Comparing demographics, treatments, and outcomes of patients with COVID-19 lesions versus hospital-acquired pressure ulcers/injuries during the first year of COVID-19.

BACKGROUND: As COVID-19 has emerged as a pandemic virus, multiple reports have surfaced to describe skin lesions that occur either associated with the virus or due to treatment. OBJECTIVE: To compare patient demographics, treatments, and outcomes in COVID-19 symptomatic patients who developed skin lesions (COVID-19 or hospital-acquired pressure ulcer/injury [HAPU/I]) during the first year of the pandemic. METHODS: A retrospective chart review was conducted on COVID-positive symptomatic patients admitted from March 1, 2020, through March 1, 2021. The authors analyzed the difference in patient demographics, patient skin tones, treatments, hospital length of stay (LOS), intensive care unit (ICU) LOS, death, and discharge disposition for those with COVID-19 lesions compared to those who developed HAPU/Is. RESULTS: Of those who developed lesions, 2.3% developed COVID-19 lesions and 7.2% developed HAPU/Is. Patients with COVID-19 lesions were more likely to be male (64%), younger (median age 60), and had a higher BMI (30) than patients with no wounds and patients with HAPU/I. CONCLUSION: This study advances the knowledge of the patient demographics and treatments that may contribute to identifying the new phenomenon of COVID lesions and how they differ from HAPU/Is.

YouTube as a source of information for pressure injury: Quality assessment and content analysis.

We aimed to assess the quality and reliability of pressure injury-related videos uploaded on YouTube, analyse the sources and contents, and examine the correlation between video parameters. We searched YouTube using two keywords, "pressure ulcer" and "pressure sore", on August 20, 2022. We sorted the videos according to their number of views and included the top 100 videos for each keyword. The quality of videos was assessed using the Global Quality Scale (GQS), while their reliability was evaluated by the modified DISCERN (mDISCERN) tool. In addition, we evaluated the videos in which content was included, analysed the correlations and differences between GQS, mDISCERN, and video parameters. We initially found a total of 100 videos for each keyword and finally included and analysed 77 videos. The mean scores for the mDISCERN and GQS were 2.35 ± 0.98 and 3.09 ± 0.99, respectively. Both GQS and mDISCERN showed statistically significant correlations with each other (rho = 0.54, p < 0.0001*) and with the length of the videos, respectively (rho = 0.36, p = 0.001*), (rho = 0.29, p = 0.01*). Of the videos created by physicians, 8 (57.1%) included content related to treatment, while of the videos created by nonphysician health personnel, 22 (57.9%) included content related to prevention. Analysing whether there were differences in video parameters based on the sources, we observed significant differences between sources in GQS (p < 0.0001*), mDISCERN (p < 0.0001*), and video length (p = 0.001*). In the post-hoc analysis, videos uploaded by physicians or nonphysician health personnel showed higher quality and reliability than videos uploaded by other sources. Therefore, the results of this study could be useful for healthcare providers, as well as patients and caregivers, to search for high-quality and reliable YouTube videos related to pressure injury.

Exploring nurses' experiences in pressure sore care in long-term care facilities.

BACKGROUND: This study uses an interpretive description approach to explore nurses' experiences with pressure sore care in long-term care facilities, highlighting the complexity of their encounters. METHODS: 10 experienced nurses from South Korean small to medium-sized hospitals were chosen via purposive sampling for interviews. Data analysis utilized Braun and Clarke's reflexive thematic analysis. RESULTS: The study's findings collectively reflect the intricate journey of nurses in Long-term care facilities as they grapple with the challenges of pressure sore care. These nurses transform their perception of pressure sores, encountering a dynamic shift in their understanding. They face multifaceted challenges in providing optimal care, marked by resource constraints and the absence of standardized guidelines. Emotionally, they navigate a complex terrain of sentiments, oscillating between feelings of accomplishment and helplessness. Despite these hurdles, they persistently strive for excellence in pressure sore nursing, driven by an unwavering commitment to delivering the best possible care within the confines of their healthcare environment. CONCLUSION: The study enhances understanding of pressure sore care in long-term facilities and suggests avenues for improving nursing practices and care quality through targeted interventions.

