Barra laterale dell'articolo

Scarica
Abbonamento o quota di accesso PDF (EUR 5)
Statistica
Leggi contatore : 1428 Scarica : 35

Contenuto dell'articolo principale

Abstract

OBIETTIVO: Il presente studio ha l'obiettivo di determinare la prevalenza e l'incidenza delle ulcere da pressione (PUs) in una struttura ospedaliera universitaria del centro Italia. 

METODI: E'stato effettuato uno studio di prevalenza e di incidenza sulle ulcere da pressione al momento del ricovero e dopo 10 giorni. I dati sono stati elaborati per statistica descrittiva, attraverso il test del Chi quadrato e un' analisi multivariata. 

RISULTATI. I due dati di prevalenza ottenuti delle PUs erano rispettivamente del 6,5% e di 9,9% dieci giorni dopo (follow-up). La prevalenza delle PUs differisce all'aumentare dell'etí  (p=0,004) e rispetto all'area di degenza di ricovero dei pazienti (p= 0,002). L'incidenza delle PUs dopo dieci giorni dal ricovero è stata del 3,6%. L'area medica si caratterizza per un numero maggiore di lesioni rispetto all'area chirurgica e intensiva. Dai risultati, è stato evidenziato un rapporto significativo tra aumentato rischio (Braden <16) e la presenza di PUs con un OR di 1,40 (95% CI 1,03-1,62) in soggetti ad alto rischio (Braden <12) e un OR di 1,61 (95% CI 1,06-2,42) in soggetti ad altissimo rischio (Braden 13-16). Le sedi maggiormente rappresentate sono sacro, tallone e malleoli. Limitata la documentazione dei piani di prevenzione, in particolare per quanto concerne la mobilizzazione. 

CONCLUSIONI. Tali dati non permettono di comprendere l'utilizzo e l'aderenza ai piani di prevenzione gií  da tempo diffusi in tutte le UU.OO. Risulta ancora carente l'atteggiamento a utilizzare strumenti utili sia a identificare il rischio di ulcera, sia a documentare i piani di mobilizzazione. Sarebbe auspicabile un monitoraggio in tempi successivi per comprendere eventuali tassi di prevalenza e incidenza . 

PAROLE CHIAVE: Ulcere da pressione, Prevalenza, Incidenza, Infermieristica 


A cross-sectional study on the prevalence and incidence of pressure ulcers in an Italian University Hospital–Umbria Region

OBJECTIVE: The aim of the present study was to assess the prevalence and incidence of pressure ulcers (PUs) in patients hospitalized in a University Hospital in central Italy. 

METHODS: We carried out a prevalence and incidence study on PUs and an additional prevalence estimate of PUs was also produced ten days after the first assessment. All data were explored by descriptive statistics, the Chi-square test and a multivariate analysis. 

RESULTS: The prevalence of pressure ulcers was of 6,5%, while it increased to 9,9% at the second assessment ten days after the first measurement. Prevalence was statistically significant and increased with the age of inpatients (p=0,004) and was correlated to the origin of the patients (p=0,002). The incidence of PUs ten days after hospital admittance was of 3,6%. Ulcers are more frequently observed in the general medicine rather than in the surgery and intensive care units. Results showed that there exists a meaningful relationship between increased risk (Braden <16) and the presence of PUs, with an OR of 1,40 (95% CI 1,03-1,62) in high risk patients (Braden <12) and with an OR of 1,61 (95% CI 1,06-2,42) in very high or prohibitive risk patients (Braden 13-16). The most affected areas are the sacrum, the heels and the ankles. Mobilization plans were scarcely available, or do not described. 

CONCLUSIONS: The obtained data confirmed the difficulty to measure whether PU prevention practices are being carried out in compliance with the set guidelines presently in use in all the University Hospital Units. There is still a very limited use of available risk assessment tools for predicting PU risk and mobilization plans are still poorly documented. A monitoring and follow-up strategy should be implemented to better understand prevalence and incidence rates. 

