Rapid Review
A review of pressure injury rates in Australian hospitals
CitationYap, G. & Melder A. 2018. A review of pressure injury rates in Australian hospitals: A Rapid
Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia.
Email: cce@monashhealth.org
Webpage: http://www.monashhealth.org/page/CCE

Executive Summary
BackgroundIn 2012, The Australia Commission for Safety and Quality in Health (ASQHC) published a safety and quality
improvement guide for Standard 8 – the prevention and management of pressure injuries [1]. As a result, robust audit
and data collection systems should be developed to evaluate the effectiveness of current strategies and identify areas
where improvements can be made. Consequently, health service organisations should ensure that mechanisms are inplace to collect data on incidence, prevalence and severity of pressure injuries [2].
To ensure the highest quality of care for our patients, and in alignment with National Standards set out by the ASHQC,
the Monash Health Skin Integrity Committee is interested in pressure injury rates in Australian hospitals in order tobenchmark pressure injury rates and indicators within Monash Health.

Objective
To review the evidence on pressure injury rates in Australian hospitals to determine the target rate used to benchmark
the rate of pressure injuries in Monash Health.

Search Strategy
A search was performed in one medical database, four guideline sources and the internet according to the inclusion andexclusion criteria and detailed strategy listed in Table 1.

Results
Three items of peer-reviewed literature were included:•••

A Systematic review on the prevalence of pressure injuries in an acute care setting (2017) [3]
A Statewide audit (2012-2014) conducted in Queensland (2017) [4]A Ten-year audit (2002-2012) in a tertiary hospital in Brisbane (2013) [5]Four items of grey literature were included:• Best practice suggestions for hospitals published by the Australia Commission on Safety and Quality in Health Care(2018) [2]• Best practice guidelines for intensive care by the New South Wales Agency for Clinical Innovation (2014) [6]• An Australasian Clinical Indicator Report published by the Australia Council on Healthcare Standards (2017) [7]• A Pressure injury point prevalence survey report published by the Clinical Excellence Commission (2018) [8]Conclusions
Number of Pressure Injuries• In 2015-2016, the rate of hospital-acquired pressure injuries in Australian hospitals was 9.7 injuries per 10,000
hospitalisations [2].
• In 2017, the annual rate of inpatients who develop one or more pressure injury was 0.071 per 100 bed days [7].
• Statewide prevalence rates from 2012 onwards range from 3.4–9.2% in New South Wales, Western Australia andQueensland [4,5,8]; where a hospital-acquired pressure injury prevalence was 4% in the most recent 2018 audit in
New South Wales [8].
• In Queensland, hospitals are required to conduct annual point prevalence audits with a target of 10% or lesshospital acquired pressure injury [4].

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Number of Pressure Injuries ≥ Stage 3• This data is not commonly reported in literature. One article reports that pressure injuries of Stage 3 or Stage 4 areless prevalent than Stage 2 in non-intensive care and intensive care patients [4].
• In ICU patients, the prevalence of Stage 3 and Stage 4 pressure injuries was each 2%; in non-ICU patients, theprevalence of Stage 3 and Stage 4 pressure injuries was 2% and 10%, respectively [4].
Number of Pressure Injuries by Stage• Only two articles report this data [4,8].
• In a recent 2018 audit in New South Wales, Stage 1 and Stage 2 hospital-acquired pressure injuries prevalence
was 54% and 31%, respectively [8].
• Excluding Stage 1, Stage 2 hospital-acquired pressure injury prevalence was the most common stage reported(53% for ICU patients vs 63% for non-ICU patients) [4]. More detailed numbers of pressure injuries by stage arefound in Table 2. Page 5 Full Report.
Pressure Injuries by Body Location• The two most common pressure injuries, as reported by four articles, occurs at the sacrum/coccyx (20–41%) andheels (16–27%) [3,4,6,8].
• Other locations reported include and are not limited to the buttocks, lips and nose. To note, mucosal pressure injury
proportion was significantly higher in intensive care patients (22%) than in non-intensive care patients (2%) [4].
Number of Pressure Injury Reports by Program• Vast majority or pressure injuries (61–73%) are reported as intensive care-acquired [6], however only one article
compared pressure injury prevalence between programs (i.e., ICU vs non-ICU) [4].
• Overall hospital-acquired pressure injury prevalence was higher (11%) for intensive care patients as compared with
non-intensive care patients (3%), where intensive care patients were 3.8 times more likely than non-intensive carepatients to develop a pressure injury whilst in hospital [4].

