Wound infection is a life-threatening problem in pressure ulcers and still develops despite interventions to reduce bioburden on wounds and periwound skin. We focused on the bed environment as the hotbed for bacteria on the wound because many patients with pressure ulcers are immobile. However, the formation process of the bed microbiota remains unclear. This study aimed to investigate the temporal changes in the diversity and composition of the bed microbiota of one patient each with an infected pressure ulcer, non-infected pressure ulcer, and without a pressure ulcer. Microbiome samples were obtained from three areas, namely the bed sheet area around the buttocks, center of the wound, and periwound skin for 7 consecutive days. The microbiota were determined by 16S ribosomal RNA gene sequencing. Sequences were clustered into operational taxonomic units, and diversity indices were calculated. Regarding the evaluation of temporal changes, the day following the changing of bed sheets was designated as the starting point. The analysis of alpha diversity showed no significant changes in bed environment over time, and this was evident in all patients. In addition, the temporal change in the composition of bed microbiota for the patient with a pressure ulcer was greater than for the patient without a pressure ulcer. This finding suggests that the bed environment is a source of wound microbiota, and the presence of a pressure ulcer is likely to affect the bed environment. Interventions in the bed environment may be effective to prevent wound infection.
Objective: Skin tears cause pain and distress for patients, and it is important to educate nurses regarding skin tear prevention. This study aimed to investigate the effectiveness of a nursing education regarding skin tear prevention in a Japanese long-term care hospital. Methods: A pre-post study was conducted at a 736-bed long-term care facility in Tokyo, Japan (December 2018 to August 2019). Nurses attended a skin tear prevention seminar, which provided information regarding the definition of skin tears, risk factors, a skin tear classification system, treatment, preventive care, and various related products (arm protectors, dressings, and skin friendly silicone adhesive tapes). The primary outcome for evaluating the effectiveness of the education program was the incidences of skin tears during the 1-month period before the seminar and during the 6-month period after the seminar. Results: Forty-two nurses were recruited and attended the educational seminar, and 97 older adults consented to evaluations of their forearm skin. The care products introduced in the hospital after the educational seminar were skin moisturizers, silicon medical tapes, silicone foam dressings, and arm protectors. The incidence of skin tears was 2.1% during the 1-month period before the seminar. During the 6-month period after the seminary, the monthly incidences of skin tears were 4.2% during the first month after the seminar, 1.1% during the next 4 months, and 0.0% during the sixth month. Conclusion: Education regarding skin tear prevention may help nurses better identify and prevent skin tears.