Effects of predictive nursing interventions on pressure ulcer in older bedridden patients: A meta-analysis.

To evaluate the effect of predictive nursing interventions on pressure ulcers in elderly bedridden patients by meta-analysis. Applied computer searches of PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials (RCTs) on the effect of predictive nursing in preventing pressure ulcers in elderly bedridden patients from the database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on inclusion and exclusion criteria. Stata 17.0 software was utilised for data analysis. Eighteen RCTs involving 6504 patients were finally included. The analysis revealed the implementation of predictive nursing interventions had a significant advantage in reducing the incidence of pressure ulcers in elderly bedridden patients compared with conventional nursing (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.15-0.28, p < 0.001), while the patients' satisfaction with nursing care was higher (OR = 3.70, 95% CI: 2.99-4.57, p < 0.001). This study shows that the implementation of a predictive nursing interventions for elderly bedridden patients can effectively reduce the occurrence of pressure ulcers and significantly improve patients' satisfaction with nursing care, which is worthy of clinical promotion and application.

Real-world data analysis of bilayered living cellular construct and fetal bovine collagen dressing treatment for pressure injuries: a comparative effectiveness study.

Aim: To determine the effectiveness of bilayered living cellular construct (BLCC) versus a fetal bovine collagen dressing (FBCD) in pressure injuries (PRIs). Methods: A real-world data study was conducted on 1352 PRIs analyzed digitally. 1046 and 306 PRIs were treated with BLCC and FBCD, respectively. Results: Cox healing for BLCC (n = 1046) was significantly greater (p < 0.0001) at week 4 (13 vs 7%), 8 (29 vs 17%), 12 (42 vs 27%), 24 (64 vs 45%), and 36 (73 vs 56%). The probability of healing increased by 66%, (hazard ratio = 1.66 [95% CI (1.38, 2.00)]; p < 0.0001. Time to healing was 162 days for FBCD and 103 days for BLCC showing a 36% reduction in time to healing with BLCC; (p < 0.0001). Conclusion: BLCC significantly improved healing of PRIs versus FBCD.

Aetiology, risk factors and treatment of typical and atypical pressure ulcers in patients with traumatic brain injury: A narrative review.

Pressure ulcers are one of the leading complications in bedridden patients that result in multiple burdens on healthcare systems and patients (11 billion dollars/year). The prevalence of pressure ulcers in traumatic brain injury patients is 1.5-fold compared with the other bedridden patients. Moreover, critical traumatic brain injury patients who are admitted to the intensive care unit experience severe pressure ulcers and further complications. The motor/sensory disabilities and low supplementation and oxygenation to the pressured side were the main mechanisms of the typical pressure ulcers. Intellectual evaluation is the first essential step to prevent the development of pressure ulcers in high-risk patients. Till now, different scales, including Injury Scale Score and Braden Scale Score, have been provided to assess the pressure ulcer. Since low stages of pressure ulcers heal rapidly, traumatic brain injury patients require a periodical assessment to prevent further developments timely. Alongside different procedures provided to prevent and treat any pressure ulcer, traumatic brain injury patients required additional specific protections. For the first line, fast and efficient rehabilitation repairs motor/sensory disabilities and decreases the chance of pressure ulcer. Our review indicated that pressure ulcer in traumatic brain injury had several complex mechanisms that demand special care. Therefore, further studies are required to address these mechanisms and prevent their progression to typical and atypical pressure ulcers.

Trends in pressure injury prevalence rates and average days to healing associated with adoption of a comprehensive wound care program and technology in skilled nursing facilities in the United States.

