Incidence of hospital-acquired pressure ulcers in acute care using two different risk assessment scales: results of a retrospective study.

More than one million people develop pressure ulcers (PU) every year in the US - a major problem that leads to increased morbidity and mortality. A hospital-acquired PU (HAPU) is defined as any ulcer noted 24 or more hours after hospital admission. The purpose of this retrospective study was to compare the incidence of HAPUs between two 1-year periods of time (March 1, 2007 through March 17, 2008 and March 18, 2008 through March 31, 2009) at an acute care facility. Records from all admitted adult medical-surgical and critical care patients along with routinely submitted quality control reports on patients who acquired PUs during hospitalization were reviewed and abstracted. A locally developed PU risk assessment instrument (SST) was used during the first time period and the Braden Scale (BS) was used during the second time period. The overall PU incidence was 368 in 41,840 patient admissions (8.80 per 1,000); 9.49 in the SST and 8.08 in the BS patient sample (P = 0.125). No significant differences in patient age, race, and PU severity or location were observed. However, the incidence of more severe ulcers (Stage III and Stage IV) was lower in the BS group (0.5667 in the SST group compared to 0.2419 per 1,000 admissions in the BS group) even though median patient length of stay was longer (28 days and 34 days in the SST and BS groups, respectively), suggesting that use of a valid and reliable PU risk assessment instrument may reduce the incidence of severe PUs. Study design and sample size limit the ability to generalize the results of this study. Controlled clinical studies comparing the effect of different PU risk assessment instruments on PU incidence are needed.