Implications for practiceThere is no single ‘right’ approach to measuring pressure ulcer rates. Every approach has advantages anddisadvantages. While considering recommendations from various sources, the most important point is to be consistent.
Rates calculated by one approach or methodology cannot be compared to rates calculated another way [2].

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Full Report
BackgroundIn 2012, The Australia Commission for Safety and Quality in Health (ASQHC) published a safety and quality
improvement guide for Standard 8 – the prevention and management of pressure injuries [1]. As a result, robust audit
and data collection systems should be developed to evaluate the effectiveness of current strategies and identify areas
where improvements can be made. Consequently, health service organisations should ensure that mechanisms are inplace to collect data on incidence, prevalence and severity of pressure injuries [2].
To ensure the highest quality of care for our patients, and in alignment with National Standards set out by the ASHQC,
the Skin Integrity Committee is interested in pressure injury rates in Australian hospitals in order to benchmark pressure
injury rates and indicators within Monash Health.

Objectives
To review the evidence on pressure injury rates in Australian hospitals to determine the target rate used to benchmark
the rate of pressure injuries in Monash Health.

Definitions
The terms pressure injury and pressure ulcer are used interchangeably in literature, and will be referred to as pressure
injuries for the purpose of this report.
Prevalence – The total number of a given population with pressure injuries (PI) [6]. It describes the number orpercentage of people having a pressure ulcer while on the unit. It may reflect a single point in time or prolonged periodof time (i.e. entire hospital stay) [2]. Most recent literature report hospital-acquired pressure injury (HAPI) prevalence.
Incidence – The proportion of at-risk patients who develop a new pressure injury over a specific period [6]. It describes
the number or percentage of people developing a new ulcer while in a facility or unit. Therefore, incidence only counts
pressure injuries developing after admission [2].

Search strategy
Inclusion/Exclusion Criteria
Table 1. Inclusion/Exclusion criteria decided a priori in accordance with PRISMA statement [9]Population

Include: Hospitals in Australia

Interventions

Include: Pressure Injury rates/prevalence

Outcomes

Primary: Benchmarking/target rates based on following indicators• Number of Pressure Injuries• Number of Pressure Injuries ≥ Stage 3• Number of Pressure Injuries by stage• Pressure injuries by body location• Number of pressure injury reports by program

Types of evidence

Include: Peer-reviewed and grey literature
Exclude: Conference abstracts

LimitsDate: 2013 – Current (22 June 2018)
Publications: Systematic reviews (and Australia-wide studies), guidelines, quality standards,
white papers
Language: Publications in English

Databases

Medical: Cochrane Database of Systematic Reviews; Ovid MEDLINE(R) Epub Ahead ofPrint, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid MEDLINE
and Versions(R)Guideline Databases: National Institute of Health and Care Excellence, TRIP Database,
National Health and Medical Research Council, National Guidelines Clearinghouse
Grey Literature Databases: Google

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Study Selection
Titles and abstracts identified were exported to EndNote X7 (Thompson, Reuters, Carlsbad, California, USA). Papers
identified were screened using inclusion and exclusion criteria established a priori. Searches of Medline, the internet(using Google) and guideline websites were screened by one reviewer in consultation with colleagues as necessary.
Literature was included based on the above criteria.

Quality Appraisal
No quality appraisal was conducted for grey literature search. The systematic review was of high quality whereas
methodological quality of included studies were variable, making it difficult to compare the reported pressure injury
outcomes (e.g., prevalence rates) between and across different countries and regions [3]. The other two items of peerreviewed literature were retrospective audits, and therefore open to a high risk of bias [4,5].

Results
Summary of Findings
Figure 1. Flow diagram to indicate the included articles from the different sources searched.
A total of 223 articles wereidentified from the medical
database search (Ovid
Reference mining andMedline search results
Medline). After screening, 1
articles known to223
authorarticle was included.
A total of 1845 articles wereidentified from the grey
literature sources. Afterscreening, 4 articles were
included.
Reference mining fromarticles identified in the
search, as well as previous
articles already known to theauthor resulted in 2 morereferences being included.
Details and results of search
are found in Appendix Table
3.