INTRODUCTION: A large SNF system in the United States adopted a holistic wound care model that included an AI DWMS to improve PI care. OBJECTIVE: To compare the trend in PI point prevalence rates and average days to healing linked to adopting technology in practice from 2021 to 2022, and to assess the rate of received PI F686 citations in facilities that adopted the technology compared with those that did not. METHODS: The study used the DWMS database to compare anonymized PI data assessed in 2021 (15 583 patients) vs 2022 (30 657 patients) from all SNF facilities that adopted the technology in 2021 and 2022. F686 citations data were provided by the SNF organization. RESULTS: There was a 13.1% reduction in PI prevalence from 2021 to 2022 across all PI stages. Facilities that adopted the technology demonstrated a significant reduction in days to healing from 2021 to 2022, with an average of 17.7 days saved per PI or a 37.4% faster healing rate (P < .001). A significant reduction in the average days to healing was noted for all PI stages, with the most significant savings observed for stages 3 and 4, with an average savings of 35 days (stage 3) and 85 days (stage 4) in 2022 vs 2021 (P < .001). From 2021 to 2022, facilities that adopted the technology reported an overall 8.2% reduction in F-686 citations severity >G compared to those that did not adopt the technology. CONCLUSION: Use of technology as part of a comprehensive wound care program has the potential to not only improve patient care and quality of life, but to realize considerable annual savings in additional PI out-of-pocket expenses (up to $1 410 000) and of clinicians' time (44 808 hours).

Use of hyperbaric oxygen therapy to treat a pressure ulcer complicated by osteomyelitis: a case report.

The development of a pressure ulcer (PU) following hospitalisation and immobility can lead to more severe complications, such as osteomyelitis. We report the case of a 60-year-old female patient with a PU complicated with osteomyelitis who was treated with hyperbaric oxygen therapy (HBOT). The patient was diagnosed with an unstageable PU according to the European Pressure Ulcer Advisory Panel classification. A total of 35 HBOT sessions were administered to manage her condition. HBOT is considered a safe and effective treatment for osteomyelitis and decreases mortality rate.

Effectiveness of a kinesio-taping-based treatment in stage IV sacral pressure ulcers in older patients: a pilot study.

OBJECTIVE: As reduced tissue vascularity is one of the mechanisms that prevent skin ulcers from healing, treatments that can improve local circulation could accelerate their clinical resolution. Given that kinesio-taping (KT) can improve tissue blood circulation and lymphatic drainage, we aimed to determine whether applying KT close to stage IV pressure ulcers (PUs) could improve their healing. METHOD: Older patients with stage IV sacral PUs, and impaired mobility and functional dependency who were consecutively admitted in a six-month period to the Home Care service of Galliera Hospital (Genoa, Italy) were screened for participation in this pilot clinical trial. Patients' PUs were divided into two treatment areas-in the experimental intervention, KT was applied close to a portion of the PU, while the contralateral portion of the same lesion was treated according to the standard protocol ('control'). The surface reduction of both portions was measured every four days, for a total of five examinations (timepoints (T2-T6) after the baseline evaluation (T1). RESULTS: A total of 12 patients (male=5, female=7; mean age 78.83±8.94 years) fulfilled the inclusion criteria and were enrolled in the study. At all timepoints (T2-T6), the mean percentage reduction was significantly greater in KT-treated areas than in control areas: T2=20.66% versus 6.17%, respectively; p<0.001; T3=37.33% versus 17.31%, respectively; p<0.001; T4=57.01% versus 30.06%, respectively; p<0.001; T5=69.04% versus 40.55%, respectively; p<0.001; and T6=80.34% versus 51.91%, respectively; p<0.001. Furthermore, from T3 onwards, a significantly higher number of KT-treated areas than control areas had halved in size, the maximum difference being recorded at T5 (10 versus two, respectively; p=0.002). CONCLUSION: From the findings of this pilot study, KT would seem to be an effective, rapid, low-cost therapy for advanced sacral PUs in older patients with impaired mobility and functional dependency. Declaration of interest: The authors have no conflicts of interest to declare.

Effect evaluation of new dressing URGOTULRANGE in the treatment of pressure injury.

