Pressure sore prevalence within a public health services area

1. Pressure sore prevalence within a public health services area 文章出處：Lindgren M, Unosson M, Ek A-C. International Journal of Nursing Practice 2000; 6: 333-337 報告者：門診 王鶯娟 1/21

2. ABSTRACT • Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, • treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore • assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure-sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. 2/21

3. The most fre-quently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures.There was no statistical difference in pressure-sore preva-lence when compared with a similar study from 1980. Patients were, however, older in 4/21

4. 壓瘡是一個令病患，人員和社會頭痛的大問題。 這項研究的目的是檢查流行， 在瑞典在一個公共衛生服務地區裡治療和防止壓瘡的產生。 用於壓瘡的標準 ，評估是持久的變色，上皮的損害和對皮膚充分的損害，沒有或者有凹洞 數據從1173名住院病患在1995年4月的2 周收集。壓瘡的流行比率是3.75%； 44位病患有共68個壓瘡。 大多數報告預防的措施是antidecubitus褥墊和轉動時間表。 減輕壓力和可吸收的敷料是最普通的處理measures. 當與來自1980的一項相似的研究相比較時，不過病患在1995老。 關鍵字︰ decubitus潰瘍，壓力疼痛，流行，預防，治療。

5. INTRODUCTION • Traditionally, pressure sore occurrence has been regarded as a measure of the quality of nursing care since pressuresore prevention is a matter of care of the whole person. • Pressure sores are a great problem for affected patients, for staff who care for them and for society, which has to pay for increased expenses due to the pressure sores. • previous study with similar design was performed inFebruary 1980 in the public health ser vice institutions County of Ostergotland, Sweden • 傳統上，壓瘡的事件已經被注意，從護理品質的質量的評量標準，是全部人的關心的問題。 • 壓瘡處是一個大的令病患頭痛的問題，因為人員誰照顧他們。人員和社會必須增加的花費支付。 • 之前在1980年2月瑞典公共衛生中心，壓瘡的研究有與本文類似的看法。 5/21

6. The criteria used to dentify pressure lesions or sores were persistent dis-coloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The overall pressure sore prevalence was 4%, and 83% of the patients with a pressure sore were 65 years of age or older 這套標準認為壓瘡的分級標準從皮膚是否持久性變色、上皮細胞損壞、對皮膚的充分的損害，有沒有一個凹洞 壓瘡盛行率是4%，病患的83%有壓瘡，年齡是65歲或者更老。

7. This previous study was followed by a longitudinal study consisting of 515 newly admitted patients who came to the long-term care clinic from home or were referred from an acute-care clinic.The pressure-sore prevalence on admis- • sion was 16%,while 7.6% developed pressure sores duringthe observation period.2 Another study consisting of 501newly admitted geriatric patients, hospitalized in a geri-atric clinic, was performed.The pressure-sore prevalenceperiod. • Another study consisting of 501newly admitted geriatric patients, hospitalized in a geri-atric clinic, was performed.The pressure-sore prevalenceOn admission was 14%, and 10% developed pressure sores during the observation period • ㄧ個之前的研究包含515新進病患，由長照機構或急性醫療來的病患，其壓瘡盛行率是16%，然而在觀察期間有7.6%發展成壓瘡 • 另一項研究由501新進病患，為老年醫學的病患，其壓瘡盛行率是14%，然而在觀察期間有10%發展成壓瘡 6/21

8. A point prevalence study including 2513 inpatients reported pressure-sore prevalence of 5.3%. • University and teach-ing hospitals with acute, long-term and geriatric wards repor ted a pressure sore prevalence ranging from 5.1% to 32.1% • Barrois et al. examined the pressure sore prevalence at 150 hospitals in France. The study included12050 patients and reported a pressure-sore prevalence of 5.2%. • The biggest differences in pressure sore preva-lence may be due to different grading systems, different patient groups and different definitions used.There is alsoa risk for under-repor ted or over-reported early stages of pressure sores that is related to the grading score use • 有ㄧ個研究進行包含2513個病患，其壓瘡盛行率是5.3%。 • 然而在大學醫院和教學醫院，報告由長照機構和老年醫院，其壓瘡盛行率是5.0%-32.1% • Barrois在法國150間醫院，包含12050個病患的研究，其壓瘡盛行率是5.2%。 • 壓瘡盛行率最大的不同是由於不同等級的界定系統，敘述不同，分數也有影響。 7/21