Internet & guideline
search results
1845

Duplicates removed0
2 articles included

222 articles were
excluded

4 articles were included

1 articles were included

7 articles were included

Three items of peer-reviewed literature were included:•••

Systematic review on the prevalence of pressure injuries in acute care setting (2017) [3]
Statewide audit (2012-2014) conducted in Queensland (2017) [4]Ten-year audit (2002-2012) in a tertiary hospital in Brisbane (2013) [5]Four items of grey literature were included:••••

Best practice suggestions for hospitals published by the Australia Commission on Safety and Quality in Health Care(2018) [2]Best practice guidelines for intensive care by the New South Wales Agency for Clinical Innovation (2014) [6]
Australasian Clinical Indicator Report published by the Australia Council on Healthcare Standards (2017) [7]
Pressure injury point prevalence survey report published by the Clinical Excellence Commission (2018) [8]The included literature use the approach and methodology from the two resources:
1. Australian Wound Management Association (AWMA). Pan Pacific Clinical Practice Guideline for the Prevention andManagement of Pressure Injury. Osborne Park, WA: Cambridge Media; 2012 [10]2. National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel, and Pan Pacific
Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Osborne Park,
Australia: Cambridge Media; 2014 [11]Rapid Review

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Table 2. Indicators of interest for pressure injuries rates in hospitals
1. Number of pressure injuries
Australia-wide: There were 4,313 pressure injuries occurring in Australian public hospitals in 2015-2016. The rate of
hospital-acquired pressure injuries (HAPI) which includes the diagnoses Stage III ulcer, Stage IV ulcer and Unspecified
decubitus ulcer and pressure area, in Australian hospitals was 9.7 injuries per 10,000 hospitalisations in 2015–16 [2].
The Australasian Clinical Indicator Report 2017 presents data from 825 healthcare organisations (HCO), which has
been validated by statisticians. In 2016, there were 724 records from 414 HCOs. The annual rate of inpatients whodevelop one or more pressure injury was 0.071 per 100 bed days. In 2016, the potential gains totalled 6,733 fewer
patients who develop one or more pressure injuries, corresponding to a reduction by approximately three-quarters. In
2016, there were 49 outlier records from 36 HCOs whose combined excess was 2,289 more patients who develop one
or more pressure injuries. The outlier HCO rate was 0.16 per 100 bed days [7].
State-wide: In 2017, 17 New South Wales (NSW) Health local health districts and specialty health networks (consistingof 172 inpatient facilities) undertook a comprehensive pressure injury prevalence survey. Overall prevalence of pressure
injuries for inpatients consenting to a skin inspection in hospitals in NSW was 7.7%; where prevalence of HAPI was
4.0% [8]. The prevalence rate in 18 rural hospitals in NSW, was 6% in 2000, as reported in a 2017 systematic review [3].
A HAPI prevalence was 3.4% in intensive care (ICU) and non-ICU patients, published in a national three-year audit(2012–2014) in 18 hospitals in Queensland [4].
Miles et al (2013) reported a district recorded prevalence rate of HAPI in 2011 to be 7.6%, which was comparable tostate-wide prevalence rates in Queensland, Western Australia and NSW (8.8%; 7.7%; and 9.2% respectively) [5]. The
statewide prevalence for HAPI in Victoria, as reported by a 2006 survey, was 11.9% [5].
2.

Number of pressure injuries ≥ stage 3This was not commonly reported in literature, and only one article reported data on pressure injury ≥ Stage 3 [4].
In ICU patients, the prevalence of Stage 3 and Stage 4 pressure injuries was each 2%. In non-ICU patients, theprevalence of Stage 3 and Stage 4 pressure injuries was 2% and 10%, respectively [4]. Stage 1 pressure injuries were
excluded in the analysis. Detailed tables of results are found in Appendix Tables 5 and 6.
3. Number of pressure Injuries by stage
Hospital-acquired pressure injury rates reported in hospitals in NSW in a 2017 point prevalence survey was [8]:Stage 1: 54%
Stage 2: 31%
In another article, Stage 1 PI was excluded from analysis on the basis that these injuries are reversible; therefore Stage
2 HAPI prevalence was the most common stage reported [4].
StagesICU

Non-ICU1

Not analysed

No analysed2n=26 (53%)

n=179 (63%)

3n=1 (2%)n=28 (10%)

4n=1 (2%)n=4 (3%)*Unstageable

n=6 (22%)n=31 (11%)^Suspected deep tissue injury (SDTI)

n=3 (5%)n=43 (15%)

Hospital-acquired pressure injury rates reported in non-ICU and ICU patients (2012-2014) are listed in the Appendix
Tables 5 and 6.
*Unstageable – Full thickness tissue loss in which the base of the wound is covered by slough and/or eschar in the wound bed. Depth
unknown.
^SDTI – A localised area of purple or maroon discoloured, intact skin or blood-filled blister. The area may be preceded by tissue thatis painful, firm, mushy, boggy, warmer or cooler as compared to surrounding tissue. Depth unknown.

