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Prevalence of Pressure Ulcer

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The management of chronic wounds is a significant part of the workload for any nurse caring for elderly vulnerable people since these patients are more prone to the conditions that can lead to chronic wounding. Chronic wounds like pressure ulcers demands a detailed and individual treatment plans depending upon the nature of the wound and the circumstances of the patient. The experience of having a pressure ulcer can result in the loss of a patient’s sense of self

Exudation and malodour may lead to social problems and this, along with skin problems, may decrease a patient’s quality of life. Hence Pressure ulcers need to be prevented as far as possible in all care settings. Pressure ulcer management involves treating infection, providing a moist wound-healing environment and choosing the appropriate dressing.

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The use of oral antibiotics or topical sulfa silverdiazine has also been found to be effective in decreasing the bioburden in the ulcer bed. Treatment using silver-impregnated dressings has been shown to be somewhat effective in decreasing bacterial bioburden load. One in vivo study found that silver-based dressings decreased specific bacteria

However, a systematic review of the research literature found only three randomized controlled trials covering participants. This Cochrane review determined that based on only three randomized controlled trials, there remains insufficient evidence to recommend the use of silver-containing dressings or topical agents for treatment of infected or contaminated chronic wounds.The use of antiseptics to reduce wound contamination continues to be a controversial topic. The ideal agent for an infected pressure ulcer would be bactericidal to a wide range of pathogens and noncytotoxic to leukocytres. In vitro studies of 1 percent povidone-iodine have been found to be toxic to fibroblast, but a solution of 0.005% sodium hypochlorite (P = 0.001) caused no fibroblast toxicity and was still bactericidal to Staphylococcus aureus.111 Another common antiseptic with conflicting data is sodium hypochlorite (Dakins solution). Studies suggest that 0.005 percent concentration of sodium hypochlorite to be bactericidal; however, its use can also cause inhibition of fibroblast and neutrophil migration necessary for pressure ulcer healing.

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According to Lewis M, et al (2003) if the patients having a moderate to high possibility of developing pressure sore, dynamic support surfaces include a large cell alternating pressure mattress, a low air loss or air fluidized bed, or other pressure redistributing systems can be recommended. In a study conducted by Nixon et al (2006)found that in operating tables, specialized foam mattress overlays are effective to reduce the incidence of postoperative pressure sores while in other settings, specialized foam and overlays were the only surfaces that were constantly better to standard hospital mattresses in reducing incidence of pressure ulcers. To decrease the contact between bony prominences and support surfaces, pillows and foams are used. In addition to that for reducing the friction and shearing damage, lifting devices such as slide sheets, slings or sleeves can be used to move the patients. On the other hand, it is unclear about the evidence for the advantages of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure sores. However, there is clinical evidence of a difference in risk of developing pressure ulcers when using high-specification foam mattresses, compared to standard hospital mattresses

(NICE 2005) Decisions for pressure relieving device should determine at risk assessment. It must include level of risk, comfort, patient`s preferences, general health and timing of the surgery.

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On balance, the world health organization sensitizes that countries should ensure the proper risk assessment and management measures are well implemented. The global interactions of this century call for complex immigration cycles

These immigration cycles can lead to spread of communicable diseases through human interactions. Thus, there should be a proper global risk management protocol for communicable diseases. The inefficiency of health systems can lead to huge loss of lives. For instance, the unpreparedness by third world African countries towards the Ebola epidemic has led to wide spread of the disease. In such situations, the safety of health staff is not guaranteed and work inefficiency due to personal fear may be encountered.

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Kaitani, T., Tokunaga, K., Matsui, N. and Sanada, H. (2010). Risk factors related to the development of pressure ulcers in the critical care settings. Journal of Clinical Nursing, 19, 414-421.

Lewis,M., Pearson,A., Ward,C. (2003) Pressure ulcer prevention and treatment: Transforming research findings into consensus based clinical guidelines. International Journal of Nursing Practice, 9, p.92-102.

Lindgren, M., Unosson, M. and Krantz, A. M. (2002) A risk assessment scale for the prediction of pressure sore development: reliability and validity. Journal of Advanced Nursing. 38, p.190-199.

Nix DP. Support surfaces. In: Bryant R, Nix D, eds. Acute & Chronic Wounds: Current Management Concepts. 3rd ed. St Louis MO: Mosby; 2007:235-248.

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