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Pressure ulcers and incontinence-associated dermatitis: effectiveness of the Pressure Ulcer Classification education tool on classification by nurses
  1. Dimitri Beeckman1,2,
  2. Lisette Schoonhoven3,
  3. Jacqui Fletcher4,
  4. Katia Furtado5,
  5. Hilde Heyman6,7,
  6. Louis Paquay8,9,
  7. Dirk De Bacquer1,
  8. Tom Defloor1
  1. 1Department of Public Health, Ghent University, Gent, Belgium
  2. 2Department of Bachelor in Nursing, University College Arteveldehogeschool Ghent, Gent, Belgium
  3. 3IQ Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  4. 4School of Nursing and Midwifery, University of Hertfordshire, Hatfield, UK
  5. 5Centro de Saude de Arronches, Portalegre, Portugal
  6. 6Nursing Home Sint Bartholomeus, Antwerp, Belgium
  7. 7Wound care Consultant Society (WCS), Belgium
  8. 8Wit-Gele Kruis van Vlaanderen, Brussels, Belgium
  9. 9Academic Centre for General Practice, KULeuven, Leuven, Belgium
  1. Correspondence to Mr Dimitri Beeckman, Nursing Science, Ghent University, UZ Block A 2nd Floor, De Pintelaan 185, Gent B-9000, Belgium; dimitri.beeckman{at}


Context Previous studies report that pressure ulcer classification and differentiation from incontinence associated dermatitis are difficult. Incorrect classification and differentiation result in incorrect prevention and treatment. Education is important to spread evidence-based insights about this topic and to improve classification skills.

Aim To assess the effectiveness of the Pressure Ulcer Classification (PUCLAS) education tool. PUCLAS was developed by the PUCLAS Workgroup of the European Pressure Ulcer Advisory Panel.

Design Randomised controlled trial.

Setting and participants A convenience sample of 1217 Belgian, Dutch, British and Portuguese nurses.

Outcome measure Correct classification of pressure ulcer photographs and differentiation from photographs of incontinence-associated dermatitis.

Results Baseline, 44.5% of the photographs were classified correctly. In the post-test, the results in the intervention group were significantly higher (63.2%) compared with the control group (53.1%; p<0.001). The percentage of correct assessments of incontinence associated dermatitis (IAD) was 70.7% in the intervention group and 35.6% in the control group (p<0.001). The skill to differentiate IAD from pressure ulcers was significantly associated with the experimental intervention (OR 4.07, 95% CI 3.21 to 5.15, p<0.001).

Conclusion The PUCLAS tool improved pressure ulcer classification and IAD differentiation significantly.

  • Pressure ulcer
  • classification
  • education
  • incontinence associated dermatitis
  • nurses

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  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Ethics Committee of Ghent University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.