BACKGROUND: Pressure injury (PI) is a local injury of the skin and/or soft tissue located at the bone caused by medical or other equipment and is common in long-term bedridden patients. OBJECTIVE: To investigate the clinical effect of Urgotul foam dressing in the treatment of stage 3 ∼ 4 PI and deep tissue PI. METHODS: A total of 38 patients with stage 3 ∼ 4 PI and deep tissue PI admitted to Jinan Central Hospital from January 2016 to December 2018 were selected and randomly divided into a control group (dressing change plus silver ion cream dressing) and an observation group (dressing change plus Urgotul Absorb non-border foam dressing), with 19 cases in each group. After 4 weeks of treatment, the pain intensity during dressing change and the treatment efficacy for PI wounds were compared between the two groups. RESULTS: There were no differences in gender (P= 0.740), age (P= 0.130), single wound area (P= 0.673), consultation department (P= 0.972), stage (P= 0.740), presence of undermining (P= 0.721), deep tissue PI (P= 0.721), and systemic antibiotic therapy (P= 1.000) between the two groups, which were comparable. The treatment effect of the observation group was better than that of the control group (P= 0.003), and the pain score of the observation group was lower than that of the control group (P< 0.001). CONCLUSION: Urgotul Absorb non-border foam dressing has a good effect in the treatment of stage 3 ∼ 4 PI and deep tissue PI and can relieve patients' pain, and is thus worth promoting.

WHS guidelines for the treatment of pressure ulcers-2023 update.

The major populations at risk for developing pressure ulcers are older adults who have multiple risk factors that increase their vulnerability, people who are critically ill and those with spinal cord injury/disease. The reported prevalence of pressure ulcers in the United States is 2.5 million. However, this estimate is derived from acute care facilities and does not include people who are living at home or in nursing facilities. Despite the implementation of hospital and facility-based preventive measures, the incidence of pressure ulcers has not decreased in decades. In addition to the burden of pain, infection and death, it is estimated that hospital-acquired pressure ulcers cost the health system $26.8 billion annually with over 50% of the cost attributed to treating Stage 3 and 4 pressure injuries. Thus, it is critical to examine the literature and develop guidelines that will improve the outcomes of this complex and costly condition. This guideline update is a compendium of the best available evidence for the treatment of Pressure Ulcers published since the last update in 2015 and includes a new section based on changing demographics entitled 'Palliative wound care for seriously ill patients with pressure ulcers'. The overall goal of the Wound Healing Society Guideline project is to present clear, concise and commercial free guidelines that clinicians can use to guide care, that researchers can use to develop studies that will improve treatment and that both clinicians and researchers can use to understand the gaps in our knowledge base.

Switching from Galenic to Advanced Dressings or Vacuum Assisted Closure Therapy Can Improve Quality of Life of Patients with Chronic Non-Responsive Pressure Skin Ulcers: Preliminary Data with Italian Translation of WOUND-Q.

Objective: A few studies have focused on the quality of life (QoL) of patients with chronic non-responsive pressure skin ulcers. The aim of this study was to assess how correct treatment (advanced wound care [AWC] dressings alone or vacuum assisted closure [VAC] therapy alone) changes the QoL of these patients. Approach: One hundred six patients with chronic non-responsive pressure skin ulcers, who had previously used galenic dressings, applied without proper therapeutic indication, were included in this study. We administered the WOUND-Q, at time 0 and after 1 month of appropriate therapy, to assess patient-reported outcome measures. Group 1 consisted of 30 patients treated with advanced dressings, Group 2: 22 patients treated with VAC therapy, and Group 3: 30 patients continuing conventional galenic dressings (Control group). Statistical analysis allowed us to analyze QoL changes over time and to compare WOUND-Q Group 1 and 2 deltas with those of Group 3. The study followed the STROBE statement. Results and Innovation: In all the scales evaluated (Assessment, Drainage, Smell, Life impact, Psychological, Social, Sleep and Dressing), there were significant improvements in mean values for Groups 1 and 2. Kruskal-Wallis tests with Dunn's multiple-comparisons tests and Brown-Forsythe and Welch Analysis of Variance tests demonstrated significant differences between deltas of Group 1 and Group 2 compared with those of Group 3 for most scales analyzed. Conclusions: Administration of the WOUND-Q demonstrated that the application of advanced dressings alone or VAC therapy alone positively affects the QoL of patients with chronic nonresponsive pressure wounds, in comparison with galenic dressings alone. The WOUND-Q has been shown to be a valid tool in studying changes in QoL of these patients.

