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Estimates are that between 1.5 and 3 million people in the United States have pressure ulcers. Hospital stays with pressure ulcers listed as a diagnosis increased by nearly 80% in the United States between 1993 and 2006. These chronic wounds cost approximately $5 billion annually to treat, and Center for Medicaid and Medicare Services (CMS) no longer reimburses for additional costs arising from nosocomial stage III or IV pressure ulcers.1–6
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The prevalence and incidence of pressure ulcers varies with the clinical setting. In acute care, the incidence ranges from 0.4% to 38%; in long-term care, from 2.2% to 23.9%; and in home care, from 0% to 17%. Most pressure ulcers develop during the first few weeks of hospitalization. The prevalence of pressure ulcers in acute care settings is approximately 15%, in long-term care settings from 2.3% to 28%, and in home care from 0% to 29%.1–4
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Pressure ulcers are more common in the elderly, especially those over the age of 70, in patients who have had surgery for hip fracture, and in patients with spinal cord injury. A multicenter study of 3,233 elderly admitted from the emergency demonstrated a pressure-ulcer incidence (mostly stage II) of 6.2% on hospital day 3, with significant associations to advanced age, male gender, dry skin, urinary and fecal incontinence, difficulty turning in bed, and poor nutritional status.7
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The majority of pressure ulcers occur on the lower part of the body, 65% in the pelvic area and 30% on the lower limbs, though other locations include the scalp in infants with neurological injury or the face from endotracheal tubes during long surgeries or intensive care unit (ICU) stays.1–4
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The main etiologic factors contributing to pressure ulcer development include pressure, shearing forces, friction, and moisture.
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Pressure or force per unit area is considered to be the most important factor in pressure ulcer formation. Normal tissue pressure is between 12 and 32 mm Hg. Pressures higher than this upper limit can compromise tissue circulation and oxygenation. When a patient lies immobile on a hospital bed, pressures as high as 150 mm Hg can be generated, especially over bony prominences. At pressures of 70 mm Hg or more, there is an inverse time–pressure curve with rapid pressure ulcer formation....