Pressure Ulcer Risk in the Incontinent Patient Population: Analysis of Incontinence and Hospital Acquired Pressure Ulcers from the International Pressure Ulcer Prevalencetm Survey

Introduction: Incontinence is recognized as a factor in the development of pressure ulcers.   Limited evidence exists to demonstrate the relative increased pressure ulcer risk, the types of pressure ulcers related to incontinence, and sufficiency of risk assessment tools relative to incontinence.  

Methods:   This study analyzed the 2013 and 2014 International Pressure Ulcer Prevalence^TM Surveys (IPUP) comparing 1) prevalence and relative risk of developing Facility Acquired Pressure Ulcers (FAPU), and 2) severity of FAPUs by risk assessment level in incontinent vs. continent patients.  The IPUP survey is an annual voluntary survey of hospitalized patients or residents in facilities conducted over a pre-determined 24 hour period on a pre-determined day.  Demographics, presence of pressure ulcers, pressure ulcer risk scores, and other pertinent data are collected.  This study analyzes aggregate data by incontinence category for the prevalence and severity of FAPUs. 

Results:  IPUP records (n = 176,689) were analyzed with 83,800 continent patients compared to 92,889 patients (53%) who were either managed by Foley or fecal management systems, or had unmanaged incontinence (all considered incontinent in this analysis).  Overall prevalence of pressure ulcers was 4.1% for continent patients and 16.3% for incontinent. FAPU prevalence was 1.6% as compared to 6.0% respectively.   The relative risk for PU development in incontinent patients was much higher than predicted by Braden risk score.  As wound severity increased, the odds ratios for pressure ulcer development for incontinent patients increased dramatically.

Discussion: Incontinent patients were older, had higher Braden Risk scores, higher overall and FAPU prevalence. Incontinence was associated with increased risk of all pressure ulcers, but especially severe pressure ulcers. Incontinent patients assessed at low PU risk demonstrated higher than expected FAPU prevalence.

Clinical relevance:  These results reinforce the importance of incontinence as a pressure ulcer risk factor for serious pressure ulcers independent of Braden score.