66 Wound Dressing and Pressure Ulcer Prevention ㈠ Stotts & Wu, %39.6% 38%; Shahin et al., 2008Theaker 2005 European Pressure Ulcer Advis

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1 65 比較傷口敷料處置於壓瘡預防之成效 曹文昱 1 羅淑芬 2 哈鐵木爾 3 李茹萍 4* 1 花蓮慈濟醫院整形外科病房副護理長 3 花蓮慈濟醫院神經外科主治醫師 2 慈濟技術學院護理系副教授 4 慈濟大學護理學系教授 傷口護理之高科技敷料於國內外臨床上廣為使用, 但被用於預防壓瘡之成效, 並無實證探討 探討常規翻身護理處置與合併使用親水性敷料或泡棉敷料後, 對預防尾薦骨壓瘡發生之成效 採類實驗設計及方便取樣方式, 以花蓮某醫院外科加護病患共 90 位為樣本, 隨機分派至 常規翻身組 常規翻身合併使用親水性敷料組 或 常規翻身合併使用泡棉敷料組 以 Braden scale 作為評估壓瘡風險工具, 並採歐洲壓瘡諮詢委員會最新壓瘡分級標準用以每日檢視皮膚 資料分析以 t 檢定 ANOVA 及曼 惠特尼 U 檢定 合併使用泡棉敷料組 之病人並未發生任何壓瘡 餘發生壓瘡比率以 常規翻身組 最高, 其次為 合併使用親水性敷料組, 發生壓瘡等級以一 二級居多 ; 然此兩組在發生壓瘡的時間上未達顯著差異 檢視 有發生壓瘡組 與 無發生壓瘡組 之間, 其性別 高血壓史及身體質量指數變項均達顯著差異 (p <.05) 建議對於臨床上高危險群病患, 除了應採落實的更換姿位以及檢視皮膚之外, 可視情況介入親水性敷料或泡棉敷料以預防尾薦骨壓瘡 關鍵詞 : 加護病房 預防 壓瘡 親水性敷料 泡棉敷料 Taiwan clinical performance indicators, TCPI 31.7% % Terekeci et al., 2009; Theaker, Kuper, & Soni, 2005; Whittington & Briones, * fish@mail.tcu.edu.tw Shahin, Dassen, & Halfens, 2008 Compton et al., 2008 doi: /jn

2 66 Wound Dressing and Pressure Ulcer Prevention ㈠ Stotts & Wu, %39.6% 38%; Shahin et al., 2008Theaker 2005 European Pressure Ulcer Advisory Panel EPUAP, 2009 category/stage I II III IV unstageable/unclassified suspected deep tissue injury McInnes, Jammali-Blasi, Bell- Syer, Dumville, & Cullum, 2011 Shahin et al., 2008Lindgren, Unosson, Fredrikson, & Ek, 2004; Pender & Frazier, % 2006 sacrum coccyx bone ㈡ Lindgren et al., 2004; Weststrate & Heule, % Stotts & Wu, 2007 Grey, Harding, & Enoch, 2006 p < National Institute for Health and Clinical Excellence NICE, 2011 acute physiology and chronic health evaluation, APACHE APACHE II Yepes, Molina, León, & Pérez, 2009 body mass index, BMI18.5 BMI 3.5g/dl 75% 3.5g/dl 16% Gehin et al., 2006; Terekeci et al., Lindgren et al., 2004 Shahin Shahin et al., 2008 EPUAP, mmhg 70 mmhg EPUAP, 2009; Grey et al., 2006 shearing force Dini, Bertone, & Romanelli, 2006; Grey et al., 2006Braden scale ㈢ Hampton, 2010

3 67 NICE NICE, 2011 support surfaces McInnes, 2004; Reddy, Gill, & Rochon, 2006 Reddy et al., % Weststrate & Heule, 2001 Agency for Healthcare Research and Quality [AHRQ], 2011 National Guideline Clearinghouse [NGC], 2011 hydrocolloid dressing foam dressing EPUAP 2009 medium effect size G power Faul, Erdfelder, Buchner, & Lang, 2009 one factor ANOVA power.8 α.05 effect size convenience sampling Braden scale Pilot & Beck, APACHE II Braden Scale + hydrocolloid dressing + foam dressing APACHE= acute physiology and chronic health evaluation.

