Prevalence, incidence and predictors of pressure ulcers in a tertiary hospital in Singapore.

Objective: In 2002 the hospital under study implemented a pressure ulcer standard care plan. This follow-up study aimed to determine the prevalence and incidence of pressure ulcers, whether demographic characteristics and medical diagnosis differed between those individuals who did and those who did not develop ulcers and the predictors of pressure-ulcer formation.

Method: The prevalence study used a cross-sectional design, while the incidence study was a prospective cohort study. Participants were scored using the Braden scale and were examined for the presence of pressure ulcers. Those who were ulcer free were monitored twice weekly until they were discharged or for 28 days.

Results: The prevalence of pressure ulcers was 18.1% (95% CI: 15.5-20.9%), while the incidence was 8.1% (95% CI: 6.1-10.4%). Participants with ulcers were older, had a longer mean length of hospital stay, lower Braden scores and were diagnosed with or had a history of cardiovascular diseases or sepsis. Logistic regression found that the total Braden score was the only significant predictor of pressure ulcers. Compared with scores 16-23, the odds ratios were 7.7 (95% CI: 3.5-17.1, p < 0.001) and 12.5 (95% CI: 4.5-34.6, p < 0.001) for scores 12-15 and 6-11 respectively. Demographic characteristics, diagnosis and length of hospital stay were not significant predictors.

Conclusion: The study identified a modest decrease in incidence and improvements in nursing care following the implementation of the care plan. It suggests that Braden scores are predictive of those at-risk of developing pressure ulcers.