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Acta Vulnologica 2005 March;3(1):31-44

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: Italian

Sepsis consequent on infected bedsores in the elderly: epidemiology and prevention of death risk. The experience of the Garbagnate Milanese Hospital

Gobbi P.

Azienda Ospedaliera “G. Salvini” Garbagnate Milanese, Milano

The prevention of the onset of bedsores and their treatment, especially in bed-ridden elderly patients, is today one of the most important aims of nursing services in hospitals within long-term care structures and in home/palliative treatment. In subjects who are already compromised, such as the elderly with multiple pathologies and/or in situations where the health assistance provided is poor or insufficient (quality- and quantity-wise) such lesions may give rise to complications at both local (infections of the bedsore and underlying tissues, osteomyelitis) and systemic (sepsis) levels. These complications are associated with a high mortality rate and thus involve health workers, particularly nurses and administrators, for 2 reasons: massive resources are needed for the treatment and assistance of such complex patients and strategies (on various levels: clinical, organisational and ethical) have to be implemented to prevent the onset of and, consequently, deaths related to infections and sepsis. The paper is subdivided into 3 parts: 1) the first describes the epidemiology of bedsores and their complications, with some mention of the diagnostic criteria for defining the infected lesion and the state of sepsis, and of the microbiology, treatment and preventive actions; 2) second, attention is paid to the epidemiology of deaths consequent on bedsores; in particular the service and economic fall-out and the ethical-legal aspects are analysed; 3) finally, the experience of the author at the Garbagnate hospital is presented; there an observatory of patients hospitalised with serious bedsores and other complications is active; in addition to the presentation of the results obtained in recent years, in terms of awareness of the problem, the present hopes to represent an invitation to create similar observatories in other hospital and residential health structures.