Yoğun Bakım Ünitelerindeki Yaşlı Hastalarda Bası Yarası Prevalansı ve Etkileyen Faktörler

Abstract

Amaç: Bu çalışmanın amacı, yoğun bakım ünitesinde yaşlı hastalarda bası yarası prevalansı ve bası yarası gelişimi ile ilişkili risk faktörlerini belirlemektir. Gereç ve Yöntemler: Araştırma tanımlayıcı olarak tasarlanmıştır. Veriler, bu araştırma için yazarlarca geliştirilen, literatürde bası yarası ile iliş- kili bulunan demografik ve klinik özelliklerden oluşan form ve Braden Ölçeği kullanılarak toplandı. Her hastanın cildi araştırmacı tarafından değerlendirildi ve bası yaraları Amerika Bası Ülseri Ulusal Danışma Paneli (NPUAP)’ne göre sınıflandırıldı. Araştırma kapsamında İstanbul’daki 21 hastanenin 50 farklı yoğun bakım ünitesinde tedavi gören 180 yaşlı hasta değerlendirildi. Veriler Haziran 2008- Haziran 2009 tarihleri arasında toplandı. Araştırma için “etik kurul onayı” alındı. Bulgular: Hastaların yaş ortalaması 72,8 idi. Bası yarası prevelansı %40,6 olarak bulundu (evre 1 bası yaraları dahil), yaralar en sık sakral bölgede izlendi (%35,9). En yaygın görülen ülserler evre 1’di (%43,6). Bası yarası olan yaşlı hastalarda yaş, BKİ değerleri ve hastanede yatış süresi bası yarası olmayan hastalara göre daha fazla, serum albümin düzeyi ve Braden Ölçek puanı daha düşüktü. Sonuç: YBÜ’deki yaşlı hastalarda bası yarası prevalansı diğer çalışmalardan yüksek bulundu. Bu sonuç yoğun bakım ünitelerindeki yaşlı hastalarda bası yarası önleme stratejilerine daha fazla önem verilmesi gerektiğini göstermektedir.

Keywords

• Bası yarası, yoğun bakım ünitesi, yaşlı hasta

Pressure Ulcer Prevalence and Effecting Factors Among Elderly Patients in Intensive Care Units

Abstract

Objective: The purpose of this study was to identify pressure ulcer (PU) prevalence and risk factors that are associated with pressure ulcer development in elderly patients in intensive care units (ICUs). Material and Methods: The research has been designed as a descriptive study. Data were collected using a form developed by the authors of this research that contains demographic and medical characteristics found in literature to be associated with PUs and the Braden Scale. The skin of each participating patient was assessed and pressure ulcers were classified according to the National Pressure Ulcers Advisory Panel grading system. Within the scope of thisresearch 180 elderly patients were evaluated in 21 hospitals in 50 different ICUs in Istanbul. Data were collected between July 2008- 2009. The ethics committee approval was obtained forresearch. Results: The average age of the patients in this study was 72.8. The prevalence of pressure ulcers in ICU patients was found out to be 40.6% (including category 1 ulcers). Pressure ulcers occurred most frequently in the sacral area (35.9%). The most common pressure ulcers were grade 1 (43.6%). In elderly patients with PUs in the ICU, age, BMI values and length of hospital stay were higher whereas serum albumin levels and Braden Scale scores were lower compared to patients without PUs. Conclusion: The prevalence of PUs in elderly patients in ICUs was found out to be higher than that reported in other studies. This outcome indicates that more attention is required for PU prevention strategies in ICUs for elderly patients.

