Maarten J. Lubbers

Statement of the European Pressure Ulcer Advisory Panel —pressure ulcer classification: differentiation between pressure ulcers and moisture lesions

Apressure ulcer is an area of localized damage to the skin and underlying tissue caused by pressure or shear and/or a combination of these. The identification of pressure damage is an essential and integral part of clinical practice and pressure ulcer research. Pressure ulcer classification is a method of determining the severity of a pressure ulcer and is also used to distinguish pressure ulcers from other skin lesions. A classification system describes a series of numbered grades or stages, each determining a different degree of tissue damage. The European Pressure Ulcer Advisory Panel (EPUAP) defined 4 different pressure ulcer grades (Table 1).1 Nonblanchable erythema is a sign that pressure and shear are causing tissue damage and that preventive measures should be taken without delay to prevent the development of pressure ulcer lesions (Grade 2, 3, or 4). The diagnosis of the existence of a pressure ulcer is more difficult than one commonly assumes. There is often confusion between a pressure ulcer and a lesion that is caused by the presence of moisture, for example, because of incontinence of urine and/or feces. Differentiation between the two is clinically important, because prevention and treatment strategies differ largely and the consequences of the outcome for the patient are imminently important. This statement on pressure ulcer classification is limitedto the differentiation between pressure ulcers and moisture lesions. Obviously, there are numerous other lesions that might be misclassified as a pressure ulcer (eg, leg ulcer and diabetic foot). Experience has shown that becauseof their location, moisture lesions are the ones most often misclassified as pressure ulcers.2-3 Wound-related characteristics (causes, location, shape, depth, edges, and color), along with patient-related characteristics, are helpful to differentiate between a pressure ulcer and a moisture lesion

Dilemmas in measuring and using pressure ulcer prevalence and incidence: an international consensus

Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in pressure ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting pressure ulcer prevalence and incidence studies. The groups main findings are summarised in this paper.

Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial.

OBJECTIVE To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles. DESIGN Randomized clinical trial. SETTING Academic Medical Center, Amsterdam, the Netherlands. PATIENTS Two hundred eighty-five hospitalized surgical patients with open wounds. INTERVENTION Patients received occlusive (ie, foams, alginates, hydrogels, hydrocolloids, hydrofibers, or films) or gauze-based dressings until their wounds were completely healed. MAIN OUTCOME MEASURES Primary end points were complete wound healing, pain during dressing changes, and costs. Secondary end point was length of hospital stay. RESULTS Time to complete wound healing did not differ significantly between occlusive (median, 66 days; interquartile range [IQR], 29-133 days) and gauze-based dressing groups (median, 45 days; IQR, 26-106 days; log-rank P = .31). Postoperative wounds (62% of the wounds included) healed significantly (P = .02) quicker using gauze dressings (median, 45 days; IQR, 22-93 days vs median, 72 days; IQR, 36-132 days). Median pain scores were low and similar in the occlusive (0.90; IQR, 0.29-2.34) and the gauze (0.64; IQR, 0.22-1.95) groups (P = .32). Daily costs of occlusive materials were significantly higher (occlusive, euro6.34 [US

Comment on: Lipsky and Berendt. Hyperbaric Oxygen Therapy for Diabetic Foot Wounds: Has Hope Hurdled Hype? Diabetes Care 2010;33:1143–1145

9.95] vs gauze, euro1.85 [US

Zuurstofbehandeling onder druk

2.90]; P < .001), but nursing time costs per day were significantly higher when gauze was used (occlusive, euro1.28 [US

Hyperbaric oxygen therapy: solution for difficult to heal acute wounds? Systematic review.

2.01] vs gauze, euro2.41 [US

Inter- and intra-observer (dis)agreement among nurses and doctors to classify colour and exudation of open surgical wounds according to the Red-Yellow-Black scheme

3.78]; P < .001). Total cost for local wound care per patient per day during hospitalization was euro7.48 (US

Pressure ulcer classification: differentiation between pressure ulcers and moisture lesions

11.74) in the occlusive group and euro3.98 (US

Inter- and intra-observer (dis)agreement among physicians and nurses as to the choice of dressings in surgical patients with open wounds

6.25) in the gauze-based group (P = .002). CONCLUSIONS The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials. Trial Registration trialregister.nl Identifier: 56264738.

Occlusive vs Gauze Dressings for Local Wound Care in Surgical Patients

We welcome the increased amount of solid evidence (1,2) with regard to hyperbaric oxygen treatment (HBOT) as an effective treatment for chronic diabetic foot ulcers in the article by Lipsky and Berendt (1). One of the concerns mentioned by Londahl et al. (2) is the limited availability and the issue of cost-effectiveness to convince policy makers to facilitate hyperbaric …