity, malnutrition, and chronic medical conditions. The prevalence and incidence of pressure ulcers in LTCFs vary from one facility to another because of differences in staffing and case mix. A survey of pressure ulcers in Finland concluded that a lower educational level of healthcare personnel and a decrease in staff members were associated with an increased occurrence of pressure ulcers.20 Likewise, in a study on the occurrence of pressure ulcers in three nursing homes, the authors hypothesized that the interfacility differences in prevalence and incidence were probably due to differences in staffing patterns.12
Scant information is available in the medical literature regarding the prevalence and incidence of pressure ulcers in residents of LTCFs in Canada. One Canadian study found the overall prevalence of pressure ulcer in eight separate institutions to be 25.7%.21 This study included two LTCFs, but the prevalence of pressure ulcers in these individual facilities was not given.