4 68 Wound Dressing and Pressure Ulcer Prevention 2006I-CVI item-content validity index.93 S-CVI scale- content validity index.32 APACHE ICU intensive care unit Braden scale 100% 90%predictive validity 64% test-retest reliability r.95 Bergstrom, Braden, Kemp, Champagne, & Ruby, % 75.1% 2005 Braden scale Likert Braden & Bergstrom, Braden scale EPUAP 11 IRB SPSS 18.0 for Windows chi-square one factor ANOVA tindependent sample t-test UMann-Whitney U test ± % 36%52% 48%46% 26% 60% ANOVA p >.05 28% 1 64% g/dl ± 2.58 g/dl BMI 15.4

5 kg/m 2 BMI 24.1 ± 4.1 kg/m g/dl 2.3 ± 0.6 g/dl APACHE II ± 7.7 MAP mmhg ± 28.0 mmhg Braden scale ± 2.1 p > % % % 4 DTI 9.1% % % N = 90 n = 30 n = 30 n = 30 n % n % n % χ 2 / F p M ± SD ± ± ± M ± SD ± ± ± BMI M ± SD ± ± ± M ± SD 2.25 ± ± ± APACHE II M ± SD ± ± ± MAP M ± SD ± ± ± Braden scale M ± SD ± ± ± BMI: body mass index; APACHE II: acute physiology and chronic health evaluation; MAP: mean arterial pressure

6 70 Wound Dressing and Pressure Ulcer Prevention N = 90 n = 30 n = 30 n = 30 n % n % n % n % DTI DTI: deep tissue injury N = 90 n = 11 n = 79 n % n % χ 2 / U p M ± SD ± ± * * *p <.05. ㈠ %36.4% 45.5% 54.5% 36.4%90.9% 18.2% ± 19.1 χ 2 = 4.313, p <.05 χ 2 = 4.988, p <.05 p >.05 ㈡ 54.5% ± 3.0 g/dl BMI kg/m ±4.4 kg/m g/dl 2.2 ±.5 g/dl BMI U = , p <.05 p >.05APACHE II ± 6.4 MAP mmhg 98.2 ± 33.3 mmhg Braden scale ± 1.8 p >.05

7 71 N = 90 n = 11 n = 79 n % n % χ 2 / U p M ± SD ± ± BMI M ± SD ± ± * M ± SD 2.15 ± ± APACHE II M ± SD ± ± MAP M ± SD ± ± Braden scale M ± SD ± ± BMI: body mass index; APACHE II: acute physiology and chronic health evaluation; MAP: mean arterial pressure; *p < ± ± ± ± ± ± 10.8 t = 0.351, p =.734 Chaiken, 2012 polyurethane foam dressing silicon absorbent foam pad Ohura, Ichioka, Nakatsuka, & Shibata, 2005 p <.05 Lindgren et al., 2004; Pieper, Sugrue, Weiland, Sprague, & Heiman, 1998; Weststrate & Heule, % Stotts Wu % 2006 p <.05 BMI U = , p <.05 BMI Terekeci et al., 2009 Pieper et al., 1998

8 72 Wound Dressing and Pressure Ulcer Prevention Thomas, 2001 Thomas, 2001 APACHE MAP Braden scale MAP APACHE Pieper et al., 1998; Terekeci et al., p < Lindgren et al., 2004; Pender & Frazier, 2005 ㈠ ㈡ ㈢ BMI APACHE Braden scale Braden scale [Yu, P. J., Lee, S. D., & Lin, S. H. (2005). Validity of assessment tools for risk factors of pressure ulcers in Taiwan. Taiwan Geriatrics & Gerontology, 1(2), ] [Chin, Y. F., Wu, W. L., Lin, S. C., & Chin, Y. P. (2006). Prevalence of pressure ulcers and associated factors among patients from a medical center. Chang Gung Nursing, 17(1), ] [Tai, J. F., Her, S. S., & Au, W. Y. (2009). The relationship between placement of decompression water cushion and prodromal pressure ulcers symptoms in the ICU-A case control study. VGH Nursing, 26(1), ] Agency for Health Care Research and Quality. (2011, October 19). Pressure ulcer in adults: Prediction and prevention.

