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ALFadhalah T, Lari M, Al Salem G, Ali S, Al Kharji H, Elamir H. Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study. BMC Health Serv Res 2024; 24:173. [PMID: 38326902 PMCID: PMC10851550 DOI: 10.1186/s12913-024-10615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals. METHODS A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis. RESULTS The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied. CONCLUSIONS The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.
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Affiliation(s)
- Talal ALFadhalah
- Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Marjan Lari
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Gheed Al Salem
- Accreditation Affairs Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Shaimaa Ali
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hamad Al Kharji
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hossam Elamir
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait.
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Liu S, Ostadabbas S. Pressure eye: In-bed contact pressure estimation via contact-less imaging. Med Image Anal 2023; 87:102835. [PMID: 37150066 DOI: 10.1016/j.media.2023.102835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 06/03/2022] [Accepted: 04/21/2023] [Indexed: 05/09/2023]
Abstract
Computer vision has achieved great success in interpreting semantic meanings from images, yet estimating underlying (non-visual) physical properties of an object is often limited to their bulk values rather than reconstructing a dense map. In this work, we present our pressure eye (PEye) approach to estimate contact pressure between a human body and the surface she is lying on with high resolution from vision signals directly. PEye approach could ultimately enable the prediction and early detection of pressure ulcers in bed-bound patients, that currently depends on the use of expensive pressure mats. Our PEye network is configured in a dual encoding shared decoding form to fuse visual cues and some relevant physical parameters in order to reconstruct high resolution pressure maps (PMs). We also present a pixel-wise resampling approach based on Naive Bayes assumption to further enhance the PM regression performance. A percentage of correct sensing (PCS) tailored for sensing estimation accuracy evaluation is also proposed which provides another perspective for performance evaluation under varying error tolerances. We tested our approach via a series of extensive experiments using multimodal sensing technologies to collect data from 102 subjects while lying on a bed. The individual's high resolution contact pressure data could be estimated from their RGB or long wavelength infrared (LWIR) images with 91.8% and 91.2% estimation accuracies in PCSefs0.1 criteria, superior to state-of-the-art methods in the related image regression/translation tasks.
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Affiliation(s)
- Shuangjun Liu
- Augmented Cognition Lab, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Sarah Ostadabbas
- Augmented Cognition Lab, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA.
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Pietrangelo L, Magnifico I, Guerrera A, Cutuli MA, Petronio GP, Venditti N, Covelli M, Buccieri N, Garofalo S, Di Marco R. LimpiAD foam and the potential control of the pressure ulcers onset. Biomed Pharmacother 2021; 144:112327. [PMID: 34653756 DOI: 10.1016/j.biopha.2021.112327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022] Open
Abstract
Pressure ulcers development is an undesirable event that often worsens the clinical condition of patients already affected by severe pathologies. Since the aetiology of this clinical complication is unclear yet, at current the primary approach to treat the problem is the adoption of suitable patients' assistance procedures. At the same time, the research focuses on finding medicaments or treatment strategies that could prevent the lesions and/or accelerate their healing. The international market's wide range of cosmetic/pharmaceuticals products is mainly topical preparations based on emollient agents to preserve or restore skin homeostasis. On the other hand, the skin microbiome's implication in the pressure ulcers occurrence is mainly unknown. Based on these assumptions, here we tested an innovative preparation, the LimpiAD foam, as a potential preventive strategy of pressure ulcers onset. The active component of this product is composed of hyaluronic acid conjugated with a bacterial cell wall fragment of C. acnes DSM 28251. For LimpiAD foam, we hypothesised a combined action of the two components on the skin tissue, an emollient effect due to the hyaluronic acid properties together with a modulatory effect on the skin microbiota carried out by the component of bacterial derivation. Our results supported the hypothesis and suggested a potential role of LimpiAD foam in pressure ulcers prevention.
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Affiliation(s)
- Laura Pietrangelo
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute "V. Tiberio", Campobasso, Italy.
| | - Irene Magnifico
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute "V. Tiberio", Campobasso, Italy.
| | - Antonella Guerrera
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute "V. Tiberio", Campobasso, Italy.
| | - Marco Alfio Cutuli
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute "V. Tiberio", Campobasso, Italy.
| | - Giulio Petronio Petronio
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute "V. Tiberio", Campobasso, Italy.
| | - Noemi Venditti
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute "V. Tiberio", Campobasso, Italy.
| | - Matteo Covelli
- Gea Medica srl, Istituto Europeo di Riabilitazione, Isernia, Italy.
| | | | - Silvio Garofalo
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute "V. Tiberio", Campobasso, Italy; UOC Laboratorio Analisi P.O. "A. Cardarelli", Campobasso, Italy.
| | - Roberto Di Marco
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute "V. Tiberio", Campobasso, Italy.
