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incidence rate and severity of HAPUs in intensive care patients.A study conducted of 461 patients, 5 developed pressure ulcers with adhesive foamdressings, 7 developed pressure ulcers using fatty acid oil dressings, and 10 developed pressure ulcers in the standard care group. Level IIQuasi-experimental studySystematic review ofcombination of RCTs and quasi-experimental, or non-experimental with/without meta-analysis2A- High QualityThe repositioning of routine management group had the highest-pressure injury incidence rate, followed by the hydrocolloid-dressing group. The foam-dressing group recorded no pressure injuries.The number of unit-acquired sacral pressure injuries decreased by 3.4 to 7.6 per 1000 patient days depending on the unit using adhesive foam dressing. Level IIINon-experimental studySystematic review ofcombined RCTs, quasi-experimental, and non-experimental studies only, with/without meta-analysisQualitative study or systematic review of qualitative studies with/without meta-synthesis2B- Good QualityOut of 128 patients using foam dressings (Mepilex), 45 pressure ulcers resolved, 48pressure ulcers decreased, 12 remained unchanged, and 20 increased in severities.The average baseline sacral HAPU prevalence during the 35-month observation was 13.6% as compared to an incidence of 1.8% during the 6-month prospective study. Three of the 5 patients developed suspected deep tissue injuries and subsequently expired. The remaining 2 subjects developed stage 2 pressure ulcers, one of who also expired. Following application of a silicone-bordered foam dressing, we were able to achieve a HAPU of 1.8%.Level IVOpinion of respectedauthorities and/or reports of nationally recognized expert 2B- Good QualityRecommendation 1: ACP recommends that clinicians should perform a risk assessment toidentify patients who are at risk of developingpressure ulcersRecommendation 2: ACP recommends that 16
Running head: EVIDENCE BASED PRACTICE PAPERcommittees/ consensus panels based on scientific evidenceclinicians should choose advanced static mattresses or advanced static overlays in patients who are at an increased risk of developing pressure ulcers.Recommendation 3: ACP recommends against usingalternating-air mattresses or alternating-air overlaysin patients who are at an increased risk of developingpressure ulcers. Foam dressings are encouraged versus standard pressure ulcer care. These recommendations combined reduce the risk of HAPU’s. Recommendation 1: ACP recommends that clinicians use protein or amino acid supplementation in patients with pressure ulcers to reduce wound sizeRecommendation 2: ACP recommends that clinicians use hydrocolloid or foam dressings in patients with pressure ulcers to reduce wound size.