KEY WORDS: Pressure Ulcer, Prevalence, Incidence, Nursing 


Dettagli dell'articolo

Come citare
Mitello, L., Salvatore, S., Falchetti Ballerani, V., Bianco, M. A., Perugini, D., Sabatini, P., Luciani, C. P., & Latina, R. (2020). Prevalenza e incidenza delle ulcere da pressione in Italia: studio trasversale in un’Azienda Ospedaliera-Universitaria dell’Umbria. PROFESSIONI INFERMIERISTICHE, 73(1). Recuperato da https://www.profinf.net/pro3/index.php/IN/article/view/738
Scarica citazione
Endnote/Zotero/Mendeley (RIS)
BibTeX

Riferimenti

  • Alja'afreh, M., & Mosleh, S. M. (2013). Pressure ulcers in Jordan: a snapshot survey of a tertiary public hospital. British Journal of Nursing, 22(Sup15), S10-S16.
  • Artico, M., D'Angelo, D., Piredda, M., Petitti, T., Lamarca, L., De Marinis, M. G., ... & Matarese, M. (2018). Pressure injury progression and factors associated with different end-points in a home palliative care setting: a retrospective chart review study. Journal of Pain and Symptom Management, 56(1), 23-32. pii: S0885-3924(18)30136-2. DOI: 10.1016/j .jpainsymman.2018.03.011.
  • Aygí¶r, H.E., Sahin, S., Sí¶zen, E., Baydal, B., Aykar, F.S., & Akí§ií§ek, F. (2014). Features of pressure ulcers in hospitalized older adults., 27(3):122-6. DOI: 10.1097/01.ASW. 0000442874.86708.5e.
  • Baumgarten, M., Margolis, D.J., Localio, A.R., Kagan, S.H., Lowe, R.A., Kinosian ,B., Holmes, J.H., Abbuhl, S.B., Kavesh, W., & Ruffin, A. (2006). Pressure ulce1rs among elderly patients early in the hospital stay. The journals of gerontology, Series A, Biological sciences and medical sciences, 61(7):749-54.
  • Becker, D., Tozo, T.C., Batista, S.S., Mattos, A.L., Silva, M.C.B., Rigon, S., Laynes, R.L., Salomí£o, E.C., Hubner, K.D.G., Sorbara, S.G.B., & Duarte, P.A.D.(2017). Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil. , pii: S0964-3397(16)30124-0. DOI: 10.1016/j.iccn.2017.03.009
  • Bermark, S. (2010). Six prevalence studies for pressure ulcers. EWMA Journal,10(2):36-44.
  • Capon, A., Pavoni, N., Mastromattei, A., & Di Lallo, D. (2007). Pressure ulcer risk in long-term units: prevalence and associated factors. Journal of Advanced Nursing, 58(3), 263–272. DOI: 10.1111/j.1365-2648.2007.04232.x
  • Cittadinanza attiva (2016). Presentato il rapporto "Servizio sanitario nazionale: accesso di lusso". Accessed 06 June 2020. Retrieved from: http://www.forumterzosettore .it/2016/12/15/ cittadinanzattiva-presentato-il-rapporto-servizio-sanitario-nazionale-accesso-di-lusso/.
  • Chen,Y.T., Chang, C.C., Shen, J.H., Lin, W.N., & Chen, M.Y.(2015). Demonstrating a conceptual framework to provide efficient wound management service for a wound care center in a tertiary hospital. Medicine (Baltimore), 94:44. DOI: 10.1097/MD. 0000000000001962
  • Clark,M., Bours, G., & Defloor, T. (2002). Summary report on the prevalence of pressure ulcers. EPUAP Review, 4:49–57.
  • Cuddigan, J., Berlowitz, D., & Ayello, E.(2001). Pressure ulcers in America: prevalence, incidence, and implications for the future. An executive summary of the National Pressure Ulcer Advisory Panel monograph. Advances in Skin and Wound Care, 14 (4) 208–215.
  • Cullum, N., McInnes, E., Bell-Syer, S.E.M., & Legood, R. (2004). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, 3, CD001735. DOI: 10.1002/14651858.CD001735 .pub2
  • Donini, L.M., De Felice, M.R., Tagliaccica, A., De Bernardini, L., & Cannella, C. (2005). Nutritional status and evolution of pressure sores in geriatric patients. , 9(6):446-54.
