EPUAP 2014 Programme and Abstract Book

EPUAP 201417th Annual Meeting of the EuropeanPressure Ulcer Advisory Panel27 -29 August 2014 Stockholm, Sweden

PRESSURE ULCERSFROM BIRTH TO DEATHPrevention,Treatment and Rehabilitation

PROGRAMMEAND ABSTRACT BOOK

Organised by the European Pressure Ulcer Advisory Panelin cooperation with the Swedish Association of Tissue ViabilityNurses SSiS and Sophiahemmet University

Publikace EPUAP_Sestava 2 14.8.14 10:06 Strnka 1

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CONTENT

Welcome 4About EPUAP 5About SSiS 5Programme overview 6Oral presentation overview 17Abstracts of oral presentations 19Poster presentations overview 44Abstracts of poster presentations 46Author index 84General information 86About Stockholm 88Social events 89Sponsors and Exhibitors 90Industry satelllite symposia and workshops 91Exhibitor directory 95Exhibition plans 96


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DEARPARTICIPANTS, Finally, after a year of intense planning, the 17th conference ofEPUAP is about to take off. It is a thrilling and challengingexperience.

I would like to sincerely thank everyone involved in the planningof this event; Codan Consulting the company who organized theconference, the Swedish organizing committee, SSiS, VisitStockholm, Stockholm County Council, the City of Stockholm andSophiahemmet University. We also thank the companies, sponsorsand exhibitors for their valuable support.

We hope you will enjoy our beautiful city, the Venice of the North, ofwhich we will try to give you some glimpses in the social programme.

Most importantly, we hope that you will enjoy the scientificprogramme, carefully planned by the Scientific Committee ofEPUAP. We think this is one of the most interesting and exciting

programmes which we have ever presented at an EPUAPconference.

The programme is a mixture of key lectures, free paper sessions,symposia, workshops and poster sessions addressing the maintheme of the conference Pressure Ulcers from Birth to Death Prevention, Treatment and Rehabilitation.

This year the conference has attracted more than 500 participantsfrom 32 countries all over the world, which is a new record forEPUAP!

So, we wish you a real good time in Stockholm, returning to yourrespective country inspired and more knowledgeable and ready totake on the big challenge of providing an even better preventionand care of persons at risk of, or with manifest pressure ulcers.

Prof. Christina Lindholm Prof. Amit Gefen Prof. Dimitri Beeckman Susanne DufvaChair of the EPUAP 2014 Annual Meeting President of EPUAP Chair of the Scientific Committee President SsiS

Carina Bth Eila Sterner Lena Karlsson Madeleine Stenius Lena Gunningberg BrittLouise Andersson Ammi Hommel


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About EPUAP

The European Pressure Ulcer Advisory Panel was created inLondon in December 1996 to lead and support all Europeancountries in the efforts to prevent and treat pressure ulcers. At itsinaugural meeting in London in December 1996, which includedexperts from many European countries, the group of over twentyagreed their mission statement and the initial Executive Board andTrustees.

The mission statement reads: To provide the relief of personssuffering from or at risk of pressure ulcers, in particular through

research and the education of the public and by influencingpressure ulcer policy in all European countries towards anadequate patient centred and cost effective pressure ulcer care. Avery important activity for the EPUAP is our annual conference.These meetings are aimed at bringing together clinical carepractitioners, researchers and people from industry, to discuss thecurrent status of the problem in Europe and the world and todiscuss new developments in pressure ulcer prevention, treatmentand care.

About Swedish Societyof Wound Care Nurses SSiS

SSiS is a professional organization under the umbrella of theSwedish Nursing Society.

The aim is to work on a nation based level to improve woundmanagement in Sweden.

The Society is also official partner to different authoritiesconcerning wound related questions.

SSiS has 350 members. The Council consist of both academicallyqualified and clinically active nurses.

Every year SSiS organizes a conference on different themes,attracting approximately 200 nurses. Next conference will be inApril 2015 in Stockholm with the theme wound management andtechnology.

This years close cooperation with and support of the EPUAPconference is a welcome event for SSiS, providing internationalcontacts and extended educational options.

We welcome speakers and participants from all over the globe tothis truly inspiring conference.

EPUAP Executive BoardAmit Gefen,PresidentMichael Clark,Immediate Past PresidentJane Nixon,TreasurerDimitri Beeckman,Chair Scientific CommitteeCees Oomens,Deputy Chair Scientific CommitteeLisette Schoonhoven,Chair Guidelines CommitteeJan Kottner, Co-Chair Guidelines CommitteeZita Kis Dadara, Chair Public Relations CommitteeChristina Lindholm, Chair 17th Annual Meeting EPUAP 2014

EPUAP TrusteesDan Bader, United KingdomGuido Ciprandi, ItalyJeannie Donnelly, Northern IrelandLena Gunningberg, SwedenHilde Heyman, BelgiumNils Lahmann, GermanyPablo Lopez Casanova, SpainLenche Neloska, Republic of MacedoniaElia Ricci, ItalyMarco Romanelli, ItalyJos Schols, NetherlandsJakub Taradaj, PolandGeert Vanwalleghem, BelgiumJos Verd Soriano, SpainErik de Laat, Netherlands

Local Organising CommitteeChristina Lindholm, ChairLena GunningbergAmi HommelCarina BthEila SternerMadeleine SteniusLena KarlssonBritt Louise Anderssson


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PRESSURE ULCERS FROM BIRTH TO DEATH Prevention, Treatment and Rehabilitation. 27-29 August 2014 Stockholm, Sweden

WEDNESDAY 27.08.2014 PROGRAMMERegistration area

08:00 Registration, badge and bag collection - Registration area08:00 - 09:30 Morning coffee & tea - registration and exhibition area

Auditorium / Left side

09:30 - 10:15 Opening Ceremony in the Auditorium Left Side, Chairs: Christina Lindholm, Dimitri BeeckmanOpening festivity: Traditional Swedish horn blowing, Jan Johansson Opening of the conference by Barbro Westerholm, member of the Swedish House of ParliamentFrom off - piste to off - load: a patient experience, Ronny PerssonOpening by the President and the local organiser, Amit Gefen, Christina Lindholm

10:15 - 12:00 Key sessions, Chairs: Christina Lindholm, Dimitri BeeckmanThe skin in a gender perspective, sa BostrmPressure ulcers in neonates and a paediatric population, Guido CiprandiPressure ulcers in palliative care patients, Christina LindholmPressure ulcers after surgery, Ami HommelReconstructive surgerny of pressure ulcers, Jakob LagergrenPressure ulcers in a rehabilitation unit, Claes HultlingGeriatric experiences in the prevention of pressure ulcers, Dag Salaj

12:00 - 13:15 Lunch break and exhibition viewingAuditorium / Left side Auditorium / Right side

13:15 - 14:45 Key lectures, Chairs: Michael Clark, Jan Kottner 13:15 - 14:15 Industry WorkshopRisk factors in context; from conceptual framework to risk assessment in practice, Jane NixonThe effect of sustained loads on cells and tissues, Cees OomensContoured foam cushions in spinal cord injury care: Cinderella's shoe does not fit anymore!, Amit GefenMicroclimate, Dan BaderNutrition and pressure ulcers, Jos Schols

14:45 - 15:30 Coffee break and exhibition viewing

15:30 - 16:00 EPUAP Initiatives Key lectures, Chairs: Amit Gefen, Jeannie Donnely

15:30 - 17:00 Industry Satellite Symposium

Launch of the 2014 International Guideline for PressureUlcer Prevention and Management, Lisette SchoonhovenPuClas3 show, Dimitri BeeckmanStop Pressure Ulcer Day, Zita Kis Dadara

16:00 - 17:00 Free paper session 1: Pressure Ulcers in Trauma and ICU Patients,Chairs: Marco Romanelli, Guido Ciprandi

Pressure ulcer prevention in critical ill neonates and infants,Anne-Barbara SchlurPressure Ulcers and Pain Due to the Extrication Collar andHeadblocks in Trauma Patients, Wietske HamA prospective cohort study of the clinical effectiveness ofmulti-layer soft silicone dressings in the prevention of heelpressure ulcers in trauma and critically ill patients, Nick Santamaria

The Impact of a 5-Layered Silicone Bordered Foam Dressingon Intensive Care Unit (ICU) Patients Sacral Pressure UlcerIncidence: A Randomized Clinical Trial, Peggy Kalowes

