Hydrocolloids in Pressure Ulcer Prevention

Hospital Acquired ulcers (HAPU) are a common problem in healthcare facilities-They are a financial burden to healthcare facilities and can cause an adverse outcome to patients. An estimated 60,000 patients die each year from complications due to (HAPU) and can cost up to $362,000 to 28 billion a year (Duncan, 2007, p.605). Since 2008, the Centers for Medicare and Medicaid services will not reimburse hospitals for treatments associated with stage III and stage IV pressure ulcers.

Prevention is the cornerstone of pressure ulcer treatment. Since the 1960’s studies have shown that a moist wound environment is associated with quicker, healing compared to an environment allowed to dry through exposure to air. Modern dressings such as hydrocolloids, foams and hydrogels have been designed to maintain a moist environment, and these were found to be cost effective in the treatment of pressure ulcers (Payne, et al.2009), Heyneman, Beele, Vanderwee, & Defloor, 2008).

Technical approaches of prevention employed in hospitals include pressure reliving mattress, cushion and postures, and human approaches including turning and positioning patients (Schuurman et al., 2009) as well as applying a moisture barrier to patient’s skin. We must also ask the question is the patient incontinent.

Is the patient being left, on soiled linens, and how are the patient’s nutritional status and albumin levels, which also contribute to healing (Sayer, Turgut, Dogan Ekici, Yurtsever, Demirkin &Taselen, 2009). This is standard nursing pressure ulcer prevention. 60.4 % of all hospital-acquired pressure ulcers (HPAUs) identified occurred on the bony prominences (Alderden, Whitney Taylor, & Zaratkiewicz, 2011). The frequent positioning of the patients decreases the friction and shear on the bony prominences. Treatment based on advance dressings (hydrocolloids) may be considered as a preventative measure because of decreasing length of stay and decreasing costs of pressure ulcer treatments. Therefore, research on the use of preventive hydrocolloids is to prevent pressure ulcers, should be considered. This research is pertinent in today’s healthcare delivery.

Patient outcomes are a major focus of the Joint Commission, reimbursements or disembursements are, based on outcomes, and the lengths of hospital stay. Joint Commission’s goal, and therefore, all healthcare facilities goal, is for pressure ulcer incidence to be zero.

Research on preventative hydrocolloids is pertinent and may contribute to the enhancement of evidence-based practice. Hydrocolloids were the first modern dressings to be developed and can be said to provide a benchmark for the performance of wound dressings.

The conceptual definition of hydrocolloids is that they are occlusive dressings that provide a moist wound environment, promoting autolysis (removal of slough) and granulation tissue formation and epitheliazation. Hydrocolloids are to offer an effective barrier to the ingress of microorganisms (Cowan, 2011).

The National Pressure Ulcer Advisory Panel (NPUAP) defines pressure ulcers as, “A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear” (“Pressure ulcer prevention,’2009,p.7).

PURPOSE
The objective of this study is to determine whether the use of hydrocolloids will prevent the incidence of hospital acquired pressure ulcers. Pressure ulcers are evaluated in a systematic review of a variety of preventative approaches that may be less costly than one focused on treatment of established pressure ulcers (Reddy, M., Gill SS, Rochon, PA, 2006).Costs per patient may be lower using a more expensive dressing if frequency of dressing change is lower. Cost –effectiveness involves both costs and patient………………..