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Journal Article•DOI•

Alginate dressings for treating pressure ulcers

Jo C Dumville1, Samantha Keogh2, Zhenmi Liu1, Nikki Stubbs3, Rachel Walker2, Mathew Fortnam4 •
University of Manchester1, Griffith University2, Leeds Community Healthcare NHS Trust3, University of York4
21 May 2015-Cochrane Database of Systematic Reviews (John Wiley & Sons, Ltd)-Vol. 2015, Iss: 5
TL;DR: The relative effects of alginate dressings compared with alternative treatments are unclear and decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.
Abstract: Background: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers. Each review will focus on a particular dressing type. Objectives: To assess the effects of alginate dressings for treating pressure ulcers in any care setting. Search methods: For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. Selection criteria: Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above). Data collection and analysis Two review authors independently performed study selection, risk of bias assessment and data extraction. Main results: We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was of low or very low quality. Where data were available there was no evidence of a difference between alginate dressings and alternative treatments in terms of complete wound healing or adverse events. Authors' conclusions: The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.

Summary (1 min read)

Jump to: [Background] – [Main results] and [Authors’ conclusions]

Background

  • Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both.
  • Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings.
  • A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers.
  • Each review will focus on a particular dressing type.

Main results

  • The authors included six studies (336 participants) in this review; all studies had two arms.
  • The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy.
  • Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times.
  • All the evidence was of low or very low quality.
  • 1Alginate dressings for treating pressure ulcers Copyright © 2015 The Cochrane Collaboration.

Authors’ conclusions

  • The relative effects of alginate dressings compared with alternative treatments are unclear.
  • Pressure ulcers can be painful, may become infected, and so affect people’s quality of life.
  • Generally, the studies the authors found did not have many participants and the results were often inconclusive.
  • More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings or other treatments.
  • The mean reduction in ulcer size (compared to baseline) was 42.5%.

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Content maybe subject to copyright    Report

Alginate dressings for treating pressure ulcers (Review)
Author
Dumville, Jo C, Keogh, Samantha J, Liu, Zhenmi, Stubbs, Nikki, Walker, Rachel M, Fortnam,
Mathew
Published
2015
Journal Title
Cochrane Database of Systematic Reviews
Version
Version of Record (VoR)
DOI
https://doi.org/10.1002/14651858.CD011277.pub2
Copyright Statement
© 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is
published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2015,
Issue 5. Cochrane Reviews are regularly updated as new evidence emerges and in response
to comments and criticisms, and the Cochrane Database of Systematic Reviews should be
consulted for the most recent version of the Review.
Downloaded from
http://hdl.handle.net/10072/81471
Griffith Research Online
https://research-repository.griffith.edu.au
Cochrane Database of Systematic Reviews
Alginate dressings for treating pressure ulcers (Review)
Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M
Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M.
Alginate dressings for treating pressure ulcers.
Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD011277.
DOI: 10.1002/14651858.CD011277.pub2.
www.cochranelibrary.com
Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
T A B L E O F C O N T E N T S
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . .
5BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
20ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . .
28DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29AUTHORS’ CON CLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . .
56INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iAlginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
[Intervention Review]
Alginate dressings for treating pressure ulcers
Jo C Dumville
1
, Samantha J Keogh
2
, Zhenmi Liu
1
, Nikki Stubbs
3
, Rachel M Walker
2
, Mathew Fortnam
4
1
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
2
NHMRC Centre of Research Excellence
in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
3
Wound Prevention and Management Service, Leeds Community Healthcare NHS Trust, St Mary’s Hospital, Leeds, UK.
4
Cochrane
Wounds Group, University of York, York, UK
Contact address: Jo C Dumville, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL,
UK.
jo.dumville@manchester. ac.uk.
Editorial group: Cochrane Wounds Group.
Publication s tatus and date: New, published in Issue 5, 2015.
Review content assessed as up-to-date: 14 April 2015.
Citation: Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M. Alginate dressings for treating pressure ulce r s. Cochrane
Database of Systematic Reviews 2015, Issue 5. Art. No.: CD011277. DOI: 10.1002/14651858.CD011277.pub2.
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
Background
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying
tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings.
A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of
pressure ul cers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers.
Each review will focus on a particular dressing type.
Objectives
To assess the effects of alginate dressings for treating pressure ulce r s in any care setting.
Search methods
For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other
Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.
Selection criteria
Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or
no dressing in the treatment of pressure ulcers (stage II or above).
Data collection and analysis
Two review authors independently performed study selection, risk of bias assessment and data extraction.
Main results
We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings
with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of
the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was
of low or very low quality. Where data were available there was no evidence of a diff erence between alginate dressings and alternative
treatments in terms of complete wound healing or adverse events.
1Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
Authors’ conclusions
The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration
and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties
offered by each dressing type, for example, exudate management.
P L A I N L A N G U A G E S U M M A R Y
Alginate dressings for treating pressure ulcers
What are pressure ulcers, and who is at risk?
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are wounds involving the skin and sometimes the
tissue th at lies underneath. Pressure ulcers can be painful, may become infected, and so affect people’s quality of life. People at risk of
developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as
elderly people and people who are ill as a result of short-term or long-term medical conditions.
In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent
to 4% of the total National Health Service expenditure. Pe ople with pressure ulcers have longer stays in hospital, and this increases
hospital costs. Figures from th e USA for 2006 suggest that hal f a million hospital stays had ’pressure ulcer’ noted as a diagnosis; the
total hospital costs of these stays was USD 11 billion.
Why use alginate dressings to treat pressure ulcers?
Dressings are one treatment option for pressure ulcers. There are many types of dressings that can be used; these can vary considerably
in cost. Alginate dressings are a type that is highly absorbant and so can absorb the fluid (exudate) that is produced by some ulcers.
What we found
In June 2014 we searched for as many relevant studies as we could find that had a robust design (randomised controlled trials) and
compared alginate dressings with other treatments for pressure ulcers. We found 6 studies involving a total of 336 participants. Alginates
have been compared with hydrocolloid dressings, another type of alginate dressing, dextranomer paste dressing, silver-alginate dressing,
silver-zinc sulfadiazine cream and treatment with a radiant heat system in these studies. There was no evidence from these studies to
suggest that alginate wound dressings are more effective at healing pressure ulcers than other types of dressings or skin surface (topical)
treatments, or other interventions.
Generally, the studies we found did not have many participants and the results were often inconclusive. Some study reports did not
provide information about how they were conducted and it was difficult to tel l whether the results presented were likely to be true.
More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings
or other treatments. This review is part of a suite of reviews investigating dressings for the treatment of pressure ulcers
This plain language summary is up-to-date as of June 2014.
2Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
Citations
More filters
Journal Article•DOI•
Engineered Biopolymeric Scaffolds for Chronic Wound Healing.

