1
|
Zhang N, Li Y, Li X, Li F, Jin Z, Li T, Ma J. Incidence of medical device-related pressure injuries: a meta-analysis. Eur J Med Res 2024; 29:425. [PMID: 39155379 PMCID: PMC11331740 DOI: 10.1186/s40001-024-01986-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Medical device-related pressure injures (MDRPIs) are common in critically ill patients and associated with negative clinical outcomes and elevated healthcare expenses. We aim to estimate worldwide incidence of MDRPI and explore associated factors through systemic review and meta-analysis. METHODS The PubMed, Web of Science, Cochrane Library, and Ovid EMBASE databases were systematically queried to identify relevant studies published from Jan 1, 2010 up until June 30, 2024. Studies were included if they provided data on the incidence or prevalence of MDRPI. Random-effect models were utilized to calculate the overall or domain-specific aggregated estimates of MDRPI. A meta-regression analysis was additionally performed to investigate the heterogeneity among studies. RESULTS We included 28 observational studies on 117,624 patients in the meta-analysis. The overall incidence of MDRPI was 19.3% (95% confidence interval (CI) 13.5-25.2%). The incidence of MDRPI in Europe, North America, Asia, South America, and Oceania was 17.3% (95% CI 12.7-21.9%), 3.6% (95% CI 0.0-8.5%), 21.9% (95% CI 14.3-29.6%), 48.3% (95% CI 20.8-75.7%), and 13.0% (95% CI 5.0-21.1%), respectively (p < 0.01). Multivariate meta-regressions revealed South America and special inpatient (critically ill patient, etc.) were independently associated with higher MDRPI incidence. CONCLUSIONS Nearly, 20% of the patients in ICU suffered from MDRPI. The incidence of MDRPI in underdeveloped regions is particularly concerning, highlighting the importance of focusing on measures to prevent it, in order to reduce the medical burden and enhance the quality of life for affected patients.
Collapse
Affiliation(s)
- Ning Zhang
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Yanan Li
- Department of General Surgery, Western Medical Branch of PLA General Hospital, Beijing, 100144, China
| | - Xiaogang Li
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Fangfang Li
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Zhaofeng Jin
- Department of General Surgery, Huatan Hospital of Hechuan, Chongqing, 401520, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China.
| | - Jinfu Ma
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China.
| |
Collapse
|
2
|
Neill S, Martin D. Nursing care bundles in the prevention of medical device related pressure ulcers: An integrative review. J Tissue Viability 2024; 33:376-386. [PMID: 38641481 DOI: 10.1016/j.jtv.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
The aim of this integrative review was to explore the effect of care bundles in the prevention of Medical Device Related Pressure Ulcers (MDRPU). An MDRPU is a wound that occurs on the skin or mucosal membranes because of pressure or pressure in combination with shear. Like other types of pressure ulcers, they will have negative consequences for patients and healthcare organisations alike. Many MDRPU's are preventable. A literature search was undertaken from computerised databases using key search terms, Pressure Ulcer* Pressure Injur* and Medical Device*. Databases included CINAHL; Medline and SocIndex. A total of seven studies were found that met the criteria for inclusion in this review. When compared to the widely recognised and trusted international guidelines there was variation found between the individual interventions selected within each study for inclusion within the bundle. Skin assessment and device repositioning were the most frequently included interventions in the bundles, followed by use of prophylactic dressings, appropriate device selection and fitting. The least common intervention was monitoring the tension of the device and/or its securements. All studies reported a reduction in the number of MDRPU's when care bundles were used in clinical practice. However, there is variation in bundle designs and study methodologies employed. This review has demonstrated the potential benefit of care bundles in reducing MDRPU. However, due to heterogeneity in the study methods employed and the interventions within the care bundles, further, more robust research is required to establish which interventions show the most clinical and patient benefit.
Collapse
Affiliation(s)
- Sharon Neill
- School of Nursing and Paramedic Science, Ulster University, Northern Ireland.
| | - Daphne Martin
- School of Nursing and Midwifery, Queens University Belfast, Northern Ireland.
| |
Collapse
|
3
|
Bueno LF, Coelho MDMF, Cortez DN, Moraes JT. Incidence and Risk Factors for Medical Device-Related Pressure Injury in Hemodynamically Unstable Intensive Care Unit Patients: A Prospective Cohort Study. J Wound Ostomy Continence Nurs 2024; 51:276-282. [PMID: 38809889 DOI: 10.1097/won.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE The purpose of this study was to determine the incidence and identify potential risk factors for medical device-related pressure injury (MDRPI) in critically ill and hemodynamically unstable adults (patients classified class III or IV on the Therapeutic Intervention Scoring System-28; TISS-28). DESIGN Prospective cohort study. SUBJECTS AND SETTING The target population was critically ill adults who were using one or more medical devices and categorized as class III or IV on the TISS-28. The study sample comprised 77 participants followed daily until discharge, death, transfer, or lesion development. Data were collected from January to March 2020. The study setting was an intensive care unit with 40 beds in a large hospital in a municipality in the state of Minas Gerais, Brazil. METHODS Sociodemographic and pertinent clinical data, pressure injury (PI) risk assessed using the Braden Scale for Pressure Sore Risk, and head-to-toe skin inspections were completed. The incidence rate of MDRPIs was calculated, and survival analyses were completed via the Kaplan-Meier method and Cox regression model. RESULTS Forty-nine of 77 participants developed an MDRPI, reflecting an incidence rate of 63.6%. Collectively, 71 MDRPIs occurred in these 49 participants. Univariate analysis indicated significant associations between MDRPI occurrences and level of consciousness ( P = < .001), use of tube holder for ventilation devices ( P = .013), nasal cannula ( P = .034), nasogastric cannula ( P = .034), presence of edema ( P = .001), infection ( P = .007), higher TISS score ( P = .047), and greater number of medical devices ( P = .022). Survival analysis indicated that a high or very high-risk score on the Braden Scale for Pressure Sore Risk ( P = .043) and edema ( P = .030) are risk factors for MDRPI occurrences in this vulnerable population. CONCLUSIONS The incidence rate of MDRPIs was 63.6%. The categories with the highest high or very high risk scores on the Braden Scale for Risk of Pressure Pain and Edema emerged as risk factors for MDRPI in this critically ill and vulnerable population.
Collapse
Affiliation(s)
- Luana Furtado Bueno
- Luana Furtado Bueno, RN, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
- Manuela de Mendonça Figueirêdo Coelho, PhD, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Daniel Nogueira Cortez, PhD, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
- Juliano Teixeira Moraes, PhD, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Manuela de Mendonça Figueirêdo Coelho
- Luana Furtado Bueno, RN, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
- Manuela de Mendonça Figueirêdo Coelho, PhD, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Daniel Nogueira Cortez, PhD, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
- Juliano Teixeira Moraes, PhD, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Daniel Nogueira Cortez
- Luana Furtado Bueno, RN, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
- Manuela de Mendonça Figueirêdo Coelho, PhD, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Daniel Nogueira Cortez, PhD, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
- Juliano Teixeira Moraes, PhD, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Juliano Teixeira Moraes
- Luana Furtado Bueno, RN, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
- Manuela de Mendonça Figueirêdo Coelho, PhD, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Daniel Nogueira Cortez, PhD, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
- Juliano Teixeira Moraes, PhD, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| |
Collapse
|
4
|
Erbay Dallı Ö, Kelebek Girgin N. Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence. Intensive Crit Care Nurs 2024; 82:103622. [PMID: 38215558 DOI: 10.1016/j.iccn.2024.103622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To determine the effect of the training given to intensive care unit (ICU) nurses to prevent medical device-related pressure injuries (MDRPIs) on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs. RESEARCH METHODOLOGY/DESIGN A pre-post test intervention study without a control group. SETTING The study was conducted between May and July 2023 with ICU nurses in three phases: pre-training phase (E0) (104 nurses, 116 patients), training implementation phase (E) and post-training phase (E1) (89 nurses, 120 patients). MAIN OUTCOME MEASURES The data were collected by using the Patient (E0, E1) and Nurse (E0) Characteristic Forms, MDRPI Follow-up and Prevalence Form (E0, E1), D.E.V.I.C.E Performance Observation Checklist (E0, E1), MDRPI Knowledge Assessment Questionnaire (E0, E1), Braden Pressure Ulcer Risk Assessment Scale (E0, E1), Pressure Injury Grading Form (E0, E1), and Feedback Form about the Training Process (E). RESULTS The mean MDRPI knowledge score of the nurses increased significantly from E0 to E1 (13.23 ± 1.43 vs. 20.02 ± 1.30, p = 0.001), with the highest improvement in the staging and prevention themes. Nurses' MDRPI prevention performance increased significantly from E0 to E1 (2.15 ± 1.01 vs. 11.17 ± 1.65, p = 0.001). There was a significant difference between the PP rate at E0 (61.2 %) and E1 (27.5 %) (p = 0.001). CONCLUSION The study indicated that the training on MDRPIs given to ICU nurses increased their knowledge and prevention performance and decreased the prevalence of MDRPIs. However, further studies with a larger sample size are needed to confirm these findings. IMPLICATIONS FOR CLINICAL PRACTICE Since MDRPIs have more complex staging and prevention practices than conventional PIs, they require the adoption of a training approach that includes visual materials and practical methods in addition to theoretical knowledge. Accurate definitions of medical device dimensions and fixation, skin assessment, and prevention practices will lead to the desired outcome of reducing MDRPIs in ICUs.
Collapse
Affiliation(s)
- Öznur Erbay Dallı
- Bursa Uludag University Faculty of Health Sciences, Department of Internal Medicine Nursing, Nilüfer, BURSA 16059, Turkey.
| | - Nermin Kelebek Girgin
- Bursa City Hospital, Department of Anesthesiology and Reanimation, Division of Intensive Care, Nilüfer, BURSA 16110, Turkey
| |
Collapse
|
5
|
Lyu Y, Cui H, Liu Y, Lin F. Current perception and knowledge of preventing medical device related pressure injury among nursing staff in intensive care units: A national descriptive cross-sectional study. Intensive Crit Care Nurs 2024; 82:103656. [PMID: 38359599 DOI: 10.1016/j.iccn.2024.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Sufficient knowledge is crucial for nurses in intensive care unit to prevent medical device related pressure injuries. This study was aimed to explore the Chinese intensive care nurses' perceptions and knowledge of medical device related pressure injury prevention and identify associated factors. METHODS This descriptive cross-sectional study included a convenience sample of 1286 intensive care nurses recruited from professional networks across China. Participants completed the demographic data form and the adapted 23-item Medical device related pressure injury Knowledge Assessment Questionnaire (MKAQ) questionnaire. Multiple linear regression was used to determine the associated factors. RESULTS The medical device related pressure injury knowledge assessment questionnaire scores among intensive care nurses were relatively high, with a correct rate of 78.3 %. Multiple regression analysis revealed that management position (β = 0.131, P < 0.001) was the strongest associated factor of knowledge scores, followed by academic position (β = 0.114, P = 0.009) and received training on medical device related pressure injury (β = 0.112, P < 0.001). Hospital level (β = 0.087, P = 0.004) and sex (β = 0.068, P = 0.016) were also significant associated factors. Collectively, these five variables accounted for 18.2 % of the variance in knowledge scores. CONCLUSION Sufficient knowledge is a prerequisite for safe nursing practice. Although nurses demonstrated relatively high level of knowledge, it is essential for nursing managers to implement specific measures to enhance the knowledge among junior nursing staff, especially in non-tertiary hospitals, to promote medical device related pressure injury prevention in all intensive care settings. IMPLICATIONS FOR CLINICAL PRACTICE This study highlights the importance of sociodemographic and professional characteristics in promoting satisfactory perception and knowledge of preventing medical device related pressure injury among intensive care nurses. It is necessary for nurse managers and leaders to develop strategic interventions, along with targeted training programs and quality improvement plans that correspond to the actual training needs to improve the medical device related pressure injury prevention.
