Dry skin and pressure ulcer risk: A multi-center cross-sectional prevalence study in German hospitals and nursing homes

https://doi.org/10.1016/j.ijnurstu.2017.05.011Get rights and content

Abstract

Background

Pressure ulcers are a serious health problem in medical and nursing care. Therefore, effective prevention is crucial. Major pressure ulcer risk factors have been identified but the particular role of dry skin (xerosis cutis) is unclear.

Objectives

To investigate possible associations between dry skin and pressure ulcers focusing on the sacrum/trochanter and at heel/ankle skin areas.

Design

Two multicenter cross-sectional studies.

Settings/participants

In 2014 and 2015 thirty nursing homes and thirteen hospitals in Germany participated. In total 3837 participants were included. Mean age was 76.1 (SD 15.5) years.

Methods

Skin assessments and data collection were performed by trained nurses based on a standardized data collection form. Descriptive comparisons and multilevel logistic regressions predicting pressure ulcers at sacrum/trochanter and ankle/heel were conducted.

Results

The prevalence of skin dryness at the trunk was significantly higher for subjects with pressure ulcers category 2+ at the sacral area compared to without (39.0% vs. 24.4%, p = 0.010). Adjusted to demographic variables, mobility and type of institution dry skin at the trunk was no longer associated with pressure ulceration (OR 1.11 (95% CI 0.62–2.00)). 71.9% of patients with heel/ankle pressure ulcers category 2+ were affected by dry skin at legs or feet, compared to 42.8% of subjects without pressure ulcers (p < 0.001). In the adjusted analysis the OR was 1.85 (95% CI 0.83–4.14).

Conclusions

Study results indicate that dry skin at the feet may be considered as a risk factor for heel pressure ulcer development. Skin dryness may be less important for sacral pressure ulcers. Therefore, the variable skin status should be better defined in future studies and pressure ulcer risk models. Results further support differences in pressure ulcer aetiologies between anatomical locations.

Section snippets

What is already known about the topic?

  • Skin status is regarded as an important risk factor in pressure ulcer development.

  • The particular impact of dry skin on pressure ulcer development at pressure ulcer predilection areas has not been investigated so far.

What this paper adds

  • Dry skin at feet seems to be a relevant risk factor for pressure ulcer development at heel/ankle

  • Skin dryness at the sacral skin does not seem to increase pressure ulcer risk.

  • There seem to be differences in sacral and heel pressure ulcer development.

Study design and setting

The data used in this study is based on two multicenter descriptive cross-sectional prevalence studies in 2014 and 2015, which have been performed annually by the Department of Nursing Science at the Charité – Universitätsmedizin Berlin (Lahmann et al., 2005) since 2001. The study design is based on a similar study conducted in The Netherlands since 1999 (Bours et al., 1999) and methods have been previously described (Kottner et al., 2009b, Lahmann et al., 2005). In brief, all hospitals and

Participants

In total, 13 hospitals and 30 nursing homes participated in both years, which resulted in 3837 hospital patients and nursing home residents participating in this study. On average, 89 participants per institution were recruited. The smallest number of participants per institution was 10, the highest 396. In the hospitals the response rate was 68% and 87% in the nursing homes (Fig. 1).

Sample characteristics are shown in Table 1. The mean age was 81.4 (SD 12.1) years in nursing homes versus 69.7

Key results and interpretation

Using data from two German wide prevalence studies, which were performed in 2014 and 2015 by the Department of Nursing Science at the Charité – Universitätsmedizin Berlin (Lahmann et al., 2005), this study aimed to investigate possible associations between dry skin and pressure ulcers. Overall 2.4% of the study population was affected by at least one pressure ulcer category 2–4 and DTI. The bivariate comparisons showed that the prevalence of dry skin was significantly higher in the group

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

Medical Association of Berlin (Eth-837-262/00).

Funding

This study was supported by the Clinical Research Center for Hair and Skin Science and the Department of Nursing Science of the Charité- Universitätsmedizin Berlin.

References (33)

  • P. Baalham et al.

    Xerosis of the feet: a comparative study on the effectiveness of two moisturizers

    Br. J. Community Nurs.

    (2011)
  • M. Baumgarten et al.

    Pressure ulcers among elderly patients early in the hospital stay

    J. Gerontol. A. Biol. Sci. Med. Sci.

    (2006)
  • D.R. Berlowitz et al.

    Are all pressure ulcers the result of deep tissue injury? A review of the literature

    Ostomy Wound Manag.

    (2007)
  • G.J. Bours et al.

    The development of a national registration form to measure the prevalence of pressure ulcers in The Netherlands

    Ostomy Wound Manag.

    (1999)
  • A. Cichowitz et al.

    The heel: anatomy, blood supply, and the pathophysiology of pressure ulcers

    Ann. Plast. Surg.

    (2009)
  • S. Coleman et al.

    A new pressure ulcer conceptual framework

    J. Adv. Nurs

    (2014)
  • Cited by (56)

    • Prevalence and associated factors of dry skin among older inpatients in hospitals and nursing homes: A multicenter cross-sectional study

      2022, International Journal of Nursing Studies
      Citation Excerpt :

      Another study reported that the prevalence of dry skin was 41.2% in nursing homes (n = 1662) and 55.2% in hospitals (n = 1486) (Lechner et al., 2019), and a cohort study reported that the prevalence of dry skin was 60% in middle-aged and older people (n = 5547) (Mekić et al., 2019). It is often closely related to health conditions, some chronic diseases and drugs (Lechner et al., 2017; Hahnel et al., 2017a, 2017b, 2017c; Mekić et al., 2019). The prevalence and associated factors varied in different studies (Hahnel et al., 2016).

    • Skin areas, clinical severity, duration and risk factors of intertrigo: A secondary data analysis

      2021, Journal of Tissue Viability
      Citation Excerpt :

      Evidence indicates that obesity, diabetes mellitus, immobility, urinary and/or faecal incontinence, malnutrition, hyperhidrosis, wearing diapers, being exposed to hot and humid environments and occlusive wear may contribute to intertrigo risk [6–8,11]. However, similar to other localized skin and tissue problems such as pressure ulcers, intertrigo is skin area specific and it cannot be assumed that the listed risk factors contribute equally to intertrigo at all skin areas [12]. Also, it is possible that the duration of intertrigo lesions and its clinical severity differ between skin areas.

    View all citing articles on Scopus
    View full text