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Ibarra G, Rivera A, Fernandez-Ibarburu B, Lorca-García C, Garcia-Ruano A. Prone position pressure sores in the COVID-19 pandemic: The Madrid experience. J Plast Reconstr Aesthet Surg 2021; 74:2141-2148. [PMID: 33446462 PMCID: PMC7837206 DOI: 10.1016/j.bjps.2020.12.057] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/28/2020] [Accepted: 12/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the context of the COVID-19 pandemic, prone position (PP) has been frequently used in the intensive care units to improve the prognosis in patients with respiratory distress. However, turning patients to prone imply important complications such as pressure ulcers. The aim of this paper is to describe the prevalence and characteristics of prone-positioning pressure sores (PPPS) and analyze the related risk factors. METHODS A case-control study was performed in Gregorio Maranon hospital in Madrid during the COVID-19 pandemic between April and May 2020. We enrolled 74 confirmed COVID-19 patients in critical care units with invasive mechanical ventilation who were treated with pronation therapy. There were 57 cases and 17 controls. Demographic data, pronation maneuver characteristics and PPPS features were analyzed. RESULTS In the case group, a total number of 136 PPPS were recorded. The face was the most affected region (69%). Regarding the severity, stage II was the most frequent. The main variables associated with an increased risk of PPPS were the total number of days under pronation cycles, and PP maintained for more than 24 h. The prealbumin level at admission was significantly lower in the case group. All of the ulcers were treated with dressings. The most frequent acute complication was bleeding (5%). CONCLUSIONS According to our study, PPPS are related to the characteristics of the maneuver and the previous nutritional state. The implementation of improved positioning protocols may enhance results in critical patient caring, to avoid the scars and social stigma that these injuries entail.
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Affiliation(s)
- Gorka Ibarra
- Department of Plastic Surgery, Hospital Universitario Gregorio Marañón, Madrid Spain.
| | - Andres Rivera
- Department of Plastic Surgery, Hospital Universitario Gregorio Marañón, Madrid Spain
| | | | - Concepción Lorca-García
- Department of Pediatric Plastic Surgery, Hospital Universitario Gregorio Marañón, Madrid Spain
| | - Angela Garcia-Ruano
- Department of Plastic Surgery, Hospital Universitario Gregorio Marañón, Madrid Spain
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Sheir MM, Nasra MMA, Abdallah OY. Chitosan alginate nanoparticles as a platform for the treatment of diabetic and non-diabetic pressure ulcers: Formulation and in vitro/in vivo evaluation. Int J Pharm 2021; 607:120963. [PMID: 34363919 DOI: 10.1016/j.ijpharm.2021.120963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Chitosan and alginate are natural bioactive polymers with wound healing properties, in addition to chitosan's anti-bacterial properties. In this study, these two polymers were combined in a drug-free nanosystem with positive or negative surface charges, for the treatment of non-diabetic and diabetic pressure ulcers. Chitosan alginate nanoparticles (CA NPs) were prepared by a modified ionic gelation method. Interaction between the polymers and formation of the NPs were confirmed by Fourier-Transform infrared spectroscopy, differential scanning calorimetry and transmission electron microscopy. For in vivo study, selected CA NPs with optimum particle size, polydispersity index, positive and negative zeta potential, were evaluated for their pressure ulcers-healing effect using non-diabetic and diabetic rats. Rate of wound closure, histological examination and histomorphometric assessment were used to evaluate the CA NPs' wound healing potential. Positively and negatively charged CA NPs significantly enhanced wound closure rates, compared to control untreated group. Histological and histomorphometric analysis revealed higher quality and maturation of the formed granulation tissue, less inflammation and higher collagen content with positively charged CA NPs containing higher amount of chitosan. These results suggest that chitosan alginate nanoparticles offer a promising platform for diabetic and non-diabetic wound healing applications.
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Affiliation(s)
- Marwa M Sheir
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
| | - Maha M A Nasra
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Ossama Y Abdallah
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Cortés OL, Herrera-Galindo M, Villar JC, Rojas YA, Del Pilar Paipa M, Salazar L. Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial. BMC Nurs 2021; 20:121. [PMID: 34225724 PMCID: PMC8256643 DOI: 10.1186/s12912-021-00616-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being considered preventable, ulcers due to pressure affect between 30 and 50% of patients at high and very high risk and susceptibility, especially those hospitalized under critical care. Despite a lack of evidence over the efficacy in prevention against ulcers due to pressure, hourly repositioning in critical care as an intervention is used with more or less frequency to alleviate pressure on patients' tissues. This brings up the objective of our study, which is to evaluate the efficacy in prevention of ulcers due to pressure acquired during hospitalization, specifically regarding two frequency levels of repositioning or manual posture switching in adults hospitalized in different intensive care units in different Colombian hospitals. METHODS A nurse-applied cluster randomized controlled trial of parallel groups (two branches), in which 22 eligible ICUs (each consisting of 150 patients), will be randomized to a high-frequency level repositioning intervention or to a conventional care (control group). Patients will be followed until their exit from each cluster. The primary result of this study is originated by regarding pressure ulcers using clusters (number of first ulcers per patient, at the early stage of progression, first one acquired after admission for 1000 days). The secondary results include evaluating the risk index on the patients' level (Hazard ratio, 95% IC) and a description of repositioning complications. Two interim analyses will be performed through the course of this study. A statistical difference between the groups < 0.05 in the main outcome, the progression of ulcers due to pressure (best or worst outcome in the experimental group), will determine whether the study should be put to a halt/determine the termination of the study. CONCLUSION This study is innovative in its use of clusters to advance knowledge of the impact of repositioning as a prevention strategy against the appearance of ulcers caused by pressure in critical care patients. The resulting recommendations of this study can be used for future clinical practice guidelines in prevention and safety for patients at risk. TRIAL REGISTRATION PENFUP phase-2 was Registered in Clinicaltrials.gov ( NCT04604665 ) in October 2020.
