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The rise in the population age has led to an increase in chronic, degenerative and disabling diseases.
Due to the abovementioned phenomenon, pressure injuries are a growing problem: they tend to appear in individuals suffering from diseases that compromise neuromotor function as well as in elderly.
Only adequate measures can play a key role in preventing the appearance and/or progression of pressure injuries.
This has been confirmed in epidemiological studies conducted on the incidence and prevalence of this phenomenon.
WHAT ARE PRESSURE INJURIES?
In accordance with the European Pressure Ulcer Advisory Panel (EPUAP) a pressure injury is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear.
When a soft tissue is compressed between a bony prominence and an external surface (e.g. mattress, chair, wheelchair, etc.) for an extended length of time that can vary in different individuals, the blood vessels collapse resulting in localised ischemia and redness leading to the death of tissue (necrosis).
Body weight perpendicular pressure is not the only force involved in the onset of hypoxic, ischemic or necrotic complications; shearing and friction are usually concomitants.
This damage occurs mainly in immobilized people or with mobility problems.
Pressure injuries (PIs) are usually described using categories in order to classify the degree of tissue damage.
The international pressure ulcer classification system has been developed by the National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA).
WHO IS AT RISK OF DEVELOPING PIs?
Research and experts state with a high level of consensus, that vast majority of acquired healthcare PIs can and should be prevented!
The international EPUAP/NPUAP guidelines, clearly describe how to prevent and recognize people at risk of developing PIs: people with reduced mobility, with significant loss of protective sensation, severe cognitive impairment, unable to reposition themselves autonomously, with previous history of ulcers or tissue perfusion diseases, with severe nutritional deficiencies and heart disease and/or diabetes.
Healthcare professionals must assess the PIs risk, using validating tools along with their clinical judgment.
The most frequently used risked assessment tools are: the Norton Pressure Ulcer Prediction Score, (Norton Scale) the Braden Scale for Predicting Pressure Sore Risk the Braden Scale for Predicting Pressure Sore Risk specifically in physically and cognitively compromised elderly or the Waterloo Score (WUWHS, 2016).
Consensus of experts suggests that the approach should be ‘structured’ via the use of clinical judgment, in order to facilitate the relevant risk factors evaluation.
PRESSURE INJURIES PREVENTION
In order to prevent pressure injuries, frequent posture changes should be planned, because even a minimal movement, enhances the circulation and prevent pressure damage.
To reduce friction and pressure between skin and bed or wheelchair surfaces, pressure relieving devices such as mattresses, cushions and padding are used..
The pressure relieving support, has to be chosen in accordance with the individual needs, and the judgment should be based on: mobility degree, BMI and body shape along with the risk assessment.
However, it is important that the individual is in a comfortable position.
Termoletto support surfaces are “specialized devices for pressure redistribution, designed for the management of tissue loads, microclimate and/or other therapeutic functions (including: any mattress, integrated bed system, replacement mattress, mattress overlay, cushion for seat or cushion overlay for seat)”.
Pressure relieving support surfaces should be selected in accordance with the care setting and on an individual basis meeting the individual needs in terms of pressure redistribution and other therapeutic functions described above.
To prevent pressure relieving support surfaces from being ineffective from a preventive and/or therapeutic point of view, it is necessary to:
- place the least possible layer of bed sheets in the patient’s contact areas;
- avoid the use of absorbent inco sheet and absorbent pads, in order to allow the maximum patient envelopment on the surface and to promote the load distribution with a reduced contact pressure;
- avoid tucking in the bed sheets under the mattress to prevent the “hammock effect”, which erase the body redistribution action on the support surface, causing peaks of pressure on the bony prominences (Friuli-Venezia Giulia Guidelines, 2013).
In all cases, the manufacturer’s recommendations regarding usage and maintenance should be followed.