To the Editor.
—In the excellent article by Dr Allman and colleagues1 discussing pressure ulcer risk factors, the most important risk factor of all has been omitted, that is, the staff taking care of the patient. The so-called high-risk factors causing patients to develop pressure ulcers are well known to all. In addition, the means of preventing pressure ulcers are well known. So what is the problem? If you surveyed rehabilitation hospitals across the country and evaluated the same high-risk patients, you would find the incidence of pressure ulcers would be minimal.2 As these same high-risk patients are cared for in less-skilled environments where staff numbers and training are less, where pressure-relieving specialty beds are not as available, and where the accountability for the level of care is less, the incidence of pressure ulcers will dramatically increase. The common denominator is the staff.The article by Allman et
Olshansky K. Nursing Care and Development of Pressure Ulcers. JAMA. 1995;274(13):1014. doi:10.1001/jama.1995.03530130020016