Collapse
Affiliation(s)
- Yang Lyu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Honghong Cui
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Frances Lin
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, Australia; Caring Futures Institute, Flinders University, Bedford Park, Adelaide, Australia
| |
Collapse
|
6
|
Jia L, Deng Y, Xu Y, Wu X, Liu D, Li M, Huang S, Zhang Y, Du A, Liu H, Tian Y. Development and validation of a nomogram for oral mucosal membrane pressure injuries in ICU patients: A prospective cohort study. J Clin Nurs 2024. [PMID: 38797947 DOI: 10.1111/jocn.17296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/12/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
AIMS Establishing a nomogram to estimate the probability of oral mucosal membrane pressure injury of endotracheal tube-intubated hospitalized patients in intensive care unit. DESIGN Multicentre prospective cohort study. METHODS Using Lasso regression and COX regression, variable selection was performed on demographic, clinical and laboratory data of 1037 ICU endotracheal tube-intubated hospitalized patients from West China Hospital, to construct a nomogram. External validation was conducted on 484 ICU endotracheal tube-intubated patients from People's Hospital of Zhongjiang County. RESULTS Among 38 potential predictors, five variables emerged as independent predictors, integrated into the nomogram: administration of antibiotics, nutritional therapy duration, agitation, hypotension and albumin levels. CONCLUSIONS We established a nomogram based on the hospital characteristics of ICU endotracheal tube-intubated patients, aiding in the prediction of the occurrence of oral mucosal membrane pressure injury. REPORTING METHOD The study followed TRIPOD guidelines. RELEVANCE TO CLINICAL PRACTICE The nomogram we developed can assist clinical worker in better identifying at-risk patients and risk factors. It enables the implementation of evidence-based nursing interventions in care to prevent the development of oral mucosal membrane pressure injury. TRIAL REGISTRATION The study has been registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) under registration number ChiCTR2200056615.
Collapse
Affiliation(s)
- Lingli Jia
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuchun Deng
- Department of Critical Care Medicine, People's Hospital of Zhongjiang County, Zhongjiang, Sichuan Province, China
| | - Yu Xu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoli Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Critical Care Medicine, People's Hospital of Zhongjiang County, Zhongjiang, Sichuan Province, China
| | - Muying Li
- Department of Critical Care Medicine, People's Hospital of Zhongjiang County, Zhongjiang, Sichuan Province, China
| | - Shijun Huang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yaodan Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Aiping Du
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Huan Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongming Tian
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Yilmaz Akyaz D, Cevizci T, Sengul T. Everyday Prevention: The Impact of Daily Comprehensive Skin Assessments on Pressure Injury Healing in the General ICU. Adv Skin Wound Care 2024; 37:248-253. [PMID: 38648237 DOI: 10.1097/asw.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To investigate the effect of daily versus weekly comprehensive skin assessments on wound healing status in patients with pressure injuries (PIs) treated in the general ICU. METHODS This quasi-experimental study was conducted at a foundation hospital from November 15, 2022, to March 15, 2023. The sample consisted of 193 patients with PIs who met the inclusion criteria. The Braden Scale, Nutritional Risk Scale 2002 (NRS-2002), and Pressure Ulcer Scale for Healing (PUSH) were used. The intervention group (n = 98) underwent comprehensive skin assessment every day, whereas the control group (n = 95) followed routine procedures. The study findings were reported according to TREND (Transparent Reporting of Evaluations with Non-randomized Designs) guidelines. RESULTS Patients were older adults, with a mean age of 70 ± 15.45 years in the intervention group and 71 ± 13.20 years in the control group. The mean NRS-2002 score was 3 ± 2.01 in the intervention group and 2 ± 1.38 in the control group. Medical device-related PI incidence was high in both groups (intervention: 36.8%, control: 24.5%). In the intervention (14.3%) and control (50%) groups, PIs developed mostly due to antiembolic stockings. Deep-tissue PIs were the most common (intervention: 56.8%, control: 62.2%). The last PUSH scores decreased in both groups. The difference between the PUSH scores of the intervention and control groups was statistically significant (P < .05). CONCLUSIONS The findings of this study demonstrate the critical role of daily comprehensive skin assessment in the healing process of PIs. Especially in ICUs, the study provides compelling evidence for the need to prioritize and implement regular skin assessments to prevent PIs and support the healing process.
Collapse
Affiliation(s)
- Dilek Yilmaz Akyaz
- At Koç University Hospital, İstanbul, Turkey, Dilek Yilmaz Akyaz, MSc, RN, and Tugba Cevizci, RN, are Wound and Ostomy Care Nurses. Tuba Sengul, PhD, RN, CWON, is Associate Professor, Koç University. Acknowledgments: The authors thank all institutions and Sena Sukran Gura, Busra Serap Seyyar, and Nihan Tiryakioglu for their contributions to the study. The authors have disclosed no financial relationships related to this article. Submitted January 5, 2023; accepted in revised form March 14, 2023
| | | | | |
Collapse
|
8
|
Coyer F, Delaney L, Ingleman J. Preventing pressure injuries in intensive care unit patients compared to non-intensive care unit patients: Is it any different? Intensive Crit Care Nurs 2024; 81:103586. [PMID: 38016400 DOI: 10.1016/j.iccn.2023.103586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Fiona Coyer
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Lori Delaney
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Jessica Ingleman
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| |
Collapse
|
9
|
Dirgar E, Gider NY, Tosun B. Determination of Incidence and Risk Factors of Medical Device-Related Pressure Injury in the ICU: A Descriptive Study. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38393711 DOI: 10.1097/asw.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To determine the incidence and risk factors of medical device-related pressure injury (MDRPI) in the ICU. METHODS In this descriptive study, the researchers collected data through systematic observation of patients (n = 58) in the ICU. The patients were evaluated within 24 hours of ICU admission and then followed up until they were discharged. A total of 482 patient-days were followed. The researchers used the MDRPI follow-up form, the patient descriptive form, the MDRPI follow-up form, and the Braden Scale for Predicting Pressure Sore Risk for data collection. RESULTS Overall, 39.7% of the 58 patients hospitalized in the ICU developed an MDRPI, and 5.2% of the MDRPIs were evaluated as stage 2. These injuries occurred in an average of 5 days after the patient was admitted to the ICU. Among the MDRPIs that developed, 31.9% were located in the nose, 21.3% in the mouth, and 14.9% on the cheeks. Intubation tubes were used in 7.3% of the patients, nasogastric tubes in 22.4% of the patients, and radial artery catheters in 10.5% of the patients. CONCLUSIONS The development of MDRPI is correlated with the type of medical device used. Providers should establish a planned care protocol based on the anatomic placement of the medical device and take necessary precautions to prevent MDRPI.
Collapse
Affiliation(s)
- Ezgi Dirgar
- Ezgi Dirgar, PhD, RN, is Assistant Professor, Department of Midwifery, Faculty of Health Sciences, Gaziantep University, Turkey. Neslihan Yağmur Gider, MSc, RN, is Nurse, Ceyhan State Hospital, Adana, Turkey. Betül Tosun, PhD, RN, is Associate Professor, Department of Nursing, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey. The authors have disclosed no financial relationships related to this article. Submitted April 4, 2023; accepted in revised form July 24, 2023
| | | | | |
Collapse
|
10
|
Chen G, Li X, Li X, Liu S, Xie J. Mucosal membrane pressure injury in intensive care units: A scoping review. Intensive Crit Care Nurs 2024; 80:103560. [PMID: 37918080 DOI: 10.1016/j.iccn.2023.103560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023]
Abstract
AIM To describe published work on the current situation of mucosal membrane pressure injury of patients in the intensive care unit. BACKGROUND Device-related pressure injuries in critically ill patients are mostly focused on skin surface injuries, and less attention is paid to mucosal membrane pressure injury. METHODS We searched PubMed, Embase, Web of Science, CINAHL, and Cochrane Library from database construction until March 1, 2023. Two researchers independently screened and extracted data. RESULTS Eighteen articles met our criteria and were published in 2014-2023. The included studies showed that the incidence of mucosal membrane pressure injury in critically ill patients ranged from 0.83% to 88.2%, and the prevalence ranged from 0.16% to 55.6%. The most frequently reported site of mucosal injury is the oral mucosa, followed by the nasal mucosa. Ten studies used Braden to assess the risk of mucosal membrane pressure injury, and only six studies reported specific stages of mucosal membrane pressure injury. Thirteen studies described 30 risk factors for mucosal membrane pressure injury, with albumin being the most frequently reported risk factor, followed by the vasoconstrictive drugs use. Thirty risk factors were summarized in six aspects: medical device-related factors, disease-related factors, treatment- related factors, physiological and biochemical parameters, demographic-related factors, and microbial colonisation. CONCLUSIONS The incidence or prevalence of mucosal membrane pressure injury varies widely, and specific risk assessment tools and standardized staging criteria need to be further determined. The risk factors of mucosal membrane pressure injury involve multiple aspects, and some risk factors have only been explored in few studies and need to be further verified, in order to detect the risk group of mucosal membrane pressure injury early and take targeted preventive measures. IMPLICATIONS FOR CLINICAL PRACTICE We synthesized the current research status of mucosal membrane pressure injury in critically ill patients, which can provide a valuable reference for the clinical staff to develop preventive and management measures for such patients.
