海南省三级甲等医院住院患者压疮及其他皮肤损伤现状调查与分析

Investigation and analysis on status quo of pressure ulcer and other skin injuries among inpatients in Class Ⅲ Grade A hospitals in Hainan province

目的调查海南省三级甲等医院住院患者压疮及其他皮肤损伤患病率和压疮预防措施的执行情况并分析，为制订本省三级甲等医院集束化压疮预防干预模式、建立院内压疮预警管理模式等提供依据。方法运用横断面调查法。采用自行设计的住院患者压疮及其他皮肤损伤调查表对海南省7家三级甲等医院的住院患者7248例进行调查。数据采用SPSSl9．0软件进行统计分析。结果自行设计的住院患者压疮及其他皮肤损伤调查表内容效度为0．91，Cronbaeh α 系数为0．93。压疮患病率为2．28％（165／7248），其中家庭带人占66．06％（109／165），医院获得占30．30％（50／165），社区带人占3．03％（5／165），家庭带人及医院获得均有者占0．61％（1／165）。医疗器械相关性损伤占压疮总数的18．18％（30／165），其余占81．82％（135／165）。压疮发生的最常见部位是骶尾部，占47．94％（93／194），Ⅱ期压疮比例最高占35．57％（69／194）。存在压疮危险的患者中有52．01％（647／1244）未使用防压装置，主要受压部位有81．40％（1013／1244）的患者未使用敷料保护，35．50％（442／1244）的患者没有按计划／规律的进行翻身，每隔2小时翻身的占56．19％（699／1244），有61．57％（442／1244）的压疮风险患者没有防压疮标识。其他皮肤损伤中：失禁相关性皮炎患病率0．88％（64／7248）、撕脱性皮肤损伤患病率0．37％（27，7248）。结论海南省三级甲等医院获得性压疮发生率较高，原因可能是医院配置规范的防压装置不够、缺乏量身定做的集束化压疮预防措施和未建立有效的压疮预警管理模式等，因此对压疮的预防与处理还需要做更进一步的规范化管理。医疗器械相关性损伤及失禁相关性皮炎也应该引起临床护士与管理者的关注。

Objective To investigate and analyze the prevalence of pressure ulcer and other skin injuries, and the implementation of pressure ulcer prevention measures among inpatients in Class Ⅲ Grade A hospitals in Hainan province. To provide basis for fomulating bundle of care model to prevent and intervent pressure ulcer, and establishing early warning management model on nosocomial pressure ulcer in Class Ⅲ Grade A hospitals in Hainan province. Methods A cross-sectional survey was conducted on inpatients from 7 Class Ⅲ Grade A hospitals in Hainan province. A investigation was performed by a self-designed inpatients＇ questionnaire and qualified tools on pressure ulcer and other skin injuries. Statistical analysis of data using by SPSS19.0 software. Results The content validity index of the self-designed inpatients＇ questionnaire and qualified tools on pressure ulcer and other skin injuries was 0.91, Cronbach ct coefficient was 0.93. The prevalence of oressure sores was 2.28%（165/7 248）. of which 66.06%（109/165） was family involvement, 30.30% （50/165） was hospital acquired, 3.03% （5/165） was community involvement,and 0.61%（1/165） was both from family and hospital acquired. Medical instrument related pressure ulcer accounted for 18.18%（30/165） of the total number of pressure ulcer. The most common site of pressure ulcer was the sacrococcygeal region, accounting for 47.94% （93/194）. The proportion of pressure ulcer in stage Ⅱ was the highest （35.57%, 69/194）. 52.01% （647/1 244） of patients at risk of pressure ulcer did not use the anti-pressure devices,and 81.40% （1 013/l 244） of patients＇ main compression sites were not covered by dressings.35.50%（442/1 244） of patients did not according to plans or regularly turn over, only 56.19%（699/1 244） patients turned over every 2 hours. 61.57%（442/1 244） patients who have pressure ulcer did not have anti-pressure ulcer signs. Among other skin injuries： the prevalence of incontinence related dermatitis was 0.88%（64/7 248）, and the prevalence of avulsion skin injury was 0.37%（27/7 248）. Conclusions The incidence of acquired pressure ulcer in Class Ⅲ Grade A hospitals in our province is slightly higher than other domestic investigation results. The reasons may be that anti-pressure devices in hospital configuration are not enough, lack of the tailored bundle of prevention measures of pressure ulcer, and failure to establish an effective early warning management model on pressure ulcer etc. So prevention and treatment of pressure ulcer should have a further standard management. Instrument related pressure ulcer and incontinence related dermatitis should also attract the attention of clinical nurses and managers.