As the Guideline Development Group representative for the New Zealand Wound Care Society (NZWCS), PAM MITCHELL was pleased to be involved in the creation of the 2014 International Guideline: Prevention and Treatment for Pressure Ulcers: Clinical Practice Guideline.

Representatives from the New Zealand Wound Care Society collaborated with colleagues from around the world in creating the 2014 International Guideline, Prevention and Treatment for Pressure Ulcers: Clinical Practice Guideline. The new guideline was launched at the European Pressure Ulcer Advisory Panel (EPUAP) conference in Stockholm on 27 August this year by chairperson of the Guideline Development Group Dr Lisette Schoonhoven.

It provides the best practice evidence for the implementation of preventative strategies in regard to pressure injury.

Building the Guideline – a global effort

The 2014 International Guideline, Prevention and Treatment for Pressure Ulcers: Clinical Practice Guideline, is the culmination of two years of work.

The invitation in 2012 by the NPUAP/EPUAP (North American and European Pressure Ulcer Advisory Panel) group to update their guidelines opened the door for Pan-Pacific Pressure Injury Prevention (PPPIP) members to work on these from a global viewpoint.

Pressure injuries (also known as pressure ulcers, bed sores, or decubitus ulcers) create a cost of millions of health dollars per year internationally. In Australia alone, the cost in 2005 was $285 million nationally. New Zealand does not hold national database figures. Therefore, the costs associated with pressure injuries and the extent of the problem is largely unknown. A number of New Zealand District Health Boards do conduct prevalence and incidence studies but data collection tools, as well as reporting the findings, are inconsistent.

There should be little doubt that New Zealand’s pressure injuries are comparable with those in Australian care facilities. Some estimates for acute and sub-acute healthcare facilities are between six and 48 per cent, and around 26 per cent for long-term care.

Pressure injuries have a profound physical and psychological effect on their recipients, aside from the pain, anxiety, loss of income, and limitations in function that the person may experience. They can also cause death.

The New Zealand Wound Care Society began to work more closely with our Australian and Pan-Pacific colleagues. This aim climaxed in the publication of the Pan Pacific Clinical Practice Guidelines for the Prevention and Management of Pressure Injury Guidelines (PPCPG) in 2012.

Highlights of the new Guideline

The new 2014 International Guideline builds on the evidence base surrounding pressure injuries. It contains many new recommendations and new sections. Some address the specific needs of special populations, including obese individuals, critically ill individuals, older adults, paediatric individuals, palliative care patients, and patients in operating rooms. These chapters will support us in our daily practice and improve our knowledge and management of these vulnerable groups.

Each recommendation has both strength of evidence (evidence base indicating volume and quality of evidence) and strength of recommendation (the extent to which one can be confident that adherence to a recommendation will do more good than harm) which are based on rigorous methodological standards and will support health professionals in their decision-making.

Contemporary issues such as biofilms, the use of prophylactic dressings, microclimate control, the development of medical-device-related pressure ulcers, and the use of low-friction fabrics are also covered. This new research and technology will challenge us, increase our knowledge, and provide innovative ways of addressing these issues that will benefit our patients.

The NPUAP/EPUAP International Pressure Ulcer Classification system is complete with category/stage descriptions and illustrative photography is included.

Implementation can be challenging, and to this end, there are four chapters to assist in the implementation of the guideline within organisations.

The guideline is relevant to all clinicians, consumers, administrators, educators, researchers, policy makers, and industry. The section for consumers is a demonstration of its versatility, written in lay language, to further increase the guideline’s use.

Stop Pressure Injury Day

The new guideline is just part of a wider campaign to increase the profile of pressure injuries and optimise the care of people most at risk. Another strategy, The International Stop Pressure Ulcer/Injury Day, is aimed to raise awareness and is held annually on the third Thursday in November, this year on 20 November.

The NZWCS encourages facilities to organise activities around this day, making use of the resources available for download on its website (, to help increase the profile of pressure injury awareness.

References are available on request.

Guideline Development Group Members:

Dr. Diane Langemo (chair)
Dr. Janet Cuddigan
Mrs. Laurie L. McNichol
Dr. Joyce K. Stechmiller

Dr. Lisette Schoonhoven (chair)
Prof. Dr. Michael Clark
Dr. Jan Kottner
Dr.Ir.Cees Oomens

Prof. Keryln Carville (chair) (Australia)
Mrs. Susan Law (Hong Kong)
Ms. Pam Mitchell (NZ)
Ms. Ai Choo Tay (Singapore)

Dr. Takafumi Kadono (Observer)


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