Collapse
Affiliation(s)
- Guanjie Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Xiaoqing Li
- Department of Nursing, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.
| | - Xuezhu Li
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| |
Collapse
|
11
|
Aydım Kudu A, Taşdemir N, Sönmez M. Incidence of medical device-related pressure injuries in the intensive care unit and related risk factors. J Tissue Viability 2023; 32:564-571. [PMID: 37407387 DOI: 10.1016/j.jtv.2023.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/18/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
AIM At present, physicians employ medical devices extensively in the treatment of numerous diseases and in the care and follow-up of patients. However, these medical devices are a potential cause of pressure injuries.The study aimed to investigate the incidence and affecting risk factors of medical device-related pressure injuries (MDRPIs) in an adult intensive care unit. MATERIALS AND METHODS This is a longitudinal descriptive/analytical and cross-sectional study. The researchers conducted this study with 213 intensive care patients between 15.06.2021 and 15.12.2021. The skin and mucosa under and around each medical device were observed once a day for MDRPIs during the stay of patients who had been hospitalized in the intensive care unit for at least 24 h. The data were collected using Patient Information Form developed by the researchers based on the literature, Medical Device-Related Pressure Injury Monitoring Form, the Jackson/Cubbin Pressure Area Risk Calculator (Jackson/Cubbin BARHATr)-Turkish Version, the National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System and the Glasgow Coma Scale. RESULTS The incidence of MDRPIs was 28.6% (61/213). The study revealed that 48.4% (46/95) of these injuries were caused by medical devices for respiratory system, 26.3% (25/95) by devices for gastrointestinal and genitourinary system. The study also revealed that 70.5% of MDRPIs occurred on the skin and 29.5% on the mucosal membrane, and that 82.1% of the MDRPIs occurring on the skin were at Stage 1. In terms of anatomical location, 21.1% of these injuries developed on the fingers and 13.7% on the mouth/lip. In multivariate analysis, parenteral + enteral (p = 0.006, OR = 0.083, 95%CI = [0.014-0.497]) and oral nutrition (p = 0.037, OR = 0.210, 95%CI = [0.049-0.908]), a higher number of devices (nine or more) (p = 0.002, OR = 5.387, 95%CI = [1.840-15.772]) and the duration of device wear (p < 0.05) were identified as independent risk factors for the occurrence of MDRPIs. CONCLUSIONS The study showed that the incidence of MDRPIs was relatively high and was associated with various factors. It is critical for intensive care nurses, who encounter MDRPIs more frequently, to consider these factors while caring for their patients and to take appropriate preventive measures to reduce the incidence of these injuries.
Collapse
Affiliation(s)
- Aslıhan Aydım Kudu
- Department of Nursing, Zonguldak Bülent Ecevit University Health Sciences Institute, Zonguldak, Turkey.
| | - Nurten Taşdemir
- Zonguldak Bülent Ecevit University, Health Sciences Faculty, Nursing Department, 67000, Zonguldak, Turkey.
| | - Münevver Sönmez
- Faculty of Health Science, Department of Fundamentals of Nursing, Atılım University, 06830, Ankara, Turkey.
| |
Collapse
|
12
|
Karacabay K, Savci A, Dalkılıç M, Kabu Hergül F. Determining the incidence and risk factors of medical device-related pressure injury in intensive care patients. J Tissue Viability 2023; 32:596-600. [PMID: 37607845 DOI: 10.1016/j.jtv.2023.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/07/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
AIM This study aims to determine the incidence and risk factors of Medical Device-Related Pressure Injury (MDRPI) in Intensive Care Unit (ICU) patients. MATERIAL AND METHODS This descriptive cross-sectional study involved 300 patients who did not have an MDRPI at the time of admission to the ICU of a university hospital in Turkey. The data was collected using the Patient Information Form, the Medical Device-Related Pressure Injury Follow-Up Chart, and the Jackson/Cubbin Risk Assessment Scale. RESULTS The mean age of the patients was 71.88 ± 14.82 years old. Precisely 31% of patients were found to be at risk for pressure injuries, and MDRPI occurred in 18% of them. It was found that patients most commonly experienced stage 1 MDRPI in the hand-finger region due to pulse oximetry. It was also determined that nasal cannulas caused MDRPI the fastest. Patients with MDRPI had low Jackson/Cubbin scores, low albumin and hematocrit levels, and longer hospitalization durations (p < .05). Dependence on -respiratory support device, bedridden, and experiencing non-device-related pressure injuries were associated with MDRPI (p < .05). CONCLUSION It was found that factors causing non-device-related pressure injuries may also pose an MDRPI risk for patients in intensive care. It was also observed that devices used in ICU could cause pressure injuries even in very short periods in cases where necessary precautions are not taken. Periodic evaluation of the area the medical devices are in contact with, removal of unused devices as quickly as possible, and the use of prophylactic dressings can play an important role in preventing MDRPI.
Collapse
Affiliation(s)
- Kevser Karacabay
- Kütahya Health Sciences University, Health Sciences Faculty, Nursing Department, Germiyan Campus, Kütahya, Turkey.
| | - Ayşegül Savci
- Kütahya Health Sciences University, Health Sciences Faculty, Nursing Department, Germiyan Campus, Kütahya, Turkey.
| | - Mehmet Dalkılıç
- Kütahya Health Sciences University, Evliya Çelebi Training and Research Hospital, Kütahya, Turkey.
| | - Filiz Kabu Hergül
- Pamukkale University, Health Sciences Faculty, Nursing Department, Denizli, Turkey.
| |
Collapse
|
13
|
Kim M, Shin YS. Risk factors for device-related pressure injuries in general ward inpatients of a tertiary general hospital: A case-control study. J Tissue Viability 2023; 32:601-606. [PMID: 37558560 DOI: 10.1016/j.jtv.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
AIMS To identify the characteristics of device-related pressure injuries (DRPI) in general ward inpatients, and to confirm the DRPI risk factors by examining differences between a DRPI and non-DRPI group. METHODS This study is a retrospective case-control study. High-risk adult patients for pressure injuries (rated at 16 points or less on the Braden scale) who were admitted to a general ward of a tertiary general hospital in South Korea from January 1 to September 30, 2021 were enrolled in this study. Among them, participants were selected by matching the patients with DRPI (n = 50) to the non-DRPI patient group (n = 100) in a ratio of 1:2. RESULTS As for risk factors, longer hospitalization periods and the presence of oedema increased DRPI risk. In blood tests, higher glucose levels increased the risk by 1.03 times, and lower albumin levels increased the risk by 0.08 times. Furthermore, the risk of developing DRPI was 7.89 times higher when sedatives were administered. CONCLUSIONS Based on the DRPI risk factors identified in this study, patients who have oedema, who have long hospital stays, use sedatives and devices, have a low albumin level, and whose blood glucose is not well controlled should be recognized as having a high risk of developing DRPI. In order to prevent the development of DRPI, it is necessary to recognize risk factors at an early stage, increase actively preventive interventions. The results of this study contribute to recognizing the risk of DRPI in patients and evaluating risk factors for DRPI prevention.
Collapse
Affiliation(s)
- Minkyung Kim
- Graduate School, Hanyang University, Samsung Medical Center, 81 Irwon-Ro Gangnam-gu. Seoul, 06351, Republic of Korea.
| | - Yong Soon Shin
- College of Nursing, Hanyang University, Republic of Korea.
| |
Collapse
|
14
|
Herring B, Lowen D, Ho P, Hodgson R. A systematic review of venous thromboembolism mechanical prophylaxis devices during surgery. Langenbecks Arch Surg 2023; 408:410. [PMID: 37851108 PMCID: PMC10584699 DOI: 10.1007/s00423-023-03142-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Hospitalisation and surgery are major risk factors for venous thromboembolism (VTE). Intermittent pneumatic compression (IPC) and graduated compression stockings (GCS) are common mechanical prophylaxis devices used to prevent VTE. This review compares the safety and efficacy of IPC and GCS used singularly and in combination for surgical patients. METHODS Ovid Medline and Pubmed were searched in a systematic review of the literature, and relevant articles were assessed against eligibility criteria for inclusion along PRISMA guidelines. RESULTS This review is a narrative description and critical analysis of available evidence. Fourteen articles were included in this review after meeting the criteria. Results of seven studies comparing the efficacy of IPC versus GCS had high heterogeneity but overall suggested IPC was superior to GCS. A further seven studies compared the combination of IPC and GCS versus GCS alone, the results of which suggest that combination mechanical prophylaxis may be superior to GCS alone in high-risk patients. No studies compared combination therapy to IPC alone. IPC appeared to have a superior safety profile, although it had a worse compliance rate and the quality of evidence was poor. The addition of pharmacological prophylaxis may make mechanical prophylaxis superfluous in the post-operative setting. CONCLUSION IPC may be superior to GCS when used as a single prophylactic device. A combination of IPC and GCS may be more efficacious than GCS alone for high-risk patients. Further high-quality research is needed focusing on clinical relevance, safety and comparing combination mechanical prophylaxis to IPC alone, particularly in high-risk surgical settings when pharmacological prophylaxis is contraindicated.
Collapse
Affiliation(s)
- Brianna Herring
- Department of Surgery, University of Melbourne, Epping, Australia
| | - Darren Lowen
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, VIC, 3076, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Prahlad Ho
- Department of Haematology, Northern Health, Epping, VIC, 3076, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
- Department of Medicine, Northern Health, University of Melbourne, Heidelberg, Australia
| | - Russell Hodgson
- Department of Surgery, University of Melbourne, Epping, Australia.
- Department of Surgery, Northern Health, Epping, VIC, 3076, Australia.
| |
Collapse
|
15
|
Solmos S, Gefen A, Black J, Orlov A, Belo O, Cuddigan J. Medical Device Testing: Methods, Significance, and Clinical Applications. Adv Skin Wound Care 2023; 36:513-522. [PMID: 37729161 DOI: 10.1097/asw.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
GENERAL PURPOSE To present a study conducting objective biomechanical testing of medical devices known to cause medical device-related pressure injuries (MDRPIs) in critically ill adults and comparing those results with clinical outcomes associated with each device. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Explain the results of the study of the relationships between objective biomechanical tests of medical devices and clinical outcomes that help inform clinicians using these devices.2. Synthesize the background information that informed the study.
Collapse
|
16
|
Jia YJ, Hu FH, Zhang WQ, Tang W, Ge MW, Shen WQ, Chen HL. Incidence, prevalence and risk factors of device-related pressure injuries in adult intensive care unit: A meta-analysis of 10,084 patients from 11 countries. Wound Repair Regen 2023; 31:713-722. [PMID: 37587087 DOI: 10.1111/wrr.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/20/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
Device-related pressure injuries (DRPIs) prevail in the intensive care unit (ICU) and have much to do with medical devices and patients' conditions. This meta-analysis aims to systematically assess the incidence, prevalence and risk factors related to DRPIs among adults in ICU. Web of Science, Cochrane Library, MEDLINE, PubMed and CINAHL were searched from inception to March 2023. Observational studies were included, and the Newcastle-Ottawa scale (NOS) was used to assess literature quality. The primary outcomes were the incidence, prevalence and risk factors regarding DRPIs among adults in ICU. The 19 studies conformed to the criteria for inclusion in the review. The estimated pooled incidence of DRPIs was 14.7% (95% CI: 9.7%-19.6%) in 10 studies (4866 participants). The estimated pooled prevalence of DRPIs was 19.0% (95% CI: 13.6%-24.3%) in 9 studies (5218 participants). The most significant risk factor for DRPIs was using mechanical ventilation. The pooled analysis of the four studies showed that DRPIs were more likely to occur in patients who required mechanical ventilation compared with patients who did not use mechanical ventilation (OR: 9.67, 95% CI: 5.03-18.61, p < 0.001) and using vasopressors, age, length of ICU stays, APACHE II score, Braden score, fever, sex, oedema, diabetes and number of medical devices, SOFA score was also related to pressure injuries risk. The incidence and prevalence of DRPIs in adult ICU were high, and the most significant risk factor for DRPIs was using mechanical ventilation. It is imminent to identify patients of increased risk with DRPIs early.
