Results
As shown in Table 1, there is a large fluctuation in the number of patients who participated in the LPZ at a national level. This is largely because of the voluntary nature of participation in the LPZ and because not all nursing homes participated during the whole study period. The increase of Avoord patients is based on its organizational increase of available beds. As shown in Table 1, the mean age of the participating patients was approximately 80 years, and there was no statistical difference between the participating patients at a national level and those residing at the Avoord nursing homes.
The results of the national nursing home sector show a linear reduction of the nosocomial prevalence of category 2–4 PUs from 8.7% in 2005 to 3.7% in 2011 (Table 1). After the introduction of the new 3-step model at the Avoord nursing homes in 2005, the PU nosocomial prevalence dropped to 0.5% within 1 year. This level was maintained at a rate of between 1.2% and 2.6% (category 2–4) throughout the rest of the study period. In the period since the implementation of the new 3-step protocol in 2005, the PU prevalence rate has been significantly lower in the Avoord nursing homes than in the overall national nursing home sector.
Although the national PU guidelines recommend that patients should be repositioned, this is not a standard procedure in Dutch nursing homes, as shown in Figure 1. The national annual data show a small fluctuation in repositioning percentages between 10% and 17%. The data from Avoord nursing homes show a decline from 22% in 2005 to 7% in 2006, and a trend of stabilization in the years following that.
Figure 2 shows data for the most commonly used types of mattresses for patients who did not receive enough pressure relief from a visco-elastic mattress and/or repositioning, a standard measure in the current national guidelines. In Dutch nursing homes during the study period, an average of 11.7% (ranging from 9.7%-14.3%) of the patients at risk received an alternating mattress and 9.2% (ranging from 6.8%-12.4%) a static air mattress, indicating that about 20% of the patients received these 2 types of additional mattresses (alternating or static air) for extra PU prevention. Comparable data for the Avoord nursing homes show an average of 2.3% (ranging from 0.4%-5.4%) received alternating mattresses and 13.1% (ranging from 0%-25.4%) received static air mattresses in addition to a visco-elastic foam mattress. This means that 15.4% of the patients received these 2 types of mattresses. Differences in the use of alternating systems and static air overlay mattresses between national and Avoord nursing homes were all significant (P < 0.001).
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Figure 2.
Use of alternating systems and static air systems in Avoord nursing homes versus the national Dutch nursing home sector (2002–2011).