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1992.05.18 :  AHCPR Study -- Pressure Ulcers (Bed Sores)

Contact: Bob Isquith (301) 227-8370  
May 18, 1992

        Pressure ulcers cause pain, anguish and are costly.   But
the high toll of pressure ulcers can be significantly reduced
through aggressive use of simple, "low-tech" procedures,
according to a new guideline developed by a private-sector panel
and released today by the Agency for Health Care Policy and
Research.
     Also known as bed sores, pressure ulcers occur when the skin
of bed- or chair-bound persons presses against bony body parts,
such as heels or hips.  Severe pressure ulcers expose muscle and
bone, can cause serious infections and may require surgery. 
Although anyone can develop these injuries, older persons are the
most common victims.
     Up to one of every three nursing home patients has a
pressure ulcer, as do one of every 10 patients in acute care
hospitals plus an unknown number of patients treated at home.
     "This guideline, the first developed for preventing pressure
ulcers, spells out a comprehensive approach to reverse this
little-known, but often devastating, problem," said AHCPR
Administrator J. Jarrett Clinton, M.D.  
        According to Dr. Clinton, without effective prevention
programs the incidence, and therefore the impact, of pressure
ulcers is likely to increase as America's population ages.  
        "Fortunately, pressure ulcers are not inevitable," said
the panel's chair, Nancy Bergstrom, Ph.D., R.N., a professor of
nursing at the University of Nebraska Medical Center and a
leading expert on pressure ulcers.  "And, when prevention is
targeted specifically to those at risk, these wounds should be
less costly to prevent than treat."  
        Dr. Bergstrom said the panel's recommendations for
preventing the development and worsening of ulcerations include:
     o    Aggressive assessment at the time of admission for all
          bed-and chair-bound persons;

     o    Periodic reassessment of persons determined to be at
          risk of developing pressure ulcers;

     o    Daily skin inspection and care for at-risk persons,
          including keeping skin clean and well moisturized;

     o    Use of appropriate devices (such as pillows and either
          foam or air mattress overlays) and techniques (such as
          frequent repositioning of bed- and chair-bound
          individuals) to help prevent pressure; and

     o    A team approach, including education programs on
          pressure ulcer prevention for physicians, nurses, nurse
          practitioners, geriatricians, physical and occupational
          therapists, dieticians, patients, families and care
          givers.

     According to the panel, bed or chair confinement is only one
risk factor in developing pressure ulcers; risk increases with
immobility; skin moisture from urinary or fecal incontinence,
perspiration, or wound drainage; nutritional deficiencies; and
reduced mental awareness.  High-risk patients include
hospitalized quadriplegics; elderly, hip-fracture patients; other
orthopedic patients (especially those with fractures); and
persons treated in critical care units.

     "As much as we would like to eliminate pressure ulcers   
entirely, some are probably inevitable.  But this is not an
excuse for less than diligent care," said Dr. Bergstrom.  "Some
very high-risk patients will develop these wounds despite 
diligent care.  

Also, aggressive prevention may not be appropriate for persons in
the latter stages of a terminal illness, when techniques such as
frequent turning or repositioning can interfere with relieving
pain and promoting comfort."

     The 13-member guideline panel consisted of physicians
specializing in geriatrics, dermatology and family practice;
nurse practitioners, educators and researchers; a bioengineer; an
occupational therapist; and a consumer representative.

     The panel conducted an extensive literature search, heard
public testimony and examined information provided by
consultants.  The draft guideline was widely circulated for
review by other pressure ulcer experts and testing by personnel
in hospitals, nursing homes and other settings.

    AHCPR will distribute copies of the guideline to
organizations representing physicians, nurses and allied health
care professionals; hospital, nursing home and home health
associations; medical and nursing schools; and consumers.

     The guideline is the third issued by AHCPR since March 5. 
Like other guidelines developed under AHCPR sponsorship, its
purpose is to provide health care practitioners with
recommendations based on expert opinion and a thorough review of
research on the guideline topic.  

        Copies of "Pressure Ulcers in Adults:  Prediction and
Prevention" and an accompanying quick reference guide and patient
guide are free of charge.  Write:  AHCPR Publications
Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907; or call 
1-800-358-9295. 
                                 

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