Prevalence of chronic wounds and structural quality indicators of chronic wound care in Dutch nursing homes

Abstract

The aim of this study was to measure the prevalence of (infected) chronic wounds in Dutch nursing homes and to explore which signs and symptoms are used to diagnose infected chronic wounds. Moreover, it was to determine which structural quality indicators related to chronic wound care at ward and institutional levels were fulfilled. In April 2012, as part of the annual National Prevalence Measurement of Care Problems of Maastricht University [Landelijke Prevalentiemeting Zorgproblemen (LPZ)], a multi-center cross-sectional point-prevalence measurement was carried out together with an assessment of relevant care quality indicators. The prevalence was 4·2%; 16 of 72 (22%) chronic wounds were considered to be infected. Increase of exudate (81·3%; n = 13), erythema (68·8%; n = 11), pain (56·3%; n = 9) and wound recalcitrance (56·3%; n = 9) were considered to be diagnostic signs and symptoms of a chronic wound infection. Although at institutional level most quality indicators were fulfilled, at ward level this was not the case. Despite the relatively low number of residents, we consider our population as representative for the nursing home population. It may be an advantage to appoint specific ward nurses and to provide them specifically with knowledge and skills concerning chronic wounds.

The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice

“…However, no attempts were made to differentiate clinical signs of infection between different types of chronic wounds. When these criteria were used to diagnose infection in 192 patients with 211 chronic wounds from a Dutch nursing home, Rondas et al found that pain, increased exudate, erythema, and delayed healing were the only relevant signs to diagnose infected chronic wounds . More importantly, no association between clinical signs of infection and microbiological cultures, taken by a Levine‐technique swab, was found.…”

Identifying risk factors associated with infection in patients with chronic leg ulcers

“…In a cross‐sectional study of 77 chronic leg ulcers from 75 participants, De Souza found 27% of the ulcers were infected . Similarly, Rondas et al in 2015 found 22% (16/72 chronic wounds) were found infected . This discrepancy could be explained by the following reasons.…”

“…First, in the 2014 study, the sample (77 cases) was much smaller than the current study sample (561 cases). Second, in the 2015 study, the majority of the chronic wounds were pressure ulcers (46%) and post‐surgical wounds (9.5%), while venous leg ulcers were only 3.6% and arterial ulcers 1.6% . Importantly, this prevalence was still significant generating a number of infected ulcers in the whole population.…”

“…Infection prolongs wound healing and increases complications and mortality in patients with leg ulcers, resulting in a negative impact on the patients’ quality of life and increased financial burden on the healthcare system and society . The prevalence of infection is very high in chronic wounds, ranging from 22% to 27% …”

Effects of an Arginine-Enriched Oral Nutritional Supplement on the Healing of Chronic Wounds in Non-Malnourished Patients; A Multicenter Case Series from the Netherlands and Hungary

“…Worldwide, the chronic wound burden lies chiefly within the elderly population [6,11,12] and the morbidity accompanying age-related delay in healing, is readily acknowledged [11,12]. In 2013 in the Netherlands, a multi-centre cross-sectional point-prevalence measurement on chronic wounds in nursing home patients was conducted [13]. Out of 1514 patients, 63 patients had one or more chronic wounds, which resulted in a prevalence of 4.2%.…”