Of all patients in a hospital environment, trauma patients may be particularly at risk for developing (device-related) pressure ulcers (PUs), because of their traumatic injuries, immobility, and exposure to immobilizing and medical devices. Studies on device-related PUs are scarce. With this study, the incidence and characteristics of PUs and the proportion of PUs that are related to devices in adult trauma patients with suspected spinal injury were described. From January–December 2013, 254 trauma patients were visited every 2 days for skin assessment. The overall incidence of PUs was 28⋅3% (n = 72/254 patients). The incidence of device-related PUs was 20⋅1% (n = 51), and 13% (n = 33) developed solely device-related PUs. We observed 145 PUs in total of which 60⋅7% were related to devices (88/145). Device-related PUs were detected 16 different locations on the front and back of the body. These results show that the incidence of PUs and the proportion of device-related PUs is very high in trauma patients
Background: A new selective preventive spinal immobilization (PSI) protocol was introduced in the Netherlands. This may have led to an increase in non-immobilized spinal fractures (NISFs) and consequently adverse patient outcomes. Aim: A pilot study was conducted to describe the adverse patient outcomes in NISF of the PSI protocol change and assess the feasibility of a larger effect study. Methods: Retrospective comparative cohort pilot study including records of trauma patients with a presumed spinal injury who were presented at the emergency department of a level 2 trauma center by the emergency medical service (EMS). The pre-period 2013-2014 (strict PSI protocol), was compared to the post-period 2017-2018 (selective PSI protocol). Primary outcomes were the percentage of records with a NISF who had an adverse patient outcome such as neurological injuries and mortality before and after the protocol change. Secondary outcomes were the sample size calculation for a larger study and the feasibility of data collection. Results: 1,147 records were included; 442 pre-period, and 705 post-period. The NISF-prevalence was 10% (95% CI 7-16, n = 19) and 8% (95% CI 6-11, n = 33), respectively. In both periods, no neurological injuries or mortality due to NISF were found, by which calculating a sample size is impossible. Data collection showed to be feasible. Conclusions: No neurological injuries or mortality due to NISF were found in a strict and a selective PSI protocol. Therefore, a larger study is discouraged. Future studies should focus on which patients really profit from PSI and which patients do not.
Early mobilisation after abdominal surgery is necessary to avoid complications and increase recovery. However, due to a variety of factors, failure of early mobilisation is seen in clinical practice. The aim of this study is to investigate the perspectives of nurses and patients of the Haaglanden Medical Center (HMC) how to increase mobilisation frequency after colorectal surgery in the oncological surgery ward. This explorative study employed qualitative data collection and analysis by means of semi-structured interviews with patients and nurses. Patients were included when they had a colorectal resection, were older than 18 years and spoke Dutch. The interviews were audiotaped and verbatum transcribed. A thematic content analysis was performed. It was concluded that mobilisation can be increased when it is incorporated in daily care activities and family support during visiting hours. Appropriate information about mobilisation and physical activity is needed for nurses, patients and family and the hospital environment should stimulate mobilisation.
About 35-40 kton used mattresses available yearly for the recycling only in the Netherlands. Mattresses that are offered at recycling companies, municipal yards and retailers often find their way to incinerators. However, several fraction components of used mattresses can be reused/resale in a useful manner. One of the mattress fractions is textile cover with residue of Polyurethane (PU) foam. Effective removal of PU foam would enable further reuse of textile materials. Use of harsh chemicals/ thermo-, photo-, oxidative, processes including hydrolysis, aminolysis, phosphorolysis, glycolysis etc [1,2] for PU foam degradation is not a good solution, since it will cause non-specific damage to textiles and other parts, making recycle/ reuse difficult. Therefore, Mattress Recycling Europe BV (MRE) is looking for an eco-friendly mild process for selective degradation of PU foam component. PU is a mixed polymer; therefore, it is important to establish the physio-chemical nature of PU before identifying suitable and sustainable degradation route. The proposed solution is selective degradation of PU polymer using biotechnology. Enzymatic bio-catalysis enables a targeted, specific reaction at mild process conditions (pH, temperature) without harming other components in the process. Primarily hydrolase class of enzymes is assumed to be among the most effective options for the proposed degradation of PU foam residue [3,4]. From previous research, adding mechanical shear provides a synergistic effect for enzyme catalysed reaction [5-7]. Therefore, within the scope of this exploratory practice-oriented project, technical feasibility of bio-catalyst and shear (including well established PU degradation techniques) towards the selective degradation of PU foam residue attached to textile part from used mattresses will be explored together with cost estimation of the overall process and re-usability of enzymes using suitable immobilisation technique, addressing an urgent industrial need in the field of green chemistry.