[...]

Laura E. Dickinson, Sharon Gerecht1•
Johns Hopkins University1
05 Aug 2016-Frontiers in Physiology
TL;DR: Key polymeric scaffold design criteria, including degradation, biocompatibility, and microstructure, and how they translate to inductive microenvironments that stimulate cell infiltration and vascularization to enhance chronic wound healing are discussed.
Abstract: Skin regeneration requires the coordinated integration of concomitant biological and molecular events in the extracellular wound environment during overlapping phases of inflammation, proliferation, and matrix remodeling. This process is highly efficient during normal wound healing. However, chronic wounds fail to progress through the ordered and reparative wound healing process and are unable to heal, requiring long-term treatment at high costs. There are many advanced skin substitutes, which mostly comprise bioactive dressings containing mammalian derived matrix components and/or human cells, in clinical use. However, it is presently hypothesized that no treatment significantly outperforms the others. To address this unmet challenge, recent research has focused on developing innovative acellular biopolymeric scaffolds as more efficacious wound healing therapies. These biomaterial-based skin substitutes are precisely engineered and fine-tuned to recapitulate aspects of the wound healing milieu and target specific events in the wound healing cascade to facilitate complete skin repair with restored function and tissue integrity. This mini-review will provide a brief overview of chronic wound healing and current skin substitute treatment strategies while focusing on recent engineering approaches that regenerate skin using synthetic, biopolymeric scaffolds. We discuss key polymeric scaffold design criteria, including degradation, biocompatibility, and microstructure, and how they translate to inductive microenvironments that stimulate cell infiltration and vascularization to enhance chronic wound healing. As healthcare moves towards precision medicine-based strategies, the potential and therapeutic implications of synthetic, biopolymeric scaffolds as tunable treatment modalities for chronic wounds will be considered.

144 citations

Cites background from "Alginate dressings for treating pre..."

  • ...…numerous alginate-based wound dressings approved for use in managing variety of wound types in which exudate is present, such as chronic wounds, including TegagenTM (3M), AlgisiteTM (Smith and Nephew), and Algi-Fiber (CoreLeader Biotech) to name a few (Dumville et al., 2015; O’Meara et al., 2015)....

    [...]

Journal Article•DOI•
Review of the Current Management of Pressure Ulcers.

[...]

