Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - iii

CLINICAL PRACTICE GUIDELINE

Foreword

P

ressure ulcers are a frequent, costly, and potentially life-threatening
complication of spinal cord injury (SCI). They complicate the rehabilitation
process and are a significant deterrent to participation in activities that
contribute to independent, productive, and satisfying lives. Pressure ulcers
result in prolonged hospitalizations, delayed community reintegration, reduced
quality of life, and loss of self-esteem. The etiology of pressure ulcers is
complex and multidimensional. Biochemical, mechanical, and environmental
and contextual factors interact at various times to damage tissue. Clinicians and
researchers focus on unrelieved pressure, shear, friction, moisture, poor
nutrition, immobility, and psychological, social, and economic factors, such as
drug abuse, depression, inadequate personal and financial resources, and noncompliance to acknowledged preventive behaviors as the most significant
aspects of pressure ulcer development. Every person with SCI is at risk for the
development of pressure ulcers and almost all will develop at least one serious
pressure ulcer during their lifetime.
The prevention and management of pressure ulcers are processes that
are inextricably linked across the continuum of care of individuals with SCI.
Current prevention programs, specifically hospital-based education
interventions, have had limited success in reducing the occurrence of pressure
ulcers especially after these individuals return to their families and community.
This may be due, in part, to very short hospital stays, currently 3 to 4 weeks,
in many rehabilitation facilities, resulting in extremely limited pressure ulcer
prevention education. Furthermore, despite the plethora of education and
treatment programs and protocols described in the literature, few have been
validated for their ability to promote the preventive behaviors that reduce the
occurrence or recurrence of pressure ulcers, especially after the person has
returned to his or her home and community where out-patient educational
resources are very limited.
Since the publication of the original clinical practice guideline Pressure
Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical
Practice Guideline for Health-Care Professionals (2000), a number of
present scientific studies have advanced our knowledge of the factors that
contribute to the formation of pressure ulcers and have provided new directions
for improving preventive techniques and treatment. The purpose of this new/
updated clinical practice guideline is to present the current state of the science
in pressure ulcer research and clinical practice and scientifically sound
strategies that are effective in identifying risk and reducing the incidence,
prevalence, and recurrence of this lifelong complication of SCI. More than
225 new articles specific to pressure ulcers among persons with spinal cord
injury have been reviewed and graded. The recommendations in this guideline
cover a broad spectrum of issues that have been addressed by the new
multidisciplinary pressure ulcer clinical practice guideline development panel
and several consultants. The significant constructs of this problem are risk and
risk assessment; prevention strategies across the continuum of care; assessment
and reassessment, following the onset of a pressure ulcer, of the individual with
a pressure ulcer and of the ulcer itself; nonsurgical and surgical treatments
interventions and their complications; and pressure redistribution and support
surfaces and positioning for managing tissue loads for the bed and wheelchair.
The recommendations are based on an extensive review and analysis of
the available scientific literature and represent the most current understanding
of the interventions applied in clinical practice. Where the scientific literature
failed to provide guidance in the development of this document, the panel

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Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

Table of Contents for the Digital Edition of Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury