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4. Pressure injuries by body location
Data on pressure injuries by body location was reported by four articles [3,4,6,8].
In a NSW evaluation conducted in 2012, the distribution of pressure injury in ICU according to location are [6]:1. Sacrum (29% in 2009; 30.1% in 2010; 29% in 2011)
2. Heels (19.7% in 2009; 16.3% in 2010; 19.7% in 2011)
3. Buttock (11.1% in 2009; 14.8% in 2010; 11.1% in 2011)
4. Lips/mouth (9.2% in 2009; 8.8% in 2010; 6.6% in 2011)
5. Nose/nares (6.9 % in 2009; 7.5% in 2010; 6.3% in 2011)

Hospital-acquired pressure injury rates reported in NSW hospitals in a 2017 point prevalence survey was [8]:1. Buttocks and sacrum (41%)
2. Heels (27%)

In rural hospitals in NSW, the prevalence rate reported by one study (n=18 rural hospitals) in 2000 [3]:1. Sacrum (20%)
2. Heels (26%)

In a three-year audit conducted in Queensland between 2012-2014, the three most common PI by site were [4]:1. Saccrum/coccyx (34%)
2. Heels (21%)
3. Nose (5%)
A list of pressure injuries listed by site are included in Appendix Table 7 [4].
5. Number of pressure injury reports by program
The NSW Agency for Clinical Innovation report 2427 pressure injuries (790 in 2009, 863 in 2010 and 774 in 2011) withthe vast majority reported as ICU-acquired (72% in 2009, 61% in 2010 and 73% in 2011) [6].
The Queensland Bedside Audit (QBA), is a significant collaborative annual clinical benchmarking process within
Queensland Health Hospital Health Service (HHS). The QBA audit measures clinical practice within health care facilities
against elements of the National Safety Quality Health Service Standards which can be compared between and within
facilities of the HHS and benchmarked. Tools developed for the HHS in response to the National Safety and Quality
Health Service Standards, were used in collect QBA audit data to compare state-wide pressure injury prevalence of ICU
versus non-ICU patients [4].
In Queensland, prevalence was significantly higher in ICU patients (11.5%, n = 296) than non-ICU patients (3.0%) (p <0.001), where HAPI prevalence in non-ICU patients was skewed towards those in older age groups, especially those
aged ≥76 years (4.0%, n = 2114). Mucosal pressure injury proportion was significantly higher in intensive care patients(22%) [4].

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Discussion
In acute care, prevalence rate varies between studies depending on the methodology of data collection [3]. The two main
approaches and methodology that are referenced are the Australian Wound Management Association [10] and the
National Pressure Ulcer Advisory Panel [11]. With the advent of the classification in 2009 (EUPAP) of the suspected deep
tissue injury and unstageable pressure injury, more recent studies report a higher and increasing incidence of theseclassifications of pressure injuries [6]. Also worthy of note is the inclusion of incontinence associated dermatitis (IAD)
questions in most recent point prevalence survey (2018) in NSW [8].
It is critical to distinguish between incidence and prevalence. Incidence rates capture new pressure injuries developing
during an admission, and provide the most direct evidence of the quality of care [2]. Prevalence rates include all pressure
injuries present in a group of patients – those that developed during a hospital stay as well as those that developed
elsewhere [2]. Prevalence rates can provide a useful snapshot of the pressure injury burden but they say less about yourquality of preventive care than do incidence rates [2]. However, it is noted that prevalence measurements may be usefulby providing an estimate of the frequency of pressure injuries and therefore the scope of the problem in a given setting[3]. Recently, much included literature report on the prevalence of hospital-acquired pressure injury (HAPI) [2,4,5,8].
Inpatients who develop one or more pressure injuries is also listed as a clinical indicator in the Australasian Clinical
Indicator Report [7]. Having said this, HAPI is commonly viewed as a nurse-sensitive indicator. Nevertheless it isimportant to note that the impact of nursing care on prevention may be complicated by patient factors, for example,
patients who decline repositioning or nutritional guidance [7].
In Queensland, hospitals are required to conduct annual point prevalence audits with a target of 10% or less hospitalacquired PI set in the Patient Safety and Quality Plan 2008–2012 [4]. In NSW, the CEC supports a standard approach topressure injury point prevalence survey data collection [8,12]. To facilitate this, a Monitoring and Auditing Framework was
released in March 2014 [13], and an electronic data collection tool was released in the QARS in July 2016 [14].
Having said this, the most important thing is to be consistent. Therefore, rates calculated by one approach or
methodology cannot be compared to rates calculated another way [2].

