Pressure ulcer risk in long-term units: prevalence and associated factors

Aim. This paper is a report of a study to assess pressure ulcer prevalence in a group of long-term units and to describe the main factors associated both with risk for and presence of a pressure ulcer. Background. Despite being potentially preventable, pressure ulcers are highly frequent among institutionalized patients and are associated with increased morbidity and mortality. Method. A cross-sectional study was carried out, involving 571 patients from 10 long-term units in Rome, Italy. Healthcare staff in each unit evaluated pressure ulcer risk and collected clinical data while a single Registered Nurse assessed all patients to identify pressure ulcers. Univariate and multivariate analyses were performed for the two outcomes: condition at risk for pressure ulcers (Braden score <= 16) and pressure ulcer presence. The data were collected in February-March 2005. Findings. The overall prevalence of pressure ulcers was 27%. Multivariate analysis showed a statistically significant positive association between high-risk condition of pressure ulcer and previous stroke (OR = 1.96; 95% CI 1.30-2.96), previous trauma (OR = 1.83; 95% CI 1.12-2.99) and cognitive decline (OR associated with a 1 point Short Portable Mental State Questionnaire increase = 1.26; 95% CI 1.05-1.50). The model for pressure ulcer presence confirmed a statistically significant excess in patients with cardiovascular diseases (OR = 1.79; 95% CI 1.13-2.85), with high Activity of Daily Living scores (OR associated with a 1 point increase 1.38; 95% CI 1.03-1.84) and low Braden Scale scores (OR associated with a 1 point increase = 0.80; 95% CI 0.70-0.87). The risk of pressure ulcers according to number of full-time nurses and auxiliary staff per 10 beds lower than five was marginally statistically significant (OR = 1.60; 95% CI 0.98-2.61). Conclusion. Further research is needed to validate our findings and further prospective research is needed to identify ways of preventing pressure ulcers. Our data on staffing suggest that organizational factors should be taken into account when exploring determinants of pressure ulcers.