17:00 - 17:30 Official opening of the exhibition and refreshments (in the exhibition area)19:00 Welcome reception at the Stockholm City Hall, Nobel Prize Hall


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08:0008:00 - 09:30

09:30 - 10:15

10:15 - 12:00

Bergsmannen Spelbomskan13:15 - 14:45

14:45 - 15:30

15:30 - 16:00

Free paper session 2: Pressure Ulcers in Older Persons,Chairs: Cees Oomens, Hilde Heyman

Free paper session 3: Tailoring of care: one size doesn'tfit all, Chairs: Geert Vanwalleghem, Elia Ricci

16:00 - 17:00

Higher mortality if admitted with a pressure ulcer to a nursing home Results of a cohort study, Nils Lahmann

Can a multi-faceted intervention affect pressure ulcer prevention?, Eva Sving

Pressure ulcers on a static air mattress: incidence and risk factors, Brecht Serraes

Clinical Unit Microsystem Pressure Ulcer Prediction and Prevention, Nancy Donaldson

A randomised control trial into the impact of prescribed seating in pressure ulcer prevention for nursing home residents, Olivia McVey

Head, Shoulders, Hips and Heels A Multi-Modal Approachto the Reduction of Pressure Ulcers in Infants, Children andYoung People, Sarah Kipss

A clinical evaluation of a specifically designed alternatingsupport surface device for achieving the 30 degree tilt in older individuals at risk of pressure ulcer development,Zena Moore

Can real-time feedback of interface pressure optimise adequate repositioning in bed?, Lena Gunningberg

17:00 - 17:3019:00

See the industry satellite symposia and workshops at page 91


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Registration area

08:00 Registration, badge and bag collection Registration area

Auditorium / Left side Auditorium / Right side

08:00 - 09:00 Free paper session 4: Pressure Ulcers: Learningfrom the Lab and Applying to the Patient, Chairs: Jos Schols, Lena Gunningberg

Buttock pressure management of able-bodied people seatedon a rigid surface for two hours, Olivier Chenu

Evaluating the Sensitivity of Actimetry to detect PosturalChanges in Seated Individuals, Peter Worsley

08:30 - 09:30 Industry Satellite Symposium

Does the calcaneus morphology have an influence on the riskof posterior heel ulcer?, Vincent Luboz

Simulation and Discussion of the Microclimate in Heel Protector Boots, Evan Call

09:00 - 10:00 Key lectures, Chairs: Dan Bader, Jose Verdu SorianoThe skin in a lifepan perspective, Jan KottnerRecent health economic data from a systematic review of international literature, Dimitri BeeckmanNeglect - shame or blame, Agnetha Folestad

10:00 - 10:45 Coffee break and exhibition viewing 10:00 - 11:00 Industry Workshop10:45 - 11:45 EPUAP Experienced and Novice Investigator

Awards 2014, Introduction to the Awards by theChair of the Scientific Committee, Dimitri Beeckman

Experienced Investigator Award: Wound healing from past tofuture: What can we learn from history?, Christina LindholmLactic acid bacterial symbionts in honeybees an unknownkey to honeys antimicrobial and therapeutic activities, AlejandraVsquez Novice Investigator Award: Pressure ulcer care: the Netherlands vs. Germany 0 - 1, Esther Meesterberends

11:45 - 13:15 Lunch break and exhibition viewing12:45 - 13:15 Annual General Meeting of the EPUAP13:15 - 14:15 Session for physiotherapists / occupational

therapists, Chair: Richard GoossensFree paper session 7: Biomechanics and Etiology,Chairs: Lena Gunningberg, Jos Schols

The five why's about seating, Milja Vaitilo Self-Propagation of Cell Death in Muscle Tissue via Myoglo-bin Release: A Computational Model of Mechano-ChemicalInterplay in Deep Tissue Injury (DTI), Lisa Tucker-Kellogg

Position changes - why, when and how often, Ulrika Kallman The Role of Mathematics in Ulcer Development and WoundHealing, Fred Vermolen

Cognition and compliance with pressure ulcer prevention, Dorothy Riedel

A novel MR compatible indentation setup to study the etiology of pressure ulcers and related deep tissue injury,Jules Nelissen

Characterization of walk and seating in young adults withspina bifida; Challenges and possibilities, Martina Bendt

Discrimination between diabetic patients with and without diabetic foot ulcer based on testing the cutaneous microcirculationin response to low pressure, Dominique Sigaudo Roussel


Thursday 28.08.2014 PROGRAMME


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08:00

Bergsmannen Spelbomskan

Free paper session 5: Innovative Approaches forRisk Assessment, Chairs: Hilde Heyman, Geert Vanwalleghem

Free paper session 6: Pressure Ulcer Research andBasic Science, Chairs: Zita Kis Dadara, Lenche Neloska

08:00 - 09:00

Pressure ulcer prevalence and prevention practices a comparison between formal risk assessment and assessment using clinical judgement alone, Zena Moore

PRESSURE 2 Trial: Considerations on the design of the trial and the decision making process at the interim analyses,Sarah Brown

Improving the risk assessment of pressure ulcer by nurses for elderly with psychiatric disorder a pilot project,Florence Bassin

The Effect of a Bacteria and Fungi Binding Mesh Dressingon the Bacterial Load of Pressure Ulcers Treated with Negative Pressure Wound Therapy (NPWT), a Pilot Study,Marino Ciliberti

Is pain a predictor of Category 2 pressure ulcers? Analysis of skin site level data from the PURPOSE Pain CohortStudy, Isabelle Smith

Numerical Study of different Types of Supporting Structuresregarding the Prevention of Deep Tissue Injuries,Alexander Siefert

Early pressure ulcer prevention and Intervention for patientsundergoing fasttrack surgery, Brigitte Skovgaard

A clinical comparative study on 940, 808 and 658 nm lasertherapy in pressure ulcer healing: early and long term results,Jakub Taradaj

09:30 - 10:30 Industry Workshop 09:00 - 10:00

10:00 - 10:4510:45 - 11:45

11:00 - 12:30 Industry Workshop

11:45 - 13:1512:45 - 13:15

Workshop: The implementation of the 2014 pressure ulcerguidelines in clinical practice, Lisette Schoonhoven

Workshop: Pressure Ulcer Classification: PuClas3, Dimitri Beeckman

13:15 - 14:15



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14:15 - 15:15 EWMA - EPUAP Session, Chair: Jane Nixon 14:15 - 15:45 Industry Satellite Symposium

EWMA: Working together for better wound care education inEurope, Salla SeppnenEPUAP: Integrating pressure ulcer prevention and management in educational curricula: current status, views and joint initiatives, Trudie Young

EWMA: EWMA Managing wounds as a team document,Zena Moore

15:15 - 16:00 Coffee break and exhibition viewing16:00 - 17:15 Key lectures, Chairs: Nihls Lahman, Jakub Tarafaj 16:00 - 17:00 Industry Workshop

SSiS scholarship

Telemedicine in pressure ulcer prevention and management,Rolf JelnesThe National Register of Wounds, RiksSar (RUT), Ruth ien

Swedish National Prevalence Study Initiative 2009 - 2014, Agneta Andersson

Mobile pressure ulcer team, Karin Hagqvist and Mona Johansson

19:30 Conference Dinner, Solliden Restaurant


Thursday 28.08.2014 PROGRAMME


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Free paper session 8: Patient Safety, Quality of Care and Policy (1), Chairs: Lena Gunningberg, Lisette Schoonhoven

14:15 - 15:30 Student free papers session: Clinicaland Applied Science, Chairs: Lenche Neloska, Marco Romanelli

14:15 - 15:15

Home-care wound care a EWMA document, Sebastian Probst Patients and nurses experiences of using the 30 degree tilt forthe prevention of pressure ulcers, Urmila Victor

What Percentage of Hospital-Acquired Grade 3 and 4 Pressure Ulcers are Avoidable?, Fiona Downie

Evidence-based skin care at a university hospital in Germany- Andrea Lichterfeld

Do patient safety culture items affect pressure ulcer prevalence in a sample of Norwegian hospitals?,Ida Marie Bredesen

RNs knowledge of PU risk factors and prevention in internal medicine of a University Hospital In Iceland,Iris Gsladttir & Arna rardttirPressure Ulcers due to Stroke patients receiving PercutaneousEndoscopic Gastrostomy, Gunnel Wrn HedeRole of Braden scale scoring as a prognostic tool for pressureulcers, Kumar Madhaver

