Prevalence and incidence of pressure ulcers in Japanese long-term-care hospitals

In Japan, long-term-care hospitals and facilities face the problem of quality of care, and providing adequate pressure ulcer care is one of the most urgent quality issues. Purpose of the present study was to explore the prevalence and incidence of pressure ulcers in long-term-care hospitals in Japan, and to identify factors associated with them. An anonymous questionnaire was sent to 720 randomly sampled, long-term-care hospitals all over Japan. The prevalence and incidence of pressure ulcers and their factors, including organizational strategies for pressure ulcer prevention and management, were examined. The mean prevalence and incidence of pressure ulcers was 9.6 and 1.9% per month, respectively. Almost all hospitals had established an interdisciplinary team for pressure ulcer prevention, developed a clinical protocol for pressure ulcers, and implemented education for staff. However, 35% of the interdisciplinary teams were not useful, more than half of the clinical protocols were not used frequently, and about half of the wards did not have sufficient pressure-relieving mattresses. In multiple regression analyses, a low prevalence of pressure ulcers was associated with a lower ratio of clients with a high medical severity level (p=0.034), the use of a clinical protocol including the management of preventive devices (p=0.023), the standardized pressure ulcer assessment tool (DESIGN-R; p=0.017), and staff education (p=0.003). This study demonstrated a higher prevalence and incidence of pressure ulcers in long-term-care hospitals in Japan as compared to regular acute-care hospitals, as well as poor organizational strategies for managing pressure ulcers.