Keywords

• Pressure ulcer, intensive care unit, elderly patient

References

1. Cheung C. Older adults and ulcers: chronic wounds in the geriatric population. Adv Skin Wound Care 2010;23(1):39-44.
2. de Souza DM, de Gouveia Santos VL. Inci- dence of pressure ulcers in the institutional- ized elderly. J Wound Ostomy Continence Nurs 2010;37(3):272-6.
3. Casimiro C, García-de-Lorenzo A, Usán L. Prevalence of decubitus ulcer and associated risk factors in an institutionalized Spanish eld- erly population. Nutrition 2002;18(5):408-14.
4. Moore Z, Cowman S. Pressure ulcer preva- lence and prevention practices in care of the older person in the Republic of Ireland. J Clin Nurs 2012;21(3-4):362-71.
5. Theisen S, Drabik A, Stock S. Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational- study. J Clin Nurs 2012;21(3-4):380-7.
6. Aygör HE, Sahin S, Sözen E, Baydal B, Aykar FS, Akçiçek F. Features of pressure ulcers in hospitalized older adults. Adv Skin Wound Care 2014;27(3):122-6.
7. European Pressure Ulcer Advisory Panel (EPUAP). European Pressure Ulcer Preva- lence Study http://www.epuap.org/pressure- ulcer-research/pressure-ulcer-prevalence-coll ection-sheet (Erişim Tarihi: 02.02.2016)
8. Lyder CH, Wang Y, Metersky M, Curry M, Kli- man R, Verzier NR, et al. Hospital-acquired pressure ulcers: results from the National Medicare Patient Safety Monitoring System Study. J Am Geriatr Soc 2012;60(9):1603- 8.

