The General Practice edition of Research Review has recently published findings which identify some interesting risk factors associated with infection in patients with chronic leg ulcers. This study was coordinated in Queensland Australia.The study was titled Identifying risk factors associated with infection in patients with chronic leg ulcers.Authors: Bui U et al.
Summary: This cross-sectional study combined data from 4 longitudinal prospective studies to identify risk factors associated with infections in chronic leg ulcers. It was performed by researchers from the School of Nursing at the Queensland University of Technology and the Wound Management Innovation Cooperative Research Centre in Brisbane, using a sample of 561 patients previously recruited from outpatient clinics and community settings in Australia between 2008 and 2015. Wound infection prevalence was 7.8% (44 patients) at the time of study recruitment.
The study identified 7 significant risk factors for leg ulcer infection: depression, chronic pulmonary disease, taking anticoagulants, calf-ankle circumference ratio 1.3,ulcer area >10cm, ulcers with slough tissue and ulcers with heavy exudate.
Comment (VE): As chronic leg ulcers are hard to heal and infection delays that process further, early identification by clinicians of risk factors such as these can help prevent negative outcomes by early and appropriate interventions and wound care.This study found that those diagnosed with depression were 3 times more likely to develop infection than those without, and 2 times more likely to develop infection if they had chronic pulmonary disease.
Large ulcers and the presence of slough and heavy exudate would not be surprising risk factors to most practice nurses, however, anticoagulant medication may not have been considered a risk factor previously. Interesting to note was that this study did not find age, use of corticosteroids, or presence of comorbidities such as rheumatoid arthritis and peripheral vascular disease to increase the risk of leg ulcer infection. These factors have been identified in previous studies.
Other relevant issues such as malnutrition and surrounding skin were not able to be appropriately assessed in this study due to the small amount of data collected regarding these in the original studies. The findings of this study appear to be relevant and appropriate for those caring for people with leg ulcers in the primary care setting. The risk factors can be considered and simply identified when providing wound assessment and ongoing care. More studies are needed, however, to evaluate these risk factors further.
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Reference: Int Wound J 2018;15:283-90 Abstract
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