Conclusions
Number of Pressure Injuries
In 2015-2016, the rate of hospital-acquired pressure injuries in Australian hospitals was 9.7 injuries per 10,000
hospitalisations [2]; the annual rate of inpatients who develop one or more pressure injury was 0.071 per 100 bed days
[7]. Statewide prevalence rates from 2012 onwards range from 3.4–9.2% in New South Wales, Western Australia andQueensland [4,5,8]. In the most recent audit in New South Wales, HAPI prevalence was 4% [8]. In Queensland, hospitals
are required to conduct annual point prevalence audits with a target of 10% or less hospital acquired pressure injury [4].
Number of Pressure Injuries ≥ Stage 3This data is not commonly reported in literature. One article reports that pressure injuries of Stage 3 or Stage 4 are lessprevalent that of Stage 2 in non-intensive care and intensive care patients [4]. In ICU patients, the prevalence of Stage 3
and Stage 4 pressure injuries was each 2%. In non-ICU patients, the prevalence of Stage 3 and Stage 4 pressure
injuries was 2% and 10%, respectively [4].
Number of Pressure Injuries by stage
Only two articles report this data [4,8]. In the most recent audit in New South Wales, Stage 1 and Stage 2 HAPI
prevalence was 54% and 31%, respectively [8]. Excluding Stage 1, Stage 2 hospital-acquired pressure injury prevalence
was the most common stage reported (53% for ICU patients vs 63% for non-ICU patients) [4].
Pressure injuries by body location
The two most common pressure injuries, as reported by four articles, occurs at the sacrum/coccyx (20–41%) and heels(16–27%) [3,4,6,8]. Other locations reported include and are not limited to the buttocks, lips and nose. To note, mucosal
pressure injury proportion was significantly higher in intensive care patients (22%) than in non-intensive care patients(2%) [4].
Number of pressure injury reports by program
Vast majority or pressure injuries (61–73%) are reported as intensive care-acquired [6], however only one article
compared pressure injury prevalence between programs (i.e., ICU vs non-ICU) [4].
Overall hospital-acquired pressure injury prevalence was higher (11%) for intensive care patients as compared with
non-intensive care patients (3%), where intensive care patients were 3.8 times more likely (RR 2.7–5.4, 95% CI) than
non-intensive care patients to develop a pressure injury whilst in hospital [4].

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Implications for practiceThere is no single ‘right’ approach to measuring pressure ulcer rates. Every approach has advantages anddisadvantages. While considering recommendations from various sources, the most important thing is to be consistent.
Rates calculated by one approach or methodology cannot be compared to rates calculated another way [2].

References
1. Australian Commission on Safety and Quality in Health Care. Safety and Quality Improvement Guide Standard 8:
Preventing and Managing Pressure Injuries (October 2012). Sydney: ACSHQC; 2012.
2. Australian Commission on Safety and Quality in Health Care. Selected best practices and suggestions for
improvement for clinicians and health system managers; (March 2018). Sydney: ACSHQC; 2018.
3. Tubaishat A., Papanikoulaou P., Anthony D. and Habiballah, L. Pressure Ulcers Prevalence in the Acute Care
Setting: A Systematic Review, 2000-2015. Clinical Nursing Research. 2017; 1-28.
4. Coyer F., Miles S., Gosley S., Fullbrook P. et al. 2017 Pressure injury prevalence in intensive care versus nonintensive care patients: A state-wide comparison. Australian Critical Care. 2017; 30:244-250.
5. Miles SJ., Fullbrook P. and Franks C. Decreasing pressure injury prevalence in an Australian general hospital: a 10year review. Wound practice research. 2013; 21 (4): 148-156.
6. Rolls K, Jones S, Power D, Cook S, Flood K, Hennessy C, Mackenzie K, Robertson Y, Rodgers J, Blanchfield D,
Kuzmiuk L and Fullbrook P. Pressure Injury Prevention for Critically Ill Adults: a clinical practice guideline. Agency
for Clinical Innovation NSW Government Version 1, Chatswood NSW; 2014
7. Australian Council on Healthcare Standards (ACHS). Australasian Clinical Indicator Report: 2009–2016: 18th
Edition. Sydney, Australia; ACHS; 2017.
8. Clinical Excellence Commission. 2017 NSW Pressure Injury Point Prevalence Survey Report (2018), Sydney:
Clinical Excellence Commission; 2018
9. Moher, D., Liberati, A., Tetzlaff J., and Altman D.G. Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. BMJ. 2009;339:b2535
10. Australian Wound Management Association (AWMA). Pan Pacific Clinical Practice Guideline for the Prevention andManagement of Pressure Injury. Osborne Park, WA: Cambridge Media; 2012.
11. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury
Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Osborne Park, Australia:
Cambridge Media; 2014.

