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Pressure ulcers (PUs) are an important and distressing problem in Dutch nursing homes. A secondary analysis of longitudinal data from the Dutch National Prevalence Measurement of Care Problems (LPZ) - an annual, multicenter, point-prevalence survey - was conducted for the years 2005-2014 to determine the use of specific recommended PU preventive measures from the European Pressure Ulcer Advisory Panel 1998, the National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel 2009, and the 2002 and 2011 Dutch PU guidelines. Preventive care was investigated among nursing home residents at risk for PUs and included skin care (moisturization); nutritional and hydration status assessment and optimization; and pressure redistribution involving mattresses, cushions, and heel pressure-relieving strategies and devices. Following abstraction from the study database, data for 3 at-risk groups were distinguished: 1) residents with a Braden score of 17, 18, or 19; 2) residents with a Braden score below 17; and 3) residents with a PU. Data were aggregated at the institutional level. Differences were tested with multiple regression analyses. The mean number of residents over the study period was 5435, the mean age was 82.8 years, and the mean Braden score was 15.3. None of the recommended preventive measures from the guidelines consulted was applied 100% of the time: preventive skin care measures were used in 25.1% to 63.8% of cases and dehydration and/or malnutrition were identified and managed in 27.8% to 65.6% of patients. Pressure redistribution with special types of mattresses was used in 85.2% of patients, cushions in (wheel)chairs were used in 64.8% of patients, and heels were offloaded in 57.8% of patients. The results regarding repositioning for the 3 groups, respectively, showed a maximum use of 9.7%, 30.3%, and 65.6%; the higher the PU risk, the more preventive measures were used. Although the results show a decrease in the percent of category 2 through category 4 PUs from 16.6% to 5.5% and a trend toward increased use of preventive measures (more skin care, attention for dehydration/malnutrition, use of floating heels/heel devices, and pressure-relieving systems when a PU was present), the reason why measurements were suboptimally used remains unclear. Further research to address the application of guidelines in daily practice is needed.

Pressure ulcers (PUs) are a common concern for hospitalized children and adults, but knowledge about PU risk factors,prevalence, and incidence rates among children remains limited. To assess the prevalence of and risk factors for PUs in pediatric care settings, a 1-day cross-sectional study was conducted among all hospitalized children ages 0 to 18 years in all 14 pediatric hospitals in the German-speaking part of Switzerland. Data collection involved a direct systematic inspection and assessment of the skin. A standardized data collection instrument was used, and each patient was assessed by a previously instructed rater pair. The total number of participating children was 412 (75% of all hospitalized children). An overall PU prevalence of 35% (including European Pressure Ulcer Advisory Panel category 1 ulcers) was observed. Most patients with PUs (80%) had category 1 ulcers. The prevalence rate was highest among patients in the pediatric intensive care unit (PICU) (16/36, 44%), followed by the department of neonatology (47/109, 43%). The presence of a PU was significantly higher among patients with a medical device, who were young (<1 year old), had a longer length of stay, and low Braden scale score (P <0.05). Rates also varied by institution (P <0.05). Department, patient age,Braden scale score, and institution explained 25% of the variance in PU prevalence. The prevalence of PUs in pediatric patients is higher than expected, and the rate of category 1 PUs suggests that interventions to prevent PUs are needed,especially in the high-risk patients identified. Future studies are needed to further assess these risk factors, especially for patients in PICUs.

Pressure ulcers remain prevalent in hospitals and nursing homes despite the availability of evidence-based guidelines for prevention and care. To evaluate the level of evidence-based literature and its application in pressure ulcer treatment, a search was conducted of relevant English and German articles published between 1994 and 2002 using the key terms decubitus ulcer and its synonyms in different combinations with therapy, wound management, and specific wound treatment terms. Results were compared to wound dressing use data obtained from two pressure ulcer prevalence surveys conducted in 51 hospitals and 15 nursing homes in Germany in 2001 and 2002 (N = 11,584). Dressing usage evidence levels were reviewed and reported usage was classified as consistent or not consistent with existing guidelines or as evidence base unknown. Pressure ulcer prevalence rates ranged from 10.6% to 13.2% and the majority of pressure ulcers (60%) were Grade 1. In nursing homes, dressing selection was consistent with current evidence in 6.8% of Grade 1 and 27.8% of Grade 2 ulcers. In acute care facilities, dressing selection in 2001 and 2002 was consistent with current evidence in 21.6% and 38.5%, respectively, of Grade 1 ulcers and in 40.2% and 51.5%, respectively, of Grade 2 ulcers. Although strong evidence exists to support the use of dressings that facilitate moist wound healing, barely half of the grade 3 and grade 4 ulcers in all care settings received this treatment. While dressing classification limitations restricted the ability to analyze all treatment methods used, findings suggest that clinician knowledge deficits regarding evidence-based treatments remain. The literature review results also indicate the level of evidence for many practice recommendations remains low. Studies to increase evidence levels of pressure ulcer prevention and treatment as well as programs to improve awareness and implementation of current evidence-based guidelines are needed.