Tatiana Boyko1, Michael T. Longaker1, George P. Yang1, George P. Yang2•
Stanford University1, Veterans Health Administration2
27 Sep 2016-Advances in wound care
TL;DR: Despite an increased number of therapies available on the market, none has demonstrated any clear benefit over the others and pressure ulcer treatment remains frustrating and time-consuming.
Abstract: Significance: The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately is increasingly important for all professionals in wound care. Recent Advances: Many new dressings and treatment modalities have been developed over the recent years and the goal of this review is to highlight their benefits and drawbacks to help providers choose their tools appropriately. Critical Issues: Despite an increased number of therapies available on the market, none has demonstrated any clear benefit over the others and pressure ulcer treatment remains frustrating and time-consuming. Future Directions: Additional research is needed to develop products more effective in prevention and treatment of pressure ulcers.

141 citations

Journal Article•DOI•
First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence.

[...]

Carolina D Weller1, Victoria Team1, Geoffrey Mendes Sussman1•
Monash University1
28 Feb 2020-Frontiers in Pharmacology
TL;DR: There is lack of high quality evidence and the need for future well designed trials on physical properties of wound dressing products, including semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels.
Abstract: Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians' knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.

107 citations

Journal Article•DOI•
Silver in Wound Care—Friend or Foe?: A Comprehensive Review

[...]

Ibrahim Khansa1, Anna R. Schoenbrunner2, Casey T. Kraft2, Jeffrey E. Janis2•
Nationwide Children's Hospital1, The Ohio State University Wexner Medical Center2
12 Aug 2019-Plastic and reconstructive surgery. Global open
TL;DR: In infected wounds, silver is beneficial for the first few days/weeks, after which nonsilver dressings should be used instead, and for clean wounds and closed surgical incisions, silver confers no benefit.
Abstract: The usefulness of silver for wound treatment has been known since 69 B.C.1 While silver metal (Ag) has no medicinal activity, silver ion (Ag+) has a broad antimicrobial spectrum, and is cytotoxic to bacteria, viruses, yeast, and fungi.2 Ag+ binds to DNA, RNA, and various proteins, leading to cell death via multiple mechanisms,3 such as protein and nucleic acid denaturation, increased membrane permeability, and poisoning of the respiratory chain.4 For this reason, resistance against the silver ion has only rarely been reported.5–7 The past few decades have seen a renewed interest in silver as a topical antimicrobial agent. Silver sulfadiazine (SSD) is a very widely used silver formulation, especially in burns. More recently, dressing with nanocrystalline silver has been developed. These novel dressings release silver ions into the wound in a sustained fashion. While the silver ion has great antimicrobial and bactericidal properties, it is also toxic to fibroblasts when present in high concentration.1,16,17 Injudicious use of silver-containing dressings can lead to impaired wound healing.45 It is imperative, therefore, that guidelines be developed on the proper use of silver-containing dressings. Our purpose in this study was to evaluate the existing evidence on the use of silver in wound care. The questions that we sought to answer were: 1) What is the quality of the published studies on the use of silver in wound care? 2) What are the advantages and disadvantages of various silver delivery systems? 3) What is the evidence for the use of silver-containing dressings in infected and heavily contaminated wounds? 4) What is the evidence for the use of silver-containing dressings in clean and clean-contaminated wounds? 5) What is the evidence for the use of silver-containing dressings in burns? 6) What is the evidence for the use of silver-containing dressings over closed surgical incisions? 7) What is the optimal strategy for the use of silver-containing dressings? 8) How does silver compare to alternative, lesser known agents? METHODS A PubMed literature search was performed using the following search parameters: silver AND (antimicrobial OR antibacterial) AND wound AND randomized; Silver AND epithelialization AND randomized; Silver AND negative pressure. The results were screened manually to exclude articles that were not relevant to our study (not about wound care), not in English, or which did not compare a silver-containing product to another product. We also excluded clinical studies with fewer than 20 patients. The articles were manually screened and duplicates were excluded. The remaining articles were analyzed in detail qualitatively, to extract answers to our study questions. The articles analyzed in this study are shown in Table ​Table11. Table 1. Summary of the Articles Included in This Study

90 citations

Journal Article•DOI•
Hydrolytically-degradable click-crosslinked alginate hydrogels.

[...]

Aline Lueckgen1, Daniela S. Garske1, Agnes Ellinghaus1, Rajiv Desai2, Alexander G. Stafford2, David J. Mooney2, Georg N. Duda1, Amaia Cipitria1, Amaia Cipitria3 •
Charité1, Wyss Institute for Biologically Inspired Engineering2, Max Planck Society3
01 Oct 2018-Biomaterials
TL;DR: Degradable biomaterials with tunable and decoupled mechanical and degradation behavior could be useful in many tissue engineering applications.

