Risk, prevalence and prevention of pressure ulcers in three Swedish healthcare settings.
OBJECTIVE
This cross-sectional survey set out to delineate risk, prevalence and prevention of pressure ulcers in a university hospital, a general hospital and a nursing home in Sweden. It also looked at the differences in risk factors and preventive strategies between patients with and without pressure ulcers.


METHODS
The one-day survey followed the methodology developed by the European Pressure Ulcer Advisory Panel (EPUAP). It was conducted on Tuesday 5 February 2002. Each patient was visited by two registered nurses, their skin was inspected and any pressure ulcer classified according to the EPUAP grading system. A total of 695 patients were included: 612 from the university hospital, 38 from the general hospital and 45 from the nursing home.


RESULTS
The prevalence of pressure ulcers was 23.9% (university hospital), 13.2% (general hospital) and 20.0% (nursing home). Most (60-66%) of the pressure ulcers in the hospitals were assessed as grade I. Only half of the patients at risk or with pressure ulcers were placed on a pressure-reducing mattress and a third of these patients had a plan for repositioning. Significant variables associated with pressure ulcers were old age, geriatric care, low Braden score and incontinence.


CONCLUSIONS
Prevalence of pressure ulcers was higher than expected. Results relating to both prevalence of pressure ulcers (grade I excluded) and the preventive care given to patients at risk or with pressure ulcers accord with those of a larger Dutch study. Attention must focus on the appropriate risk-assessment skills, highlighting grade I as pressure damage, and the use of appropriate preventive strategies, based on the level of risk.
Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden. lena.gunningberg@akademiska.se
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D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001513:Beds / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011187:Posture; D003668:Pressure Ulcer / Q000145:classification / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology