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Is incidentie een betere frequentiemaat dan prevalentie in de strijd tegen decubitus?

(2017) Cheung, V.H.Y. (Victoria)

Pressure injuries are defined as local damage to the skin or to the underlying tissue as a result of (prolonged, sustained) pressure and/or shearing of the skin or the underlying tissue. This damage can occur hours to days after the removal of those forces. It is often seen in cases of long-term immobility, for example in bedridden patients, but depending on various variables it can occur within shorter periods of pressure on the skin. Not all causes of pressure injuries are known. Possible causes are the deformation of tissue due to external forces, ischemia and reperfusion injury. Pressure injuries causes a significant amount of suffering; in addition to pain and discomfort, pressure injuries lead to social isolation due to odor nuisance.
Pressure injuries can prolong a patient’s stay at a healthcare facility and is often used as an indication of the level of care a facility provides.
Material and method
The data of patients of the Deventer Ziekenhuis with pressure injuries confirmed by an authorized person were used. The data of a total of 608 patients admitted between 2011 and 2016 who developed pressure injuries during their admittance were included. Firstly, this data was used to calculate the prevalence and incidence of the pressure injury and these were compared with each other. Secondly, the degree of implementation of the pressure injury guidelines of 2011 and its effect on the amount of pressure injuries was evaluated.
Increases in prevalence did not occur parallel to increases in incidence. The prevalence of pressure injuries shows a rise throughout the years, the incidence did not. The pressure injury guideline of 2011 resulted in a pressure injury prevention protocol in the Deventer Ziekenhuis, this was based on the most important recommendations from the guideline. 54.3% of the patients that developed pressure injuries during their admittance in the Deventer Ziekenhuis had received adequate prevention, 45.7% had not. The implementation of the guideline has not resulted in a decline in the prevalence of pressure injuries.
An increase in prevalence does not necessarily mean an increase in incidence and can thus result in a distorted perception of the situation. The prevalence level can for example be distorted by an increase in pressure injury patients before a measurement takes place or by the amount of time these patients were admitted to the hospital. The incidence shows the exact situation at a certain point in time, this way it can be used to search for possible causes of the problem and ultimately, to find a solution for the problem. In conclusion, the use of incidence can lead to improvement of patient care, the use of prevalence can only be used for the detection of a problem.

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