Molecular characterization of chronic cutaneous wounds reveals subregion- and wound type-specific differential gene expression.

A limited understanding of the pathology underlying chronic wounds has hindered the development of effective diagnostic markers and pharmaceutical interventions. This study aimed to elucidate the molecular composition of various common chronic ulcer types to facilitate drug discovery strategies. We conducted a comprehensive analysis of leg ulcers (LUs), encompassing venous and arterial ulcers, foot ulcers (FUs), pressure ulcers (PUs), and compared them with surgical wound healing complications (WHCs). To explore the pathophysiological mechanisms and identify similarities or differences within wounds, we dissected wounds into distinct subregions, including the wound bed, border, and peri-wound areas, and compared them against intact skin. By correlating histopathology, RNA sequencing (RNA-Seq), and immunohistochemistry (IHC), we identified unique genes, pathways, and cell type abundance patterns in each wound type and subregion. These correlations aim to aid clinicians in selecting targeted treatment options and informing the design of future preclinical and clinical studies in wound healing. Notably, specific genes, such as PITX1 and UPP1, exhibited exclusive upregulation in LUs and FUs, potentially offering significant benefits to specialists in limb preservation and clinical treatment decisions. In contrast, comparisons between different wound subregions, regardless of wound type, revealed distinct expression profiles. The pleiotropic chemokine-like ligand GPR15L (C10orf99) and transmembrane serine proteases TMPRSS11A/D were significantly upregulated in wound border subregions. Interestingly, WHCs exhibited a nearly identical transcriptome to PUs, indicating clinical relevance. Histological examination revealed blood vessel occlusions with impaired angiogenesis in chronic wounds, alongside elevated expression of genes and immunoreactive markers related to blood vessel and lymphatic epithelial cells in wound bed subregions. Additionally, inflammatory and epithelial markers indicated heightened inflammatory responses in wound bed and border subregions and reduced wound bed epithelialization. In summary, chronic wounds from diverse anatomical sites share common aspects of wound pathophysiology but also exhibit distinct molecular differences. These unique molecular characteristics present promising opportunities for drug discovery and treatment, particularly for patients suffering from chronic wounds. The identified diagnostic markers hold the potential to enhance preclinical and clinical trials in the field of wound healing.

Nutritional therapy in chronic wound management for older adults.

PURPOSE OF REVIEW: We provided an updated overview of recent data on the value of nutritional therapy in the management of chronic wounds in older adults. RECENT FINDINGS: In the last years, advances in this area were limited, but new data suggest considering nutritional care (screening and assessment of malnutrition and nutritional interventions) also in patients with chronic wounds other than pressure ulcers, namely venous leg and diabetic foot ulcers, as in these patients, nutritional derangements can be present despite overweight/obesity and their management is beneficial. SUMMARY: Chronic wounds are wounds in which the process of repair does not progress normally due to a disruption in one or more of the healing phases. Nutritional therapy is aimed at recovering the process of repair. General principles of nutritional care in geriatrics apply to these patients but disease-specific recommendations are available, particularly for pressure ulcers. Interventions should address nutritional status, comorbidities, hydration and should provide key nutrients playing an active role in the healing process (arginine, zinc, and antioxidants) but always within the context of an individual care plan addressing patients requirements, particularly protein needs. Further evidence of efficacy in vascular and diabetic foot ulcers is warranted.

Medical device-related pressure injury from compression therapy.

