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©The Author(s) 2024.
World J Clin Cases. Jul 6, 2024; 12(19): 3873-3881
Published online Jul 6, 2024. doi: 10.12998/wjcc.v12.i19.3873
Published online Jul 6, 2024. doi: 10.12998/wjcc.v12.i19.3873
Table 1 Bundled care in the management of pressure ulcers in critically Ill adults in intensive care units
Bundled care | Contents |
1. Multidisciplinary collaboration | Ensure collaboration among healthcare professionals, including physicians, nurses, physical therapists, dietitians, and other specialists, to develop and execute a comprehensive care plan |
Hold regular interdisciplinary meetings to share information, coordinate treatment measures, and provide a unified approach to care | |
Nurses conducts a thorough skin inspection during each shift and recording relevant information | |
2. Assessment | Conduct a thorough pressure ulcer assessment, including a detailed description of the wound's depth, size, shape, edge condition, and characteristics of the wound base |
Evaluate the skin surrounding the wound for signs of inflammation, redness, or swelling | |
3. Wound cleansing | Use a gentle saline solution or specialized wound cleansing solution to clean the wound with gauze or sterile cotton balls, avoiding the introduction of new bacteria |
Remove necrotic tissue, exudate, and debris to ensure a clean wound surface | |
4. Maintain moisture | Use the dressing to maintain a moist wound environment, which accelerates healing and supports new tissue growth |
Change the dressing as needed, typically when the dressing changes color from dark green to light green, indicating over 70% of the silver has been released | |
5. Nutritional support | Dietitians closely monitor the nutritional status of patients and design high-protein dietary plans to support wound healing |
Ensure the patient receives adequate protein and vitamin intake to support wound healing | |
Provide oral nutritional supplements or enteral nutrition support through a feeding tube, depending on the patient's oral intake capacity | |
6. Pain management | Offer effective pain management, including medication, to alleviate wound discomfort |
Use non-pharmacological methods such as heat therapy, cold compresses, or relaxation techniques to reduce discomfort and pain | |
7. Prevent further deterioration | Ensure regular patient repositioning t least every 2 hours to prevent prolonged pressure on the same area |
Use specialized mattresses, cushions, and care pads to reduce pressure and provide appropriate support | |
8. Education | Provide comprehensive education to both the patient and family members, including wound monitoring, recognizing signs of infection, and proper wound care methods |
Emphasize the importance of pressure ulcer prevention, including pressure distribution and turning techniques | |
9. Data monitoring | Continuously monitor wound progress and any changes, documenting observations |
Reassess the pressure ulcer's status regularly to track healing progress |
Table 2 Assigning scores to parameters in the pressure ulcer scale for healing tool
Parameter | Description | Score |
Surface area | Determined by multiplying the greatest length by the greatest width | 0-10 |
0 cm² | 0 | |
< 0.3 cm² | 1 | |
0.3-0.6 cm² | 2 | |
0.7-1.0 cm² | 3 | |
1.1-2.0 cm² | 4 | |
2.1-3.0 cm² | 5 | |
3.1-4.0 cm² | 6 | |
4.1-8.0 cm² | 7 | |
8.1-12.0 cm² | 8 | |
12.1-24.0 cm² | 9 | |
> 24.0 cm² | 10 | |
Exudate (drainage) | Assessed at dressing removal before applying a topical agent | 0-3 |
None | 0 | |
Light | 1 | |
Moderate | 2 | |
Heavy | 3 | |
Tissue type | 0-4 | |
Closed/resurfaced | The wound is completely covered with epithelium/new skin | 0 |
Epithelial tissue | New pink or shiny tissue/skin growing in from the edges or as islands on the ulcer surface (for superficial ulcers) | 1 |
Granulation tissue | Pink or beefy red tissue with a shiny, moist, granular appearance | 2 |
Slough | Yellow or white tissue adhering to the ulcer bed in strings or thick clumps, or is mucinous | 3 |
Necrotic tissue/eschar | Black, brown, or tan tissue adhering firmly to the wound bed or ulcer edges, may be firmer or softer than surrounding skin | 4 |
Total PUSH score | Obtained by summing the scores for the above three parameters | 0-17 |
Table 3 Baseline characteristics of control and intervention groups
Total (n = 98) | Control group (n = 49) | Intervention group (n = 49) | P value | |
Age (yr) | 54 (35.5-68.5) | 52 (36.5-69.5) | 0.881 | |
Gender | ||||
Male | 61 | 29 | 32 | |
Female | 37 | 20 | 17 | 0.677 |
Stage | ||||
Stage I | 38 | 20 | 18 | |
Stage II | 39 | 21 | 18 | |
Stage III | 12 | 6 | 6 | |
Stage IV | 2 | 1 | 1 | |
Unstageable | 7 | 1 | 6 | 0.419 |
Location | ||||
Coccyx | 36 | 20 | 16 | |
Buttocks | 14 | 8 | 6 | |
Trochanter | 10 | 5 | 5 | |
Scapila | 8 | 4 | 4 | |
Malleolus | 8 | 4 | 4 | |
Head | 5 | 3 | 2 | |
Heel | 7 | 3 | 4 | |
Elbow | 10 | 2 | 8 | 0.700 |
Comorbid conditions | ||||
Sepsis | 45 | 24 | 21 | 0.685 |
Myocardial infarction | 1 | 1 | 0 | 1.000 |
Congestive heart failure | 29 | 16 | 13 | 0.659 |
Cerebral vascular disease | 2 | 0 | 2 | 0.495 |
Chronic pulmonary disease | 14 | 8 | 6 | 0.774 |
Diabetes with complication | 4 | 2 | 2 | 1.000 |
Diabetes without complications | 20 | 9 | 11 | 0.803 |
Total braden at ICU admit | 14 (10-20) | 13 (10.5-18.5) | 0.565 |
Table 4 Comparison of pressure ulcer scale for healing score before and after intervention in two groups
Time points | Control group (n = 49) | Intervention group (n = 49) | ||||||
Surface area | Exudate (drainage) | Tissue type | Total scores | Surface area | Exudate (drainage) | Tissue type | Total scores | |
Day 0 | 7 (4-9) | 1 (0-2) | 2 (1-2) | 9 (5-13) | 6 (3-8) | 1 (0-2) | 1 (1-2) | 10 (5-11.5) |
Day 3 | 7 (4-8.5)a | 1 (0-2) | 1 (1-2) | 9 (5-12.5)a | 5 (3-7.5)a | 1 (0-1)a | 1 (1-2)a | 8 (4-10.5)a |
Day 6 | 7 (4-8)a | 1 (0-2)a | 1 (1-2) | 9 (5-12)a,b | 5 (2.5-7)a,b | 1 (0-1)a,b | 1 (1-2)a | 8 (4-9.5)a,b |
Day 9 | 7 (4-8)a | 1 (0-2)a | 1 (1-2)a | 9 (5-12)a,b | 4 (2-6)a,b,c | 1 (0-1)a,b | 1 (1-2)a | 6 (3-9)a,b,c |
Day 12 | 7 (4-8)a | 1 (0-2)a | 1 (1-2)a | 9 (5-12)a,b,c | 4 (2-6)a,b,c,d | 0 (0-1)a,b,c | 1 (1-2)a,b,c,d | 6 (3-8)a,b,c,d |
- Citation: Yu H. Improving pressure ulcer care in intensive care units: Evaluating the impact of bundled care and silver nanoparticle dressings. World J Clin Cases 2024; 12(19): 3873-3881
- URL: https://www.wjgnet.com/2307-8960/full/v12/i19/3873.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v12.i19.3873