Additional Resources
12. http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/259250/pipmp-monitoring-and-auditing-frameworkmarch-2014.pdf
13. A Monitoring and Auditing Framework promoting a standard approach to pressure injury point prevalence survey
data collection. http://www.cec.health.nsw.gov.au/patient-safetyprograms/adult-patient-safety/pressure-injurypreventionproject/evaluation
14. Electronic data collection tool to support the 2018 Point Prevalence survey; Quality Audit Reporting System (QARS)
available at http://qars.cec.health.nsw.gov.au/

Excluded
Nicholas Graves & Henry Zheng. The prevalence and incidence of chronic wounds: a literature review. Wound practiceand research, Vol 22 (1): March 2014 pp 4-19.
Victorian Quality Council VQC State-wide PUPPS Report 2006. [Internet]. Victoria; Department of Human Services;
2007 Available from: http://www.health.vic.gov.au/pressureulcers/downloads/pupps3.pdf
Nguyen K-H, Chaboyer W, Whitty JA. Pressure injury in Australian public hospitals: a cost-of-illness study. Australian
Health Review, 2015.
Hahnel E., Lichterfeld A., Blume-Peytavi U., and Kottner, J. The epidemiology of skin conditions in the aged: A
systematic review. Journal of tissue viability, 2017; 26: 20-28
Australian Institute of Health and Welfare 2009. Towards national indicators of safety and quality in health care. Cat. no.
HSE 75. Canberra: AIHW. Summary and Appendix 1.

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Appendix 1
Table 3. Information sources and search terms
Search Terms
Terms related to “pressure (injuries OR ulcers)” AND “rate OR prevalence”
Search Results
Guideline Databases

Search Results

Included

TRIP Database8570National Health and Medical Research Council

1

1National Guidelines Clearinghouse (Website available only until 16 July 2018)

162

0

Agency for Healthcare Research and Quality

600

0

Google225

3

Table 4. Database Search Terms
Search terms in Medline (25 June 2018)
1
2
3

4

5

6

7

8

9
10

11
12
13

exp Pressure Ulcer/cl, di, ep, nu [Classification, Diagnosis, Epidemiology, Nursing]exp Skin Ulcer/cl, di, ep, nu [Classification, Diagnosis, Epidemiology, Nursing]decubit*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating subheading word, keyword heading word, protocol supplementary concept word, rare disease supplementary
concept word, unique identifier, synonyms](skin adj3 breakdown).mp. [mp=title, abstract, original title, name of substance word, subject heading word,
floating sub-heading word, keyword heading word, protocol supplementary concept word, rare disease
supplementary concept word, unique identifier, synonyms]
bedsore.mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating subheading word, keyword heading word, protocol supplementary concept word, rare disease supplementary
concept word, unique identifier, synonyms](bed adj1 sore).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating
sub-heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary
concept word, unique identifier, synonyms](decubitus adj (ulcer or sore)).mp. [mp=title, abstract, original title, name of substance word, subject heading
word, floating sub-heading word, keyword heading word, protocol supplementary concept word, rare disease
supplementary concept word, unique identifier, synonyms](pressure adj (wound or sore or ulcer or injur* or damag*)).mp. [mp=title, abstract, original title, name ofsubstance word, subject heading word, floating sub-heading word, keyword heading word, protocol
supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]
1 or 2 or 3 or 4 or 5 or 6 or 7 or 8
(incidence or prevalence or rate or survey or statistic*).mp. [mp=title, abstract, original title, name of substanceword, subject heading word, floating sub-heading word, keyword heading word, protocol supplementary
concept word, rare disease supplementary concept word, unique identifier, synonyms]
9 and 10limit 11 to (english language and humans and yr="2013 -Current")
Limit 12 to “review articles”
Results = 223

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Table 5. Hospital-acquired pressure injury rates reported in ICU patients (2012-2014) listed according to ICU level [4]Table 6. Hospital-acquired pressure injury rates reported in non-ICU patients (2012-2014) [4]Table 7. Pressure injury by site [4]Rapid Review

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