71 citations

References
More filters
Journal Article•DOI•
Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden Scale

[...]

Nancy Bergstrom1, Barbara Braden, Mildred G. Kemp, Mary T. Champagne, Elizabeth I. Ruby •
University of Nebraska Medical Center1
01 Sep 1998-Nursing Research
TL;DR: Risk assessment on admission is highly predictive of pressure ulcer development in all settings but not as predictive as the assessment completed 48 to 72 hours after admission, which is important for timely planning of preventive strategies.
Abstract: Background There have been no studies that have tested the Braden Scale for predictive validity and established cutoff points for assessing risk specific to different settings. Objectives To evaluate the predictive validity of the Braden Scale in a variety of settings (tertiary care hospitals, Veterans Administration Medical Centers [VAMCs], and skilled nursing facilities [SNFs]). To determine the critical cutoff point for classifying risk in these settings and whether this cutoff point differs between settings. To determine the optimal timing for assessing risk across settings. Method Randomly selected subjects (N= 843) older than 19 years of age from a variety of care settings who did not have pressure ulcers on admission were included. Subjects were 63% men, 79% Caucasian, and had a mean age of 63 (+/-16) years. Subjects were assessed for pressure ulcers using the Braden Scale every 48 to 72 hours for 1 to 4 weeks. The Braden Scale score and skin assessment were independently rated, and the data collectors were blind to the findings of the other measures. Results One hundred eight of 843 (12.8%) subjects developed pressure ulcers. The incidence was 8.5%, 7.4%, and 23.9% in tertiary care hospitals, VAMCs, and SNFs, respectively. Subjects who developed pressure ulcers were older and more likely to be female than those who did not develop ulcers. Braden Scale scores were significantly (p = .0001) lower in those who developed ulcers than in those who did not develop ulcers. Overall, the critical cutoff score for predicting risk was 18. Risk assessment on admission is highly predictive of pressure ulcer development in all settings but not as predictive as the assessment completed 48 to 72 hours after admission. Conclusions Risk assessment on admission is important for timely planning of preventive strategies. Ongoing assessment in SNFs and VAMCs improves prediction and permits fine-tuning of the risk-based prevention protocols. In tertiary care the most accurate prediction occurs at 48 to 72 hours after admission and at this time the care plan can be refined.

361 citations

Journal Article•
Results of the 2008-2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis.

[...]

Catherine VanGilder, Stephanie Amlung, Patrick Harrison, Stephanie Meyer
01 Nov 2009-Ostomy Wound Management
TL;DR: Both the overall and FA pressure ulcer prevalence rates were lower in 2008 and 2009 than in 2006 and 2007, and, although overall prevalence trends are encouraging, there is a stark contrast from the desired state, especially in adult ICUs.
Abstract: The National Quality Forum has identified a pressure ulcer as a hospital-acquired condition (HAC) that is high-cost and high-volume and may be preventable with implementation of evidence-based guidelines The Center for Medicare and Medicaid Services no longer reimburses acute care facilities for the ancillary cost of facility-acquired (FA) ulcers Benchmarking patient safety indicators, such as FA, may help facilities reduce pressure ulcer rates The purpose of this observational, cross-sectional cohort study was to report the International Pressure Ulcer Prevalence Survey (IPUP) in the United States in 2008 and 2009 In addition, previously collected data (2006/2007) were used to evaluate and report general and unit-specific prevalence rates in acute care facilities The overall prevalence and FA pressure ulcer rates were 135% and 6% (2008, N = 90,398) and 123 and 5% (2009, N = 92,408), respectively In 2008 and 2009, overall prevalence rates were highest in long-term acute care (22%) FA rates were highest in adult intensive care units (ICUs) and ranged from 92% (general cardiac care unit [CCU]) to 121% (medical ICU) in 2008 and from 88% (general CCU) to 103% (surgical ICU) in 2009 In 2009, 33% of ICU patients developed severe FA ulcers (Stage III, Stage IV, eschar/unable to stage, or deep tissue injury) In 2009, approximately 10% (n = 1,631) of all ulcers were described as device-related The most common anatomic locations for device-related ulcers were the ear (20%) and sacral/coccyx region (17%) Both the overall and FA pressure ulcer prevalence rates were lower in 2008 and 2009 than in 2006 and 2007 Results indicate that, although overall prevalence trends are encouraging, there is a stark contrast from the desired state, especially in adult ICUs

354 citations

Journal Article•DOI•
Effect of Air Drying and Dressings on the Surface of a Wound

[...]