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Affiliation(s)
- Olga L Cortés
- Research Unit & Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Cl. 163a #13B-60, Bogotá D. C, Colombia.
| | - Mauricio Herrera-Galindo
- Faculty of Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia, Avenida 42 No 48-11PBX
| | - Juan Carlos Villar
- Faculty of Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia, Avenida 42 No 48-11PBX
| | - Yudi A Rojas
- Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá D. C, Cl. 163a #13B-60, Colombia
| | - María Del Pilar Paipa
- Intensive Care Units, Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá D. C, Cl. 163a #13B-60, Colombia
| | - Luzdary Salazar
- Ambulatory Nursing Department, Fundación Cardioisnfantil-Instituto de Cardiología, Bogotá D. C, Cl. 163a #13B-60, Colombia
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Zanini C, Brach M, Lustenberger N, Scheel-Sailer A, Koch HG, Stucki G, Rubinelli S. Engaging in the prevention of pressure injuries in spinal cord injury: A qualitative study of community-dwelling individuals' different styles of prevention in Switzerland. J Spinal Cord Med 2020; 43:247-256. [PMID: 30540555 PMCID: PMC7054934 DOI: 10.1080/10790268.2018.1543094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Context: Spinal cord injury (SCI) is a complex chronic condition with multiple self-management requirements and a high prevalence of complications. Pressure injuries (PIs) are among the most common ones and represent a frequent reason for re-hospitalization. This study aimed to identify styles of prevention that individuals with SCI adopt to deal with the risk of developing PIs.Design: Qualitative explorative interview study. Data was collected through semi-structured interviews, which were transcribed verbatim and analyzed following the principles of thematic analysis.Setting: Switzerland.Participants: The participants were a purposive sample of community-dwelling Swiss residents with SCI for at least five years.Interventions: Not applicable.Outcome measures: Not applicable.Results: Although all participants (N = 20) showed at least a basic knowledge of prevention of PIs by describing some preventive measures, they had different prevention styles characterized by different behavioral patterns (i.e. complying with all recommended measures, performing only a selection of them or delegating them to others) and different beliefs and attitudes towards prevention.Conclusion: By identifying the style of prevention of an individual, it is possible to develop tailored interventions that have an impact on the factors which seem to play a role in determining the adoption of preventive behaviors (i.e. perceived susceptibility to PIs, attitudes towards prevention, and self-efficacy). Such interventions would constitute a concrete effort to support individuals with SCI during their self-management. Besides alleviating a frequent and disabling medical complication and contributing to an enhanced quality of life, these interventions might also help decrease healthcare costs.
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Affiliation(s)
- Claudia Zanini
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Mirjam Brach
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | | | | | | | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
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Nayak D, Srinivasan K, Jagdish S, Rattan R, Chatram VS. Bedsores: "top to bottom" and "bottom to top". Indian J Surg 2008; 70:161-8. [PMID: 23133050 PMCID: PMC3452776 DOI: 10.1007/s12262-008-0046-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 11/26/2022] Open
Abstract
Bedsore is a global problem concerning the bedridden, infirm, debilitated and malnourished patients in hospitals and community setups. The cost of treatment is enormous involving billions of dollars to nations and individuals. Mortality increases two to six times if bedsores are present. There is little research done despite its commonness to understand how they occur or why they occur; etiology is not much understood. The two theories called 'top to bottom' and 'bottom to top' contradict each other. It is thought that 'pressure', shear-stress' and 'ischemia' may be causing it in some yet to be understood way.There is little awareness on how to prevent them or how to treat them if they do occur. Seldom applied, various scales exist and should be used to identify patients at high risk. Braden scale is the most tested and widely accepted scale. The various available dressings and pressure relief devices are mostly inadequately studied; which is superior is a question that begs an answer. This article aims to underline the importance of bedsores by reviewing our current and past knowledge with emphasis on practical implications thereof.
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Affiliation(s)
- Debashish Nayak
- Department of Surgery, Jawarharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | - K. Srinivasan
- Department of Surgery, Jawarharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | - Sadasivan Jagdish
- Department of Surgery, Jawarharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | - Roma Rattan
- Department of Surgery, Jawarharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | - Vinayaka S. Chatram
- Department of Surgery, Shri Lakshminarayana Institute of Medical Sciences (SLIMS), Pondicherry, India
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