Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients

Crit Care Med. 2007 Mar;35(3):815-20. doi: 10.1097/01.CCM.0000257072.10313.56.


Objective: To describe the short-term and long-term effects of a hospital-wide pressure ulcer prevention and treatment guideline on both the incidence and the time to the onset of pressure ulcers in critically ill patients.

Design: Prospective cohort study.

Setting: Adult intensive care department of a university medical center.

Patients: Critically ill patients (n = 399).

Interventions: A guideline for pressure ulcer care was implemented on all intensive care units. The attention of nurses for timely transfer to a specific pressure-reducing device was an important part of this guideline.

Measurements and main results: Patient characteristics, demographics, pressure ulcer risk profile at admission, daily pressure ulcer grading, and type of mattress were determined to describe the short-term and long-term effects 3 and 12 months after the implementation. The incidence density of pressure ulcers grade II-IV decreased from 54 per 1000 patient days at baseline to 32 per 1000 days (p = .001) 12 months after the implementation. The median pressure ulcer-free time increased from 12 days to 19 days (hazard rate ratio, 0.58; p = .02). After adjustment for differences in risk factors in a Cox proportional hazard model, the number of preventive transfers to special mattresses was the strongest indicator for the decreased risk of pressure ulcers (hazard rate ratio, 0.22; p < .001). The number needed to treat to prevent one pressure ulcer during the first 9 days was six.

Conclusions: The implementation of a guideline for pressure ulcer care resulted in a significant and sustained decrease in the development of grade II-IV pressure ulcers in critically ill patients. Timely transfer to a specific mattress (i.e., transfer before the occurrence of a pressure ulcer) was the main indicator for a decrease in pressure ulcer development.

MeSH terms

  • Adult
  • Aged
  • Beds
  • Cohort Studies
  • Critical Illness*
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Intensive Care Units* / statistics & numerical data
  • Male
  • Middle Aged
  • Netherlands
  • Practice Guidelines as Topic*
  • Pressure Ulcer / epidemiology
  • Pressure Ulcer / nursing
  • Pressure Ulcer / prevention & control*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Software Design