| [Background] Pressure ulcer is a worldwide health problem, most common in elderly and fragil bedridden patient. More and more medical facilities using pressure ulcer prevalence as nursing quality indicator and to evaluate the effectiveness of pressure ulcer prevention guidelines. Many European countries conducted national pressure ulcer prevalence survey, such as USA, Netherlands, Germany, Australia, French and Canada, etc. But the nationwide pressure ulcer prevalence data was sparse in China, only few hospitals had conducted the survey with the prevalence data was limited and cannot compare to each other.【Aim】①To ascertain the pressure ulcer prevalence and hospital-acquired pressure ulcer incidence in hospitalized patient through multicenter collaborative study, and serve as baseline data to evaluate the effect of pressure ulcer prevention;②To analyzed the cause and risk factor of hospital-acquired pressure ulcer;③To make suggestion about pressure ulcer prevention and management based on results from study.【Design】 Cross-sectional study.【Instrument】①A self designed questionnaire based on American Nurse Association National Database of Nursing Quality Indicator pressure ulcer training program;②European Pressure Ulcer Advisory Panel (EPUAP) data collection instrument Minimum Data Set (MDS) and Wound, Ostomy and Continence Nurses society (WOCNs) pressure ulcer data collection tool were used for this study.[Methods]①The hospitals included in this study was volunteered participated and the official agreement was taken from12hospitals. Each hospital choose1-2contact person whose responsible for the study and with the tilt of nursing director or ET.②Training: using European pressure ulcer prevalence survey methodology, the instrument was translated into Chinese by2bilingual experts. The pressure ulcer training package was design to train the contact person of12hospitals, and then these contact person train the investigator who included in this study to collect data in each hospital. Training time at least2h;③Post-test:after the training program, the post-test was carry out, the investigator identify pressure ulcer and staging correctly. Total score≥90is the cut-off point whose qualified to participate the pressure ulcer prevalence study.④Procedure:using unified process, method and instrument, organized457investigator to conduct the inpatient pressure ulcer prevalence survey in12hospitals. Survey team(2wound care nurses) enter patient’s room with unified method and process. Each team with2-3unit and to avoid the nurses inspect her own ward..Inclusion and exclusion criteria:all hospitalized patients who aged18or above and admitted before midnight and consented to participated were included except outpatient department, peadiatric unit, psychiatric unit and the patients with hemodynamic instability.⑤Dtabase: ll data from each hospital were mailed to set up the database after checked for missing value, and the incomplete questionnaire was eliminated;⑥Data analysis:using SPSS18.0Chinese edition to analyze the data, using rate, percentage, mean and standard deviation for descriptive analysis, and the difference between the nursing group for training score was compared in ANOVA, and with significant level0.05.【Results】(1) Training result: A ttal of462nurses included in training program, of those457(98.918%)nurses were qualified to conduct the prevalence study, and435questionairs (94.156%) were return in paper. The range of experience year was1~32, and Mean was12.816±7.720, the mean score was94.853±3.806. Most of nurses can correctly identified pressure ulcer stage. The accurate identification of pressure ulcer stage is Stage I (97.701%), stage11(95.678%), stage IV(95.316%) and suspected Deep Tissue Injury(93.793%), which leaves stage III(87.663%) and unstageable(87.471%) more difficult to identify. There is no significant differences between groups(p>0.05) except different hospital level (p<0.05)。(2) Survey results:①type of hospital:A Twelve hospitals in9cities were volunteered to participate, in which4military hospitals and8local hospitals;9tertiary hospitals and3grade II hospitals;3traditional Chinese hospitals and9non traditional hospitals;②A sample of39,952was surveyed. The overall prevalence with (without) stage I was1.579%(1.121%), in which hospital-acquired pressure ulcer incidence was0.628%. A total of631inpatients had1035pressure ulcers, this rate averages to1.640ulcers per patients.③Specialty: Prevalence was highest in ICU (11.199%) and lowest in surgical ward (0.804%), step-down ward was3.287%, neurology ward was2.135%and internal medical ward was1.482%.④Age:the prevalence was0.534%in18-39year-old,0.936%in40-59year-old,1.129%in60-69year-old,2.648%in70-79year-old,4.548%in80-89year-old and was highest (7.706%) in inpatient who above89year-old.㏄ressure ulcer location and stage:The most common location was sacrum/coccyx(46.473%) and iliac crest(11.208%), and stage II(34.976%) was predominant in this study.⑥Pressure ulcer prediction and prevention:In all patient surveyed, the support surface coverage level was61.805%in patients with Braden<16, and in which75.149%can reposition regularly; in pressure ulcer patient, the coverage level reached to79.524%, and91.905%can reposition regularly.⑦Pressure ulcer associated factors:Age, sex, expected length of stay, incontinence and support surface usage are associated with pressure ulcer development.【Conclusion】 This is the first national pressure ulcer prevalence study. National pressure ulcer prevalence study can serve as benchmarking approach to help evaluate the best practice inside and outside the organization. Although, the hospital participation rate was low, the conclusion still could be drawed from this study, based on distribution of diverse institution and sample size. It is suggested that the official Website to be setup to invite more hospitals through the country conduct the pressure ulcer prevalence study. The further nationwide pressure ulcer prevalence study was needed periodically to monitor and maintain the patient outcomes and nursing care quality.③The methodology used in this study was effect and objective, and the survey process was monitored by researcher thorough online surveillance.④Pressure ulcer prevention:In this study, more than half patient who have risk for develop pressure ulcer did not lying on support surface accordingly. Near1/4patients missing repositioning measure. In patients with pressure ulcer,1/5did not lying on support surface and about10%of patient did not turn regularly. The pressure ulcer support surface coverage level was not sufficient and the reposition was not carry out regularly. In other hand,5.153%patient who have no risk for develop pressure ulcer was lying on support surface, causes the waste of pressure ulcer prevention resource. |
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