9 73 AHCPR supported clinical practice guidelines. Retrieved from Bergstrom, N., Braden, B., Kemp, M., Champagne, M., & Ruby, E. (1996). Multi-site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses, and prescription of preventive interventions. Journal of the American Geriatrics Society, 44(1), Braden, B. J., & Bergstrom, N. (1994). Predictive validity of the Braden scale for pressure sore risk in a nursing home population. Research in Nursing & Health, 17(6), doi: /nur Chaiken, N. (2012). Reduction of sacral pressure ulcers in the intensive care unit using a silicone border foam dressing. Journal of Wound Ostomy and Continence Nursing, 39(2), doi: /won.0b013e c Compton, F., Hoffmann, F., Hortig, T., Strauss, M., Frey, J., Zidek, W., & Schäfer, J. H. (2008). Pressure ulcer predictors in ICU patients: Nursing skin assessment versus objective parameters. Journal of Wound Care, 17(10), Dini, V., Bertone, M., & Romanelli, M. (2006). Prevention and management of pressure ulcers. Dermatologic Therapy, 19(6), doi: /j x European Pressure Ulcer Advisory Panel. (2009). Pressure ulcer treatment: Quick reference guide. Retrieved from Faul, F., Erdfelder, E., Buchner, A., & Lang, A. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), doi: /brm Gehin, C., Brusseau, E., Meffre, R., Schmitt, P. M., Deprez, J. F., & Dittmar, A. (2006). Which techniques to improve the early detection and prevention of pressure ulcers? Paper session presented at the 2006 International Conference of the IEEE Engineering in Medicine and Biology Society, New York, NY. doi: /iembs Grey, J. E., Harding, K. G., & Enoch, S. (2006). Pressure ulcers. British Medical Journal, 332(7539), doi: /bmj Hampton, S. (2010). An evaluation of a silicone adhesive shaped heel dressing. British Journal of Nursing, 19(6, Suppl.), S30 S33. Lindgren, M., Unosson, M., Fredrikson, M., & Ek, A. C. (2004). Immobility- A major risk factor for development of pressure ulcers among adult hospitalized patients: A prospective study. Scandinavian Journal of Caring Sciences, 18(1), doi: /j x McInnes, E. (2004). The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. Journal of Tissue Viability, 14(1), 4 6, 8, 10. McInnes, E., Jammali-Blasi, A., Bell-Syer, S. E. M., Dumville, J. C., & Cullum, N. (2011). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, 4. Art. No.: CD doi: / CD pub4 National Guideline Clearinghouse. (2011, October 17). Guideline synthesis: Prevention of pressure ulcers. Retrieved from 78&search=prevention+of+pressure+ulcers National Institute for Health and Clinical Excellence. (2011, August 5). Pressure ulcer risk assessment and prevention. Retrieved from Ohura, N., Ichioka, S., Nakatsuka, T., & Shibata, M. (2005). Evaluation dressing materials for the prevention of shear force in the treatment of pressure ulcers. Journal of Wound Care, 14(9), Pender, L. R., & Frazier, S. K. (2005). The relationship between dermal pressure ulcers, oxygenation and perfusion in mechanically ventilated patients. Intensive and Critical Care Nursing, 21(1), doi: /j.iccn Pieper, B., Sugrue, M., Weiland, M., Sprague, K., & Heiman, C. (1998). Risk factors, prevention methods, and wound care for patients with pressure ulcers. Clinical Nurse Specialist, 12(1), doi: / Pilot, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what s being reported? Critique and recommendations. Research in Nursing and Health, 29(5), doi: /nur Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing pressure ulcers: A systematic review. The Journal of the American Medical Association, 296(8), doi: / jama Shahin, E. S. M., Dassen, T., & Halfens, R. J. G. (2008). Pres-

