FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Wednesday August 31st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
Epidemiology of pressure ulcers in Portugal – the current position
Alves, Paulo 1 , Neves-Amado, João 1 , Amado, João 1 , Vieira, Margarida 1
1 Health Sciences Institute – Oporto – Catholic University of Portugal
Pressure ulcers are a major and global health
problem. The healing is difficult and complex; they
bring with them great physical, psychological and
social suffering, decreases the quality of life of the
person and their family members, and a major
economic burden. The most recent definition of
Pressure Ulcers is the International NPUAP-EPUAP
Pressure Ulcer Definition, defined as “A pressure ulcer
is a localized injury to the skin and/or underlying tissue
usually over a bony prominence, as a result of
pressure, or pressure in combination with shear. A
number of contributing or confounding factors are also
associated with pressure ulcers; the significance of
these factors is yet to be elucidated” [1].
The pathophysiology of pressure ulcers describes four
mechanisms on the soft tissue in response to
mechanical loading: localized isquemia, Impaired
interstitial fluid flow and lymphatic drainage,
reperfusion injury and sustained deformation of cells.
Hospital Managers and Administrators are now giving,
more attention to this problem. Some numbers show
the extent of this issue, Pressure Ulcers are a major
cause of morbidity in the population [2] and increased
mortality [3].
The surgeon general’s Healthy People 2010 document
has identified pressure ulcers as a national health
issue for long-term care, and the Health Care
Financing Administration (HCFA; in June 2001
renamed the Centers for Medicare & Medicaid
Services) has designated pressure ulcers as one of
three sentinel events for long-term care [4].
Approximately 18% of hospitalised patients have a
pressure ulcer [5].
Regular measurement of pressure ulcer prevalence is
for many of health care institutions an action of
evaluation of the quality of care. Compare data is
difficult to achieve, related to methodology, sample
selection, collecting data tool, between others, that´s
why literature shows a large variety of figures from
different countries and different care-settings.
Some data of incidence and prevalence of Portugal
demonstrates completely different figures,
demonstrating diverse realities. This is important to
reflect on contributing factors, preventive measures,
prevention material available, location and categories
of the population studied.
In Portugal the first prevalence study on wounds
(EPNFeridas)[6], started on March 2011 and some
preliminary data is already available. This study and
the most recent prevalence studies used the EPUAP
collection form toll [7].
pjalves@porto.ucp.pt
27
In the year 2002 EPUAP, as published the results of
the pilot study of prevalence [7], in hospital setting,
from five European countries (Belgium, Italy, Portugal,
United Kingdom and Sweden), with more than 5000
patients. The median prevalence was 18,1%, in
Portugal was 12.5%, there were evaluated 784
hospitalized patients, of whom 98 had pressure ulcers.
First study of prevalence and incidence of pressure
ulcers, was conducted for the validation of the Braden
Scale in Portugal [8], 9841 patients were evaluated,
with a prevalence of 11,5%. The other study, the
Project ICE [9], included hospitals, nursing homes and
primary health care, the sample included 1,186
individuals, with an overall prevalence of 14.2%, and
the highest prevalence was found at the level of
primary health care. The figures corresponding to the
locations were similar, the same we cannot say about
the categories of the pressure ulcers in Portugal.
Professionals should be aware that most pressure
ulcers can be prevented, and the approach with
objective preventive measures, may be cheaper than
the concern to treat this type of chronic wound
[10,11,12]. It is known that the treatment and
prevention of pressure ulcers is expensive for health
services, yet there is little information on precise direct
costs [2]
The prevention and healing of pressure ulcers requires
the cooperation and skills of the entire interdisciplinary
health care team [4].
Conflict of Interest
None
References
[1] NPUAP & EPUAP (2009). Prevention and treatment of pressure ulcers:
clinical practice guideline. Washington DC: National Pressure Ulcer Advisory
Panel.
[2] Franks, P. (2007). The cost of pressure Ulceration. EWMA Journal , 15-17.
[3] Allman, R. (1997). Pressure ulcer prevalence, incidence, risk factors and
impact. Clinical Geriatric Medicine , 241-246.
[4] Lyder, C (
[5] EPUAP, E. P. (2002). Summary report on the prevalence of pressure
ulcers. EPUAP Review , 49-57.
[6] Alves, P. Amado, J. Vieira, M (2011). Estudo Nacional de Prevalência em
Feridas. Universidade Católica Portuguesa – Instituto Ciências da Saúde.
[7] Clark, M. Bours, G. & Flour, T. (2002) Summary report on the prevalence
of pressure ulcers. EPUAP Review 4.
[8] Ferreira, L. Miguéns, C. Gouveia, J. Furtado, K. (2007) Risco de
desenvolvimento de úlceras de pressão – Implementação Nacional da Escala
de Braden. Lusociência. Loures
[9] Grupo ICE (2008). Enfermagem e úlceras por pressão: Da reflexão sobre
a disciplina às evidências nos cuidados. Imprenta Pelayo: Islas Canarias
[10] Hopkins B, e. a. (2000). Reducing Nosocomial Pressure Ulcers in acute
care facility. Journal of Nursing Care Quality , 28.
[11] Whitefield, M. (2000). How effective are prevention strategies in reducing
the prevalence of pressure ulcer? Journal Wound Care , 9: 261-266.
[12] Lyder, C. (2006). Pressure Ulcer prevention and management. JAMA ,
August - Vol 296 nº8, 23-30.
Copyright © 2011 by EPUAP