In German healthcare facilities, research-based knowledge of pressure ulcers and their relation to patient characteristics is limited. To provide information for national and international comparison on pressure ulcers and related issues, two cross-sectional surveys were conducted among 21,574 German hospital patients and nursing home residents (147 institutions total) in 2002 and 2003. Prevalence and frequency rates of pressure ulcers in people at risk (Braden score of

General information about the effects of massage to prevent pressure ulcers is limited. A literature search was conducted to provide more detailed knowledge about the effects of massage in general and in preventing the development of pressure ulcers in particular. Using the keywords massage, rubbing, prevention of pressure ulcers/pressure ulcers, and paying particular attention to referenced articles yielded a summary of different manual massage techniques and indications/contraindications of this intervention for both healthy tissues and tissues in patients at risk for developing pressure ulcers. A careful review of this information; the clinical, physical, and pathophysiological aspects of pressure ulcers, including extrinsic and intrinsic factor; and the time-pressure relationship suggests that one type of massage may be beneficial for persons who are at risk for developing pressure ulcers. Specifically, effleurage applied with moderate pressure is the most preferred massage in the treatment of pressure ulcers, although based on currently existing studies, it cannot be proven statistically that massage is an adequate preventive method for pressure ulcers. Although many guidelines advised against use of massage in people at risk for pressure ulcers, current evidence suggests that research to increase knowledge about the mechanism behind the effects of massage as part of an individualized prevention and treatment plan should be conducted.

This article discusses a study of publications on pressure ulcers from 1965 to 1999 using the information available in Medline. Results show that .06% of all articles relate to pressure ulcers. Of all the articles about pressure ulcers, 49% were research articles and 51% were clinical articles. When comparing the total percentage of articles on pressure ulcers to the costs of pressure ulcers in healthcare (1.3% of the total Netherland healthcare budget), one can conclude that clinicians and scientists insufficiently appreciate pressure ulcers as a problem. The number and the proportion of pressure ulcer articles are growing, as well as initiatives to urge researchers studying the same topic to start international working groups, but more research is needed. This article offers insight into the current status of pressure ulcer literature and addresses some reasons for the lack of interest in the pressure ulcer problem.

Several instruments have been devised to measure risk of developing pressure ulcers. In this article, the value of risk assessment scales is explored and discussed from a theoretical, methodological, and clinical perspective. The first part of the article focuses on the validity of such scales from the first two perspectives. It is argued that currently it is not possible to devise an instrument with perfect content validity because too many factors are involved in the development of pressure ulcers. When establishing predictive validity of a risk assessment instrument, one needs an external criterion to test sensitivity and specificity. This article argues that the external criterion normally used--pressure ulcers that actually develop--is not a good indicator of the risk of developing pressure ulcers, because this criterion is influenced by the use of preventive methods. Therefore, the author suggests using not only the pressure ulcers that actually develop, but also incorporating preventive methods into the external criterion. Despite their limitations, risk assessment scales are recommended. However, to be effective, they should be used within a broader preventive program. Furthermore, using the chance a patient has of developing pressure ulcers, instead of one or two cutoff points, is recommended.

To gain insight into the prevalence of pressure ulcers in Dutch healthcare institutions, a national registration form to measure the prevalence of pressure ulcers annually in different healthcare settings was developed based on a literature study and responses from a Delphi panel. The reliability and the feasibility of the form devised were tested in a pilot study conducted in a university hospital, a nursing home, and in a home healthcare setting. Interrater reliability of the grading system varied between the institutions from 0.49 to 0.97 (Cohen's Kappa). In the home healthcare setting, interrater reliability was 0.80 (Pearson correlation coefficient) for the total score on the Braden scale. The prevalence rates were 10.1% (n = 368) in the university hospital, 12.7% (n = 1,541) in the home healthcare setting, and 83.6% (n = 122) in the nursing home, although the latter figure seemed to be somewhat exaggerated. The most common lesions were found on the sacrum and below the knee (heel and malleolus). The pilot study concluded that it is possible to collect accurate and reliable data on the scope and severity of pressure ulcers with a uniform instrument in different healthcare settings.