Bacterial colonization of pressure ulcers: assessment of risk for bloodstream infection and impact on patient outcomes

Braga, Iolanda Alves; Pirett, C.C.N.S.; Ribas, Rosineide Marques; Filho, Paulo Pinto Gontijo; Filho, Augusto Diogo

doi:10.1016/j.jhin.2012.11.008

Cited by 74 publications

(70 citation statements)

References 27 publications

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“…In the participating hospitals, most patients were accompanied by one or more family members who were also involved in the execution of PU preventive measures. There were only a few PU patients who did not need repositioning because they had no activity limitations and could walk occasionally. More than half of the 82 patients (64·6%) with limited activity, mobility and friction and shear problems received repositioning.…”

Section: Discussionmentioning

confidence: 99%

“…A PU might be misclassified as other types of wounds, such as moisture‐associated skin damage and/or incontinence‐associated dermatitis . PUs are frequently seen in immobile hospitalised patients and have a significant negative impact on patients' quality of life because of pain , prolonged hospital stays and a high risk of wound infection . PUs are also the most expensive of all medical errors that occur among elderly US populations, and they increase the workload of nurses considerably .…”

Section: Introductionmentioning

confidence: 99%

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Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment

Amir

Lohrmann

Halfens

et al. 2016

International Wound Journal

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The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four Indonesian general hospitals. A multicentre cross-sectional design was applied to assess pressure ulcers and pressure ulcer care in adult patients in medical, surgical, specialised and intensive care units. Ninety-one of the 1132 patients had a total of 142 ulcers. Half (44·0%) already had pressure ulcers before admission. The overall prevalence of category I-IV pressure ulcers was 8·0% (95% CI 6·4-9·6), and the overall nosocomial pressure ulcer prevalence was 4·5% (95% CI 3·3-5·7). Most pressure ulcer patients had friction and shear problems, were bedfast, had diabetes and had more bedridden days. Most ulcers (42·3%) were category III and IV. One third of the patients had both pressure ulcers and moisture lesions (36·3%) and suffered from pain (45·1%). The most frequently used prevention measures were repositioning (61·5%), skin moisturising (47·3%), patient education (36·3%) and massage (35·2%). Most pressure ulcer dressings involved saline-impregnated or antimicrobial gauzes. This study shows the complexities of pressure ulcers in Indonesian general hospitals and reveals that the quality of pressure ulcer care (prevention and treatment) could be improved by implementing the recent evidence-based international guideline.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment

Amir

Lohrmann

Halfens

et al. 2016

International Wound Journal

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“…The ability to quickly respond to external injury, such as load, should not be interpreted as inability to mount an inflammatory response. In addition, this discrepancy can originate from difference in bacterial presence, which will be included in our future experiments, since presence of infection is one of the frequent problems in PU [60].…”

Section: Discussionmentioning

confidence: 99%

Deep Tissue Injury in Development of Pressure Ulcers: A Decrease of Inflammasome Activation and Changes in Human Skin Morphology in Response to Aging and Mechanical Load

et al. 2013

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Molecular mechanisms leading to pressure ulcer development are scarce in spite of high mortality of patients. Development of pressure ulcers that is initially observed as deep tissue injury is multifactorial. We postulate that biomechanical forces and inflammasome activation, together with ischemia and aging, may play a role in pressure ulcer development. To test this we used a newly-developed bio-mechanical model in which ischemic young and aged human skin was subjected to a constant physiological compressive stress (load) of 300 kPa (determined by pressure plate analyses of a person in a reclining position) for 0.5–4 hours. Collagen orientation was assessed using polarized light, whereas inflammasome proteins were quantified by immunoblotting. Loaded skin showed marked changes in morphology and NLRP3 inflammasome protein expression. Sub-epidermal separations and altered orientation of collagen fibers were observed in aged skin at earlier time points. Aged skin showed significant decreases in the levels of NLRP3 inflammasome proteins. Loading did not alter NLRP3 inflammasome proteins expression in aged skin, whereas it significantly increased their levels in young skin. We conclude that aging contributes to rapid morphological changes and decrease in inflammasome proteins in response to tissue damage, suggesting that a decline in the innate inflammatory response in elderly skin could contribute to pressure ulcer pathogenesis. Observed morphological changes suggest that tissue damage upon loading may not be entirely preventable. Furthermore, newly developed model described here may be very useful in understanding the mechanisms of deep tissue injury that may lead towards development of pressure ulcers.

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“…Despite low prevalence of multi-resistant Gram-positive pathogens in Austria, wounds have been identified as primary source of infection in at least 1.6% of hospitalized patients with multi-resistant Staphylococcus aureus (MRSA) bacteremia [2]. A study conducted in Brazil demonstrated that in patients with pressure ulcers stage II 65% of wounds were colonized or infected with multidrug-resistant organisms, thereof 33% with Gr-negative bacilli, 21% with MRSA, and 47% with both [3].…”

Section: Introductionmentioning

confidence: 99%

Bacterial Growth Kinetics under a Novel Flexible Methacrylate Dressing Serving as a Drug Delivery Vehicle for Antiseptics

Forstner

Leitgeb

Schuster

et al. 2013

IJMS

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A flexible methacrylate powder dressing (Altrazeal®) transforms into a wound contour conforming matrix once in contact with wound exudate. We hypothesised that it may also serve as a drug delivery vehicle for antiseptics. The antimicrobial efficacy and influence on bacterial growth kinetics in combination with three antiseptics was investigated in an in vitro porcine wound model. Standardized in vitro wounds were contaminated with Staphylococcus aureus (MRSA; ATCC 33591) and divided into six groups: no dressing (negative control), methacrylate dressing alone, and combinations with application of 0.02% Polyhexamethylene Biguanide (PHMB), 0.4% PHMB, 0.1% PHMB + 0.1% betaine, 7.7 mg/mL Povidone-iodine (PVP-iodine), and 0.1% Octenidine-dihydrochloride (OCT) + 2% phenoxyethanol. Bacterial load per gram tissue was measured over five days. The highest reduction was observed with PVP-iodine at 24 h to log10 1.43 cfu/g, followed by OCT at 48 h to log10 2.41 cfu/g. Whilst 0.02% PHMB resulted in a stable bacterial load over 120 h to log10 4.00 cfu/g over 120 h, 0.1% PHMB + 0.1% betaine inhibited growth during the first 48 h, with slightly increasing bacterial numbers up to log10 5.38 cfu/g at 120 h. These results indicate that this flexible methacrylate dressing can be loaded with various antiseptics serving as drug delivery system. Depending on the selected combination, an individually shaped and controlled antibacterial effect may be achieved using the same type of wound dressing.

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Bacterial colonization of pressure ulcers: assessment of risk for bloodstream infection and impact on patient outcomes

Cited by 74 publications

References 27 publications

Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment

Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment

Deep Tissue Injury in Development of Pressure Ulcers: A Decrease of Inflammasome Activation and Changes in Human Skin Morphology in Response to Aging and Mechanical Load

Bacterial Growth Kinetics under a Novel Flexible Methacrylate Dressing Serving as a Drug Delivery Vehicle for Antiseptics

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