Pressure Ulcers as a Commonly Encountered Health Care Problem
Pressure ulcers can develop solely from or due to a complex interplay of several different factors including and not limited to extrinsic factors such as pressure, shear forces and friction. and certain intrinsic factors or patient factors, such increased age, poor nutritional status, the presence of comorbid conditions or physical disability. The prevalence of pressure ulcers varies, depending on the population being studied, the health care setting under consideration and the assessment tools used to measure outcomes. In the United Kingdom, the prevalence of pressure ulcers ranging between 10% to 33% has been reported. Pressure ulcers are a serious concern for all health care providers since they not only cause significant morbidity and impair quality of life amongst patients, but also pose an economic burden on the health care system by escalating health care costs associated with an extended period of hospitalisation and additional treatment costs, including costs of providing intensive nursing care and specialised equipment. During the year 2008, the annual cost for the management of pressure ulcers in the United Kingdom was found to approximately £1.4-2.1 billion, amounting to almost 4% of the total NHS expenditure. Pressure ulcers are graded according to the European Pressure Ulcer Advisory Panel (EPUAP) guidelines and have been classified into four different grades based on their severity. Grade I pressure ulcers have been defined as a localized area of non-blanchable erythema limited to the skin with both the skin and the underlying tissues being intact. Grade II pressure sores refer to a superficial ulcer with the damage extending into the dermis and sometimes extending beyond the dermis to involve the epidermis. Grade III ulcers include ulcers causing full thickness skin damage, extending into the subcutaneous but not involving the fascia. Grade IV ulcers are the most severe and involve all layers of the skin and the damage extending to the muscle and bone.