title: Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study.
abstract: OBJECTIVE
  To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents.
  
  
  METHODS
  A prospective multicenter cohort study.
  
  
  METHODS
  Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg).
  
  
  METHODS
  A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer.
  
  
  METHODS
  Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants.
  
  
  RESULTS
  A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home.
  
  
  CONCLUSIONS
  The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular internal quality controls.
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands. e.meesterberends@maastrichtuniversity.nl
authors.forename: Esther
authors.initials: E
authors.lastname: Meesterberends
authors.forename: Ruud J G
authors.initials: RJ
authors.lastname: Halfens
authors.forename: Marieke D
authors.initials: MD
authors.lastname: Spreeuwenberg
authors.forename: Ton A W
authors.initials: TA
authors.lastname: Ambergen
authors.forename: Christa
authors.initials: C
authors.lastname: Lohrmann
authors.forename: Jacques C L
authors.initials: JC
authors.lastname: Neyens
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors
keywords: Pressure ulcers; incidence; nursing homes; prevention