Abstract

This Clinical Practice Guideline offers a comprehensive program for treating adults with pressure ulcers. The recommendations are intended for clinicians who examine and treat individuals in all health care settings.

The guideline was developed by a panel of experts and is based on the best available scientific evidence and clinical expertise. The recommended treatment program focuses on (1) assessment of the patient and pressure ulcer, (2) tissue load management, (3) ulcer care, (4) management of bacterial colonization and infection, (5) operative repair in selected patients with Stage III and IV pressure ulcers, and (6) education and quality improvement.

Accurate, ongoing assessment of the ulcer is essential. Of equal importance are the assessment and management of the individual's overall health, including physical, psychosocial, and nutritional status. Pain should be assessed and managed. Management of tissue loads (i.e., pressure, friction, and shear), through vigilant use of positioning techniques and appropriately selected support surfaces, is critical.

Ulcer care includes (1) debridement of necrotic tissue and debris, (2) wound cleansing using saline and avoiding antiseptics, and (3) application of dressings that maintain a clean, moist environment while keeping the surrounding skin dry. Education and quality improvement are integral to an effective pressure ulcer treatment program.

Contents

• Treatment of Pressure Ulcers Guideline Panel
• Guideline Development and Use
• Foreword
• Panel Members
• Acknowledgments
• Executive Summary
• 1. Overview
  • Introduction
  • Definitions
  • Incidence and Prevalence
  • Methodology for Guideline Development
  • Strength-of-Evidence Ratings
  • Economic Impact and Public Policy Implications
  • Followup Activities
  • Organization of the Guideline
  • Clinical Algorithm
• 2. Assessment
  • Assessing the Pressure Ulcer
  • Assessing the Individual With a Pressure Ulcer
• 3. Managing Tissue Loads
  • While in Bed
  • While Sitting
• 4. Ulcer Care
  • Debridement
  • Wound Cleansing
  • Dressings
  • Adjunctive Therapies
• 5. Managing Bacterial Colonization and Infection
  • Pressure Ulcer Colonization and Infection
  • Infection Control
• 6. Operative Repair of Pressure Ulcers
  • Patient Selection
  • Controlling Factors That Impair Healing
  • Operative Procedures
  • Postoperative Care
• 7. Education and Quality Improvement
  • Education
  • Quality Improvement
• Acronyms
• Glossary
• Contributors
• Attachments
• Availability of Guidelines
• References

Suggested citation:

Bergstrom N, Bennett MA, Carlson CE, et al. Treatment of Pressure Ulcers. Clinical Practice Guideline, No. 15. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 95-0652. December 1994.