Incidence of Pressure Ulcers in Adults Hospitalized in Intensive Care Units in Colombia

Authors

  • Olga L. Cortés Fundación Cardioinfantil - Instituto de Cardiología
  • Juan C. Villar Universidad Autónoma de Bucaramanga
  • Yudy A. Rojas Fundación Cardioinfantil - Instituto de Cardiología
  • Skarlet M. Vásquez Universidad Autónoma de Bucaramanga
  • Jessica Ruiz Sandoval Fundación Cardioinfantil - Instituto de Cardiología
  • Claudia P. Becerra Fundación Cardioinfantil - Instituto de Cardiología
  • Víctor Herrera Universidad Autónoma de Bucaramanga
  • Researchers from PENFUP-2 Colombia Participating Hospitals Group of researchers from hospitals of the study “Evaluation of Two Levels of Frequency of Repositioning in the Reduction of Pressure Ulcers (PENFUP-2)”. See participants at the end of the article.

DOI:

https://doi.org/10.17533/udea.iee.v43n2e12

Keywords:

incidence, pressure ulcer, nursing, critical care

Abstract

Objective. To estimate the incidence of pressure ulcers (PU) in hospitalized adults and its relationship with prevention practices in adult intensive care units (ICU) in Colombian hospitals.

Methods. This was a multicenter prospective cohort study in 31 non-COVID-19 ICUs from 11 hospitals in Colombia, including 1543 patients without ability to move, but with healthy skin, admitted consecutively upon admission to ICU. The primary outcome was the incidence of PU per 1,000 days of hospital stay.

Results. The participants were mostly men (57.5%), with mean age of 59±18 years and body mass index of 25.5±4.6 kg/m2. The study observed 120 PU in 17 063 days of hospital stay, the majority were in the sacral region (60.0%) and heels (10.8%). Overall incidence was of 7.03 (95%CI 5.9-8.41) by 1000 days-patient. The PU incidence rate was double in ICUs of public hospitals than in private hospitals [Incidence Rate Ratio (IRR) = 2.00; 95%CI: 1.30 to 3.01]. The risk of pressure ulcers was lower in hospitals that had skin-care group (IRR = 0.38; 95%CI: 0.25 to 0.58), used dressings [IRR = 0.66; 95%CI: 0.45 to 0.95] and support surfaces [IRR = 0.37; 95%CI: 0.24 to 0.59] in their preventive care practices.

Conclusion. Much variability was noted in the PU incidence among the hospitals observed. However, Grade I and II ulcers and located in the sacral region continue having the highest incidence, according with global reference data. Hospital preventive care patterns reported a series of interventions administered in ICU that can be related with the risk of PU.

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Author Biographies

Olga L. Cortés, Fundación Cardioinfantil - Instituto de Cardiología

Nurse, PhD. Associate Researcher

Fundación Cardioinfantil - Instituto de Cardiología, La Cardio. Bogotá DC, Colombia.

Juan C. Villar, Universidad Autónoma de Bucaramanga

MD. MSc. PhD.

Fundación Cardioinfantil - Instituto de Cardiología, La Cardio. Bogotá DC, Colombia.

Universidad Autónoma de Bucaramanga, Colombia

Yudy A. Rojas, Fundación Cardioinfantil - Instituto de Cardiología

Nurse, Specialist.

Fundación Cardioinfantil - Instituto de Cardiología, La Cardio. Bogotá DC, Colombia.

Skarlet M. Vásquez, Universidad Autónoma de Bucaramanga

RN, MSc. Professor

Universidad Autónoma de Bucaramanga, Colombia

Jessica Ruiz Sandoval, Fundación Cardioinfantil - Instituto de Cardiología

RN MSc. Researcher.

Fundación Cardioinfantil - Instituto de Cardiología, La Cardio. Bogotá DC, Colombia.

Claudia P. Becerra, Fundación Cardioinfantil - Instituto de Cardiología

RN, MSc. Researcher

Fundación Cardioinfantil - Instituto de Cardiología, La Cardio. Bogotá DC, Colombia.

Víctor Herrera, Universidad Autónoma de Bucaramanga

MD, PhD. Professor.