9. Because the population is becoming older and sicker and the average length of life is increasing, • The purpose of the present study was to examine pressure-sore prevalence and how pressure sores are distributed over age and sex; to describe what the patients pressure sores look like with regard to stages, and to describe the methods of preventive care and treatment used. • 然而人口越來愈老化，生命長度一直在增加。 • 這研究的目的是在細心檢視壓瘡盛行率、年齡、性別的分類、描述病患壓瘡的等級、預防的方法 8/21

10. METHODS • The investigation was carried out in the health service institutions within the central public health services area of the County of Ostergotland, in Sweden. • One university hospital, with a large number of specialities nursing homes was included (55 wards in total, patients aged 18 years and older).The data were collected by interview during 2 weeks in April 1995. • A pressure sore was defined as a sore that had devel- as a result of a prolonged period of insufficien or nonexistent blood FL.ow (ischaemia) in the tissues. Ischaemia can be due to pressure and shearing force, and increased temperature makes these effects worse. • 研究的地區在瑞典， Ostergotland縣，有許多專業的大學醫院和和小型醫院包括(包含55 病房，病患18歲和更老) • 數據收集在1995年4月的2 週，調查壓瘡的病患並收集資料 • 壓瘡被解釋成長時間組織裡的灌流不足的狀態，一個延長時間局部缺血 • 局部缺血可能由於加壓和剪切力，溫度的增加使這些影響更壞 9/21

11. The various stages of pressure-sore development used inthe study • stage 1, persistent discoloration with intact skin surface; • stage 2, epithelial damage with absion, blister or shallow crater; • stage 3, damage to the full thickness of the skin without a deep cavity down to butnot through the subcutis; • stage 4, damage to the full thickness of the skin with a deep cavity through the sub-cutis extending to underlying tissue such as muscle and bone • 第一階段：皮膚表面，持久性的變色 • 第二階段：上皮細胞的損害，水泡、淺顯的傷口 • 第三階段：皮膚深度（皮下組織）完全的損害，有深部的凹洞 • 第四階段：皮膚深度完全的損害，有深部的凹洞，甚至接近肌肉和骨頭 10/21

12. The interviews were carried out by telephone.Two forms were used for data collection. • One consisted of questions regarding the prevalence of pressuresores on the ward and measures of prevention and treatment. • The second form described the patients with presure sores with regard to sex, age and diagnoses and the site and size of the sores, measured by overall length and width • 研究運用深度會談的技巧，以及電話進行接見，收集數據 • 有2個重點形式用於：1.病房壓瘡盛行率、壓瘡使用的分級、描述預防和治療方法 2.關於病患的年齡、性別、臨床診斷、壓瘡部位和大小和寬度，被全程測量 11/21

13. RESULTS • The total number of inpatients was 1173, of whom 714（60.9%) were women and 459 men (39.1%). Out of 55 wards, four reported that pressure sores never occurred, 24 wards stated that pressure sores sometimes occurred,though not at that moment, while 27 wards had patients with pressure sores at the time of investigation. • Reasons mentioned for not having pressure sores in theward were: good nursing care, active patients, turningschedules/relief from pressure, preventive measures, short hospital stay, mobilization, taking care of the patients skin, good nutrition and good hygiene. • In most nurses opinions, patients developed pressure sores because of immobility, disease, poor food and .uid intake, general physical condition, inadequate care, surgery and incontinence. 12/21

14. 結果 • 病患總數1173，其中714 ( 60.9%)是婦女和459個男人(39.1%)。 55間病房，有4 個報告沒有壓瘡，24間病房有時有壓瘡發生，但是在那片刻沒有，27間病房說有壓瘡 • 原因分析，沒有壓瘡最好的病房是︰ 好的護理照顧，活躍的病患，轉身時間表/減輕壓力。 • 預防的措施：醫院停留時間短，注意照顧病患皮膚，好營養和好衛生學。 • Nurses的意見：病患發展成壓瘡，是因為固定不動，疾病，不好的營養和糟糕的身體狀態，不適當手術 13/21

15. In total, 44 patients (3.75%) among the had pressure sores. The highest pressure-sore prevalence of 9.2%, occurred in the geriatric wards. The pressure sore prevalence in nursing homes and acute wards was 4.1% and 2.2%, • .The age of patients with pressure sores ranged from 19years to 95 years; 97.7% were 65 years of age or older and 62.8% were older than 80 years. The mean ages in patients with pressure sores were 79.8 ±12.4years, the women were older (84.6 ± 6.6 years) than the men (72.5 ± 15.2 years • 全部，在1173patients中的44位病患(3.75%)壓瘡盛行率9.2%，發生在老人病房。在護理之家和急性病房壓瘡盛行率4.1%和2.2 % • 病患的年齡 19歲到95 歲，97.7% 是65歲和62.8%比80歲老 • 平均是79.8±12.4歲，婦女平均是(84.6±6.6歲) (男人72.5± 15.2歲） 14/21

