There are a wide range of recognized risk factors for the development of pressure injuries; poor nutritional status, dehydration, being under- or overweight, stroke, recent bone fractures, anaemia, diabetes, vitamin deficiency, and age >70 years old (Kenneweg et al. 2015). Infected pressure injuries are difficult to treat. Underlying causes often cannot be corrected, and are associated with a high risk of clinical recurrence. Long-term surveys report an ulcer recurrence risk from 12% to 82%, with a total complication rate of 17% to 46% (Jugun et al. 2016). The table below outlines different factors that are associated with various treatment successes.
In a retrospective chart review, Lane et al. (2016) evaluated the impact of implementing evidence-based guidelines on smoking cessation in persons with spinal cord injuries and pressure injuries, as well as the impact of smoking on pressure injury healing in this population.
48% percent of the control group participants and 57% of the intervention group participants smoked cigarettes at baseline. Smoking cessation doubled with the use of the clinical practice guidelines (P=0.03). Smokers presented with a greater number of pressure injuries than nonsmokers. They experienced a mean increase rather than reduction in wound size. Nearly half (45.5%) of the intervention group participants who desired to have surgery had it performed, compared with only 34.9% of the control group participants (P=0.35).
Jugun et al. (2016) assessed interdisciplinary surgical and medical parameters associated with recurrences of infected pressure injuries. Authors found that in patients with infected pressure injuries, clinical recurrence occurs in almost two-thirds of lesions, but in only 14% with the same pathogens. The number of surgical debridements, flap use, or duration of antibiotic therapy was not associated with recurrence of pressure injury infection. Similarily, Kenneweg et al (2015) aimed to identify perioperative risk factors that may predict improved outcomes and reduced complications in primary and recurrent pressure injury reconstructions. A total of 49 patients with 102 reconstructions were reviewed. Numerous differences between primary and recurrent pressure injuries were identified, including ulcer location, patient nutritional status, wound infection, postoperative course and recurrence. Multivariate analysis revealed a flap reconstruction prediction model using creatinine, haematocrit, haemoglobin, and prealbumin that is able to successfully predict closure outcome in 83.6% of cases.
There is level 2 evidence (from one cohort study; Lane et al. 2017) that implementing evidence-based guidelines on smoking cessation in persons with spinal cord injuries can improve pressure injury healing.
There is level 4 evidence (from two series; Jugun et al. 2016, Kenneweg et al. 2015) that recurrences of pressure injury infection may be caused by reinfections from extrahospital factors other than of surgical debridements, flap use, or duration of antibiotic therapy.
The use and implemtation of clinical practice guidelines may help individuals stop smoking.
Many factors play a role in the development, course and treatment of PIs. It is vital to understand the role of patient risk factors in the development of PIs, to direct subsequent management and reconstruction, and to prevent future recurrences.