Yu H. Improving pressure ulcer care in intensive care units: Evaluating the impact of bundled care and silver nanoparticle dressings. World J Clin Cases 2024; 12(19): 3873-3881 [PMID: 38994315 DOI: 10.12998/wjcc.v12.i19.3873]
Corresponding Author of This Article
Hong Yu, MD, Nurse, Department of Intensive Care Unit, The First People's Hospital of Ziyang, No. 66 Rende West Road, Yanjiang District, Ziyang 641300, Sichuan Province, China. 17780765705@163.com
Research Domain of This Article
Nursing
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 6, 2024; 12(19): 3873-3881 Published online Jul 6, 2024. doi: 10.12998/wjcc.v12.i19.3873
Table 1 Bundled care in the management of pressure ulcers in critically Ill adults in intensive care units
Bundled care
Contents
1. Multidisciplinary collaboration
Ensure collaboration among healthcare professionals, including physicians, nurses, physical therapists, dietitians, and other specialists, to develop and execute a comprehensive care plan
Hold regular interdisciplinary meetings to share information, coordinate treatment measures, and provide a unified approach to care
Nurses conducts a thorough skin inspection during each shift and recording relevant information
2. Assessment
Conduct a thorough pressure ulcer assessment, including a detailed description of the wound's depth, size, shape, edge condition, and characteristics of the wound base
Evaluate the skin surrounding the wound for signs of inflammation, redness, or swelling
3. Wound cleansing
Use a gentle saline solution or specialized wound cleansing solution to clean the wound with gauze or sterile cotton balls, avoiding the introduction of new bacteria
Remove necrotic tissue, exudate, and debris to ensure a clean wound surface
4. Maintain moisture
Use the dressing to maintain a moist wound environment, which accelerates healing and supports new tissue growth
Change the dressing as needed, typically when the dressing changes color from dark green to light green, indicating over 70% of the silver has been released
5. Nutritional support
Dietitians closely monitor the nutritional status of patients and design high-protein dietary plans to support wound healing
Ensure the patient receives adequate protein and vitamin intake to support wound healing
Provide oral nutritional supplements or enteral nutrition support through a feeding tube, depending on the patient's oral intake capacity
6. Pain management
Offer effective pain management, including medication, to alleviate wound discomfort
Use non-pharmacological methods such as heat therapy, cold compresses, or relaxation techniques to reduce discomfort and pain
7. Prevent further deterioration
Ensure regular patient repositioning t least every 2 hours to prevent prolonged pressure on the same area
Use specialized mattresses, cushions, and care pads to reduce pressure and provide appropriate support
8. Education
Provide comprehensive education to both the patient and family members, including wound monitoring, recognizing signs of infection, and proper wound care methods
Emphasize the importance of pressure ulcer prevention, including pressure distribution and turning techniques
9. Data monitoring
Continuously monitor wound progress and any changes, documenting observations
Reassess the pressure ulcer's status regularly to track healing progress
Table 2 Assigning scores to parameters in the pressure ulcer scale for healing tool
Parameter
Description
Score
Surface area
Determined by multiplying the greatest length by the greatest width
0-10
0 cm²
0
< 0.3 cm²
1
0.3-0.6 cm²
2
0.7-1.0 cm²
3
1.1-2.0 cm²
4
2.1-3.0 cm²
5
3.1-4.0 cm²
6
4.1-8.0 cm²
7
8.1-12.0 cm²
8
12.1-24.0 cm²
9
> 24.0 cm²
10
Exudate (drainage)
Assessed at dressing removal before applying a topical agent
0-3
None
0
Light
1
Moderate
2
Heavy
3
Tissue type
0-4
Closed/resurfaced
The wound is completely covered with epithelium/new skin
0
Epithelial tissue
New pink or shiny tissue/skin growing in from the edges or as islands on the ulcer surface (for superficial ulcers)
1
Granulation tissue
Pink or beefy red tissue with a shiny, moist, granular appearance
2
Slough
Yellow or white tissue adhering to the ulcer bed in strings or thick clumps, or is mucinous
3
Necrotic tissue/eschar
Black, brown, or tan tissue adhering firmly to the wound bed or ulcer edges, may be firmer or softer than surrounding skin
4
Total PUSH score
Obtained by summing the scores for the above three parameters
0-17
Table 3 Baseline characteristics of control and intervention groups
Total (n = 98)
Control group (n = 49)
Intervention group (n = 49)
P value
Age (yr)
54 (35.5-68.5)
52 (36.5-69.5)
0.881
Gender
Male
61
29
32
Female
37
20
17
0.677
Stage
Stage I
38
20
18
Stage II
39
21
18
Stage III
12
6
6
Stage IV
2
1
1
Unstageable
7
1
6
0.419
Location
Coccyx
36
20
16
Buttocks
14
8
6
Trochanter
10
5
5
Scapila
8
4
4
Malleolus
8
4
4
Head
5
3
2
Heel
7
3
4
Elbow
10
2
8
0.700
Comorbid conditions
Sepsis
45
24
21
0.685
Myocardial infarction
1
1
0
1.000
Congestive heart failure
29
16
13
0.659
Cerebral vascular disease
2
0
2
0.495
Chronic pulmonary disease
14
8
6
0.774
Diabetes with complication
4
2
2
1.000
Diabetes without complications
20
9
11
0.803
Total braden at ICU admit
14 (10-20)
13 (10.5-18.5)
0.565
Table 4 Comparison of pressure ulcer scale for healing score before and after intervention in two groups
Citation: Yu H. Improving pressure ulcer care in intensive care units: Evaluating the impact of bundled care and silver nanoparticle dressings. World J Clin Cases 2024; 12(19): 3873-3881