Collapse
Affiliation(s)
- Yi-Jie Jia
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Fei-Hong Hu
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wan-Qing Zhang
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wen Tang
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Meng-Wei Ge
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wang-Qin Shen
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, People's Republic of China
| |
Collapse
|
17
|
Parvizi A, Haddadi S, Mollaei A, Ghorbani Vajargah P, Takasi P, Firooz M, Hosseini SJ, Farzan R, Karkhah S. A systematic review of nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers. Int Wound J 2023; 20:2843-2854. [PMID: 36792930 PMCID: PMC10410313 DOI: 10.1111/iwj.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
The aim of this review study is to investigate the nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers (MDRPUs). An extensive search was conducted in international electronic databases such as PubMed, Web of Science, and Scopus, and Persian databases, such as Iranmedex and the Scientific Information Database from December 1, 2022. During this search, keywords extracted from Medical Subject Headings, such as "Prevention knowledge," "Nurse," "Pressure ulcer," "Equipment and Supplies," and "Intensive Care Units" were used. The quality of the present studies in this review was evaluated based on the appraisal tool for cross-sectional studies (AXIS tool). A total of 1847 nurses participated in this review from five studies, and the majority of them (82.94%) were female. The mean age of the participants was 31.40 (SD = 5.97). The mean score of MDRPUs prevention knowledge in nurses based on PU2014 scale and researcher-made questionnaires were 16.50 (SD = 3.74) out of 31 and 65.49 (SD = 6.33) out of 100, respectively. The knowledge of nurses is influenced by factors such as age, sex, level of education, work experience, technical titles, type of hospital, level of hospital, and type of ward. Various factors had a significant positive relationship with nurses' MDRPUs prevention knowledge, which includes level of education, work experience, previous training on MDRPU, having a wound care certificate, an online search about MDRPU, and attitude and practise towards MDRPU prevention. At the same time, nurses' knowledge about the prevention of MDRPUs had a significant negative relationship with the time interval since last participating in MDRPU training or workshop. Overall, the level of MDRPUs prevention knowledge among nurses was insufficient to moderate. Therefore, it is suggested to provide facilities for nurses to receive the necessary training.
Collapse
Affiliation(s)
- Arman Parvizi
- Anesthesiology Research Center, Department of AnesthesiologyAlzahra Hospital, Guilan University of Medical SciencesRashtIran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of AnesthesiologyAlzahra Hospital, Guilan University of Medical SciencesRashtIran
| | - Amirabbas Mollaei
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Pooyan Ghorbani Vajargah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Poorya Takasi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Mahbobeh Firooz
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
| | | | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Samad Karkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| |
Collapse
|
18
|
Lewis CP, Schenkenfelder R, Davies CC, Monroe M, Acton D, Phillips T. Developing the Baptist Health Injury Risk Assessment Phase 1: Exploring Risk Factors. J Nurs Adm 2023; 53:438-444. [PMID: 37585494 DOI: 10.1097/nna.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVES The aim of this study was to explore risk factors for developing hospital-acquired pressure injuries (HAPIs) among critically ill adult inpatients. BACKGROUND Hospital-acquired pressure injuries remain a priority quality focus for Magnet ® organizations. Recent studies cite medical devices as a primary cause, yet published risk assessments lack inclusion of those threats. METHODS Nurses at a 434-bed, 4-time Magnet ® -designated hospital led a retrospective study acros 9 American Nurses Credentialing Center-designated facilities. Using a chart review tool, data were collected within 48 hours of a confirmed HAPI. RESULTS Of 207 HAPIs reported, 54% (n = 113) involved deep tissue pressure injuries and 50.2% (n = 104) involved 19 medical devices. Individuals with a HAPI also used 1 or more of 7 distinct types of mobility-limiting medical equipment. CONCLUSIONS Study findings support the development of a critical care risk assessment with inclusion of a medical device and mobility-limiting medical equipment as risk factors. A secondary study is underway for specificity and sensitivity testing of this assessment.
Collapse
Affiliation(s)
- C Preston Lewis
- Author Affiliations: Executive Director of Orthopedics/Urology Services & Magnet Recognition Program (Dr Lewis), WOC Clinical Nurse (Schenkenfelder), and Research Consultant (Drs Davies and Monroe), Baptist Health Lexington; WOC Clinical Nurse (Acton), Baptist Health Louisville; and Research Nurse (Dr Phillips), Baptist Health Paducah, Paducah, Kentucky
| | | | | | | | | | | |
Collapse
|
19
|
Gou L, Zhang Z, A. Y. Risk factors for medical device-related pressure injury in ICU patients: A systematic review and meta-analysis. PLoS One 2023; 18:e0287326. [PMID: 37352180 PMCID: PMC10289390 DOI: 10.1371/journal.pone.0287326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/02/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Medical device-related pressure injury (MDRPI) in intensive care unit (ICU) patients is a serious issue. We aimed to evaluate the risk factors for MDRPI associated with ICU patients through systematic review and meta-analysis, and provide insights into the clinical prevention of MDRPI. METHODS We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, and China BioMedical Literature Database (CBM) (from inception to January 2023) for studies that identified risk factors of MDRPI in ICU patients. In order to avoid the omission of relevant literature, we performed a secondary search of the above database on February 15, 2023. Meta-analysis was performed using Revman 5.3. RESULTS Fifteen studies involving 4850 participants were selected to analyze risk factors for MDRPI in ICU patients. While conducting a meta-analysis, we used sensitivity analysis to ensure the reliability of the results for cases with significant heterogeneity among studies. When the source of heterogeneity cannot be determined, we only described the risk factor. The risk factors for MDRPI in ICU patients were elder age (OR = 1.06, 95% CI: 1.03-1.10), diabetes mellitus (OR = 3.20, 95% CI: 1.96-5.21), edema (OR = 3.62, 95% CI: 2.31-5.67), lower Braden scale score (OR = 1.22, 95%CI: 1.11-1.33), higher SOFA score (OR = 4.21, 95%CI: 2.38-7.47), higher APACHE II score (OR = 1.38, 95%CI: 1.15-1.64), longer usage time of medical devices (OR = 1.11, 95%CI: 1.05-1.19), use of vasoconstrictors (OR = 6.07, 95%CI: 3.15-11.69), surgery (OR = 4.36, 95% CI: 2.07-9.15), prone position (OR = 24.71, 95% CI: 7.34-83.15), and prone position ventilation (OR = 17.51, 95% CI: 5.86-52.36). Furthermore, we found that ICU patients who used subglottic suction catheters had a higher risk of MDRPI, whereas ICU patients with higher hemoglobin and serum albumin levels had a lower risk of MDRPI. CONCLUSION This study reported the risk factors for MDRPI in ICU patients. A comprehensive analysis of these risk factors will help to prevent and optimize interventions, thereby minimizing the occurrence of MDRPI.
Collapse
Affiliation(s)
- Ling Gou
- Department of Gastrointestinal surgery, Xining, China
| | - Zhiqin Zhang
- Department of Gastrointestinal surgery, Xining, China
| | - Yongde A.
- Intensive Care Unit, Qinghai Provincial People’s Hospital, Xining, China
| |
Collapse
|
20
|
Fu F, Zhang L, Fang J, Wang X, Wang F. Knowledge of intensive care unit nurses about medical device-related pressure injury and analysis of influencing factors. Int Wound J 2023; 20:1219-1228. [PMID: 36495034 PMCID: PMC10031207 DOI: 10.1111/iwj.13981] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
To investigate ICU nurses' knowledge level with regard to device-related pressure injuries in northern, central, and southern China and analyse its influencing factors. A total of 261 ICU nurses participated in this cross-sectional survey A convenience sampling method was used to select ICU nurses as respondents from one hospital in each of the six cities of Taiyuan, Wuhan, Xianning, Guangzhou, Foshan, and Huizhou. Data were collected using the MDRPI Knowledge Questionnaire. The questionnaire was developed by the investigators based on a summary of evidence of MDRPI, which has been reviewed and validated by experts. The obtained data were analysed using SPSS software. The average rate of the correct response about MDRPI was 60.54% (15.74 ± 2.90). The lowest percentage of correct responses was on the "concept and staging" dimension rated 28% (0.56 ± 0.67). The "skin assessment" dimension rated 39.2% (1.57 ± 0.84). Multiple linear regression analysis showed that the factors influencing the MDRPI knowledge of ICU nurses included hospital grade, the highest educational attainment, whether or not they had wound care certification, when they last attended MDRPI training or lectures, and whether or not they had attended MDRPI training or lectures. The level of knowledge of nurses about MDRPI was insufficient. Training of ICU nurses on MDRPI should be emphasised at the institutional level. MDRPI training contents should be based on clinical evidence and updated timely. There is a need to focus on the training of wound care certification and education.
Collapse
Affiliation(s)
- Fang Fu
- School of Nursing, Huizhou Health Sciences Polytechnic, Huizhou, China
| | - Lanlan Zhang
- Department of Neurology, Wuhan Fourth Hospital, Wuhan, China
| | - Jiexin Fang
- Department of Nursing, Shunde Hospital of Southern Medical University, Foshan, China
| | - Xiaoli Wang
- School of Nursing, Huizhou Health Sciences Polytechnic, Huizhou, China
| | - Fangfang Wang
- Department of Nursing, Shanxi Cancer Hospital, Taiyuan, China
| |
Collapse
|
21
|
Ratwani R, Adams K, Kim T, Busog DN, Howe J, Jones R, Krevat S. Assessing Equipment, Supplies, and Devices for Patient Safety Issues. PATIENT SAFETY 2023. [DOI: 10.33940/data/2023.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: Medical equipment, supplies, and devices (ESD) serve a critical function in healthcare delivery and how they function can have patient safety consequences. ESD-related safety issues include malfunctions, physically missing ESDs, sterilization, and usability. Describing ESD-related safety issues from a human factors perspective that focuses on user interactions with ESDs can provide additional insights to address these issues.
Methods: We manually reviewed ESD patient safety event reports submitted to the Pennsylvania Patient Safety Reporting System to identify ESD-related safety issues using a taxonomy that was informed by the Food and Drug Administration Manufacturer and User Facility Device Experience taxonomy. This taxonomy consisted of the following high-level categories: malfunctions, physically missing, sterilization, and usability. The type of ESD and associated components or ESD subtypes, event classification, and care area group were noted for each report.
Results: Of the 450 reports reviewed, the most frequent ESD-related safety issue coded was malfunction (n=365 of 450, 81.1%) followed by sterilization (n=40 of 450, 8.9%), usability (n=36 of 450, 8.0%), and physically missing (n=9 of 450, 2.0%). Among the coded malfunctions, software/output problem (n=122 of 365, 33.4%) was the most frequent, followed by general malfunction (n=103 of 365, 28.2%); material integrity (n=72 of 365, 19.7%); and activation, positioning, or separation (n=68 of 365, 18.6%). The most frequent ESDs noted were infusion pump, instrument set, and intravenous, and the most frequent components/subtypes noted were alarm/alert, tubing, and tray.
Conclusion: ESD-related patient safety issues, especially malfunctions, impact patient care despite current policies and practices to address these issues. Healthcare facilities may be able to address some ESD-related patient safety issues during procurement through use of the accompanying procurement assessment tool.
