Modifiable patient-related factors associated with pressure ulcers on the sacrum and heels: Secondary data analyses.

Aim: To explore factors associated with the presence of category I-IV pressure ulcers on the sacrum and heels.

Design: Cross-sectional, secondary data analysis using data collected from the Landelijke Prevalentiemeting Zorgproblemen (LPZ) project, a multicentre prevalence study including nursing home residents and community care clients (N = 4,842) in the Netherlands in 2017.

Methods: A single binary logistic regression model was designed to identify factors associated with the presence of pressure ulcers. Additionally, a multiple binary logistic regression model including modifiable explanatory factors associated with the presence of pressure ulcers was designed.

Results: Impaired mobility, friction and shear (evaluated using the Braden Scale) are significantly associated with the presence of both sacral and heel category I-IV pressure ulcers. Incontinence-associated dermatitis is significantly associated with category I-IV sacral pressure ulcers.

Conclusion: In pressure ulcer prevention, nursing interventions should focus on frequent repositioning and mobilization while avoiding exposure of the skin to friction and shear. The need to consider incontinence-associated dermatitis, incontinence and moisture as important factors in pressure ulcer risk assessment is confirmed.

Impact: Pressure ulcers occur when skin and tissues are deformed between bony prominences and the support surface in a sitting or lying position. They are the result of a complex interaction between direct causal factors and a wide range of indirect factors. Recognition of these factors influences risk assessment guidance and practice. Knowledge of skin-specific factors at the patient level, modifiable by nursing interventions, enables a better targeted and tailored preventive approach.