Prevalence, risk factors and prevention of pressure ulcers in Dutch intensive care units - Results of a cross-sectional survey

Objective: Evaluating the prevalence, risk factors and prevention of pressure ulcers in Dutch intensive care units (ICUs). Design: Cross-sectional design. Setting: ICUs of acute care hospitals that participated in the 1998 and 1999 national prevalence surveys. Data were collected on 1 day in each year. Patients: Eight hundred fifty patients admitted to Dutch ICUs. Interventions: None. Measurements and main results: Six categories of data were collected: (1) characteristics of the institution, (2) characteristics of the ward, (3) characteristics of the patients (age, sex, date of admission, reason for admission), (4) risk assessment using the Braden scale and two additional risk factors (malnutrition and incontinence), (5) severity of the pressure ulcers and (6) supportive surface used. The prevalence of pressure ulcers was 28.7 %. In a forward logistic regression analysis, four risk factors were significantly associated with the presence of pressure ulcers: infection, age, length of stay and total Braden score. Of the patients at high risk of developing pressure ulcers but without actual pressure ulcers, 60.5 % were positioned on a support system. Only 36.8 % of the patients who were determined to need repositioning were actually being turned. Conclusions: The prevalence of pressure ulcers in Dutch ICUs is high and their prevention is flawed, especially as regards the use of support systems. Patients for whom turning is indicated are not being turned. Predicting pressure ulcers in ICU patients is difficult and needs further investigation.