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Differences in prevalence of pressure ulcers between the Netherlands and Germany – associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes


  • Antje Tannen MA, RN, MPH,

  • Theo Dassen PhD, RN,

  • Ruud Halfens PhD

Antje Tannen
Charité– Universitätsmedizin Berlin
Department of Nursing Science
Charitéplatz 1
Berlin 10117
Telephone: 0049 3045 0529059


Aim.  This study compares pressure ulcer prevalence and prevention activities in nursing homes and hospitals within two European countries.

Background.  Over three years stable differences have been found between the Netherlands (NL) and Germany (GER) with higher pressure ulcer rates in the NL. As previous analyses have shown, the differences cannot be entirely explained by differences in the population’s vulnerability to pressure ulcers because they still remain after risk adjustment. Therefore, the differences in prevalence must be caused by other factors. The purpose of this study is to analyse if any potential differences in preventive activities can account for the varying occurrence of pressure ulcers.

Method.  In both countries, nation-wide surveys were conducted annually using the same standardised questionnaires. Trained nurses examined all consenting patients of the voluntarily participating facilities. This examination included a skin assessment of the entire body. Data regarding risk factors, prevention and details about wounds were then collected.

Results.  In-patients of 29 German (n = 2531) and 71 Dutch (n = 10 098) nursing homes and 39 German (n = 8515) and 60 Dutch (n = 10 237) hospitals were investigated. The use of pressure-reducing devices was more common in the NL than in GER, but all other interventions were more frequently provided to German risk patients than to their Dutch counterparts. The pressure ulcer prevalence was significantly higher in the Dutch sample. After adjusting for gender, age, Braden Score and prevention, the probability of having a pressure ulcer was 8·1 times higher for Dutch nursing home residents than for German residents.

Conclusion.  Some of the variance in pressure ulcer prevalence between the two countries can be explained by varying pressure ulcer prevention. However, some remarkable differences still remain unexplained.

Relevance to clinical practice.  The extent of pressure ulcer prevention, especially repositioning and nutrition intervention provided to patients at risk, is not in accordance with international guidelines.