PREVALENCE AND ASSOCIATED FACTORS WITH THE DEVELOPMENT OF PRESSURE ULCER IN ADULT INTENSIVE CARE AND HIGH DEPENDENCY UNIT AT SAINT PAUL`S HOSPITAL MILLENIUM MEDICAL COLLEGE

Abstract

Abstract Background: Pressure ulcer is a localized area of damage to the skin and/or underlying tissue, usually over a bony prominence, resulting from sustained pressure or pressure in combination with shear, as defined by the European Pressure Ulcer Advisory Panel (EPUAP). It is a largely preventable but serious health problem in both acute and chronic healthcare settings. Pressure ulcers impose a significant burden on patients, caregivers, and healthcare systems by increasing morbidity, mortality, length of hospital stay, and healthcare costs. Although pressure ulcer development is considered an indicator of quality of care, concerns remain regarding circumstances in which they may be unavoidable. Understanding the magnitude of the problem and identifying associated risk factors are essential for effective prevention. Objective: the prevalence and associated risk factors for the development of pressure ulcers at critical care settings (intensive care units and high dependency units) of Saint Paul's Hospital Millennium Medical College was assessed. Methods: An institution-based cross-sectional study was conducted at Saint Paul’s Hospital Millennium Medical College from September 2025 to January 2026. Data was collected using an interviewer-administered structured questionnaire and observational checklist. Data has been entered into and analyzed using appropriate statistical software. Binary logistic regression analysis was performed to identify factors associated with pressure ulcer development. Variables with a p value ≤ 0.25 in the bi-variable analysis were entered into multivariate logistic regression. Variables with a p-value < 0.05 at a 95% confidence interval is considered statistically significant. The Findings are presented using text, tables, and graphs. Results: The prevalence of pressure ulcers was 12.5% (28/224; 95% CI: 8.5–17.6%), with the sacra l area being the most commonly affected site (10.3%). Grade 1 ulcers were most frequent (6.3%). Independent predictors of pressure ulcer development included smoking (AOR = 202.96, 95% CI: 4.70–8764.32, p = 0.006), incontinence (AOR = 0.001, 95% CI: 0.000–0.22, p = 0.012), repositioning every 4 hours compared to every 2 hours (AOR = 110.29, 95% CI: 3.14–3874.07, p = 0.010), impaired level of consciousness (AOR = 0.27, 95% CI: 0.12–0.61, p = 0.002), and longer hospital stay (AOR = 2.67 per day, 95% CI: 1.61–4.43, p < 0.001). Age, BMI, sex, and Branden risk levels showed marginal associations but were not statistically significant after adjustment. The multivariate model showed excellent fit (Hosmer-Lemeshow χ² = 0.721, Df = 8, p = 0.999) and classified 96.9% of cases correctly. Conclusion: Pressure ulcers remain a significant concern among hospitalized patients at Saint Paul’s Hospital. Major risk factors included smoking, incontinence, less frequent repositioning, impaired consciousness, and prolonged hospitalization. Preventive strategies, including early risk assessment, frequent repositioning, and careful monitoring of high-risk patients, are essential to reduce the burden of pressure ulcers in hospital settings. Keywords: Pressure ulcer, prevalence, risk factors, cross-sectional study, quality of care