The objective was to determine the relationship between time in the operating room (OR) and hospital-acquired pressure ulcers (HAPUs), controlling for temporality. The research team identified 931 HAPUs among surgical patients and matched them to 4 controls by hospital length of stay at the time the pressure ulcer (PU) was documented. A regression model estimated the relationship between OR time and HAPU after controlling for matching, age, sex, admission and current Braden score, weight, year, and American Society of Anesthesiologists physical status score. OR time in the 24 hours prior to PU documentation was associated with PUs. Only 5% of HAPUs occurred within 24 hours of extended (>4 hours) surgery and 58% occurred after hospital day 5. Extended surgery is confirmed as a risk factor for PU development. Most PUs do not appear in the immediate postoperative period, and prevention efforts should focus on postoperative patient care, when most HAPUs develop.

This paper presents a proposed conceptual model to guide research on pressure ulcer risk in critically ill patients, who are at high risk for pressure ulcer development. However, no conceptual model exists that guides risk assessment in this population. Results from a review of prospective studies were evaluated for design quality and level of statistical reporting. Multivariate findings from studies having high or medium design quality by the National Institute of Health and Clinical Excellence standards were conceptually grouped. The conceptual groupings were integrated into Braden and Bergstrom's (Braden and Bergstrom [1987] Rehabilitation Nursing, 12, 8-12, 16) conceptual model, retaining their original constructs and augmenting their concept of intrinsic factors for tissue tolerance. The model could enhance consistency in research on pressure ulcer risk factors.

The Braden score is a reliable predictor of a patient's potential for developing pressure ulcers. Moisture is 1 of 6 indicators considered when calculating a Braden score. Efforts to reduce the effects of moisture and enzymatic activity on skin from incontinent diarrhea have employed various types of nonstandardized and nonapproved approaches. Rigid rectal tubes and catheters designed for other purposes are among the devices being utilized. These devices may put the patient at risk for rectal necrosis and loss of sphincter tone, and their use has produced no demonstrable positive outcomes. Additionally, their use is limited to those patients who are experiencing active diarrhea. The Zassitrade mark Bowel Management System (BMS) developed by Zassi Medical Evolutions, Inc., has produced promising outcomes. While the BMS is useful in managing patients with diarrhea, it can also be used to modify formed stool in patients who have wounds that are likely to become contaminated with incontinent feces, or who are too hemodynamically unstable to turn for lengthy or frequent incontinence care.