Pressure Ulcers

By Lauren Lazarevski RN, BSN, CWOCN

As I contemplate the current conversation around ventilators, I am encouraged to refresh my knowledge about mucosal pressure injuries. Pressure injuries on the mucous membranes present and are staged differently from cutaneous pressure ulcers, and they are usually attributed to a medical device or tube. Nasogastric or orogastric tubes, oxygen cannulas or masks, endotracheal tubes, and urinary and fecal containment devices pose a risk of causing local ischemia to tissue in the nose, mouth, genitals, or rectum, respectively. Once a mucosal injury occurs, the patient is at increased risk of other problems, including pain, infection (especially if injury occurs to the urinary tract), and even malnutrition, if pain from oral wounds makes it difficult to eat and drink. These hospital-acquired pressure injuries contribute to the physical burden on the patient, as well as the financial burden on the hospital because they do count as a nosocomial—and usually, preventable—ulcer.

By the WoundSource Editors

The World Health Organization declared COVID-19 a pandemic on March 11, 2020. Whether you are a provider or a frontline health care professional, we are experiencing a worldwide increase in “unavoidable” medical device–related pressure injuries (MDRPIs) during the current COVID-19 pandemic. Health care workers are challenged with a higher risk of pressure injury development secondary to prolonged wear time of the N95 mask, face shield, and goggle personal protective equipment (PPE). The intensity of one or more factors of pressure, moisture, shear, and friction influence pressure injury risk.

By Kara S. Couch, MS, CRNP, CWCN-AP

Hospital-acquired pressure ulcers (HAPUs) pose a challenge for acute and post-acute care environments and are listed as hospital-acquired conditions (HACs) by the Centers for Medicare & Medicaid Services (CMS). Other HACs include central line–associated blood stream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Although CLABSIs and CAUTIs have seen a decrease in prevalence over the past decade, the HAPU is the only HAC that has not. In my recent WoundSource webinar, I discussed the topic of building a pressure ulcer prevention program within hospitals. The webinar is still available for viewing on WoundSource.com.

By Heidi Cross, MSN, RN, FNP-BC, CWON

"It was the best of times, it was the worst of times." – Charles Dicken

When Charles Dickens wrote this introduction to his Victorian-era novel, A Tale of Two Cities, his novel was aimed at the brewing French Revolution, but he could have been writing about the best and worst of modern American health care. His novels depicted how life could be pretty miserable during those times, with no social safety net and no real medical care. Fortunately, times have changed, and we have improved social supports as well as, some would argue, the best health care system in the world (although, sadly, not all people in the United States enjoy access to our great health care system, but I digress).

By the WoundSource Editors

Ulcers in the lower extremities are more common in patients older than 65. Ulcerative wound types include venous, arterial, diabetic neuropathic, and pressure. To identify ulcer types, these wounds should be examined thoroughly for their distinct characteristics such as location and shape, as well as in conjunction with other patient information, to ensure an accurate diagnosis and treatment plan.

By Holly M. Hovan MSN, RN-BC, APRN.ACNS-BC, CWOCN-AP

Often when we hear the words "pressure injury," our brains are trained to think about staging the wound, considering treatment options, and obtaining a provider's order for care. Ideally, when we hear the words "pressure injury," we should think prevention! As Benjamin Franklin once said, "an ounce of prevention is worth a pound of cure." This is a very true statement and speaks volumes to our goals of care and education format when developing pressure injury prevention curriculum for our facilities.

By the WoundSource Editors

Pressure injuries represent a great challenge in patient care, as well as a significant burden on the health care system. This burden is likely to continue to increase as a result of the growing geriatric population, along with the increasing rates of obesity, diabetes, and cardiovascular disease. Recent estimates in the United States show annual costs of pressure injury treatment to be approximately $9.1 to $11.6 billion. In addition to cost, these localized injuries to the skin are often very painful for patients, particularly as the injuries become more severe.

By the WoundSource Editors

Pressure injuries require complex care. They can be incredibly painful for patients, and they represent an enormous financial burden on the health care system. Nationally, pressure ulcers cost between approximately $9.1 and $11.6 billion annually to treat. A subset of these patients includes those who are particularly prone to developing pressure ulcers as a result of comorbid conditions. This subset includes patients who may have cognitive disabilities, those who have a spinal injury or have undergone an amputation, and bariatric patients.

By the WoundSource Editors

Pressure injuries are a significant risk for patients and pose a tremendous clinical challenge to medical providers. Serious pressure injuries can present a substantial threat to patients' survival when comorbidities are present, and even less serious pressure injuries can negatively affect a patient's comfort and well-being. Although some pressure injuries are unavoidable, best practices in patient skin care can greatly reduce the risk in many circumstances, with some research demonstrating that up to 95% of pressure injuries are preventable.

By the WoundSource Editors

With aging populations facing increasingly complex comorbid medical conditions coupled with polypharmacy and multidrug-resistant organisms, wound healing can often feel like an uphill, never-ending battle. There are often elements that cannot be allayed, and some factors will always be outside the control of the patient and the practitioner. Barriers that can be eliminated should be, but sometimes compliance is a concern.