Universidad Autónoma de Bucaramanga, Colombia

Researchers from PENFUP-2 Colombia Participating Hospitals, Group of researchers from hospitals of the study “Evaluation of Two Levels of Frequency of Repositioning in the Reduction of Pressure Ulcers (PENFUP-2)”. See participants at the end of the article.

Group of researchers from hospitals of the study “Evaluation of Two Levels of Frequency of Repositioning in the Reduction of Pressure Ulcers (PENFUP-2)”. See participants at the end of the article.

References

1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide 2019. (Emily Haesler, ed.). EPUAP/NPIAP/PPPIA; 2019. Available from: https://epuap.org/pu-guidelines/

2. Mervis JS, Philips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology. 2019; 81:881–90.

3. Soban LM, Hempel S, Munjas BA, Miles J, Rubenstein LV. Preventing pressure ulcers in hospitals: A systematic re-view of nurse-focused quality improvement interventions. The Joint Commission Journal on Quality and Patient Safety. 2011; 37(6):245-52.

4. Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. International Journal of Nursing Studies. 2020; 105:103546.

5. Mehta C, George JV, Mehta Y, Wangmo N. Pressure ulcer and patient characteristics – A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set. Journal of Tissue Viability. 2015; 24(3):123–30.

6. Wannous H, Lucas Y, Treuillet S, Albouy B. A complete 3D wound assessment tool for accurate tissue classification and measurement. 2008 15th IEEE International Conference on Image Processing. 2008; 2928–31

7. Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. American Family Physician. 2008; 78(10):1186–94.

8. Lin F, Wu Z, Song B, Coyer F, Chaboyer W. The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. International Journal of Nursing Studies. 2020; 102: 103483.

9. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territo-ries, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258):1204-22.

10. Zhang X, Zhu N, Li Z, Xie X, Liu T, Ouyang G. The global burden of decubitus ulcers from 1990 to 2019. Scientific Reports. 2021; 11(1):21750.

11. Becker D, Tozo TC, Batista SS, Mattos AL, Silva MCB, Rigon S, et al. Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil. Intensive and Critical Care Nursing. 2017; 42:55-61.

12. Lima-Serrano M, González-Méndez MI, Carrasco-Cebollero FM, Lima-Rodríguez JS. Factores de riesgo asociados al desarrollo de úlceras por presión en unidades de cuidados intensivos de adultos: revisión sistemática. Medicina Intensiva. 2017; 41(6):339-46.

13. Ministerio de Salud y Protección Social. Prevención úlceras por presión: Paquetes instruccionales Guía técnica: Bue-nas prácticas para la seguridad del paciente en la atención en salud. Bogotá: Ministerio de Salud; 2015. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/CA/prevenir-ulceras-por-presion.pdf

14 González-Méndez MI, Lima-Serrano M, Martín-Castaño C, Alonso-Araujo I, Lima-Rodríguez JS. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. Journal of Clinical Nursing. 2018; 27(5-6):1028-37.

15. Barrera-Arenas E, Pedraza-Castañeda MC, Pérez-Jiménez G, Hernández-Jiménez P, Reyes-Rodríguez A, Padilla-Zárate M. Prevalencia de úlceras por presión de un hospital de tercer nivel en México DF. Gerokomos. 2016; 27(4):176-81.

16. Ma C, Park SH. Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers. Journal of Nursing Scholarship. 2015;47(6):565-73.

17. González-Consuegra D, Cardona-Mazo P, Murcia-Trujillo G, et al. Prevalencia de úlceras por presión en Colombia: informe preliminar. Revista de la Facultad de Medicina. 2014; 62(3):1-32.

18. Esparza-Bohórquez M, Granados-Oliveros LM, Joya-Guevara K. Implementación de la guía de buenas prácticas: valo-ración del riesgo y prevención de úlceras por presión: experiencia en la Fundación Oftalmológica de Santander (FOSCAL). Me-dUNAB. 2016; 19(2):115-23.