Collapse
|
22
|
Togluk Yiğitoğlu E, Aydoğan S. Determination of medical device-related pressure injury in COVID-19 patients: A prospective descriptive study. J Tissue Viability 2023; 32:74-78. [PMID: 36371244 PMCID: PMC9616480 DOI: 10.1016/j.jtv.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND COVID-19 patients are at risk for the development of pressure injuries (PI). AIM The aim of this study was to determine the incidence of medical device-related pressure injury (MDRPI) in patients treated in the COVID-19 Intensive Care Unit (ICU)s. METHODS The sample of the study consisted of 132 patients, and each with a maximum follow-up of 7 days. Data were collected in the COVID-19 ICU of a university hospital between January and May 2021 by using a Patient Characteristics Form, the MDRPI Follow-up Form, the Braden Pressure Ulcer Risk Assessment Scale, and the Pressure Ulcer Staging Form. RESULTS Of the patients, 59.1% (n = 78) developed at least one MDRPI. MRDPI was observed in those with a mean age of 65.45 ± 2.462 years who were invasively ventilated (51.3%), enterally fed (46.2%), placed in the prone position (78.2%), and had a Braden score ≤12 (50%). The most common medical devices that caused MDRPIs included endotracheal tube (ET) (31.2% n = 44), non-invasive mechanical ventilation (NIVM) (23.4% n = 33), nasal high-flow (11.3% n = 16), nasogastric tube (10.6% n = 15), the ET connection (8.5% n = 12), respectively. The most common sites for pressure injuries were the nose (28.8% n = 34), mouth (25.8% n = 34), ear (12.9% n = 17), lip (9.1% n = 12), and cheek (8.3% n = 11). The most common gradings of MDRPIs were stage 2 (28.8% n = 38), stage 1 (19.7% n = 26), stage 3 (9.1% n = 12) mucous membrane injuries (12.9% n = 17) and suspected deep tissue injuries (9.1% n = 12), respectively. The time to PI was 3 days (25.7% n = 36). CONCLUSIONS MDRPI was common among COVID-19 patients. It was found that the most common cause of pressure injury was ventilators, and PI developed in the mouth and lip sites most frequently in patients in prone position, stage 2 and suspected deep tissue damage was the most common grade. It is important to evaluate the skin in contact with medical devices in COVID-19 patients and to take the necessary interventions to prevent PI.
Collapse
Affiliation(s)
- Eylem Togluk Yiğitoğlu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, Ostomy and Wound Care Unit, Istanbul, Turkey.
| | - Semine Aydoğan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, Sadı Sun İntensive Care Unit, Istanbul, Turkey.
| |
Collapse
|
23
|
Formal Caregiver Experiences of Caring for Individuals at Risk for or with a Pressure Injury: A Metasynthesis. Adv Skin Wound Care 2022; 35:680-687. [PMID: 35895590 DOI: 10.1097/01.asw.0000855044.92545.af] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore formal caregiver experiences caring for patients with a pressure injury (PI) or who are at risk of developing a PI. DATA SOURCES In November 2019, the researchers searched CINAHL (Cumulative Index to Nursing and Allied Health Literature) and MEDLINE databases for articles related to caregivers and their experiences with PI prevention and care. STUDY SELECTION Twenty-eight qualitative studies were included in this review. DATA EXTRACTION Literature was graded and critiqued with regard to design and research quality and then synthesized utilizing a narrative approach. DATA SYNTHESIS Four themes were found within the literature: knowledge and education, environment and resources, collaboration and role clarity, and risk assessment. CONCLUSIONS Across healthcare settings, formal caregivers noted the importance of effective PI knowledge and education. Recognizing both barriers and facilitators to PI prevention and management within the healthcare environment can help decision-makers make informed choices to improve PI management within their settings. In addition, developing interprofessional team skills and relationships, rather than practicing in silos, may have an impact on PI management. Although there are many interventions that reduce PI risk and assist in the management of PIs, not every intervention is appropriate for every healthcare setting. Clinician education on PIs, along with new interventions, could significantly impact the effectiveness of patient care.
Collapse
|
24
|
Thom LM, James-McAlpine J. Reducing pressure injuries in children caused by peripheral intravenous cannulae. Nurs Child Young People 2022; 34:22-28. [PMID: 35437975 DOI: 10.7748/ncyp.2022.e1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 02/02/2023]
Abstract
Medical devices such as peripheral intravenous cannulae (PIVC) are commonly used in the care of children across all hospital settings. However, the association between PIVC and the development of pressure injuries in this population became a concern on one Australian paediatric ward. A quality improvement project was conducted to reduce the incidence of pressure injuries in children caused by PIVCs. A tubular bandage and microfoam surgical tape were introduced to replace crepe bandage PIVC securement. At the same time, education was provided to alert nurses to medical device-related pressure injuries and the PIVC securement changes. The introduction of the tubular bandage and staff education improved skin inspections of PIVCs and decreased the incidence of pressure injuries from these devices.
Collapse
Affiliation(s)
- Lynn Maree Thom
- children's and adolescent ward, Cairns Hospital, Cairns, Queensland, Australia
| | | |
Collapse
|
25
|
The prevalence of facial pressure injuries among nurses during COVID-19 pandemic and its relationship to COVID-19 infection. J Tissue Viability 2022; 31:699-706. [PMID: 36195528 PMCID: PMC9526514 DOI: 10.1016/j.jtv.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/12/2022] [Accepted: 09/25/2022] [Indexed: 02/04/2023]
Abstract
AIM The aim of this study was to investigate the prevalence of facial pressure injuries related to personal protective equipment use in nurses and the relationship with getting COVID-19 infection. DESIGN The study used descriptive and correlational online survey design. METHODS Nurses in Turkey were recruited via an electronic link sent to their social media platforms (e.g., Facebook, Instagram, Twitter), WhatsApp, and e-mail during the study: March-April 2021. Of them, 603 participants completed the survey form from all over Turkey. RESULTS/FINDINGS Facial pressure injuries develop in nurses due to use of personal protective equipment. The rates of facial pressure injuries were higher in the nurses who were younger (p=0.002) and those who had less experience years (p=0.005) than the other nurses. The statistically significant variables were determined as age, status of using face shield, status of wearing overalls and status of wearing shoe covers (p<0.05). We determined that facial pressure injuries were not significantly associated with getting COVID-19 infection (p>0,05). CONCLUSIONS This study showed that facial pressure injuries associated with personal protective equipment use among nurses, who work on the frontlines in the COVID-19 pandemic period, is highly prevalent. Experiencing facial pressure injuries did not have a significant effect on the participants' statuses of getting infected with COVID-19. Providing training in health institutions may present an effective strategy in lowering problems.
Collapse
|
26
|
Coyer F, Chaboyer W, Lin F, Doubrovsky A, Barakat-Johnson M, Brown W, Lakshmanan R, Leslie G, Jones SL, Pearse I, Martin K, McInnes E, Powell M, Mitchell ML, Sosnowski K, Tallot M, Thompson A, Thompson L, Labeau S, Blot S. Pressure injury prevalence in Australian intensive care units: A secondary analysis. Aust Crit Care 2022; 35:701-708. [PMID: 34848121 DOI: 10.1016/j.aucc.2021.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Pressure injuries (PIs) are an enduring problem for patients in the intensive care unit (ICU) because of their vulnerability and numerous risk factors. METHOD This study reports Australian data as a subset of data from an international 1-day point prevalence study of ICU-acquired PI in adult patients. Patients aged 18 years or older and admitted to the ICU on the study day were included. The outcome measure was the identification of a PI by direct visual skin assessment on the study day. Data collected included demographic data and clinical risk factors, PI location and stage, and PI prevention strategies used. Descriptive statistics were used to describe PI characteristics, and odds ratios (ORs) were used to identify factors associated with the development of a PI. RESULTS Data were collected from 288 patients from 16 Australian ICUs. ICU-acquired PI prevalence was 9.7%, with 40 PIs identified on 28 patients. Most PIs were of stage 1 and stage 2 (26/40, 65.0%). Half of the ICU-acquired PIs were found on the head and face. The odds of developing an ICU-acquired PI increased significantly with renal replacement therapy (OR: 4.25, 95% confidence interval [CI]: 1.49-12.11), impaired mobility (OR: 3.13, 95% CI: 1.08-9.12), fastest respiratory rate (OR: 1.05 [per breath per minute], 95% CI: 1.00-1.10), longer stay in the ICU (OR: 1.04 [per day], 95% CI: 1.01-1.06), and mechanical ventilation on admission (OR: 0.36, CI: 0.14-0.91). CONCLUSION This study found that Australian ICU-acquired PI prevalence was 9.7% and these PIs were associated with many risk factors. Targeted PI prevention strategies should be incorporated into routine prevention approaches to reduce the burden of PIs in the Australian adult ICU patient population.
Collapse
Affiliation(s)
- Fiona Coyer
- Joint Appointment School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK.
| | - Wendy Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Frances Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Australia; Sunshine Coast Health Institute, Australia; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Australia.
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District, Australia; Hospital-Acquired Complication Operational Coordinator for Pressure Injury, Sydney Local Health District, Australia; Faculty of Medicine and Health, University of Sydney, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Australia.
| | - Wendy Brown
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital Health Service, Queensland, Australia.
| | - Ramanathan Lakshmanan
- Fairfield Hospital, Australia; Liverpool Hospital, Australia; UNSW, Australia; WSU, Australia.
| | - Gavin Leslie
- Curtin Nursing School, Curtin University, Perth, Western Australia, Australia; School of Nursing & Midwifery, University South Australia, Adelaide, South Australia, Australia.
| | - Sarah L Jones
- Intensive Care Unit, St George Hospital, NSW, Australia.
| | - India Pearse
- Critical Care Research Group, The Prince Charles Hospital, Queensland, Australia.
| | - Kerrie Martin
- Intensive Care Unit, The Tweed Hospital, NSW, Australia; Intensive Care NSW, Agency for Clinical Innovation, NSW Health, Australia.
| | - Elizabeth McInnes
- St Vincent's Hospital Melbourne, Australia; Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia.
| | - Madeleine Powell
- University of New South Wales, School of Population Health, New South Wales, Australia.
| | - Marion L Mitchell
- Menzies Health Institute Queensland, Griffith University, Australia; Princess Alexandra Hospital, Brisbane, Australia.
| | | | - Mandy Tallot
- Intensive Care Unit, Gold Coast University Hospital, Queensland Australia.
| | - Amy Thompson
- Nepean Blue Mountains Local Health District, NSW, Australia.
| | - Lorraine Thompson
- Practice Development, Sunshine Coast University Hospital, Australia.
| | - Sonia Labeau
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.
| | - Stijn Blot
- Dept. of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium; Burns Trauma and Critical Care Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| |
Collapse
|
27
|
Alderden J, Kennerly SM, Wilson A, Dimas J, McFarland C, Yap DY, Zhao L, Yap TL. Explainable Artificial Intelligence for Predicting Hospital-Acquired Pressure Injuries in COVID-19-Positive Critical Care Patients. Comput Inform Nurs 2022; 40:659-665. [PMID: 36206146 PMCID: PMC9555852 DOI: 10.1097/cin.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
28
|
Wang C, Xie A, Zhou W, Cheng F, Tian J, Xu Y. A Phenomenological Study of Nurses' Experiences in a Pediatric Fever Clinic During the COVID-19 Epidemic. Res Theory Nurs Pract 2022; 36:RTNP-2021-0003.R4. [PMID: 36137751 DOI: 10.1891/rtnp-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE In the initial COVID-19 outbreak, nursing staff reportedly experienced high levels of psychological stress. The purpose of this study was to explore the real experience of the first cohort of pediatric fever clinic nurses during the COVID-19 epidemic. METHODS Semi-structured interviews were conducted with eight nurses who worked in a fever clinic at a children's hospital in China. The interviews were conducted by an experienced and trained interviewer. Qualitative content analysis was used to describe the experiences of the nurses. RESULTS Three themes were distilled from the interviews: 1) complex psychological experiences including positive experiences (increased sense of responsibility and honor, gaining the respect and recognition of parents, having a sense of achievement in personal growth) and negative experiences (panic and compulsion, guilt towards their family, antipathy, and dissatisfaction); 2) extreme physical discomfort; and 3) a lack of relevant knowledge. IMPLICATIONS FOR PRACTICE The nurses in the pediatric fever clinic experienced various psychological impacts and physiological discomfort. Nursing managers should improve the management of hospital emergency nursing, strengthen the psychological guidance and logistics support of frontline nurses, and provide nurses with the relevant knowledge and skills training. These improvements would support frontline nurses in their work to provide effective patient treatment during the COVID-19 epidemic.
