Occurrence of Pressure Ulcers and Risk Factors in a Mixed Medical-Surgical ICU — A Cohort Study

Abstract

In 2010, a three-year research programme was launched to study the occurrence and significance of certain risk factors for pressure ulcers (PUs) in a mixed intensive care unit (ICU), and to find previously unidentified risk factors. A modified Jackson/Cubbin (mJ/C) risk scale was used to formalise PU risk assessment. Adult patients needing intensive or high dependency care were included. The first results of a whole cohort (n=1,629 patients) treated in 2010 are reported. In this cohort, 72% of the patients had a surgical condition and 31% needed treatment for three or more days. The prevalence of PUs was 11.8% and the incidence was 11.1% (181/1,629) or the incidence rate was 3.0/100 ICU days. The most common sites of PUs were the sacrum, heels and nose. Nasal PUs were associated with masks used for noninvasive ventilation. Demographic variables did not differ between patients with or without PUs. Medical patients had the highest incidence of PUs (18.2%). In this group, 46.6% of patients without PU had a mJ/C-score ≤29 and 55.8% of the patients with PUs had a similar score. Patients with longer treatment times (three days or more) and medical patients had increased risk for PU development. The results indicate that the previously published J/C cut-off score of 29 may not be optimal for the identification of high/extremely high-risk patients. Further analysis of the patient populations, their PU risk factors and the significance of individual components of the J/C risk scale are ongoing.