9. Redelings MD, Lee NE, Sorvillo F. Pressure ulcers: more lethal than we thought? Adv Skin Wound Care 2005;18(7): 367-72.
10. Terekeci H, Kucukardali Y, Top C, Onem Y, Celik S, Oktenli C. Risk assessment study of the pressure ulcers in intensive care unit pa- tients. Eur J Intern Med 2009;20(4):394-7.
11. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Pre- vention and treatment of pressure ulcers: quick reference guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009. (Çev. Yara Ostomi İnkontinans Hemşireleri Derneği). Basınç Ülserlerini Önleme: Hızlı Başvuru Kılavuzu. Aralık 2010, Ankara. www.epuap.org/ guidelines/QRG_Prevention_in_Turkish.pdf (Erişim Tarihi: 03.03.2016).
12. World Health Organization-BMI classification - http://apps.who.int/bmi/index.jsp?introPage=in tro_3.html Erişim Tarihi: 17.02.2016
13. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nurs Res 1987;36(4):205-10.
14. Oğuz S. Braden Ölçeği ile hastaların risklerinin belirlenmesi ve planlı hemşirelik bakımının bası yaralarının önlenmesindeki etkinliğinin saptanması. [Yüksek Lisans Tezi], İstanbul: Marmara Üniversitesi Sağlık Bilimleri En- stitüsü; 1997.
15. Pınar R, Oğuz S. Norton ve Braden bası yarası değerlendirme ölçeklerinin yatağa bağımlı aynı hasta grubunda güvenirlik ve geçerliğinin sınanması: Uluslararası Katılımlı VI. Ulusal Hemşirelik Kongresi, Kongre Kitabı; 1998. s.172-5.
16. Park SH, Lee YS, Kwon YM. Predictive valid- ity of pressure ulcer risk assessment tools for elderly: a meta-analysis.West J Nurs Res 2016;38(4):459-83.
17. de Laat EH, Schoonhoven L, Pickkers P, Ver- beek AL, van Achterberg T. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care 2006;15(6):269-75.
18. Hug AKME, Ünalan H, Karamehmetoğlu ŞS, Tüzün Ş, Gürgöze M, Tüzün F. Bir eğitim has- tanesinde bası yarası prevalansı ve bası yarası gelişiminde etkili risk faktörleri. Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi 2001;47(6):3-11.
19. Uzun O, Tan M. A prospective, descriptive pressure ulcer risk factor and prevalence study at a university hospital in Turkey. Os- tomy Wound Manage 2007;53(2):44-56.
20. Inan DG, Oztunç G. Pressure ulcer preva- lence in Turkey: a sample from a university hospital. J Wound Ostomy Continence Nurs 2012;39(4):409-13.
21. Sayar S, Turgut S, Doğan H, Ekici A, Yurt- sever S, Demirkan F, et al. Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow Scale and factors influencing the development of pres- sure ulcers. J Clin Nurs 2009;18(5):765- 74.
22. Petzold T, Eberlein-Gonska M, Schmitt J. Which factors predict incident pressure ulcers in hospitalized patients? A prospective cohort study. Br J Dermatol 2014;170(6):1285-90.
23. Khor HM, Tan J, Saedon NI, Kamaruzzaman SB, Chin AV, Poi PJ, et al. Determinants of mortality among older adults with pressure ul- cers. Arch Gerontol Geriatr 2014;59(3):536-41.
24. Leijon S, Bergh I, Terstappen K. Pressure ulcer prevalence, use of preventive measures, and mortality risk in an acute care population: a quality improvement project. J Wound Os- tomy Continence Nurs 2013;40(5):469-74.
25. Webster J, Coleman K, Mudge A, Marquart L, Gardner G, Stankiewicz M, et al. Pressure ul- cers: effectiveness of risk-assessment tools. a randomised controlled trial (the ULCER trial). BMJ Qual Saf 2011;20(4):297-306.
26. İstatistiklerle Yaşlılar. Türkiye İstatistik Ku- rumu; Bakım Hizmetleri. 2014. s.77-9, www.tuik.gov.tr/IcerikGetir.do?istab_id=265 (Erişim Tarihi:10.01.2016)
27. Aydin AK, Karadağ A. Assessment of nurses' knowledge and practice in prevention and management of deep tissue injury and stage I pressure ulcer. J Wound Ostomy Continence Nurs 2010;37(5):487-94.
28. Kottner J, Wilborn D, Dassen T, Lahmann N. The trend of pressure ulcer prevalence rates in German hospitals: results of seven cross- sectional studies. J Tissue Viability 2009;18 (2):36-46.
29. SKS Işığında Sağlıkta Kalite 3. Cilt. İndikatör Yönetimi. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü, Sağlıkta Kalite ve Akredita- syon Daire Başkanlığı. 1. Basım 2012. s.1-10. https://kalite.saglik.gov.tr/content/files/duyuru- lar_2011/2011/09_temmuz_2012/sks3cilt.pdf (Erişim Tarihi:17.06.2015)