Collapse
Affiliation(s)
- Chunjuan Wang
- Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - Anwei Xie
- Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - Weifang Zhou
- Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - Fangfang Cheng
- Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - Jianmei Tian
- Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - Yunqiu Xu
- Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, China
| |
Collapse
|
29
|
Fulbrook P, Lovegrove J, Butterworth J. Incidence and characteristics of hospital-acquired mucous membrane pressure injury: A five-year analysis. J Clin Nurs 2022. [PMID: 35932156 DOI: 10.1111/jocn.16473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pressure injuries on mucous membranes are caused by pressure from medical devices at the site of injury and differ to those on the skin. Intensive care patients, who have multiple devices in situ, are particularly vulnerable. There is a significant knowledge gap regarding mucous membrane pressure injury (MMPI) incidence in acute hospital settings. AIM To analyse MMPI incidence and characteristics in a tertiary acute general hospital. METHODS A secondary data analysis of hospital clinical incident reports was conducted. The sample included all adults with MMPIs between 2015 and 2019. The STROBE reporting guideline was followed. RESULTS There were 414 reports of MMPI. Most (91.5%, n = 379) were hospital-acquired with the majority found in intensive care patients (74.4%, n = 282). Hospital-acquired MMPI incidence was 0.1% (11 MMPI per 10,000 hospital episodes). In intensive care, the incidence was 2.4% (235 MMPI per 10,000 intensive care episodes). The median time from device insertion until reporting of an MMPI was 3 days. The most common sites of mucosal injury were the lips (35.6%) and mouth (28.8%). In all cases except one, MMPI was associated with medical device use at the site of injury. Five device types were identified (oral endotracheal tube-related 70.3%; urinary catheter 15.5%; gastric tube 8.3%; nasal prongs 3.5%; tracheostomy tube 2.4%). In intensive care, oral endotracheal tube-related devices were most often associated with MMPI (84.8%), whereas in non-intensive care MMPI it was the urinary catheter (51.4%). CONCLUSIONS While hospital-acquired MMPI incidence is relatively low, it is considerably higher in intensive care patients compared to those in non-intensive care settings. The most common sites are the lips and mouth. RELEVANCE TO CLINICAL PRACTICE Mucous membrane pressure injuries represent a significant proportion of all hospital-acquired pressure injuries. PATIENT OR PUBLIC CONTRIBUTION Neither patients nor the public were directly involved in this project.
Collapse
Affiliation(s)
- Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jacob Butterworth
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| |
Collapse
|
30
|
Teixeira ADO, Brinati LM, Toledo LV, Silva Neto JFD, Teixeira DLDP, Januário CDF, Silva Neto LMD, Salgado PDO. Factors associated with the incidence of pressure wounds in critical patients: a cohort study. Rev Bras Enferm 2022; 75:e20210267. [PMID: 35766752 DOI: 10.1590/0034-7167-2021-0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the incidence of pressure wound in critical patients and its associated factors. METHODS retrospective cohort study, based on the analysis of 369 critical patients' records. Descriptive and inferential statistics were used, as well as logistic regression. RESULTS the incidence of pressure wounds was 11.4%. Patients who had been hospitalized for four days or more (OR 2.99; CI95% 1.15-7.78), used nasoenteric tubes (OR: 3.81; CI95%: 1.4010.38), vesical drainage catheters (OR: 4.78; CI95%: 1.31-17.38) and tracheostomy (OR: 3.64; CI95%: 1.48-8.97) had a higher chance of developing pressure wounds. The mean score of the Braden scale among participants who developed (14.2 points) pressure wounds was statistically different (p<0.001) than that of those who did not (12.3 points). CONCLUSIONS the incidence of pressure wounds was associated with a higher time in the unit, the use of nasoenteric tubes, vesical drainage catheters, and tracheostomies were associated with a higher time of hospitalization in the unit.
Collapse
|
31
|
Crunden EA, Worsley PR, Coleman SB, Schoonhoven L. Barriers and facilitators to reporting medical device-related pressure ulcers: A qualitative exploration of international practice. Int J Nurs Stud 2022; 135:104326. [DOI: 10.1016/j.ijnurstu.2022.104326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 10/31/2022]
|
32
|
Alderden J, Kennerly SM, Cox J, Yap TL. Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit. AACN Adv Crit Care 2022; 33:173-185. [PMID: 35657764 DOI: 10.4037/aacnacc2022335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury. METHODS Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury. RESULTS A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination. CONCLUSIONS Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.
Collapse
Affiliation(s)
- Jenny Alderden
- Jenny Alderden is Associate Professor, Boise State University School of Nursing, 1910 University Dr, Boise, ID 83725
| | - Susan M Kennerly
- Susan M. Kennerly is Professor, East Carolina University College of Nursing, Greenville, North Carolina
| | - Jill Cox
- Jill Cox is Clinical Associate Professor, Rutgers University, and Wound, Ostomy, Continence Advanced Practice Nurse, Englewood Health, Newark, New Jersey
| | - Tracey L Yap
- Tracey L. Yap is Associate Professor, Duke University School of Nursing, Durham, North Carolina
| |
Collapse
|
33
|
Najjar YW, Saleh MY, Hassan ZM. Medical device related pressure ulcers in Jordan: Prevalence study among critically ill patients. Health Sci Rep 2022; 5:e620. [PMID: 35539444 PMCID: PMC9069546 DOI: 10.1002/hsr2.620] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background Medical device‐related pressure ulcers are increasingly common in critical care units. These ulcers can be complicated due to the necessity of the device for diagnosis or treatment. Purpose To determine the prevalence of and risk for medical device‐related pressure ulcers in critical care units in Jordan in addition to identifying the preventive measures for those ulcers as well as identifying the most frequently used medical devices that cause ulcers and to assess the relationships between prevention measures and developing ulcers. Methods A cross‐sectional survey was used to assess ulcers among 318 patients who were elder than 18 years old. Data collection was based on an outline published by the European Pressure Ulcer Advisory Panel, Braden Scale, and an author‐developed specific checklist. Results The prevalence rate of medical device‐related pressure ulcers was 38.1%. Most affected sites were sacrum and heel, and most affected were those with old age, being admitted to public hospitals, and with a prolonged hospital stay. About half of the patients (46.3%) had severe risk. Only 17% of the patients who were at risk got adequate preventive measures. Face masks, endotracheal tubes, pulse oximetry probes, and intravenous catheters were associated with almost half of the ulcers. Conclusion Medical device‐related pressure ulcers are threats to patient safety and quality of nursing care in hospitals, which require determining appropriate preventive measures. Key messages: Medical device‐related pressure ulcers are common among patients in critical care units, which raise the need to evaluate the prevalence of such type of ulcers in those patients. Three hundred and eighteen patients were investigated for the prevalence of medical device‐related pressure ulcers through a cross‐sectional survey. Patients in critical care units in Jordan had a high prevalence rate for medical device‐related pressure ulcers, which require the need to apply appropriate preventive measures.
Collapse
Affiliation(s)
- Yahya W. Najjar
- Zarqa University College Al‐Balqa Applied University Zarqa Jordan
| | | | | |
Collapse
|
34
|
Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
35
|
Cavalcante EDO, Kamada I. MEDICAL DEVICE-RELATED PRESSURE INJURY: FREQUENCY AND ASSOCIATED FACTORS. ESTIMA 2022. [DOI: 10.30886/estima.v20.1146_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: to analyze the occurrence of pressure injuries related to medical devices in patients admitted to an intensive care unit. Method: quantitative, observational, descriptive, prospective cohort study, carried out with 171 patients, from May 15 to August 31, 2018 in the intensive care units of a public hospital in the Federal District. Results: the main risk factors were the presence of pressure injuries at admission, with a significant association for the formation of pressure injuries related to medical devices (p=0.002), and patients who progressed to death, with an association for the formation of pressure injuries related to medical devices (p=0.012); medical device-related pressure injury incidence rate of 40.35%. Conclusion: the use of medical devices has grown, as well as the appropriation of these technologies in the critical care environment. The multidisciplinary team should be aware of the formation of pressure injuries related to medical devices that can affect hospitalized patients.
Collapse
|
36
|
Cavalcante EDO, Kamada I. LESÃO POR PRESSÃO RELACIONADA A DISPOSITIVOS MÉDICOS: FREQUÊNCIA E FATORES ASSOCIADOS. ESTIMA 2022. [DOI: 10.30886/estima.v20.1146_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:analisar a ocorrência de lesões por pressão relacionadas a dispositivos médicos em pacientes internados em unidade de terapia intensiva. Método: estudo quantitativo, de caráter observacional descritivo, do tipo coorte prospectivo, realizado com 171 pacientes, no período de 15 de maio a 31 de agosto de 2018 nas unidades de terapia intensiva de um hospital público do Distrito Federal. Resultados: os principais fatores de risco foram presença de lesões por pressão na admissão, com associação significativa para a formação de lesão por pressão relacionada a dispositivos médicos (p=0,002), e pacientes que evoluíam ao desfecho óbito, com associação para formação de lesão por pressão relacionada a dispositivos médicos (p=0,012); taxa de incidência de lesão por pressão relacionada a dispositivos médicos de 40,35%. Conclusão: o uso de dispositivo médico tem crescido, bem como a apropriação dessas tecnologias no ambiente de cuidados críticos. A equipe multiprofissional deve ficar atenta para a formação das lesões por pressão relacionadas a dispositivos médicos que podem acometer os pacientes internados.