15:15 - 16:0016:00 - 17:15 Student free papers session: Basic Science, Chairs: Zita Kis Dadara, Jeannie Donnelly

16:00 - 17:00 Workshop: Pressure Ulcer PreventionPathways (PUPPS): Active Monitoring Model of Care Incorporating PURPOSE T', Susanne Coleman

16:00 - 17:15

Heel Ulcers: Simulations of Injurious Tissue Loads and Remedial Local Drug Delivery, Rinat FriedmanChanges in topography and structural properties of healthyaged skin after loading, Gabor DobosThe quest for smart materials to protect the fragile skin:Computational modeling of how shear and microclimate influence skin that rubs against clothing, incontinence pads,diapers etc., Mor Ben-or Frank

Development of biomarkers for the Wound Fluid RT-PCRmethod to detect critically colonised and infected wounds,Mayumi Asada

Biomechanical simulation of the Charcot neuroarthropathicfoot with plantar ulcer, Antoine Perrier

19:30



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Registration area

08:00 Registration, badge and bag collection - Registration area


09:00- 10:00 Key lectures, Chairs: Jane Nixon, Jeannie Donnely Free papers session 9: Pressure Ulcer Epidemiology, Chairs: Lisette Schoonhoven, Geert Vanwalleghem

International initiatives and experiences, Terence Ryan Pressure Ulcers in Iceland prevalence, seriousness and prevention, Gubjrg Plsdttir

Pressure ulcers: an African initiative, Katarzyna Trok The effect of a simple three-step pressure relieving strategyfor preventing pressure ulcers: an explorative longitudinalstudy from 2002-2011, Martin van Leen

Pressure ulcers in the darkly pigmented skin, Madeleine Stenius Suspected Deep Tissue Injury on Heels of Nursing Home Residents: Development and Evolution within 16 weeks,Barbara Bates-Jensen

Pressure Ulcer Prevalence 2011-2014: Data from the International Pressure Ulcer PrevalenceTM Survey,Charlie Lachenbruch

10:00 - 10:45 Coffee break and exhibition viewing10:45 - 12:00 Clinical case discussions: interactive session, Chairs:

Michael Clark, Marco RomanelliPressure ulcers in the amputation stump and how they can beavoided, Anton JohannessonPressure ulcers in the paediatric population, Guido Ciprandi

A multidisciplinary approach to prevention and treatment ofpressure ulcers in palliative care, Lenche NeloskaSuccessful management of a non-healing pressure ulcer foran immuno-compromised child with a bacteria binding geldressing, Anna Sahlqvist

12:00 - 12:30 Presentation of EPUAP 2015 Gent, Belgium, Dimitri Beeckman, Geert Vanwalleghem, Hilde HeymanClosing of the conference, Amit Gefen


Friday 29.08.2014 PROGRAMME


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08:00


09:00 - 10:30 Workshop: Debridement: Why - When -When not? Carolyn Wyndham - White

Free paper session 10: Patient Safety, Quality ofCare and Policy (2), Chairs: Michael Clark, Marco Romanelli

09:00- 10:00

Cost analysis and effects of one of the first outpatient woundclinics in the Netherlands, Armand Rondas

Nurses' attitudes and perceived barriers to pressure ulcer prevention, Ahmad Tubaishat

Knowledge among ICU nurses about pressure ulcers prevention, Maria Hansbo

Patients with pressure ulcers from prevention through treatment to healing results from the national quality registries RUT (Registry of Ulcer Treatment) and Senior alert, Ruth ien

10:00 - 10:4510:45 - 12:00

12:00 - 12:30



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EPUAP WORKSHOP:

The implementation of the 2014 pressure ulcer guidelines in clinical practice

EPUAP WORKSHOP:

Pressure Ulcer Classification: PuClas3The new PuClas version includes an update of the classification systemaccording to the latest international guideline, an updated terminology forincontinence- associated dermatitis, high quality photographs, an assessmentmodule for basic level and advance level, and a separate assessment moduleincluding cases and photographs.

Speaker: Dimitri BeeckmanDate: 28 August 2014Time: 13:15 14:15Meeting room: Spelbomskan

WORKSHOP:

Pressure Ulcer Prevention Pathways (PUPPS): ActiveMonitoring Model of Care Incorporating PURPOSE T' The NIHR PURPOSE Programme of research, highlighted the limitations ofpressure ulcer risk assessment practice and the standard 'assess, plan,implement and evaluate' model of care (Nixon et al. Submitted). This promptedthe development of a new evidenced-based risk assessment framework -PURPOSE T and an active monitoring model of care incorporating primaryand secondary Pressure Ulcer Prevention Pathways (PUPPs). The workshop willpresent the new Risk Assessment Framework PURPOSE T and allow delegatesto practice using the tool. PUPPs will also be introduced.

Speakers: Susanne ColemanDate: 28 August 2014Time: 16:00 17:00Meeting room: Spelbomskan

Implementation of guidelines in clinical practice requires a systematic approach.This approach should target relevant barriers and facilitators for use of theguidelines.This workshop will focus on the identification of these barriers andfacilitators and the development of a matching implementation strategy.

Speaker: Lisette SchoonhovenDate: 28 August 2014Time: 13:15 14:15Meeting room: Bergsmannen

DEBRIDEMENT WORKSHOP:

Why When When not? Participants will gain knowledge about wound evaluation, the goals ofdebridement (when and why), limits, dangers, and related measures. Attendeeswill be able to practice sharp debridement and learn the necessary practicalskills.

Speaker: Carolyn Wyndham - WhiteDate: 29 August 2014Time: 09:00 10:30Meeting room: Bergsmannen

SCIENTIFIC WORKSHOPS


WWW.EWMA2015.ORGWWW.EWMA.ORG WWW.TVS.ORG.UK

LONDON UKEWMA 2015

13-15 MAY 2015

25th Conference of the European Wound Management Association

WOUND CARE SHAPING THE FUTUREA PATIENT, PROFESSIONAL, PROVIDER AND PAYER PERSPECTIVE


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How can you get involved? Host educational activities on prevention and treatment of pressure ulcers Organise awareness raising events to share information about pressure ulcers Reach out to your local community to inform them about pressure ulcers Make policy makers aware about pressure ulcers

Download support material for free at: www.epuap.org

EPUAP Business OfficeEmail: [email protected]: +420 251 019 379

one GOALWorldwide

20thNovember2014

www.epuap.org

STOP PRESSURE ULCER DAY


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Oral presentations overview(Bold = presenting author)

1 Pressure ulcer prevention in critical illneonates and infantsSchlur Anne-Barbara, Degenhardt Johanna

2 Pressure Ulcers and Pain Due to theExtrication Collar and Headblocks inTrauma PatientsHam Wietske H.W., Schoonhoven Lisette,Leenen Luke P.H., Schuurmans Marieke J.

3 A prospective cohort study of the clinicaleffectiveness of multi-layer soft siliconedressings in the prevention of heelpressure ulcers in trauma and criticallyill patientsSantamaria Nick, Gerdtz Marie, Liu Wei,DeVincentis Stephanie, Ng Wei Ai

4 The Impact of a 5-Layered SiliconeBordered Foam Dressing on IntensiveCare Unit (ICU) Patients Sacral PressureUlcer Incidence: A Randomized ClinicalTrialKalowes Peggy, Messina Valerie, Li Melanie,Carlson Carole, Lukaszka Diana

5 Higher mortality if admitted with a pressure ulcer to a nursing home Results of a cohort studyLahmann Nils

6 Pressure ulcers on a static air mattress:incidence and risk factorsSerraes Brecht, Schoonhoven Lisette,Beeckman Dimitri

7 A randomised control trial into theimpact of prescribed seating in pressureulcer prevention for nursing homeresidentsMcVey Olivia, Tierney Martina, Casey Jackie, Daly Orlagh, Martin Suzanne

8 A clinical evaluation of a specificallydesigned alternating support surfacedevice for achieving the 30 degree tilt inolder individuals at risk of pressure ulcerdevelopmentMoore Zena, Urmila, Victor

9 Can a multi-faceted intervention affectpressure ulcer prevention?Sving Eva, Hgman Marieann, Mamhidir Anna-Greta, Gunningberg Lena

10 Clinical Unit Microsystem Pressure UlcerPrediction and PreventionDonaldson Nancy, Aydin Carolyn, StottsNancy, Fridman Moshe, Browne Storer Diane

11 Head, Shoulders, Hips and Heels AMulti-Modal Approach to the Reductionof Pressure Ulcers in Infants, Childrenand Young PeopleKipss Sarah Jane, Maxwell Jan

12 Can real-time feedback of interfacepressure optimise adequate repositioningin bed? Gunningberg Lena, Carli Cheryl

13 Buttock pressure management of able-bodied people seated on a rigid surfacefor two hoursChenu Olivier, Payan Yohan, Moreau-Gaudry Alexandre, Diot Bruno,Cannard Francis, Vuillerme Nicolas

14 Evaluating the Sensitivity of Actimetry todetect Postural Changes in SeatedIndividualsWorsley Peter, Webb Sally, Bader Dan L.