30. National Pressure Ulcer Advisory Panel(NPUAP). Risk Assessment http://www.npuap.org/wp-con- tent/uploads/2015/02/1.-Risk-Assessment-J- Cuddigan.pdf (Erişim Tarihi:17.04.2015)
31. Hyun S, Li X, Vermillion B, Newton C, Fall M, Kaewprag P, et al. Body mass index and pres- sure ulcers: improved predictability of pres- sure ulcers in intensive care patients. Am J Crit Care 2014;23(6):494-501.
32. Cremasco MF, Wenzel F, Zanei SS, Whitaker IY. Pressure ulcers in the intensive care unit: the relationship between nursing workload, ill- ness severity and pressure ulcer risk. J Clin Nurs 2013;22(15-16):2183-91.
33. Lahmann NA, Halfens RJ, Dassen T. Pres- sure ulcers in German nursing homes and acute care hospitals: prevalence, frequency, and ulcer characteristics. Ostomy Wound Manage 2006;52(2):20-33.
34. Lee TT, Lin KC, Mills ME, Kuo YH. Factors re- lated to the prevention and management of pressure ulcers. Comput Inform Nurs 2012;30(9):489-95.
35. Amir Y, Lohrmann C, Halfens RJ, Schols JM. Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer char- acteristics, prevention and treatment. Int Wound J 2016. doi: 10.1111/iwj.12580.
36. Ulker Efteli E, Yapucu Günes Ü. A prospec- tive, descriptive study of risk factors related to pressure ulcer development among patients in intensive care units. Ostomy Wound Man- age 2013;59(7):22-7.
37. Feuchtinger J, Halfens RJ, Dassen T. Pres- sure ulcer risk factors in cardiac surgery: a re- view of the research literature. Heart Lung 2005;34(6):375-85.
38. Raju D, Su X, Patrician PA, Loan LA, Mc- Carthy MS. Exploring factors associated with pressure ulcers: a data mining approach. Int J Nurs Stud 2015;52(1):102-11.
39. Shahin ES, Meijers JM, Schols JM, Tannen A, Halfens RJ, Dassen T. The relationship be- tween malnutrition parameters and pressure ulcers in hospitals and nursing homes. Nutri- tion 2010;26(9):886-9.
40. Kottner J, Gefen A, Lahmann N. Weight and pressure ulcer occurrence: a secondary data analysis. Int J Nurs Stud 2011;48(11):1339- 48.
41. Cai S, Rahman M, Intrator O. Obesity and pressure ulcers among nursing home resi- dents. Med Care 2013;51(6):478-86.
42. Drake DJ, Swanson M, Baker G, Pokorny M, Rose MA, Clark-Reed L, et al. The associa- tion of BMI and Braden total score on the oc- currence of pressure ulcers. J Wound Ostomy Continence Nurs 2010;37(4):367-71.
43. Miller N, Frankenfield D, Lehman E, Maguire M, Schirm V. Predicting Pressure Ulcer De- velopment in Clinical Practice: Evaluation of Braden Scale Scores and Nutrition Parame- ters. J Wound Ostomy Continence Nurs 2016; 43(2):133-9.
44. European Pressure Ulcer Advisory Panel (EPUAP). Risk Factors and Risk Assessment. Risk Assessment Tools. http://www.epuap.org/ wp-content/uploads/2010/10/Quick-Reference- Guide-DIGITAL-NPUAP-EPUAP-PPPIA- 16Oct2014.pdf (Erişim Tarihi:17.04.2015)
45. Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk as- sessment scales for pressure ulcer preven- tion: a systematic review. J Adv Nurs 2006;54(1):94-110.
46. García-Fernández FP, Pancorbo-Hidalgo PL, Agreda JJ. Predictive capacity of risk assess- ment scales and clinical judgment for pressure ulcers: a meta-analysis. J Wound Ostomy Continence Nurs 2014;41(1):24-34.
47. Braden BJ. The Braden Scale for Predicting Pressure Sore Risk: reflections after 25 years. Adv Skin Wound Care 2012;25(2):61.
48. National Pressure Ulcer Advisory Panel (NPUAP). http://www.npuap.org/wp-content/ up- loads/2014/08/Updated-10-16-14-Quick- Reference-Guide-DIGITAL-NPUAP-EPUAP-PP PIA-16Oct2014.pdf (Erişim Tarihi:17.04.2015)
49. Gillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA, Thalib L. Repositioning for pres- sure ulcer prevention in adults. Cochrane Database Syst Rev 2014;3;4:CD009958.
50. European Pressure Ulcer Advisory Panel (EPUAP). http://www.epuap.org/guidelines/ Final_Quick_Prevention.pdf (Erişim Tarihi: 17.06.2015)
51. Hess CT, Trent JT. Incorporating laboratory values in chronic wound management. Adv Skin Wound Care 2004;17(7):378-86.
52. Anthony D, Reynolds T, Russell L. An investi- gation into the use of serum albumin in pres- sure sore prediction. J Adv Nurs 2000;32(2): 359-65.
53. Stordeur S, Laurent S, D'Hoore W. The im- portance of repeated risk assessment for pres- sure sores in cardiovascular surgery. J Cardiovasc Surg (Torino) 1998;39(3):343-9.