The use of compression therapy is known to be effective in the management of patients with venous leg ulceration and is commonly recommended as a first-line treatment. A rare but known complication of compression therapy is pressure damage to the limb, also referred to as bandage damage, which should be categorised as a medical device-related pressure injury. Patients should receive a comprehensive, holistic assessment before any compression therapy is applied. Risk factors for compression therapy injury include peripheral arterial disease, older age, fragile skin, pronounced bony prominences or tendons, calf atrophy, foot drop, neuropathy/absent sensation, limited movement, cognitive impairment and receiving end of life care. Risks can be mitigated through a variety of approaches, and practitioners should be aware that these can change depending on the patient's condition. A community improvement initiative, illustrated with a case study, introduced a clinical pathway that can facilitate the identification and management of patients who are at risk of developing pressure injuries as a result of compression therapy.

Challenges in prospective observational studies evaluating pressure ulcer costs: how to price the items correctly.

OBJECTIVE: Pressure ulcers (PUs) are a significant healthcare problem with a negative impact on patients' quality of life and incurring substantial healthcare expenses. Our study aimed to analyse the costs of treating PUs in hospitalised patients in the Czech Republic, in the context of current treatment procedures and price levels, and to pilot-test the detailed methodology developed. METHOD: A prospective, observational, non-interventional study was conducted at the Clinic of Anesthesiology, Resuscitation and Intensive Medicine, the Internal Medicine Department and the Surgical Department of the University Hospital Ostrava. The study included all hospitalised patients with a PU from March-May 2021. Data were collected using the hospital information system. A bottom-up, person-based approach to cost analysis was used, based on a comprehensive cost structure using accurate patient-specific consumption records. RESULTS: The length of hospitalisations ranged from 1-31 (mean: 12.7) days. The average cost of PU treatment per hospitalisation was calculated at €1579. The average daily cost of PU treatment was €179, including antibiotic therapy (ATB) and €112 without ATB. Most of the costs were associated with ATB (38.6%) and caregivers' time (35.9%). Based on the results, a predictive model was developed to estimate the cost of treating a hospitalised patient with a PU, which could be used in future research to assess the costs of treating these patients. CONCLUSION: We have faced many challenges in the methodology of preparation of cost analysis (e.g., how to count amorphous topical agents and sprays, how to properly identify PUs, how to price the positioning aids and mattresses, and how to relate the ATB treatment to the PU). This analysis provides important input for developing a comprehensive and more accurate methodology for monitoring PU costs in hospitalised patients, applicable in clinical practice for inpatient healthcare providers.

Nutrition association with skin integrity and pressure injury in critically ill pediatric patients.

BACKGROUND: Current research highlights the positive impact of nutrition therapy, particularly enteral nutrition, in critical illness. However, little attention is given to the impact of nutrition on skin integrity during critical illness. Skin integrity is at risk in critically ill children owing to necessary clinical therapies and challenges of providing nutrition therapy. METHODS: We conducted a narrative literature review with three main thematic concepts to drive our literature search: the association of nutrition therapy with (1) skin integrity; (2) injury, wounds, and wound healing; and (3) differences of skin color. Using pertinent search and subject terms, PubMed, CINAHL, EMBASE, and SCOPUS databases were searched, yielding 316 articles. After removal of duplicates, articles were reviewed based on inclusion and exclusion criteria defined by the authors; only eight articles met the defined criteria to inform this review. RESULTS: Large and important gaps exist in the current literature regarding an association between nutrition therapy, skin injury, and wound healing. Little to no attention was found for associations with skin color. The resulting narrative review addresses these topics and subtopics with additional references included that are independent of the original search strategy. CONCLUSIONS: A dearth of evidence exists describing associations between nutrition and disruption of skin integrity in pediatric critical illness. Children with dark skin are at increased risk, as manifestation and identification of disruption to skin integrity may not be recognized. Research is needed to describe these associations and the impact of nutrition on skin integrity, including differences of skin color.