10 74 Wound Dressing and Pressure Ulcer Prevention sure ulcer prevalence in intensive care patients: A cross - sectional study. Journal of Evaluation in Clinical Practice, 14(4), doi: /j x Stotts, N. A., & Wu, H. S. (2007). Hospital recovery is facilitated by prevention of pressure ulcers in older adults. Critical Care Nursing Clinics of North America, 19(3), doi: /j.ccell Terekeci, H., Kucukardali, Y., Top, C., Onem, Y., Celik, S., & Öktenli, Ç. (2009). Risk assessment study of the pressure ulcers in intensive care unit patients. European Journal of Internal Medicine, 20(4), doi: / j.ejim Theaker, C., Kuper, M., & Soni, N. (2005). Pressure ulcer prevention in intensive care - A randomized control trail of two pressure-relieving devices. Anaesthesia, 60(4), doi: /j x Thomas, D. R. (2001). Improving outcome of pressure ulcers with nutritional interventions: A review of the evidence. Nutrition, 17(2), doi: /s (00) Weststrate, J. T. M., & Heule, F. (2001). Prevalence of PU, risk factors and use of pressure ulcer relieving mattresses in ICU patients. Connect the World of Critical Care Nursing, 1(3), Whittington, K. T., & Briones, R. (2004). National prevalence and incidence study: 6-year sequential acute care data. Advances in Skin and Wound Care, 17(9), doi: / Yepes, D., Molina, F., León, W., & Pérez, E. (2009). Incidence and risk factors associated with the presence of pressure ulcers in critically ill patients. Medicina Intensiva, 33(6), doi: /s (09)

11 75 A Comparison of the Efficacy of Different Wound Dressing Management Techniques in Preventing Pressure Ulcers Wen-Yi Tsao 1 Shu-Fen Lo 2 Tomor Harmod 3 Ru-Ping Lee 4 * 1 MSN, RN, Assistant Head Nurse, Plasty Surgery Ward, Tzu Chi Hospital; 2 PhD, RN, Associate Professor, Department of Nursing, Tzu Chi College of Technology; 3 PhD, MD, Attending Surgeon, Department of Neurosurgeon, Tzu Chi Hospital; 4 PhD, RN, Professor, Department of Nursing, Tzu Chi University. Abstract Background: Although high-technology wound dressings are widely used in clinical care worldwide, no evidence or discussions have been published regarding the efficacy of these dressings in preventing pressure ulcers. Purpose: This study presents a repositioning of routine management combined with hydrocolloid dressing or foam dressing for pressure ulcer prevention. Method: We used a quasi-experimental design and recruited a convenience sample of 90 from a surgical intensive care unit (SICU) at a medical center in Hualien County, Taiwan. Participants were allocated randomly to one of three groups: repositioning of routine management, hydrocolloid dressing, and foam dressing. Study instruments included a pressure ulcer risk table (Braden scale) and the pressure ulcer classification system of the European Pressure Ulcer Advisory Panel. An independent sample t-test, ANOVA, and Mann-Whitney U test were used to verify research hypotheses. Results: The repositioning of routine management group had the highest pressure ulcer incidence rate, followed by the hydrocolloid-dressing group. The foam-dressing group recorded no pressure ulcers. Pressure ulcer occurrence grades were primarily level 1 and 2. There was no significance difference in pressure ulcer occurrence time between the repositioning of routine-management group and the hydrocolloid-dressing group. Finally, there were significant differences (p<.05) among gender, hypertension history, and BMI regardless of pressure ulcer incidences. Conclusion: It is recommended that patients in high-risk groups in clinical settings adopt strategies including repositioning and regular visual skin examinations. Also, hydrocolloid or foam dressings may be used as appropriate to prevent sacral pressure ulcers. Key Words: intensive care unit, prevention, pressure ulcer, hydrocolloid dressing, foam dressing. Accepted for publication: June 11, 2013 *Address correspondence to: Ru-Ping Lee, No. 701, Zhongyang Rd. Sec. 3, Hualien City 97004, Taiwan, ROC. Tel: +886 (3) ext. 2225; fish@mail.tcu.edu.tw