19. Herrera-Nieto O, Ariza L, Luna-García L. Zonas más frecuentes de aparición de las ulceras por presión y su clasifica-ción según los estadios en pacientes que ingresan al servicio de urgencias de un hospital de III nivel de la ciudad de Bucara-manga. [Undergraduate thesis]. Bucaramanga (Colombia): Universidad de Santander; 2018. Available from: https://repositorio.udes.edu.co/handle/001/405

20. Medina A, Ortiz F. Factores contributivos determinantes en lesiones por presión (LPP) en pacientes atendidos en Cui-dados Intensivos durante el primer semestre 2021 en la E.S.E Hospital Universitario San Rafael de Tunja (E.S.E. HUSRT). [Undergraduate thesis]. Tunja (Colombia): Universidad Santo Tomás. 2021. Available from: https://repository.usta.edu.co/handle/11634/37706

21. Tovar A, Reyes J, Ramos J. Factores de riesgo para desarrollar Úlceras por Presión en pacientes hospitalizados de una institución de salud de alta complejidad. CINA Research. 2019; 3(2):5–12.

22. Cortés OL, Herrera-Galindo M, Villar JC, Rojas YA, Del Pilar Paipa M, Salazar L. Frequency of repositioning for pre-venting pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial. BMC Nursing 20. 2021; 20(1):121.

23. Grupo Nacional para el Estudio y Asesoramiento en Úlceras por Presión y Heridas Crónicas. Clasificación-estadiaje de las úlceras por presión. Doc.II. Logroño: España: GNEAUPP; 2003. Available from http://www.gneaupp.org

24. Pressure ulcers prevalence, cost and risk assessment: consensus development conference statement--The National Pressure Ulcer Advisory Panel. Decubitus. 1989; 2(2):24-8.

25. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al.; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics. 2019; 95:103208.

26. Reis V, Sousa DA, Di Lorenzo LM, Cordeiro KJS, Alves BL, Nascimento CS. A incidência de lesão por pressão em UTI no Brasil: uma revisão integrativa. REVISA. 2023; 12(3): 520-7.

27. Ayanian JZ, Weissman JS. Teaching hospitals and quality of care: a review of the literature. The Milbank Quarterly. 2002; 80(3):569-93.

28. Chung ML, Widdel M, Kirchhoff J, Sellin J, Jelali M, Geiser F, et al. Risk factors for pressure ulcers in adult patients: A meta-analysis on sociodemographic factors and the Braden scale. Journal of Clinical Nursing. 2023; 32(9-10):1979-92.

29. Dong J, Li L, Lu M, Cheng X, Zhai Y. Pressure ulcers in patients with diabetes: a bibliometric analysis. Annals of Palli-ative Medicine. 2021; 10(10):10515-26.

30. Chaboyer WP, Thalib L, Harbeck EL, Coyer FM, Blot S, Bull CF, et al. Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Meta-Analysis. Critical Care Medicine. 2018; 46(11):e1074-e1081.

31. Tervo-Heikkinen T, Heikkilä A, Koivunen M, Kortteisto T, Peltokoski J, Salmela S,et al. Nursing interventions in pre-venting pressure injuries in acute inpatient care: a cross-sectional national study. BMC Nursing. 2023; 22(1):198.

32. Kottner J, Cuddigan J, Carville K, Balzer K, Berlowitz D, Law S, et al. Pressure ulcer/injury classification today: An international perspective. Journal of Tissue Viability. 2020; 29(3):197-203.

33. McEvoy N, Avsar P, Patton D, Curley G, Kearney CJ, Moore Z. The economic impact of pressure ulcers among pa-tients in intensive care units. A systematic review. Journal of Intensive Care. 2021; 30(2):168-77.

34. Pozuelo-Carrascosa DP, Cobo-Cuenca AI, Carmona-Torres JM, Laredo-Aguilera JA, Santacruz-Salas E, Fernandez-Rodriguez R. Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis. Journal of Intensive Care. 2022;10(1):9.

35. Morgenstern H. Uses of ecologic analysis in epidemiologic research. American Journal of Public Health.1982; 72(12):1336-44.

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Published

2025-07-29

How to Cite

Cortés, O. L., Villar, J. C., Rojas, Y. A., Vásquez, S. M., Ruiz Sandoval, J., Becerra, C. P., Herrera, V., & Researchers from PENFUP-2 Colombia Participating Hospitals. (2025). Incidence of Pressure Ulcers in Adults Hospitalized in Intensive Care Units in Colombia. Investigación Y Educación En Enfermería, 43(2). https://doi.org/10.17533/udea.iee.v43n2e12

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Section

ORIGINAL ARTICLES / ARTÍCULOS ORIGINALES / ARTIGOS ORIGINAIS

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