16. Of 44 patients with pressure sores, 33 were referred from another clinic and 17 had pressure sores on admission. Eleven patients came from home to the wards, four of whom had pressure sores on admission. Thus, 47.7%of the pressure sores existed when patients arrived at the wards • .There was a total of 68 pressure sores The most common pressure sore was damage to the full thick ness of the skin (n = 27), with (n = 19) and without(n = 8) a deep cavity through the subcutaneous tissue • 在有壓瘡的44位病患中，33位從其他醫院轉介過來，其中17位病患到達醫院即有壓瘡。11 位病患來自家中其中4位病患到達醫院即有壓瘡到病房，因此47.7%病患在到達醫院即有壓瘡。 • 在68個壓瘡中皮膚完全損壞(n = 27) ，有(n = 19)和沒有(n = 8)透過皮下組織的一個洞。 15/21

17. Nine of those sores with a deep cavity were situated onthe heel .The pressure sores were situated mainly below the waist (i.e. on the sacrum and the heels;.The largest pressure sore measured 20 cm ¢D10 cm, and consisted of damage to the full thickness of the skin without a cavity, situated on the sacrum. • Antidecubitus mattresses and turning schedules were the most frequently used preventive measures frequently reported treatment measures Som of the measures, such as turning schedules and massage, were used both as prevention and treatment • 有9 個壓瘡是位於足跟一個深洞，壓瘡主要坐落於荐骨和足跟，最大的壓力痛處測量20厘米和10厘米，並且已對皮膚充分的損害 • Antidecubitus褥墊和轉動的時間表是 最經常使用的預防的措施 • 減輕壓力和吸收性的敷料是最多治療措施 • 轉動的時間表、並且按摩是經常報告作為預防和治療措施 16/21

18. DISCUSSION • The results observed in this study show that pressure sore development is still a problem in nursing care andmust be considered in clinical practice. Important issuesfor nurses in the prevention and treatment of pressuresores are: (i) identification of patients at risk of pressure pressure soresore development; (ii) relief of pressure; (iii) ensu ing good food and .uid intake; (iv) providing regular skin assessment and skin care. To treat existing pressuresores, there is a need for knowledge about the physiology of wound healing and local treatment of wounds. • Pressure sore prevention and treatment are areas that must beemphasized in the education of nurses and in the further education of graduate staff 17/21

19. 在這項研究過程中，觀察的結果，顯示壓瘡發展仍然在這項研究過程中，觀察的結果，顯示壓瘡發展仍然 在護理照顧過程中的一個重要的問題，必須被在臨床的實踐過程中考慮。 壓瘡預防和製療過程： (i)為病患做壓瘡危險因子的鑑定。 (ii)減輕壓力 (iii)題供好飲食和營養　 (iv)提供有規律的皮膚評估和皮膚護理 在護士的教育方面，要再進一步的強調對於生理學的知識的重要。 傷口預防和治療也是未來護理教育的方向

20. CONCLUSIONS • The pressure sore prevalence rate was as high in 1995 as it was in the same geographical area in 1980, and as lowin relation to comparable prevalence studies in Europe. • The patients with pressure sores were significantly olderin 1995 than in 1980. • Further, men were as prone todevelop pressure sores as women in spite of the fact thatmen were younger than women. • Almost the same preventive and treatment measures are mentioned in 1995 asin the previous study but in a different order. • 壓瘡的盛行率在1995年與1980年相同的地區一樣高 ， 但是關於可比較的歐洲研究而言是較低的。 • 在1995年與在1980年相比，1995年病患比較老。 • 研究中，未來男人比婦女更容易得壓瘡，儘管事實上，男人比婦女年輕。 • 壓瘡的預防，處理和治療1995年被提及作為和在以前的研究，幾乎相同；但是在一項程序不同。 19/21

21. ACKNOWLEDGEMENTS • Grants from the Swedish Medical Research Council, the research fund of the County of Ostergotland, the Regional Council of Ostergotland and the University ofLinkoping, Vardalstiftelsen nr V96¡V142, are gratefully acknowledged. 20/21

22. 謝謝聆聽指教