15 Does the calcaneus morphology have aninfluence on the risk of posterior heelulcer?Luboz Vincent, Perrier A., Bucki M., Diot B., Cannard F., Vuillerme N., Payan Y.

16 Simulation and Discussion of theMicroclimate in Heel Protector BootsCall Evan, Oberg Craig, Bill Brian, McLean Chad, Drennan Joseph W.

17 Pressure ulcer prevalence and preventionpractices a comparison between formalrisk assessment and assessment usingclinical judgement aloneMoore Zena, Johansen Edda, van Etten Menno, Strapp Helen

18 Improving the risk assessment ofpressure ulcer by nurses for elderly withpsychiatric disorder a pilot projectBassin Florence, Queiros Alcina, Djamel Moad, Charbonneau Lucie, Schet Vronique

19 Is pain a predictor of Category 2pressure ulcers? Analysis of skin site leveldata from the PURPOSE Pain CohortStudySmith Isabelle, Brown Sarah, McGinnis Elizabeth, Stubbs Nikki, Nixon Jane

20 "Early pressure ulcer prevention andIntervention for patients undergoing fast-track surgery" Skovgaard Brigitte Brask, Appelt Henriette Djuurhus

21 PRESSURE 2 Trial: Considerations onthe design of the trial and the decisionmaking process at the interim analysesBrown Sarah, Smith Isabelle, Hulme Claire,Nixon Jane

22 The Effect of a Bacteria and FungiBinding Mesh Dressing on the BacterialLoad of Pressure Ulcers Treated withNegative Pressure Wound Therapy(NPWT), a Pilot StudyCiliberti Marino

23 Numerical Study of different Types ofSupporting Structures regarding thePrevention of Deep Tissue InjuriesSiefert Alexander, Hofmann-RsenerMonika, Lachenbruch Charlie

24 A clinical comparative study on 940, 808and 658 nm laser therapy in pressureulcer healing: early and long term resultsTaradaj Jakub, Polak Anna, Halski Tomasz

25 "Self-Propagation of Cell Death inMuscle Tissue via Myoglobin Release: A Computational Model of Mechano-Chemical Interplay in Deep TissueInjury (DTI)"Tucker-Kellogg Lisa, Gefen Amit

26 The Role of Mathematics in UlcerDevelopment and Wound HealingVermolen Fred, Gefen Amit

27 A novel MR compatible indentationsetup to study the etiology of pressureulcers and related deep tissue injuryNelissen Jules, Traa Willeke, Nicolay Klaas,Strijkers Gustav, Oomens Cees

28 Discrimination between diabetic patientswith and without diabetic foot ulcerbased on testing the cutaneousmicrocirculation in response to lowpressureVouillarmet Julien, Josset-Lamaugarny A.,Viart-Ferber Ch, Sigaudo-Roussel D.

29 Home-care wound care a EWMAdocumentProbst Sebastian, Seppnen Salla, GerberVeronika, Rimdeika Rytis, Hopkins Alison,Gethin Georgina

30 What Percentage of Hospital-AcquiredGrade 3 and 4 Pressure Ulcers areAvoidable? Downie Fiona, Sandoz Heidi, PaulineGilroy, Royall Dawn, Davies Sarah

31 Do patient safety culture items affectpressure ulcer prevalence in a sample ofNorwegian hospitals?Bredesen Ida Marie, Bjro Karen L. K.,Gunningberg Lena, Hofoss Dag

32 RNs knowledge of PU risk factors andprevention in internal medicine of aUniversity Hospital In IcelandGsladttir Iris, rardttir Arna

33 Patients and nurses experiences of usingthe 30 degree tilt for the prevention ofpressure ulcersUrmila Victor, Moore Zena

34 Evidence-based skin care at a universityhospital in GermanyLichterfeld Andrea, Hauss Armin, SauberChristian, Blume-Peytavi Ulrike, Kottner Jan

35 Pressure Ulcers due to Stroke patientsreceiving Percutaneous EndoscopicGastrostomy Hede Gunnel Wrn, Faxen-Irving Gerd,Ekman Sirkka-Liisa, Crisby Milita,Ebbeskog Britt

36 Role of Braden scale scoring as a prognostic tool for pressure ulcersMadhavan Kumar, Singhal Maneesh,Ranjan Piyush, Sagar Sushma, Garg Kavita

37 Heel Ulcers: Simulations of InjuriousTissue Loads and Remedial Local DrugDeliveryFriedman Rinat, Haimy Ayelet, Shabshin Nogah, Zilberman Meital, Gefen Amit

38 Changes in topography and structuralproperties of healthy aged skin afterloadingDobos Gabor, Richter Claudia, Trojahn Carina, Blume-Peytavi Ulrike, Gefen Amit, Kottner Jan


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39 The quest for smart materials to protectthe fragile skin: Computational modelingof how shear and microclimate influenceskin that rubs against clothing,incontinence pads, diapers etc.Ben-Or Frank Mor, Limbert Georges, Fader Mandy, Kottner Jan, Gefen Amit

40 Development of biomarkers for theWound Fluid RT-PCR method to detectcritically colonised and infected woundsAsada Mayumi, Nakagami Gojiro, Tochiori Ayaka, Sugama Junko, Sanada Hiromi

41 Biomechanical simulation of the Charcotneuroarthropathic foot with plantar ulcerPerrier Antoine, Vuillerme N., Luboz V.,Bucki M., Diot B., Cannard F., Havan G.,Payan Y.

42 Pressure Ulcers in Iceland prevalence,seriousness and preventionPlsdttir, Gubjrg, Gurn Sigurjnsdttir,sta Thoroddsen

43 The effect of a simple three-step pressurerelieving strategy for preventing pressureulcers: an explorative longitudinal studyfrom 2002-2011van Leen Martin, Schols Jos, Hovius Steven E.R., Halfens Ruud J.G.

44 Suspected Deep Tissue Injury on Heelsof Nursing Home Residents:Development and Evolution within 16weeks Bates-Jensen Barbara, Patlan Anabel,McCreath Heather E., Nakagami Gojiro

45 Pressure Ulcer Prevalence 2011-2014:Data from the International PressureUlcer PrevalenceTM SurveyLachenbruch Charlie, Van Gilder Catherine,Meyer Stephanie

46 Cost analysis and effects of one of thefirst outpatient wound clinics in theNetherlandsRondas Armand, Schols Jos, Halfens R,Hull H, Stobberingh E, Evers

47 Nurses' attitudes and perceived barriersto pressure ulcer preventionTubaishat Ahmad, Aljezawi Maen, Al Qadire Mohammad

48 Knowledge among ICU nurses aboutpressure ulcers preventionHansbo Maria, Mattsson Gunilla, Bth Carina

49 Patients with pressure ulcers fromprevention through treatment to healing results from the national qualityregistries RUT (Registry of UlcerTreatment) and Senior alertien Rut, Lindholm Christina, Trinks Anna

50 Lactic acid bacterial symbionts inhoneybees an unknown key to honeysantimicrobial and therapeutic activitiesAlejandra Vasquez, Christina Lindholm,Tobias Olofsson


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osp

ita

l Z

uri

ch

(S

witze

rla

nd

),

ba

rba

ra.s

ch

lue

er@

kis

pi.u

zh

.ch

2 C

hild

ren

s R

ese

arc

h C

en

ter,

Ch

ildre

ns

Un

ive

rsity H

osp

ita

l Z

uri

ch

(S

witze

rla

nd

),

Intr

od

uc

tio

n

Th

ere

is g

rea

ter

aw

are

ne

ss t

ha

t p

ae

dia

tric

pa

tie

nts

in

ce

rta

in

he

alth

ca

re

se

ttin

gs

are

a

t h

igh

ri

sk

of

de

ve

lop

ing

pre

ssu

re u

lce

rs.

