Patient population, (P): In patients with infected, severe pressure ulcers.
Intervention of interest, (I): Is the surgical removal of the ulcers via operative debridement,
Comparison intervention, (C): compared with the administration of antibiotics
Outcome, (O): more effective in the treatment of infected severe pressure ulcers
Pressure ulcers are skin injuries or tissue underneath the skin. As the name suggests, they are caused by pressure and friction combined with pressure. Pressure is formed when the body weight applies a downward force on a slept or seated surface. Friction is combine with pressure when an individual slides down a surface e.g. bed, wheelchair, seat etc. Pressure ulcers mainly develop in bony regions such as the sacrum (tail bone) and ischial tuberosities (“sit bones”). The pressure impedes blood flow to the affected region and the skin dies. Pressure ulcers form after skin death. Decubitus ulcers form when an individual remains in a recumbent position over a long period (Semer, 2007). However, they can develop over a short duration as long as high pressure is applied on a small body area. An individual does not need to lie or sit in a given position for a long period of time. Various risk factors influence an individual’s susceptibility to developing pressure ulcers. This includes nutrition, age, mobility level, hydration, atrophy, friction, shear, moisture, incontinence as well as the moisture and temperature at the slept/seated surface.
The incidence of hospitalization cases as a result of pressure ulcers have increased by 63% in the last 10 years. Septicemia following infection of the pressure ulcers is the main admitting diagnosis (Schiffman et al., 2009). The mortality is at a high of over 68% in many settings. However, the true prevalence of pressure ulcers is not appreciated since they emerge in patients with chronic conditions such as stroke, dementia, spinal cord injury, and even in patients with acute illness.
Operative debridement has been cited as a safe and effective procedure for patients suffering from severe pressure ulcers. Proper debridement stands to prevent sepsis as well as death among patients suffering from co-morbid conditions. Devitalized tissue needs to be removed to facilitate wound healing since moist necrotic tissue is a common infection site that provokes an inflammatory response that prevents wound healing. Sharp debridement effectively eliminates an infection site thereby preventing sepsis. Superficial and small wounds are debrided from patients at the bedside. Debridement is carried out in the operation room for stage III and IV ulcers. The procedure can be performed safely in patients such patients presenting severe pressure ulcers. Operative debridement reduces the mortality rate in patients with co-morbid conditions. These patients usually have multiple hospital admissions (Schiffman et al., 2009).
Special dressings protect pressure ulcers form infection and they speed up the wound healing process. Hydrocolloid dressings have a special gel that promotes the proliferation of new cells in the pressure ulcer. The surrounding area that comprises of healthy skin is kept dry. Alginate dressings are produced from seaweed and have calcium and sodium. These elements promote the wound healing process (NHS., 2010).
Oral and topical antibiotics are administered to patients with infected pressure sores. Antiseptic creams are directly applied on the pressure ulcers to eliminate bacteria. Intravenous antibiotics are administered on patients with deep severe pressure ulcers (Romanelli et al., 2012). The patient needs to be in a stable condition before systemic treatment in order to achieve a favorable outcome. The antibiotic regimen is modified depending on the response of each individual. Usually routine drug susceptibility tests and patient’s clinical response is evaluated. Several factors are put in consideration: inappropriate drug dosage and administration route, emergence of antibiotic resistance bacteria and presence of micro-organisms that have not yet been detected.