  • D'Angelo, D., Punziano, A. C., Mastroianni, C., Marzi, A., Latina, R., Ghezzi, V., Piredda, M., & De Marinis, M. G. (2017). Translation and Testing of the Italian Version of FAMCARE-2: Measuring Family Caregivers' Satisfaction With Palliative Care. Journal of Family Nursing, 23(2), 252–272. https://doi.org/10.1177/1074840717697538
  • European Pressure Ulcer Advisory Panel (EPUAP). (1998). Pressure ulcer prevention guidelines. EPUAP Review, 1: 7–8.
  • European Pressure Ulcer Advisory Panel (EPUAP). (2001). Pressure Ulcer Risk Assessment: A drat EPUAP position statement. EPUAP Review, 3: 46-52.
  • Fiorini, J., Venturini, G., Scotti, G., Cresta, R., Latina, R., & Sili, A. (2016). Wound Care Management: impact on outcomes of nursing care.Professioni Infermieristiche, 69(4):214-224. DOI: 10.7429pi.2016.694224
  • Gethin, G., Jordan-O'Brien, J., & Moore, Z. (2005). Estimating costs of pressure area management based on a survey of ulcer care in one Irish hospital. Journal of Wound care, 14: 4, 162-165. DOI: 10.12968/jowc.2005.14.4.2675
  • Graves, N., Birrell, F., & Whitby, M. (2005). Effect of pressure ulcers on length of hospital stay. Infection Control & Hospital Epidemiology, 26(3):293-7. DOI: 10.1086/502542.
  • Gunningberg, L. (2004). Risk, prevalence and prevention of pressure ulcers in three Swedish healthcare settings. Journal of Wound Care, 13, 286–290. DOI: 10.12968 /jowc.2004.13.7.26638
  • Gunningberg, L. (2005). Are patients with or at risk of pressure ulcers allocated appropriate prevention measures?. International Journal of Nursing Practice,11(2):58-67. DOI: 10.1111/j.1440-172X.2005.00503.x
  • Haalboom JR. (1998) Pressure ulcers. The Lancet; 352(9127):581.
  • Halfens, R.J., Bours, G.J., & Bronner, C.M. (2001). The impact of assessing the prevalence of pressure ulcers on the willingness of healt care institutions to plan and implement activities to reduce the prevalence. Journal of Advanced Nursing, 36(5):617-25.
  • Iannone, P., Coclite, D., Napoletano, A., Fauci, A., Graziano, G., Iacorossi, L., & D'Angelo, D. (2019). Giornale Italiano di Nefrologia, 36(3), 2019-vol3.
  • Istituto Nazionale di Statistica (ISTAT). (2017). Il futuro demografico del Paese. Accessed 28 December 2017. Retrieved from: http://www.istat.it/it/archivio/199142.
  • Latina, R., Di Maglie, V., Sili, A., D'Angelo, D., Marucci, A. R., Di Ettore, B., & Scozzo, L. (2018). Valutazione del dolore nei pazienti affetti da sindrome di Down: una revisione narrativa della letteratura [Pain assessment in Down Syndrome patients: a narrative review of the literature]. Professioni infermieristiche, 71(4), 209–220. https://doi.org/ 10.7429/pi.2018.714209.
  • Latina, R., De Marinis, M. G., Giordano, F., Osborn, J. F., Giannarelli, D., Di Biagio, ..... & Cattaruzza, M. S. (2019). Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics. Pain Management Nursing, 20(4), 373–381. https://doi.org/10.1016/j.pmn.2019.01.005
  • Lahmann, N.A., Halfens, R.J., & Dassen, T. (2010). Impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute-care hospitals. Journal of Evaluation in Clinical Practice, 16(1):50-6. DOI: 10.1111/j.1365-2753.2008.01113.x.
  • Leijon, S., Bergh, I., & Terstappen, K. (2013). Pressure ulcer prevalence use of preventive measures and mortality risk in an acute care population: a quality improvement project. Journal of Wound Ostomy & Continence Nursing, 40(5):469-74. DOI: 10.1097/WON .0b013e3182a22032.
  • Matozinhos, F.P., Velasquez-Melendez, G., Tiensoli, S.D., Moreira, A.D., & Gomes, F.S.L. (2017). Factors associated with the incidence of pressure ulcer during hospital stay. Revista da Escola de Enfermagem USP,25;51:e03223. DOI: 10.1590/S1980-220X2016015803223.