In d

iffe

ren

t ca

re s

ett

ing

s,

su

ch

a

s p

ae

dia

tric

in

ten

siv

e ca

re u

nits (P

ICU

s)

an

d

acco

rdin

g

to

diffe

ren

t ri

sk

facto

rs,

su

ch

a

s

me

dic

al

de

vic

es,

diffe

ren

t p

ressu

re u

lce

r p

reva

len

ce

ra

tes h

ave

b

ee

n p

ub

lish

ed

[1

, 2

]. P

ressu

re u

lce

r p

reva

len

ce

ra

tes

in n

eo

na

tes a

nd

in

fan

ts v

ary

fro

m 1

1%

to

61

.5%

[3

,4].

R

isk

facto

rs

for

ho

sp

ita

lize

d

ne

on

ate

s

an

d

infa

nts

in

clu

de

a

P

ICU

sta

y

an

d

me

ch

an

ica

l ve

ntila

tio

n

su

pp

ort

. T

hu

s,

cri

tica

lly i

ll p

atie

nts

of

yo

un

ge

r a

ge

are

a

t ve

ry h

igh

ri

sk o

f d

eve

lop

ing

p

ressu

re u

lce

rs [5

,6].

T

he

refo

re

the

a

im

of

this

stu

dy

wa

s

to

imp

lem

en

t sp

ecific

p

reve

ntio

n

str

ate

gie

s

to

de

cre

ase

p

ressu

re

ulc

er

risk in

ne

on

ate

s a

nd

in

fan

ts t

rea

ted

on

a P

ICU

.

Me

tho

ds

In 2

01

3 a

lo

ng

itu

din

al

stu

dy w

as c

on

du

cte

d i

n a

Sw

iss

PIC

U

se

ttin

g

inclu

din

g

all

ne

on

ate

s

an

d

infa

nts

in

cri

tica

l lif

e

co

nd

itio

ns

ad

mitte

d

to

a

PIC

U

wh

ich

n

ee

de

d m

ech

an

ica

l ve

ntila

tio

n su

pp

ort

. A

ll n

eo

na

tes

an

d in

fan

ts w

he

re a

sse

sse

d e

ve

ry 1

2 h

ou

rs if

the

y h

ad

(1

) a

ny m

ech

an

ica

l ve

ntila

tio

n s

up

po

rt,

(2)

an

y o

the

r d

evic

e w

hic

h c

an

ca

use

pre

ssu

re in

th

e f

ace

ae

ra,

an

d

(3)

if

the

y

de

ve

lop

ed

a

p

ressu

re

ulc

er

(in

clu

din

g

ca

teg

ory

).

Th

e

asse

ssm

en

t w

as

pe

rfo

rme

d

in

all

pa

tie

nts

u

ntil

48

h

ou

rs p

ost

dis

ch

arg

e fr

om

P

ICU

o

r u

ntil d

ea

th o

f a

pa

tie

nt.

M

ech

an

ica

l ve

ntila

tio

n

su

pp

ort

d

evic

es

inclu

de

d

tra

ch

ea

l tu

be

s,

co

ntin

uo

us p

ositiv

e a

irw

ays p

ressu

re

ma

sks (

with

an

d w

ith

ou

t p

ron

gs),

ma

sks,

na

sa

l tu

be

s

an

d t

rach

eo

sto

my.

A

fte

r a

firs

t p

ha

se

la

stin

g

4

mo

nth

, a

n

ew

fixa

tio

n

str

ate

gy to

se

cu

re tr

ach

ea

l tu

be

s a

nd

u

nd

erp

ad

din

g

an

y m

asks w

as im

ple

me

nte

d.

Re

su

lts

In 2

01

3 a

to

tal

of

24

5 n

eo

na

tes a

nd

in

fan

ts w

ith

th

e

ne

ed

fo

r m

ech

an

ica

l ve

ntila

tio

n

su

pp

ort

w

he

re

asse

sse

d.

In

th

e f

irst

stu

dy p

ha

se

th

e in

cid

en

ce

of

pre

ssu

re u

lce

r (i

ncl. c

ate

go

ry 1

) w

as 4

4%

.

Aft

er

imp

lem

en

tin

g th

e sp

ecific

p

reve

ntio

n str

ate

gie

s

with

u

nd

erp

ad

din

g

an

y

ma

sks

an

d

a

ne

w

fixa

tio

n

tech

niq

ue

to

se

cu

re

tra

ch

ea

l tu

be

s

the

in

cid

en

ce

d

ecre

ase

d t

o 2

5%

.

Dis

cu

ss

ion

Incid

en

ce

ra

te

for

pre

ssu

re

ulc

er

de

ve

lop

me

nt

in

ne

on

ate

s a

nd

in

fan

ts i

n a

PIC

U s

ett

ing

are

hig

h.

Th

is

is in

lin

e w

ith

p

revio

us p

ub

lish

ed

in

cid

en

ce

ra

tes in

th

ese

se

ttin

g [

5,6

]. V

en

tila

tio

n s

up

po

rt d

evic

es s

uch

as

CP

AP

or

me

ch

an

ica

l ve

ntila

tio

n i

ncre

ase

d t

he

ris

k o

f p

ressu

re u

lce

rs.

N

eo

na

tes

an

d

infa

nts

w

ith

co

ng

en

ita

l h

ea

rt

de

fects

a

nd

a

fte

r ca

rdio

-su

rge

ry

pro

ce

du

res

wh

ere

th

e

pa

tie

nts

mo

st

at

risk f

or

pre

ssu

re u

lce

r d

eve

lop

me

nt.

W

ith

a

n

ea

sy

to

ap

ply

, b

ut

ad

ap

ted

to

th

e

stu

dy

po

pu

latio

n,

inte

rve

ntio

n t

he

pre

ssu

re u

lce

r in

cid

en

ce

in

th

e s

tud

y g

rou

p d

ecre

ase

d.

Cli

nic

al

rele

va

nc

e

Th

e p

reve

ntio

n o

f p

ressu

re u

lce

rs i

n t

his

pa

tie

nt

gro

up

m

ust

sta

rt

ea

rly

to

avo

id

an

y

furt

he

r h

arm

to

th

eir

h

igh

ly v

uln

era

ble

skin

. T

he

refo

re t

he

se

ch

ildre

n n

ee

d

evid

en

ce

ba

se

d a

nd

ap

pro

pri

ate

pre

ve

ntive

me

asu

res

to d

ecre

ase

th

eir

pre

ssu

re u

lce

r ri

sk.

Un

de

r-p

ad

din

g,

ca

refu

l fixa

tio

n

an

d

po

sitio

nin

g

of

me

dic

al

de

vic

es,

esp

ecia

lly v

en

tila

tio

n s

up

po

rt d

evic

es,

in t

he

se

hig

hly

vu

lne

rab

le p

atie

nts

are

ma

nd

ato

ry a

nd

ea

sy t

o a

pp

ly

to d

ecre

ase

th

e r

isk o

f p

ressu

re u

lce

rs.

A

ck

no

wle

dg

em

en

ts

We

ap

pre

cia

te t

he

he

lp o

f P

rof

Dr.

Be

rnh

ard

Fre

y a

nd

D

r. V

. C

an

niz

za

ro a

nd

th

e P

ICU

te

am

at

the

Ch

ildre

ns

U

niv

ers

ity h

osp

ita

l Z

uri

ch

, S

witze

rla

nd

.

Co

nfl

ict

of

Inte

res

t N

on

e.

Re

fere

nc

es

[1]

Ko

ttn

er

J.

et

al.,

Int.

J.

Nu

rs.

Stu

d,

47

:13

30

-13

40

, 2

01

0

[2]

Sch

le

r A

B.

et

al.,

Osto

my W

ou

nd

Ma

n,

58

:18

-31

, 2

01

2

[3]

Gro

ne

ve

ld A

. e

t a

l.,

J W

ou

nd

Osto

my C

on

tin

en

ce

N

urs

, 3

1:1

08

-12

2,

20

04

[4

] S

ch

le

r A

B.

et

al.,

J C

lin N

urs

, 1

8:3

24

4

32

52

, 2

00

9

[5]

Ba

ha

resta

ni M

. e

t a

l.,

Ad

v S

kin

Wo

un

d C

are

, 2

0:2

08

-22

0,

20

07

[6

] C

url

ey M

AQ

. e

t a

l.,

Pe

dia

tr C

rit

Ca

re M

ed

, 4

: 2

84

-2

90

, 2

00

3

Pro

ce

ed

ing

s o

f th

e 1

7th

An

nu

al E

uro

pe

an

Pre

ssu

re U

lce

r M

ee

tin

g

Sto

ckh

olm

, S

we

de

n

Co

py

rig

ht

2

01

4 b

y E

PU

AP

Pre

ssu

re U

lcers

an

d P

ain

Du

e t

o t

he E

xtr

icati

on

Co

llar

an

d H

ead

blo

cks i

n T

rau

ma P

ati

en

ts

Wie

tsk

e H

.W.