George D. Winter1, John T. Scales1•
Royal National Orthopaedic Hospital1
05 Jan 1963-Nature
TL;DR: It has been pointed out that the normal dry scab on a wound exposed to the air includes a superficial part of the dermis, and it was suggested that this is because the exposed dermal tissue is dehydrated.
Abstract: IT has been pointed out that the normal dry scab on a wound exposed to the air includes a superficial part of the dermis, and it was suggested that this is because the exposed dermal tissue is dehydrated1. Epidermis migrates below the dehydrated fibrous tissue where there is sufficient moisture for the cells to live. If the surface of the wound is deliberately kept moist by covering the wound with an occlusive film, the epidermis will migrate over the surface of the dermis. In this latter event migration of the epidermis is twice as rapid as when it is forced to pass through the fibrous tissue.

334 citations

Journal Article•DOI•
Pressure ulcer prevalence, incidence, risk factors, and impact.

[...]

Richard M. Allman1•
University of Alabama at Birmingham1
01 Aug 1997-Clinics in Geriatric Medicine
TL;DR: The tremendous variability in pressure ulcer prevalence and incidence in health care settings suggests that opportunities exist to improve outcomes for persons at risk for and with pressure ulcers.

310 citations

Journal Article•DOI•
Methodological bias in cluster randomised trials

[...]

Seokyung Hahn1, Suezann Puffer, David J. Torgerson, Judith Watson•
New Generation University College1
02 Mar 2005-BMC Medical Research Methodology
TL;DR: There is a tendency for cluster trials, with evidence methodological biases, to also show an age imbalance between treatment groups, and it is shown that all cluster trials show a large positive effect of hip protectors whilst individually randomised trials shows a range of positive and negative effects, suggesting that cluster trials may be producing a biased estimate of effect.
Abstract: Cluster randomised trials can be susceptible to a range of methodological problems. These problems are not commonly recognised by many researchers. In this paper we discuss the issues that can lead to bias in cluster trials. We used a sample of cluster randomised trials from a recent review and from a systematic review of hip protectors. We compared the mean age of participants between intervention groups in a sample of 'good' cluster trials with a sample of potentially biased trials. We also compared the effect sizes, in a funnel plot, between hip protector trials that used individual randomisation compared with those that used cluster randomisation. There is a tendency for cluster trials, with evidence methodological biases, to also show an age imbalance between treatment groups. In a funnel plot we show that all cluster trials show a large positive effect of hip protectors whilst individually randomised trials show a range of positive and negative effects, suggesting that cluster trials may be producing a biased estimate of effect. Methodological biases in the design and execution of cluster randomised trials is frequent. Some of these biases associated with the use of cluster designs can be avoided through careful attention to the design of cluster trials. Firstly, if possible, individual allocation should be used. Secondly, if cluster allocation is required, then ideally participants should be identified before random allocation of the clusters. Third, if prior identification is not possible, then an independent recruiter should be used to recruit participants.

276 citations

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Foam dressings for treating pressure ulcers

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12 Oct 2017-Cochrane Database of Systematic Reviews
Rachel Walker, Brigid M. Gillespie, Lukman Thalib, Niall Higgins, Jennifer A. Whitty 
Alginate dressings for venous leg ulcers

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19 Aug 2015-Cochrane Database of Systematic Reviews
Susan O’Meara, Marrissa Martyn-St James, Una Adderley
Pressure ulcer prevalence in Europe: a pilot study

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01 Apr 2007-Journal of Evaluation in Clinical Practice
Katrien Vanderwee, Michael Clark, Carol Dealey, Lena Gunningberg, Tom Defloor 
Honey as a topical treatment for wounds

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06 Mar 2015-Cochrane Database of Systematic Reviews
Andrew Jull, Nicky Cullum, Jo C Dumville, Maggie J Westby, Sohan Deshpande, Natalie Walker 
Frequently Asked Questions (6)
Q1. What are the types of people at risk of developing pressure ulcers?

People at risk of developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as elderly people and people who are ill as a result of short-term or long-term medical conditions. 

In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent to 4% of the total National Health Service expenditure. 

Published by John Wiley & Sons, Ltd.A B S T R A C TPressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. 

Figures from the USA for 2006 suggest that half a million hospital stays had ’pressure ulcer’ noted as a diagnosis; the total hospital costs of these stays was USD 11 billion. 

For this review, in April 2015 the authors searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. 

GRADE Working Group grades of evidence High quality: further research is very unlikely to change their confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on their confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on their confidence in the estimate of effect and is likely to change the estimate Very low quality: the authors are very uncertain about the estimate1