Results of nine international pressure ulcer prevalence surveys: 1989 to 2005

Abstract

Pressure ulcers continue to be a significant problem for patients and healthcare facilities. Since 1989, results from the International Pressure Ulcer Prevalence surveys--observational, cross-sectional cohort studies--conducted by Hill-Rom, Batesville, Ind, have been used to document aggregate prevalence rates and provide acute care, long-term acute care, and long-term care facilities with internal and external benchmarks of process improvement. During each of the nine surveys conducted between 1989 and 2005, clinical teams in participating facilities predominantly in the US (some facilities in Canada, Saudi Arabia, and Australia participated after 2003) assessed admitted patients on assigned study dates. For this study, trends using all records (n = 447,930; average, 49,770 per year) were reviewed. The majority of facilities in each survey year were in the US (99% overall). Overall and nosocomial pressure ulcer prevalence rates ranged from 9.2% and 5.6% in 1989 to 15.5% and 10% in 2003 and 2004, respectively. The highest prevalence was documented in long-term acute care (27.3% overall, 8.5% nosocomial). Most commonly, ulcers were located at the sacrum (28%), heels (23.6%), and buttocks (17.2%). Ulcers were more commonly assessed as Stage I and Stage II (>70%). However, in patients with dark skin tone (2004 and 2005 data, n = 162,296), 13% of identified ulcers were Stage I compared to 32% in patients with medium and 38% in patients with light skin tone. Using the most complete data sets (2003, 2004, and 2005), more severe pressure ulcer prevalence (Stage III+) was not found to be age-related. Approximately 48% of all patients who had pressure ulcers and 48% of patients with nosocomial pressure ulcers were assessed at mild or no risk (Braden scale score >14). Prevalence within the Braden Score risk categories aligned with risk for developing pressure ulcers. Despite increased attention to the pressure ulcer problem, prevalence rates from the last five survey years are relatively unchanged.