Ha

m,

MS

c,

RN

1* , L

ise

tte

Sc

ho

on

ho

ve

n,

Ph

D 2

, L

uk

e P

.H.

Le

en

en

, P

hD

, M

D,

FA

CS

3

Ma

rie

ke

J.

Sc

hu

urm

an

s,

Ph

D,

RN

1 3

4 * U

niv

ers

ity M

ed

ica

l C

en

ter

Utr

ech

t, T

he

Ne

the

rla

nd

s,

H.W

.Ha

m@

um

cu

tre

ch

t.n

l 2 R

ad

bo

ud

Un

ive

rsity M

ed

ica

l C

en

ter,

Nijm

eg

en

, th

e N

eth

erl

an

ds &

Un

ive

rsity o

f S

ou

tha

mp

ton

, S

ou

tha

mp

ton

, U

K

Intr

od

uc

tio

n

At

the

sce

ne

of

an

accid

en

t, e

ve

ry t

rau

ma

pa

tie

nt

with

su

sp

ecte

d

sp

ine

in

jury

is

im

mo

bili

ze

d

with

a

b

ackb

oa

rd,

an

d

extr

ica

tio

n

co

llar

co

mb

ine

d

with

h

ea

db

locks,

an

d

tra

nsp

ort

ed

to

th

e

em

erg

en

cy

de

pa

rtm

en

t (E

D)

for

eva

lua

tio

n

an

d

tre

atm

en

t.

Th

e

ba

ckb

oa

rd

is

use

d

as

tra

nsp

ort

atio

n

de

vic

e,

an

d

sh

ou

ld i

de

ally

be

re

mo

ve

d b

efo

re i

nitia

l a

sse

ssm

en

t in

th

e

ED

.(1

) S

pin

al

imm

ob

iliza

tio

n

sh

ou

ld

furt

he

r b

e

co

ntin

ue

d

by

str

aig

ht

alig

nm

en

t o

f th

e

sp

ine

a

nd

su

pin

e

bo

dy

po

sitio

n.

Th

e

ce

rvic

al

sp

ine

re

ma

ins

imm

ob

ilize

d w

ith

a

n e

xtr

ica

tio

n co

llar

co

mb

ine

d w

ith

h

ea

db

locks u

ntil

inju

ry i

s d

iag

no

se

d o

r ru

led

ou

t, i

.e.

the

ce

rvic

al

sp

ine

is

c

lea

red

.

It

is

kn

ow

n

tha

t im

mo

bili

zin

g

de

vic

es

ca

use

p

ain

a

nd

in

cre

ase

p

ressu

re u

lce

r (P

U)

risk.

(2)

Ho

we

ve

r, p

ain

, a

s w

ell

as

the

d

eve

lop

me

nt,

clin

ica

l sym

pto

ms a

nd

e

vo

lutio

n o

f P

U

rela

ted

to

th

e

use

o

f th

e

extr

ica

tio

n

co

llar

an

d

he

ad

blo

cks,

ha

ve

no

t b

ee

n d

escri

be

d.

Th

e p

urp

ose

of

this

stu

dy w

as t

o g

ain

in

sig

ht

into

PU

s a

nd

pa

in f

rom

th

e e

xtr

ica

tio

n c

olla

r co

mb

ine

d w

ith

la

tera

l h

ea

db

locks

in tr

au

ma

p

atie

nts

a

dm

itte

d to

th

e E

D fo

r e

va

lua

tio

n

an

d t

rea

tme

nt

of

acu

te t

rau

ma

tic in

juri

es.

Me

tho

ds

Pro

sp

ective

d

ata

o

f 3

42

co

nse

cu

tive

a

du

lt

tra

um

a

pa

tie

nts

ad

mitte

d t

o t

he

ED

aft

er

acu

te t

rau

ma

we

re

co

llecte

d

fro

m

Ja

nu

ary

2

01

3

un

til

De

ce

mb

er

20

13

. T

rain

ed

E

D

nu

rse

s

asse

sse

d

pa

in

inte

nsity

an

d

co

nd

itio

n o

f th

e skin

re

late

d w

ith

p

ressu

re a

rea

s fo

r e

ryth

em

a,

PU

a

nd

in

de

nta

tio

n m

ark

s a

t th

e m

om

en

t th

e e

xtr

ica

tio

n c

olla

r a

nd

he

ad

blo

cks w

ere

re

mo

ve

d o

r ch

an

ge

d.

Pre

ssu

re

are

as

we

re

de

fin

ed

a

s:

ch

in,

occip

ut,

cla

vic

les,

ba

ck,

ch

est

an

d e

ars

.

Re

su

lts

Th

e 3

42

tra

um

a p

atie

nts

we

re i

n a

n e

xtr

ica

tio

n c

olla

r a

nd

h

ea

db

locks

for

an

a

ve

rag

e

of

13

7.7

m

inu

tes

(Ra

ng

e (R

) 1

0-8

45

, S

tan

da

rd D

evia

tio

n (S

D)

95

.30

),

un

til

ce

rvic

al

sp

ine

cle

ara

nce

. S

eve

nty

-on

e

(20

.8%

) p

atie

nts

re

po

rte

d m

od

era

te p

ain

(N

RS

4

-6)

an

d 1

11

(3

2.5

%)

se

ve

re p

ain

(N

RS

7-1

0)

on

pre

ssu

re a

rea

s.

In

ap

pro

xim

ate

ly

ha

lf

of

the

p

atie

nts

w

ho

re

po

rte

d

mo

de

rate

o

r se

ve

re

pa

in,

pa

in

wa

s

loca

ted

a

t th

e

occip

ut.

26

8 (

78

.3%

) p

atie

nts

de

ve

lop

ed

a P

U o

f w

hic

h

75

.4%

w

as

ca

teg

ory

1

, a

nd

2

.9%

ca

teg

ory

2

. 2

05

(5

9.9

%)

ha

d m

ore

th

an

1 P

U s

ite

. T

he

ma

jori

ty o

f th

e

PU

s w

ere

lo

ca

ted

on

th

e b

ack,

ch

est

an

d s

ho

uld

ers

of

the

p

atie

nts

(1

13

, 1

35

, a

nd

1

18

tim

es,

resp

ective

ly).

2

18

p

atie

nts

d

eve

lop

ed

in

de

nta

tio

n

ma

rks;

12

5

(36

.5%

) h

ad

m

ild

an

d

93

(2

8.1

%)

ha

d

se

ve

re

ind

en

tatio

n m

ark

s.

12

6 (

36

.9%

) p

atie

nts

ha

d m

ore

tha

n o

ne

in

de

nte

d s

ite

. T

he

ma

jori

ty o

f th

e i

nd

en

tatio

n

ma

rks w

ere

lo

ca

ted

at

the

ch

est,

ba

ck,

an

d s

ho

uld

ers

(7

1,

90

, a

nd

11

1 t

ime

s,

resp

ective

ly).

Dis

cu

ss

ion

Th

is w

as t

he

fir

st

pro

sp

ective

stu

dy o

n P

U a

nd

pa

in

fro

m

extr

ica

tio

n

co

llars

a

nd

h

ea

db

locks

in

tra

um

a

pa

tie

nts

with

su

sp

ecte

d c

erv

ica

l sp

ine

in

jury

. T

he

use

o

f m

ultip

le

da

ta

co

llecto

rs

in

ou

r stu

dy

ca

n

lea

d

to

info

rma

tio

n b

ias,

ho

we

ve

r, t

he

in

terr

ate

r re

liab

ility

pri

or

an

d d

uri

ng

th

e stu

dy w

as M

Ka

pp

a 0

.58

a

nd

K

ap

pa

0

.85

re

sp

ective

ly.

