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

Objective: To describe the short-term and long-term effects ofa hospital-wide pressure ulcer prevention and treatment guidelineon both the incidence and the time to the onset of pressure ulcersin critically ill patients.Design: Prospective cohort study.Setting: Adult intensive care department of a university medicalcenter.Patients: Critically ill patients (n ? 399).Interventions: A guideline for pressure ulcer care was implementedon all intensive care units. The attention of nurses fortimely transfer to a specific pressure-reducing device was animportant part of this guideline.Measurements and Main Results: Patient characteristics, demographics,pressure ulcer risk profile at admission, daily pressureulcer grading, and type of mattress were determined todescribe the short-term and long-term effects 3 and 12 monthsafter the implementation. The incidence density of pressure ulcersgrade II–IV decreased from 54 per 1000 patient days at baselineto 32 per 1000 days (p ? .001) 12 months after the implementation.The median pressure ulcer-free time increased from 12 daysto 19 days (hazard rate ratio, 0.58; p ? .02). After adjustment fordifferences in risk factors in a Cox proportional hazard model, thenumber of preventive transfers to special mattresses was thestrongest indicator for the decreased risk of pressure ulcers(hazard rate ratio, 0.22; p <.001). The number needed to treat toprevent one pressure ulcer during the first 9 days was six.Conclusions: The implementation of a guideline for pressureulcer care resulted in a significant and sustained decrease inthe development of grade II–IV pressure ulcers in critically illpatients. Timely transfer to a specific mattress (i.e., transferbefore the occurrence of a pressure ulcer) was the mainindicator for a decrease in pressure ulcer development.