Collapse
|
37
|
Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
| |
Collapse
|
38
|
Teixeira ADO, Brinati LM, Toledo LV, Silva Neto JFD, Teixeira DLDP, Januário CDF, Silva Neto LMD, Salgado PDO. Fatores associados à incidência de lesão por pressão em pacientes críticos: estudo de coorte. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0267pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: identificar a incidência de lesão por pressão em pacientes críticos e os fatores associados à sua ocorrência. Métodos: estudo de coorte retrospectiva, baseando-se na análise dos prontuários de 369 pacientes críticos. Utilizou-se estatística descritiva e inferencial, com regressão logística. Resultados: a incidência de lesão por pressão foi de 11,4%. Pacientes com internação por mais de quatro dias (OR 2,99; IC95% 1,15-7,78), em uso de cateter nasoentérico (OR: 3,81; IC95%: 1,4010,38), cateter vesical de demora (OR: 4,78; IC95%: 1,31-17,38) e traqueostomia (OR: 3,64; IC95%: 1,48-8,97) apresentaram maior chance de desenvolver lesão por pressão. A pontuação média da escala de Braden entre os pacientes que desenvolveram (14,2 pontos) ou não (12,3 pontos) lesão por pressão foi estatisticamente diferente (p<0,001). Conclusões: a incidência de lesão por pressão esteve associada ao maior tempo de permanência na unidade, utilização de cateter nasoentérico, cateter vesical de demora e traqueostomia.
Collapse
|
39
|
Cao S, Gu M, Feng M, Jia Y, Zhao Y, Chen S, Zhu L, Bo S, Zhao Q. Implementation of evidence in preventing medical device-related pressure injury in ICU patients using the i-PARIHS framework. J Nurs Manag 2022; 30:318-327. [PMID: 34448285 DOI: 10.1111/jonm.13458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023]
Abstract
AIM To examine the effectiveness of implementing the evidence in preventing medical device-related pressure injury (MDRPI) in intensive care patients. BACKGROUND MDRPI is a common problem that significantly complicates patients' medical condition. However, evidence in preventing MDRPI is not properly implemented in clinical practice. METHODS A pre- and post-implementation study was conducted using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. A baseline survey was implemented; barriers and enablers of evidence implementation were analysed to inform facilitation support strategies, such as training nursing staff and developing resources and tools. Changes in nurses, patients and the system were assessed after evidence implementation. RESULTS Nurses' knowledge scores and evidence compliance significantly improved. The incidence of MDRPI in patients decreased from 24.39% to 4.26%. Standardized care and workflows to prevent MDRPI were established. CONCLUSION The i-PARIHS framework supported effective implementation of the evidence in preventing MDRPI, narrowing the gap between evidence and clinical practice. IMPLICATIONS FOR NURSING MANAGEMENT We provide an effective case of transforming evidence into practice based on the i-PARIHS framework. It can be used as a reference for colleagues in intensive care unit (ICU) or other settings to implement MDRPI prevention.
Collapse
Affiliation(s)
- Songmei Cao
- Department of Nursing, The Affiliated Hospital of Jiangsu University, Zhenjiang, China.,School of Nursing, Chongqing Medical University, Chongqing, China
| | - Mengqian Gu
- Medical College, Jiangsu University, Zhenjiang, China.,Department of Intensive Care Unit, Changshu NO.1 People's Hospital, Jiangsu, China
| | - Man Feng
- Medical College, Jiangsu University, Zhenjiang, China
| | - Yingying Jia
- Medical College, Jiangsu University, Zhenjiang, China
| | - Yanyan Zhao
- Department of ICU, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Shengzhi Chen
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Liqun Zhu
- Department of Nursing, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Suping Bo
- Wound Care Center, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
40
|
Crunden EA, Schoonhoven L, Coleman SB, Worsley PR. Reporting of pressure ulcers and medical device related pressure ulcers in policy and practice: A narrative literature review. J Tissue Viability 2021; 31:119-129. [PMID: 34949521 DOI: 10.1016/j.jtv.2021.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/20/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022]
Abstract
Pressure ulcers (PUs) occur in a range of care settings, resulting in reduced quality of life for the individual. There has been a growing awareness that medical devices can cause PUs, although reporting has been limited. There is a need to evaluate PU reporting practice and identify whether standards exist for medical device-related pressure ulcers (MDRPUs). AIM To synthesize academic and grey literature relevant to reporting of PUs and MDRPUs in healthcare settings. METHODS A systematic search of multiple scientific and grey literature databases was undertaken. Key search terms and Boolean operators were used to identify relevant literature. All sources of evidence discussing reporting practices were included in a synthesis. Primary topics are discussed in the corresponding analysis. RESULTS Thirty-one evidence sources met the inclusion criteria, including 16 journal articles and 15 policy and guidance documents. The results revealed a variation in reporting practices. MDRPUs were often not identified as a separate category in local and national systems. Policies for related patient safety reporting varied across all organisational levels, with more serious categories of PUs reported more consistently. Reporting to medical device regulatory bodies was not mandatory. CONCLUSION This narrative review identified inconsistencies in local and national reporting of PUs and MDRPUs, prohibiting meaningful comparisons and improvements in patient safety. Lack of specific medical device data and low levels of voluntary reporting to regulatory bodies is likely to result in an under-reporting, with little evidence of specific devices which may be a patient safety concern.
Collapse
Affiliation(s)
- Ewa A Crunden
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - Lisette Schoonhoven
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK; University Medical Center Utrecht, Julius Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Susanne B Coleman
- University of Leeds, Leeds Institute of Clinical Trials Research, Leeds, LS2 9JT, UK
| | - Peter R Worsley
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| |
Collapse
|
41
|
Relationship between skin temperature and medical device-related pressure injury in intensive care unit. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
42
|
Exploring medical device-related pressure injuries in a single intensive care setting: A longitudinal point prevalence study. Intensive Crit Care Nurs 2021; 68:103155. [PMID: 34736833 DOI: 10.1016/j.iccn.2021.103155] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To report longitudinal prevalence rates of device-related pressure injuries in critically ill adult patients in the intensive care unit and to explore the patient characteristics associated with the development of device related pressure injuries. RESEARCH DESIGN A prospective observational design where observations of patients' skin integrity were conducted on one day each week for 52 weeks. SETTING The study was conducted in the 36-bed ICU of a major metropolitan tertiary referral hospital in Queensland, Australia. The sample included all patients aged 18 years or older admitted to the intensive care unit before midnight on the day preceding the observation, with a medical device in situ. MAIN OUTCOME MEASURES The primary outcome measure was device related pressure injuries identified at the weekly observations and defined as a pressure injury found on the skin or mucous membrane with a history of medical device in use at the location of the injury. Patient demographic and clinical characteristics were recorded. RESULTS Over the study period, 11.3% (71/631) of patients developed at least one hospital-acquired DRPI. The most common devices associated with injury were nasogastric/nasojejunal tubes (41%) and endotracheal tubes (27%). Significant predictors of device related pressure injuries were the total number of devices (OR 1.230, 95% CI 1.09-1.38, p < 0.001), the length of time in the ICU (OR 1.05, 95% CI 1.02-1.09, p = 0.003), male sex, (OR 2.099, 95% CI 1.18-3.7, p = 0.012), and increased severity of illness score on admission (OR 1.044, 95% CI 1.01-1.09, p = 0.013). CONCLUSION Device related pressure injuries are an all-too-common iatrogenic problem for this vulnerable patient cohort.
Collapse
|
43
|
Kim J, Shin Y. Medical Adhesive-Related Skin Injury Associated with Surgical Wound Dressing among Spinal Surgery Patients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179150. [PMID: 34501740 PMCID: PMC8430563 DOI: 10.3390/ijerph18179150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/29/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022]
Abstract
The aim of this cross-sectional study was to determine the incidence, types, and factors associated with medical adhesive-related skin injuries (MARSIs) among spinal surgery patients. Adult patients who underwent planned spinal surgery under general anesthesia at a tertiary hospital in Seoul, Korea were enrolled. Data were collected from March through April 2019. Skins under surgical wound dressings were evaluated for MARSI once every morning until discharge. Skin injuries lasting for 30 min or more were considered as MARSIs. Logistic regression was performed to identify factors associated with MARSI. The incidence of MARSIs in surgical areas was 36.4% and the rate per 100 medical adhesives was 9.8%. All MARSIs occurred on postoperative day 1 or 2. A history of contact dermatitis (OR = 10.517, 95% CI = 3.540–31.241, p < 0.001) and late ambulation (OR = 1.053, 95% CI = 1.012–1.095, p = 0.010) were identified as risk factors for MARSI. Spinal surgery patients were at high risk of MARSIs associated with surgical wound dressings. Patients with a history of contact dermatitis or prolonged bed rest periods need more active skin assessment and more careful skin care to prevent MARSIs after spinal surgery.
Collapse
Affiliation(s)
- Jeounghee Kim
- Department of Nursing, Asan Medical Center, Seoul 05505, Korea;
| | - Yongsoon Shin
- College of Nursing, Hanyang University, Seoul 04763, Korea
- Correspondence: ; Tel.: +82-02-2220-0798
| |
Collapse
|
44
|
Galetto SGDS, do Nascimento ERP, Hermida PMV, Busanello J, de Malfussi LBH, Lazzari DD. Medical device-related pressure injuries in critical patients: prevalence and associated factors. Rev Esc Enferm USP 2021; 55:e20200397. [PMID: 34435611 DOI: 10.1590/1980-220x-reeusp-2020-0397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the prevalence of medical device-related pressure injuries in critical patients and analyze the associated factors. METHOD Epidemiological, cross-sectional study. Sociodemographic, clinical and medical device data were collected. Inspection of the skin/mucous membranes was performed to identify and classify the injuries. Analysis using descriptive statistics, Poisson regression and the Spearman correlation coefficient. RESULTS Ninety-three patients were evaluated and 58 developed injuries, with a prevalence of 62.4%. Injuries by the orotracheal tube (50%), nasogastric tube (44.1%) and urinary catheter (28.6%) were the most prevalent, and the most affected regions were, respectively, the auricular (79.5%), nasal ala (86.7%) and urethral meatus (76.9%). Factors associated with injuries were severe edema (p = 0.005), low Braden (p<0.001) and Glasgow (p = 0.008) scores, length of stay in intensive care (p<0.001) and hospitalization diagnosis classified as other causes (p<0.001). The use of more than one device (p<0.001) and a longer time of use (p<0.001) were correlated. CONCLUSION The high prevalence of injuries and the associated factors indicate the need for preventive measures and risk monitoring.
Collapse
Affiliation(s)
| | | | | | | | | | - Daniele Delacanal Lazzari
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem, Florianópolis, SC, Brazil
| |
Collapse
|
45
|
Margi R, Gefen A. Evaluation of facial tissue stresses under medical devices post application of a cyanoacrylate liquid skin protectant: An integrated experimental-computational study. Int Wound J 2021; 19:615-632. [PMID: 34402167 PMCID: PMC8874053 DOI: 10.1111/iwj.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 12/21/2022] Open
Abstract
Medical device‐related pressure ulcers (PUs) (injuries) are a subclass of PUs, associated with pressure and/or shear applied by a medical device onto the skin. Clinical application of a cyanoacrylate liquid skin protectant (CLSP) under the contours of skin‐contacting medical devices to shield an intact skin from the sustained mechanical loads that are applied by medical devices is a preventative option, but no computer modelling work has been reported to assess the biomechanical efficacy of such interventions. Here, we investigated the biomechanical protective effect of a polymerised cyanoacrylate coating using three‐dimensional, anatomically realistic finite element models of the ear with oxygen cannula and the mouth with endotracheal attachment device, informed by experimental studies. We have compared tissue stress exposures under the devices at these facial sites between conditions where the cyanoacrylate skin protectant has been applied or where the device was contacting the skin directly, without the shielding of the cyanoacrylate coating. The CLSP considerably reduced the skin stress concentration levels and overall tissue stress exposures under the aforementioned medical devices. This demonstrates strong biomechanical effectiveness of the studied cyanoacrylate‐based skin protectant in prevention of facial medical device‐related injuries at small, curved and thereby difficult to protect facial sites.