A co

nsid

era

ble

n

um

be

r o

f tr

au

ma

p

atie

nts

d

eve

lop

ed

a

ca

teg

ory

1

o

r 2

P

U,

se

ve

re

ind

en

tatio

n m

ark

s a

nd

exp

eri

en

ce

d s

eve

re p

ain

wh

ile

in a

n e

xtr

ica

tio

n c

olla

r a

nd

he

ad

blo

cks.

Cli

nic

al

rele

va

nc

e

Th

e c

urr

en

t p

ractice

of

ce

rvic

al

imm

ob

iliza

tio

n i

n c

ase

o

f su

sp

ecte

d c

erv

ica

l sp

ine

in

jury

sh

ou

ld b

e e

va

lua

ted

. F

irst,

th

e p

roce

du

re o

f ce

rvic

al

sp

ine

cle

ara

nce

sh

ou

ld

be

o

ptim

ize

d

in

ord

er

to

min

imiz

e

tim

e

in

the

e

xtr

ica

tio

n

co

llar

an

d

he

ad

blo

cks.

Se

co

nd

, d

uri

ng

ce

rvic

al

sp

ine

im

mo

bili

za

tio

n,

the

n

um

be

r o

f tr

au

ma

p

atie

nts

with

PU

, in

de

nta

tio

n m

ark

s a

nd

pa

in c

ou

ld b

e

red

uce

d

by

reco

nsid

eri

ng

th

e

de

sig

n

an

d

ma

teri

als

th

at

are

cu

rre

ntly

use

d

to

imm

ob

ilize

th

e

ce

rvic

al

sp

ine

.

Ac

kn

ow

led

ge

me

nts

We

ap

pre

cia

te t

he

he

lp o

f E

D s

taff

an

d a

ll E

D n

urs

es

fro

m t

he

Em

erg

en

cy D

ep

art

me

nt

of

the

Un

ive

rsity

Me

dic

al C

en

ter

Utr

ech

t. W

ith

ou

t th

eir

su

pp

ort

an

d

en

thu

sia

sm

, th

is s

tud

y w

ou

ld n

ot

ha

ve

be

en

po

ssib

le.

C

on

flic

t o

f In

tere

st

Re

fere

nc

es

(1)

Lu

bb

ert

PH

W,

Sch

ram

ME

, L

ee

ne

n L

PH

. Is

th

ere

a

rea

so

n f

or

sp

ine

bo

ard

im

mo

bili

za

tio

n in

th

e

em

erg

en

cy d

ep

art

me

nt

for

pa

tie

nts

with

a p

ote

ntia

l

sp

ina

l in

jury

? E

ur

J T

rau

ma

20

05

;31

(4):

37

5-3

78

.

(2)

Ha

m W

, S

ch

oo

nh

ove

n L

, S

ch

uu

rma

ns M

J,

Le

en

en

L

P.

Pre

ssu

re u

lce

rs f

rom

sp

ina

l im

mo

bili

za

tio

n in

tr

au

ma

pa

tie

nts

: A

syste

ma

tic r

evie

w.

J T

rau

ma

Acu

te

Ca

re S

urg

20

14

Ap

r;7

6(4

):1

13

1-1

14

1.

12


20

ABSTRACTS OF ORAL PRESENTATIONSP

roce

ed

ing

s o

f th

e 1

7th

An

nu

al E

uro

pe

an

Pre

ssu

re U

lce

r M

ee

tin

g

Sto

ckh

olm

, S

we

de

n

Co

py

rig

ht

2

01

4 b

y E

PU

AP

A p

rosp

ecti

ve c

oh

ort

stu

dy o

f th

e c

lin

ical

eff

ecti

ven

ess o

f m

ult

i-la

yer

so

ft s

ilic

on

e

dre

ssin

gs i

n t

he p

reven

tio

n o

f h

eel

pre

ssu

re u

lcers

in

tra

um

a a

nd

cri

tically i

ll p

ati

en

ts

Nic

k S

an

tam

ari

a 1

&2

* , M

ari

e G

erd

tz 1

&2,

We

i L

iu 1

&2 S

tep

ha

nie

De

Vin

ce

nti

s 2

, A

i W

ei

Ng

2,

1* U

niv

ers

ity o

f M

elb

ou

rne

, A

ustr

alia

, n

ick.s

an

tam

ari

a@

mh

.org

.au

2 R

oya

l M

elb

ou

rne

Ho

sp

ita

l, A

ustr

alia

.

Intr

od

uc

tio

n

Pre

ve

ntin

g p

ressu

re u

lce

rs (

PU

) in

cri

tica

lly i

ll p

atie

nts

is

ch

alle

ng

ing

fo

r clin

icia

ns

du

e

to

a

mu

ltip

licity

of

ph

ysio

log

ica

l a

nd

e

nvir

on

me

nta

l fa

cto

rs.

We

h

ave

p

revio

usly

d

em

on

str

ate

d

tha

t th

e

the

u

se

o

f p

rop

hyla

ctic

so

ft

sili

co

ne

m

ulti-

laye

r d

ressin

g

ca

n

sig

nific

an

tly re

du

ce

th

e in

cid

en

ce

o

f sa

cra

l a

nd

h

ee

l P

Us

in

this

g

rou

p

of

pa

tie

nts

[1

].

Th

e

me

ch

an

ism

s

un

de

rpin

nin

g

the

p

rote

ctive

e

ffe

ctive

ne

ss

of

the

se

d

ressin

gs

are

b

elie

ve

d

to

rela

te

to

the

ir

mu

lti-

laye

r co

nstr

uctio

n m

od

ifyin

g p

ressu

re,

fric

tio

n,

sh

ea

r fo

rce

s

an

d t

he

ma

na

ge

me

nt

of

mic

roclim

ate

.

Me

tho

ds

We

co

nd

ucte

d a

1

0-m

on

th p

rosp

ective

co

ho

rt stu

dy

with

a h

isto

rica

l co

ntr

ol

co

ho

rt (

n=

22

1)

fro

m a

re

ce

nt

ICU

pro

ject

[1]

as a

co

mp

ara

tor.

A t

ota

l o

f 1

91

cri

tica

lly

ill a

nd

tra

um

a p

atie

nts

we

re e

nro

lled

in

to t

he

stu

dy i

n

the

E

D.

E

ach

p

atie

nt

ha

d a

so

ft sili

co

ne

m

ulti-

laye

r d

ressin

g a

pp

lied

to

ea

ch

he

el

in E

D o

n a

dm

issio

n a

nd

m

ain

tain

ed

in

p

lace

th

rou

gh

ou

t th

eir

IC

U sta

y.

T

he

h

ee

ls

we

re

insp

ecte

d

da

ily

by

a

me

mb

er

of

the

re

se

arc

h

tea

m

an

d

dre

ssin

gs

we

re

rep

lace

d

eve

ry

thre

e d

ays o

r if t

he

y b

eca

me

dis

lod

ge

d.

All

pa

tie

nts

w

ere

ca

red

fo

r o

n

the

sa

me

lo

w

air

lo

ss

be

ds

thro

ug

ho

ut

the

ir sta

y in

IC

U.

Th

e e

nd

p

oin

t fo

r th

e

stu

dy w

as t

he

in

cid

en

ce

ra

te o

f h

ee

l p

ressu

re u

lce

rs.

An

aly

sis

wa

s b

ase

d o

n i

nte

ntio

n t

o t

rea

t a

nd

mu

ltip

le

reg

ressio

n

an

d

su

rviv

al

an

aly

sis

o

f tim

e

to

PU

d

eve

lop

me

nt.

Re

su

lts

Ta

ble

1:

Pa

tie

nt

ch

ara

cte

ris

tic

s a

nd

ou

tco

me

s

In

terv

en

tio

n C

oh

ort

N

= 1

91

Me

an

(S

D)

Co

ntr

ol

Co

ho

rt

N=

22

1

Me

an

(S

D)

Ag

e

54

(1

9.7

) 5

6 (

20

.5)

Ma

le/F

em

ale

M

AP

(m

mH

g)

Te

mp

(C

) S

pO

2 %

H

R (

BP

M)

Bra

de

n

AP

AC

HE

II

Le

ng

th o

f s

tay

(Hrs

) E

D

OR

IC

U

Pre

ss

ure

Ulc

ers

(%)

12

3/6

7

91

(2

1.8

)

36

.0 (

1.8

) 9

7

96

(2

5.9

)

11

(2

.9)

18

.9

6

.7 (

5.2

)

4.5

(3

.9)

10

7 (

12

2.6

)

0 (

0)

13

2/8

2

93

(2

2.7

)

36

.2 (

1.6

) 9

8

95

(2

6. 6

)

12

(3

.9)

19

.5

6

.4 (

4.6

)

5.2

(4

.2)

86

(1

00

)

19

(8

.5)

Dis

cu

ss

ion

Wh

ilst

pa

tie

nts

in

ou

r in

terv

en

tio

n a

nd

co

ntr

ol

co

ho

rts

we

re

sim

ilar

on

ke

y

de

mo

gra

ph

ic

an

d

ph

ysio

log

ica

l fa

cto

rs (

Ta

ble

1),

th

e i

nte

rve

ntio

n c

oh

ort

ha

d a

lo

ng

er

len

gth

of

sta

y i

n I

CU

wh

ich

co

uld

be

co

nsid

ere

d a

s a

g

rea

ter

risk f

or

the

se

pa

tie

nts

of

de

ve

lop

ing

a P

U.

