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Lu X, Wu B, Li Q, Wang X, Fan L, Li M, Wang L. A survey of skin failure perceptions amongst pressure injury management staff in China: A cross-sectional study. Int Wound J 2024; 21:e14890. [PMID: 38682890 PMCID: PMC11057374 DOI: 10.1111/iwj.14890] [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: 01/09/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
This study sought to evaluate the perceptions of pressure injury (PI) management staff regarding skin failure (SF). Additionally, an analysis of influencing factors based on the collected data was conducted to establish a foundation for targeted SF training. A descriptive, cross-sectional survey was undertaken in October-November 2023, utilising a convenience sampling method involving selected management staff of PI from 16 provinces in China. A total of 501 nursing participants were included, exhibiting an overall perception level that was moderately low. Although the majority were aware of the possibility of SF (n = 417, 83.23%), only 60% reported an understanding of the fundamentals of SF, with the lowest level of comprehension observed in differentiating between SF and PI (n = 212, 42.31%). Overall attitudes were generally positive. Regarding behaviour, active learning was more prevalent (n = 340, 67.86%), but training is less (n = 287, 57.29%). Family education (n = 401, 80.04%) and nursing record monitoring (n = 426, 85.03%) demonstrated better behaviour. Further analysis revealed that training (t = 13.937, p < 0.001) and professional title (F = 4.681, p = 0.010) had a significant effect on participants' perceptions. These findings underscore that there remains a substantial lack of perception about SF amongst participants. Overall, participants exhibited a positive attitude towards SF, highlighting the need for future improvements in SF training.
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Affiliation(s)
- Xiaodan Lu
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Bingbing Wu
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Qian Li
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Xuyang Wang
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Li Fan
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Min Li
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Lizhu Wang
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
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Fu L, Chen Y, Lin L, Xu Z, Zhuang Y. Knowledge, attitude, and practice of critical care nurses and their influence on acute skin failure patients in China: A multicenter cross-sectional study. Jpn J Nurs Sci 2024; 21:e12582. [PMID: 38217104 DOI: 10.1111/jjns.12582] [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: 05/05/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 01/15/2024]
Abstract
AIM Acute skin failure (ASF) can happen in critically ill patients. Therefore, adequate knowledge and skills regarding ASF are essential to manage this disorder. The aim of this work was to investigate the nurses' knowledge, attitude, and practice (KAP) regarding ASF patients and to analyze its influencing factors in the intensive care unit. METHODS A multicenter cross-sectional study was performed in 10 tertiary hospitals in March 2022. Eligible nurses received a survey with a self-designed questionnaire about their KAP regarding ASF, which included three dimensions and a maximum score of 120. A higher score corresponded to better KAP. RESULTS A total of 255 nurses participated in this study. The mean KAP score was 75.6 ± 16.9. The mean scores of the knowledge, attitude, and practice dimensions were 26.2 ± 10.6, 38.2 ± 6.1, and 11.3 ± 4.3, respectively. The dimensions were ranked according to score (from low to high) as follows: knowledge (2.6 ± 1.1), practice (2.8 ± 1.1), and attitude (3.8 ± 0.6). Multivariate linear regression analysis showed that more training sessions and an advanced professional title were associated with higher KAP scores. CONCLUSIONS The overall KAP score on ASF was low in nurses. Nurses had a positive attitude towards ASF, but their knowledge and practice required significant improvement. Those who had received more training and held a more advanced professional title exhibited higher KAP scores regarding ASF. Therefore, nurse managers should establish a relevant knowledge training system, strengthen relevant training, and improve nursing practices for ASF in order to achieve a high level of KAP in nurses who treat ASF patients.
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Affiliation(s)
- Lisang Fu
- Department of Nursing, Hospital of Putian University, Putian, China
| | - Yiyuan Chen
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Libin Lin
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Zhenmei Xu
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Yaoning Zhuang
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
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Examining Violaceous Skin Discoloration during the COVID-19 Pandemic: Conducting Research in Resource Scarcity. Adv Skin Wound Care 2023; 36:137-141. [PMID: 36812078 DOI: 10.1097/01.asw.0000911988.75204.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To describe the observed patterns and presentations of violaceous discoloration that appeared to be related to the COVID-19 disease process. METHODS This retrospective observational cohort study included adults who were COVID-19 positive with purpuric/violaceous lesions in pressure-adjacent areas of the gluteus without preexisting pressure injury. Patients were admitted to an ICU at a single quaternary academic medical center between April 1 and May 15, 2020. Data were compiled by review of the electronic health record. The wounds were described by location, tissue type (violaceous, granulation, slough, eschar), wound margin (irregular, diffuse, nonlocalized), and periwound condition (intact). RESULTS A total of 26 patients were included in the study. Purpuric/violaceous wounds were found predominantly on White (92.3%) men (88.0%) aged 60 to 89 years (76.9%) with a body mass index 30 kg/m2 or higher (46.1%). The majority of wounds were located on the sacrococcygeal (42.3%) and fleshy gluteal regions (46.1%). CONCLUSIONS Wounds were heterogeneous in appearance (poorly defined violaceous skin discoloration of acute onset), and the patient population had clinical characteristics similar to acute skin failure (eg, concomitant organ failures and hemodynamic instability). Additional larger population-based studies with biopsies may assist in finding patterns related to these dermatologic changes.