Collapse
Affiliation(s)
- Raz Margi
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
46
|
Dang W, Liu Y, Zhou Q, Duan Y, Gan H, Wang L, Zhu Q, Xie C, Hu A. Risk factors of medical device-related pressure injury in intensive care units. J Clin Nurs 2021; 31:1174-1183. [PMID: 34309103 DOI: 10.1111/jocn.15974] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Intensive care unit (ICU) patients are at high risk of medical device related pressure injury (MDRPI). This study aims to ascertain the MDRPI prevalence in ICU patients and analyse the risk factors of MDRPI. BACKGROUND The occurrence of MDRPI not only increases hospitalisation time with pain and economic burden, but also causes medical disputes. A better understanding of this condition will increase knowledge and facilitate the ability to recognise and prevent MDRPI for clinical nursing staff. However, there are few multicentre studies of MDRPI prevalence in ICU patients in China. DESIGN A cross-sectional study design was employed. METHODS Data from 694 patients in 66 adult ICU at 30 hospitals in China were included between October 2018 and March 2019. The stage of each MDRPI was determined according to the definitions of National Pressure Ulcer Advisory Panel. The study methods were followed by the STORBE guidelines. RESULTS The overall prevalence rate of MDRPI was 13.1% (91/694), with 98 anatomic locations in total. The most common stages of MDRPI were stage 1 (54.1%, 53/98), stage 2 (15.3%, 15/98) and mucosal membrane pressure injury (15.3%, 15/98). MDRPI mainly occurred in the finger (32.7%, 32/98), followed by nose (18.4%, 18/98). The prevalence rate of MDRPI caused by CPAP or BiPAP masks (25%) was highest. Lower Braden scores and having skin oedema were risk factors for MDRPI in adult ICU patients. CONCLUSION The prevalence of MDRPI in this study was still high. Nurses should take these related factors into consideration when taking care of ICU patients, and appropriate prevention measures should be adopted to decrease the prevalence of MDRPI. RELEVANCE TO CLINICAL PRACTICE The study can help to improve the PI prevention efforts in ICU patients specific to medical device related PI.
Collapse
Affiliation(s)
- Wen Dang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.,Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Liu
- The Third Affilated Hospital of Sun Yat-sen University, Lingnan Hospital, Guangzhou, China
| | - Qing Zhou
- The Third Affilated Hospital of Sun Yat-sen University, Lingnan Hospital, Guangzhou, China
| | - Yuyu Duan
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Huaxiu Gan
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Lin Wang
- Zhongshan People's Hospital, Zhongshan, China
| | | | - Chunyan Xie
- People's Hospital of Yangjiang, Yangjiang, China
| | - Ailing Hu
- The Third Affilated Hospital of Sun Yat-sen University, Lingnan Hospital, Guangzhou, China
| |
Collapse
|
47
|
Siby T, Smith U, Shajimon A. Eliminating Hospital-Acquired Pressure Injuries Caused by Graduated Compression Stockings. Am J Nurs 2021; 121:60-65. [PMID: 34156388 DOI: 10.1097/01.naj.0000758536.49559.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this evidence-based practice project was to reduce the incidence of pressure injuries (PIs) from the use of graduated compression stockings in patients on a gastrointestinal (GI) sarcoma surgery unit. Before this project, the standard of care for preventing deep vein thrombosis (DVT) included the use of graduated compression stockings, anticoagulation therapy, and intermittent pneumatic compression devices. We sought to examine the impact on PI and DVT risk of using only anticoagulation therapy and intermittent pneumatic compression devices. METHODS The pilot phase of the project began in June 2017 when nurses on the GI sarcoma surgery unit initiated a practice change in which graduated compression stockings were removed during the 7 AM shift change and put back on the patient before bedtime. Data on the incidence of DVTs and PIs were already being collected in our institution's electronic health record and safety intelligence reporting system. The project team monitored the incidence of PIs and DVTs throughout the project. After the pilot project concluded in August 2017, the GI sarcoma surgery unit staff continued the practice of taking off graduated compression stockings during the day, until on June 2018 the use of graduated compression stockings was formally discontinued for all surgical patients, both during the day and night. RESULTS Data collected during the pilot phase revealed that no PIs or DVTs occurred among the 497 study patients on the GI sarcoma surgery unit. From June to October 2017, the unit cared for a total of 856 patients and PI and DVT rates remained at zero. From the start of the pilot project in June 2017 to October 2018 (five months after the discontinuation of graduated compression stockings on all surgical units) the unit cared for 3,141 patients-an average of 174 patients per month-and had a zero rate of PIs and DVTs. CONCLUSIONS We found that the use of graduated compression stockings confers more risks than benefits for patients. Our findings prompted the discontinuation of graduated compression stockings use in postoperative patients throughout our institution. In the 17 months after the pilot project was initiated, no PIs occurred among patients in the GI sarcoma surgery unit, which also maintained a zero rate of DVTs.
Collapse
Affiliation(s)
- Tessy Siby
- Tessy Siby and Alice Shajimon are clinical nurse leaders in surgical oncology, and Uniqua Smith is associate director of nursing programs, all at the University of Texas MD Anderson Cancer Center, Houston. The authors acknowledge Colleen Villamin, MSN, RN, OCN, CNL, CPHQ, for her assistance in formatting the project data for this manuscript. Contact author: Tessy Siby, . The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | |
Collapse
|
48
|
Levine JM, Ayello EA, Persaud B, Spinner R. Medical Device-Related Pressure Injury to the Ear from a Mask. Adv Skin Wound Care 2021; 34:380-383. [PMID: 34125728 DOI: 10.1097/01.asw.0000752712.31139.c0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ABSTRACT Mask wearing is now ubiquitous because of the COVID-19 pandemic and has given rise to medical device-related pressure injuries in persons at risk of skin breakdown. The ear has unique anatomy that is particularly susceptible to injury from pressure. In this time of mandatory personal protective equipment requirements in healthcare facilities, protection and assessment of skin in the vulnerable postauricular area are needed. This article presents a case report of a pressure injury on the ear, reviews the anatomy of the ear, and provides strategies for assessment and treatment of pressure injuries in this often overlooked anatomic region.
Collapse
Affiliation(s)
- Jeffrey M Levine
- Jeffrey M. Levine, MD, AGSF, CMD, CWS-P, is Associate Clinical Professor of Geriatric Medicine and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY; and Consultant, Advantage Surgical and Wound Care, El Segundo, CA. Elizabeth A. Ayello, PhD, MSN, BSN, ETN, RN, CWON, MAPWCA, FAAN, is co-Editor-in-Chief, Advances in Skin and Wound Care , Philadelphia, PA; Faculty Emeritus, Excelsior College School of Nursing, Albany, NY; and President, Ayello Harris & Associates, Inc, Copake, NY. Balwant Persaud, LPN, is Licensed Practical Nurse, Department of Nursing, New Jewish Home, New York, NY. Ruth Spinner, MD, CMD, is Senior Medical Director, The New Jewish Home; Assistant Clinical Professor of Geriatric Medicine and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY; and Wound Consultant, Advantage Surgical & Wound Care. Acknowledgments: Dr Ayello was a member of the small working group for the chapter on medical device-related pressure injuries for the 2019 Clinical Practice Guideline for which she received no compensation. Dr Ayello has also served as an advisor to the CMS for long-term care on the Resident Assessment Instrument manual for Section M, pressure injuries. The authors have disclosed no financial relationships related to this article. Submitted October 30, 2020; accepted in revised form February 6, 2020
| | | | | | | |
Collapse
|
49
|
Fulbrook P, Lovegrove J, Miles S, Isaqi B. Systematic review: Incidence and prevalence of mucous membrane pressure injury in adults admitted to acute hospital settings. Int Wound J 2021; 19:278-293. [PMID: 34128339 PMCID: PMC8762539 DOI: 10.1111/iwj.13629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022] Open
Abstract
Mucous membrane pressure injury (MMPI) is associated with a history of medical device use at the site of injury. The current international guideline recommends they should be reported in incidence and prevalence studies. The aim of this systematic review was to analyse the incidence and prevalence of hospital-acquired MMPI in adults admitted to acute hospital settings. Database searches (EBSCO CINAHL Complete, EBSCO Medline Complete, Embase, Scopus and Web of Science) were undertaken between October 2019 and February 2021, using search terms related to hospital-acquired, mucosal and device-related pressure injury/ulcer incidence and prevalence. Searches were limited to the English language. Articles published between 2008 and 2020, reporting incidence or prevalence of mucous membrane or medical device-related pressure injury in non-interventional samples were selected. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. Twenty-one studies met inclusion criteria; most provided incidence data. No studies were found that specifically reported MMPI incidence or prevalence. It was possible to calculate incidence or prevalence from four studies; all were in intensive care settings. MMPI incidence of 0.8% and 30.4%, and prevalence of 1.7% and 3.7% were found. One study provided data that enabled calculation of prevalence of 0.1% in a non-intensive care sample. Only one other study provided specific data about MMPI. It is concluded that there is insufficient evidence available to enable estimation of MMPI incidence or prevalence in either acute hospital or intensive care settings.
Collapse
Affiliation(s)
- Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Sandra Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
| | - Ban Isaqi
- College of Dentistry, Hawler Medical University, Erbil, Iraq
| |
Collapse
|
50
|
Galetto SGDS, Nascimento ERPD, Hermida PMV, Busanello J, Malfussi LBHD, Lazzari DD. Medical device-related pressure injury prevention in critically ill patients: nursing care. Rev Bras Enferm 2021; 74:e20200062. [PMID: 33950113 DOI: 10.1590/0034-7167-2020-0062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/03/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES to know the care implemented by the nursing team to prevent medical device-related pressure injuries in critically ill patients. METHODS this is a qualitative research conducted with 15 nursing professionals from Intensive Care Unit. Sampling was carried out by theoretical saturation. For data analysis, the Discourse of the Collective Subject technique was used. RESULTS six speeches emerged, whose central ideas were interventions for medical device-related pressure injury prevention: care in fixation; frequent repositioning; protection and padding of body areas in contact; preferences for flexible materials, when available; attention of professionals so that they do not comer under patients; early assessment and removal, when clinically possible. FINAL CONSIDERATIONS nursing care was directed mainly to respiratory devices, catheters in general and monitoring equipment, indicating that professionals have the knowledge to provide safe assistance consistent with the literature.
Collapse
|