Ou

r fin

din

g t

ha

t th

e i

nte

rve

ntio

n g

rou

p d

id n

ot

de

ve

lop

an

y

he

el

PU

s o

ve

r th

e c

ou

rse

of

the

stu

dy s

ug

ge

sts

th

at

the

d

ressin

gs a

re a

via

ble

p

rote

ctive

in

terv

en

tio

n fo

r th

is g

rou

p o

f cri

tica

lly ill

pa

tie

nts

.

We

be

lieve

th

at

furt

he

r re

se

arc

h i

s r

eq

uir

ed

to

be

tte

r e

lucid

ate

th

e p

rote

ctive

m

ech

an

ism

s o

f th

ese

m

ulti-

laye

r sili

co

ne

dre

ssin

gs.

Ad

ditio

na

lly i

t is

no

t cle

ar

at

pre

se

nt

if

oth

er

dre

ssin

gs

co

mp

risin

g

diffe

ren

t co

nstr

uctio

n

an

d/o

r fo

rmu

latio

ns

of

sili

co

ne

p

rovid

e

sim

ilar

pro

tective

pe

rfo

rma

nce

.

Cli

nic

al

rele

va

nc

e

Th

e fin

din

gs o

f th

is stu

dy h

igh

ligh

t a

nd

su

pp

ort

o

ur

ea

rlie

r w

ork

on

th

e c

linic

al

eff

ective

ne

ss o

f m

ultila

ye

r so

ft s

ilico

ne

dre

ssin

gs i

n p

reve

ntin

g P

Us i

n c

ritica

lly i

ll p

atie

nts

. T

he

se

dre

ssin

gs a

pp

ea

r to

eff

ective

ly r

ed

uce

p

ressu

re,

fric

tio

n a

nd

sh

ea

r fo

rce

s a

t th

e h

ee

l.

Ac

kn

ow

led

ge

me

nts

We

are

in

de

bte

d t

o t

he

nu

rse

s f

rom

th

e E

D a

nd

IC

U a

t th

e R

oya

l M

elb

ou

rne

Ho

sp

ita

l fo

r th

eir

assis

tan

ce

with

th

is r

ese

arc

h.

Co

nfl

ict

of

Inte

res

t N

il

Re

fere

nc

es

[1]

Sa

nta

ma

ria

N,

Ge

rdtz

MF

, S

ag

e S

, M

cC

an

n J

, F

ree

ma

n A

, V

assili

ou

MT

, D

eV

ince

ntis S

, N

g A

W,

Ma

nia

s E

, L

iu W

, K

no

tt J

. A

ra

nd

om

ise

d c

on

tro

lled

tri

al

of

the

eff

ective

ne

ss o

f so

ft s

ilico

ne

fo

am

mu

lti-

laye

red

d

ressin

gs in

th

e p

reve

ntio

n o

f sa

cra

l a

nd

he

el p

ressu

re

ulc

ers

in

tra

um

a a

nd

cri

tica

lly ill

pa

tie

nts

: T

he

Bo

rde

r T

ria

l. I

nt

Wo

un

d J

20

13

do

i:1

0.1

11

1/iw

j.1

21

01

.

34


21

Pro

ce

ed

ing

s o

f th

e 1

7th

An

nu

al E

uro

pe

an

Pre

ssu

re U

lce

r M

ee

tin

g

Sto

ckh

olm

, S

we

de

n

Co

py

rig

ht

2

01

4 b

y E

PU

AP

Hig

her

mo

rtality

if

ad

mit

ted

wit

h a

pre

ssu

re u

lcer

to a

nu

rsin

g h

om

e

Resu

lts o

f a c

oh

ort

stu

dy

Nil

s A

La

hm

an

n 1

*

1* In

stitu

te o

f H

ea

lth

a

nd

Nu

rsin

g S

cie

nce

; C

ha

rit

Un

ive

rsit

tsm

ed

izin

Be

rlin

, G

erm

an

y,

nils

.la

hm

an

n@

ch

ari

te.d

e

Intr

od

uc

tio

n

Pre

ssu

re u

lce

rs (

PU

s)

are

ch

ron

ic w

ou

nd

s t

ha

t m

ostly

occu

r in

cri

tica

lly ill

or

fra

il p

atie

nts

as t

ho

se

usu

ally

su

ffe

r fr

om

mu

ltip

le r

isk f

acto

rs,

e.g

. im

pa

ire

d m

ob

ility

o

r d

istu

rbe

d p

erf

usio

n.

Ho

sp

ita

l-a

cq

uir

ed

PU

s h

ave

b

ee

n f

ou

nd

to

be

re

late

d t

o in

cre

ase

d m

ort

alit

y.

Wh

ile

the

pre

va

len

ce

of

pre

ssu

re u

lce

rs o

n h

osp

ita

l a

dm

issio

n a

mo

ng

nu

rsin

g h

om

e r

esid

en

ts t

ran

sfe

rre

d

to t

he

ho

sp

ita

l is

kn

ow

n t

o b

e h

igh

, th

ere

is a

la

ck o

f e

vid

en

ce

re

ga

rdin

g t

he

pre

va

len

ce

on

ad

mis

sio

n t

o a

n

urs

ing

ho

me

an

d h

ow

it

do

es a

ffe

ct

mo

rta

lity.

Th

e a

im

of

this

stu

dy is t

o c

om

pa

re t

he

mo

rta

lity o

f n

urs

ing

h

om

e r

esid

en

t w

ith

an

d w

ith

ou

t p

ressu

re u

lce

rs o

n

ad

mis

sio

n,

wh

eth

er

or

no

t in

div

idu

als

wh

o h

ave

be

en

a

dm

itte

d t

o a

nu

rsin

g

Me

tho

ds

30

7 n

urs

ing

h

om

e re

sid

en

ts in

1

1 n

urs

ing

h

om

es in

B

erl

in

we

re

en

rolle

d

in

a

co

ho

rt

stu

dy.

De

taile

d

info

rma

tio

n a

bo

ut

the

me

tho

do

log

y c

an

be

fo

un

d o

pe

n

at

Me

este

rbe

ren

ds e

t a

l. (

1).

Stu

dy n

urs

es e

xa

min

ed

in

div

idu

als

acco

rdin

g t

o a

sta

nd

ard

ize

d s

tud

y p

roto

co

l o

nce

a w

ee

k f

or

3 m

on

ths a

fte

r re

sid

en

ts a

dm

issio

n t

o

the

nu

rsin

g h

om

es.

Aft

er

tha

t th

e r

esid

en

ts w

as v

isite

d

eve

ry 6

m

on

th fo

r 2

.5 ye

ars

. K

ap

lan

-Me

ier

An

aly

sis

a

nd

C

ox

Pro

po

rtio

na

l H

aza

rd

will

b

e

use

d.

F

or

sta

tistica

l sig

nific

an

ce

a

n

alp

ha

o

f

8

h

ou

rs i

n b

ed

) a

nd

/or

ch

air

-bo

un

d,

(2)

a B

rad

en

sco

re

65

ye

ars

, (4

) w

eig

ht

2 P

U a

t

the

sa

me

skin

site

aft

er

ad

justin

g f

or

be

twe

en

pa

tie

nt

va

ria

tio

n.

Re

su

lts

Th

ere

w

ere

6

02

p

atie

nts

w

ith

a

co

mb

ine

d

tota

l o

f 7

,86

3

po

ten

tia

l skin

site

s

asse

sse

d,

of

the

se

7

48

3

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EPUAP 2014 Programme and Abstract Book

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