  • Moore, Z., Cowman, S., 2012. Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland. Journal of Clinical Nursing,21(3-4):362-71. DOI: 10.1111/j.1365-2702.2011.03749.x
  • National Health Service Choices. (2010). Causes of pressure ulcers. Accessed 20 March 2018, Retrieved from: https://www.nhs.uk/conditions/pressure-sores/.
  • National Institute for Health and Care Excellence (NICE). (2014). Pressure ulcers: prevention and management. Clinical guideline. Accessed 29 October 2017. Retieved from: nice.org.uk/guidance/cg179.
  • National Patient Safety Agency, (2010). NHS to adopt zero tolerance approach to pressure ulcers. Accessed 23 October 2017, Retrieved from: http://tinyurl.com/pn89tw6.
  • National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific, Pressure Injury Alliance.(2014). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Australia.
  • National Pressure Ulcer Advisory Panel (NPUAP). (1989) Pressure ulcers prevalence, cost. and risk assessment: consensus development conference statement. Decubitus, 2(2):24-8.
  • O'Dea, K. (1999). Journal of Wound Care, Apr;8(4):192-4.
  • Papanikolaou,P., Lyne, P., & Anthony, D. (2007). Risk assessment scales for pressure ulcers: a methodological review. International Journal of Nursing Studies, 44(2):285-96. Epub 2006 Dec 4. DOI: 10.1016/j.ijnurstu.2006.01.015.
  • Prentice, J.L., & Stacey, M.C. (2001). Implementing the guidelines for the prediction and prevention of pressure ulcers. Primary Intention, 9(3): 99-108. Accessed 19 March 2018, Retrieved from: http://www.
  • woundsaustralia.com.au/journal /0903 _02.pdf.
  • Rasero, L., Simonetti, M., Falciani, F., Fabbri, C., Collini, F., & Dal Molin, A. (2015). Pressure Ulcers in Older Adults: A Prevalence Study. Advanced Skin & Wound care ,28(10):461-4. DOI: 10.1097 /01.ASW. 0000470371.77571.5d.
  • Redelings, M.D., Lee, N.E., & Sorvillo, F. (2005). Pressure ulcers: more lethal than we thought?. Advances in Skin & Wound Care, 18(7):367-72
  • Sardo, P.M., Simíµes, C.S., Alvarelhí£o, J.J., Simíµes, J.F., Machado, P.A., Amado, F.M., Amaro, A.J., & Melo, E.M. (2016). Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital. Journal of Tissue Viability, 25(4):209-215. DOI: 10.1016/j.jtv.2016.08.003.
  • Simmons, S., Schnelle, J., Slagle, J., Sathe, N.A., Stevenson, D., Carlo, M., & McPheeters, M.L. (2016). Rockville (MD): Agency for Healthcare Research and Quality (US), Technical Briefs, No. 24.
  • Theisen, S., Drabik, A., & Stock, S. (2011). Pressure ulcers in older hospitalised patients and its impact on lenght of stay: a retrospective observational study. Journal of Clinical nursing, 21(3-4):380-7. DOI: 10.1111/j.1365-2702.2011.03915.x.
  • Thomson O'Brien, M.A., Oxman, A.D., Davis, D.A., Haynes, R.B., Freemantle, N., & Harvey, E.L. (2002). Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes. [Cochrane Review]. In The Cochrane Library, Issue 1,. Oxford: Update Software.
  • Vanderwee, K., Clark, M., Dealey, C., Gunningberg, L., & Defloor, T. (2007). Pressure ulcer prevalence in Europe: a pilot study. Journal of Evaluation in Clinical care, 13(2):227-35. DOI: 10.1111/j.1365-2753.2006.00684.x.
  • Vangilder, C., Mac0farlane, G.D., & Meyer, S. (2008). Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage, 54(2):40-54.
  • Wang, H., Niewczyk, P., Divita, M., Camicia, M., Appelman, J., Mix, J., & Sandel, M.E.(2014). Impact of pressure ulcers on outcomes in inpatient rehabilitation facilities. Journal of Clinical nursing, 93(3):207-16. DOI: 10.1097/PHM.0b013e3182a92b9c