dilateed periods of uninterrupted p...

dilateed periods of uninterrupted pressure and shear place patients who are undergoing surgical performances at increased risk for skin breakdown. Although incidence rates of 27% to 29% have been reported for hurry ulcers in acute care populations, the incidence leap overs to an alarming 12% to 66% for surgical patients.(1) Corresponding prevalence rates vary from 35% to 295%(2)

hurry ulcers are defined as lesions upon any skin surface that meet the eye from unrelieved pressure and be the effect in damage to underlying tissue. They usually take place over bony prominences and are graded in stages I to IV, according to the grade of tissue damage (Table 1)(3) The national richness of pressure ulcer treatment has been estimated to exce $134 billion.(4) This amount, however, does not account for the splendor of suffering experienced by patients and their family members.

STAGES OF compressing ULCERS

Stage 1

Nonblanchable erythema of intact skin; the heralding lesion of skin ulceration.

Stage II

Partial-thickness skin los involving epidermis and/or dermis. The fester is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage III

glutted thickness skin loss involving damage or necrosis of subcutaneous tissue that may stretch out down to, but not between the sides of underlying fascia. The ulcer not past nor futures clinically as a deep crater with or without undermining of adjacent tissue.

Stage IV

Full-thickness skin los with extensive destruction, tissue necrosis, or damage to muscle, bone or supporting constitution (eg, tendon, joint capsule).

Unable to stage

When eschar is at hand accurate staging of the influence ulcer is not possible until the eschar has sloughed or the injury has been debrided.

hurry ulcers that originate during surgical acts may appear within a small in number hours postoperatively, but the majority usually not past nor future one to three days after surgery(5) sum of two units studies reported skin breakdown related to a surgical experience as late as six days postoperatively.(6) with undivided animal study reporting breakdown up to the ninth postoperative day.(7) Tissue damage resulting from put offed intense pressure created during surgical acts often presents as a "burn" or bruise in its early stages and is, therefore, often misdiagnosed. These "closed" pressure sore s deteriorate fairly rapidly to stages III or IV.(8)

At our hospital, the Maine Medical Center Portland, squeezing ulcer prevalence data from a previous consideration revealed a rate of 325% and more than half of the patients with squeezing ulcers had undergone a surgical experience during their harmonizing hospitalization.(9) Prevalence data do not permit cause and meaning analysis; therefore, this study was designed to examine the etiology and incidence of postoperative constraining force ulcers and to evaluate the effectiveness of a special OR mattress overlay and heel and hustle protectors in preventing the evolution of pressure ulcers.

BACKGROUND

In 1994 data from the first compressing ulcer prevalence study in this hospital revealed a 325% prevalence rate for stages I to IV. A nursing protocol for the prediction and prevention of influence ulcer development was implemented. A follow-up studious mood six months later revealed the prevalence rate had decreased to 27% Although this reduction was clinically significant, it was not statistically significant.

Logistic regression analysis of the 625 patients in the sum of two units prevalence studies showed that patients who had been in the OR were 90% more likely to not past nor future with an ulcer than patients who had not been in the OR (P =046) Of the 268 surgical patients, 94 had common to five ulcers each, for a total of 187 sore s Discounting ulcers documented on admission, we calculated an incidence rate of 35% for surgical patients. The primary sore sites in surgical patients were the sacrum or coccyx area (66) heels (40) or flexures (22). In these specific locations, an incidence rate of 28% was comput We did not garner data regarding the day of surgery or the postoperative day when skin changes were first documented.

Other statistically significant predictors of prevalence in the ended sample of hospitalized patients included an albumin of 35 ngm/dL fragile skin as determined by way of nursing assessment, and a comorbidity of diabetes as determined on medical diagnosis (P = 016; P = 000; P = 001) Within the surgical subset fragile skin and comorbidity of diabetes were the no other than predictors. There were no statistically significant differences in sex age, or primary diagnoses in the total sample, the surgical subset or in patients with sore s As a prevalence study is complet forward current patients, the number of days since hospital admission was determined for comparison. The median day of hospitalization for all patients in the two prevalence studies was seven days. In contrast, the median day of hospitalization for surgical patients with an sore was 16.5; for nonsurgical patients with an sore the median day of hospitalization was 10