Incidence and Risk Factors of Pressure Ulcer Among Critically Ill Patients at Kenyatta National Hospital

Abstract

Background Pressure ulcer represents a significant burden in a healthcare setup. Patients admitted to the critical care unit are at high risk of PU development with an incidence ranging from 7% to 71.6% across countries. Identifying potential risk factors and implementation of preventive measures can help reduce its incidence in the critical care unit. Broad objective To determine PU incidence and risk factors among the critically ill patients at Kenyatta National Hospital – main critical care Unit. Study Methods The Study is a prospective observational single-center study conducted over 3 months at KNH. All patients admitted to KNH-main CCU without pre-existing pressure ulcers were included into the study. Data were analyzed using SPSS version 23. They were presented as frequencies and percentages for categorical data and as means with standard deviations for continuous data. The incidence of PU was calculated as a proportion of those patients who developed ulcers over the total sample size and presented as a percentage. Associated risk factors were assessed with the use of Chi-square. Logistic regression was used to identify risk factors. All statistical tests shall be considered significant where the p-value < 0.05. Results The majority of the patients were aged between 21 to 40 years (47, 41.6%), where the mean age was 37.0 (SD 20.8) years. Of the 113 patients recruited, 17 patients developed PU giving rise to an incidence of 15%. The gluteal region was the commonest location (70.6%). There was indifferences in the odds and no statistical differences (p=0.509) for age and development of PU. Mechanical ventilation was a significant risk factor for PU (p=0.001). Malnutrition (OR=3.5, p=0.091), fecal incontinence (OR= 2.4, p=0.315), hemiplegia (OR=2.4, p=0.315) increased the probability of developing PU. Increasing sedation time (OR=14.0, CI 2.63 – 74.59, p=0.002) and each unit increase to the LOS (OR=1.91, p<0.001) were independently associated with PU development. Conclusion The incidence of pressure ulcer was 15% and all of them were stage I. The most common location of ulcers was the gluteal region. Mechanical ventilation, LOS in the unit and increasing sedation time were found to be independent risk factors for PU development. x Repositioning had little effect on pressure ulcer development, which could be explained by the lack of preventive and screening strategies in patients at high risk of developing pressure ulcers.