WHS Guidelines for the Treatment of Pressure Ulcers – 2023 update

Wound Repair Regen, 2024 · DOI: 10.1111/wrr.13130 · Published: January 1, 2024

Simple Explanation

These guidelines offer a compilation of the best available evidence for treating pressure ulcers since the 2015 update. They include a new section focused on palliative wound care for seriously ill patients. The goal is to provide clinicians with clear, concise, and unbiased recommendations for care and research. The guidelines address key areas such as positioning, support surfaces, nutrition, infection management, wound bed preparation, dressings, surgical treatment, and adjuvant therapies. Each section provides specific guidelines and principles for optimal patient care. The guidelines emphasize an interdisciplinary approach to pressure ulcer treatment, involving nurses, surgeons, primary care physicians, geriatricians, palliative medicine providers, and researchers. The team-based approach ensures a comprehensive and holistic approach to patient care.

Study Duration

January 2015 to January 2023

Participants

Not specified

Evidence Level

Ranges from Level I to Level III based on the specific guideline

Key Findings

1
Repositioning schedules and avoiding positioning patients on pressure ulcers are crucial for prevention. The exact turning interval is not known and is derived empirically.
2
Nutritional status is a significant factor in pressure ulcer prevention and treatment. Nutritional assessment should be performed on entry to a new healthcare setting.
3
Necrotic tissue impairs the body’s ability to fight infection. Necrotic tissue is laden with bacteria

Research Summary

The 2023 WHS guidelines provide updated recommendations for pressure ulcer treatment, incorporating new evidence and addressing palliative care. The overall goal of the Wound Healing Society Guideline project is to present clear, concise and commercial free guidelines. The guidelines cover various aspects of pressure ulcer management, including positioning, support surfaces, nutrition, infection, wound bed preparation, dressings, surgical options, and adjuvant therapies. The strength of evidence is rated from Level I to Level III. For patients with serious illness receiving palliative care, comfort and individualized care plans are prioritized in pressure ulcer management. Pre-medication with analgesic or sedative medication may allow for more frequent turning and skin care for those who have significant pain with position changes.

Practical Implications

Improved Clinical Practice

The guidelines provide evidence-based recommendations to enhance the quality of pressure ulcer care in various settings.

Research Directions

The guidelines highlight gaps in knowledge and areas for future research to improve pressure ulcer treatment outcomes.

Palliative Care Enhancement

The new section on palliative wound care offers specific guidance for managing pressure ulcers in seriously ill patients, emphasizing comfort and quality of life.

Study Limitations

1
Limited evidence from unbiased, randomized clinical trials for chronic wound treatment.
2
Terminology inconsistencies in pressure ulcer versus pressure injury definitions.
3
Ethical limitations for clinical trials involving patients receiving comfort-focused end-of-life care.

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