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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]
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Affiliation(s)
- Jeffrey M Levine
- Jeffrey M. Levine, MD, AGSF, CMD, CWS-P, is a wound consultant for the New Jewish Home in Manhattan and Advantage Surgical and Wound Care based in El Segundo, California; and Associate Clinical Professor of Geriatrics and Palliative Care, Mount Sinai Beth Israel Medical Center, New York, New York. Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU, FAAN, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care (CIAC) and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Langone Health, New York, New York. Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, is Clinical Associate Professor, School of Nursing, Rutgers University, Newark, New Jersey, and Wound/Ostomy/Continence Advanced Practice Nurse, Englewood Hospital and Medical Center, Englewood, New Jersey. Submitted July 9, 2021; accepted in revised form October 8, 2021; published online ahead of print November 1, 2021
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Langemo D, Parish LC. The Past, Present, and Future of Skin Failure. Adv Skin Wound Care 2022; 35:81-83. [PMID: 35050915 DOI: 10.1097/01.asw.0000803596.89726.6e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane Langemo
- Diane Langemo, PhD, RN, FAAN, is Distinguished Professor Emeritus, College of Nursing, University of North Dakota; and President, Langemo & Associates, Grand Forks, North Dakota. Lawrence Charles Parish, MD, MD(Hon), is Clinical Professor of Dermatology and Cutaneous Biology and Director of the Jefferson Center for International Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. This article is considered expert opinion and was not subject to peer review
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Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis: Results From the International Pressure Ulcer Prevalence (IPUP) Survey Database. J Wound Ostomy Continence Nurs 2021; 48:492-503. [PMID: 34781304 DOI: 10.1097/won.0000000000000817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine overall pressure injury (PI) prevalence and hospital-acquired pressure injury (HAPI) prevalence in US acute care hospitals. Additionally, analysis of patient characteristics associated with HAPIs will be presented. DESIGN Observational, cross-sectional cohort study. SUBJECTS AND SETTING An in-depth analysis of data was performed from the International Pressure Ulcer Prevalence™ (IPUP) Survey database for years 2018-2019 that included 296,014 patients. There were 914 participating US acute care facilities in 2018 and 887 in 2019. Overall PI prevalence and HAPI prevalence over time were also examined for 2006-2019 acute care data from 2703 unique facilities (1,179,108 patients). METHODS Overall PI prevalence and HAPI prevalence were analyzed from the 2006-2019 IPUP survey database. Recent data for 2018-2019 PI prevalence are reported separately for medical-surgical, step-down, and critical care unit types. PI stages, anatomic locations, Braden score associated with HAPIs, and body mass index were analyzed. RESULTS Overall PI prevalence and HAPI prevalence data declined between 2006 and 2019; however, the prevalence plateaued in the years 2015-2019. Data from 2018 to 2019 (N = 296,014) showed that 26,562 patients (8.97%) had at least one PI and 7631 (2.58%) had at least one HAPI. Patients cared for in medical-surgical inpatient care units had the lowest overall PI prevalence (7.78%) and HAPI prevalence (1.87%), while critical care patients had the highest overall PI prevalence (14.32%) and HAPI prevalence (5.85%). Critical care patients developed more severe PIs (stage 3,4, unstageable, and deep-tissue pressure injuries [DTPIs]), which were proportionally higher than those in the step-down or medical-surgical units. The sacrum/coccyx anatomic location had the highest overall PI prevalence and HAPI prevalence, except for DTPIs, which most common occurred on the heel. CONCLUSIONS Overall and HAPI prevalence has plateaued 2015-2019. Prevalence of HAPIs, especially in critical care units, remain high. While medical advancements have improved survival rates among critically ill patients, survival may come with unintended consequences, including PI development.
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García-Fernández FP, Soldevilla-Agreda JJ, Rodriguez-Palma M, Pancorbo-Hidalgo PL. Skin injuries associated with severe life-threatening situations: A new conceptual framework. J Nurs Scholarsh 2021; 54:72-80. [PMID: 34741398 DOI: 10.1111/jnu.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To create a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time. To name and classify these types of skin injuries. To describe the clinical features of the different types of skin injuries that may occur in terminally ill and/or dying patients. DESIGN A sequential design with several different phases (a literature review, a nominal group, and a consensus conference) was used. METHODS Six experts with extensive knowledge of these types of injuries were selected for the nominal group. The traditional eight-phase nominal group technique was followed. The consensus conference consisted of participants voting on different options based on the statements elaborated with the expert panel summarizing the best scientific evidence available. FINDINGS Using all these elements, a conceptual framework was constructed to identify skin injuries associated with severe life-threatening situations (SI-SLTSs), defined as unpredictable and therefore unpreventable injuries indicating a serious threat to life or even imminent death. These injuries can occur in two forms: (a) as skin injuries associated with multiple organ dysfunction syndrome (SI-MODSs) or (b) as skin injuries associated with severe vasoconstriction (SI-ESVs). SI-MODSs develop very quickly and suddenly. They progress from superficial to deep stages abruptly, even within hours. The severity of the injuries does not reflect the care provided to the patient. Individuals suffering from these injuries have an irreversible clinical condition. SI-ESVs also appear in individuals who are in a very critical, even terminal, clinical condition. They are frequently treated in the ICU and may exhibit severe vasoconstriction due to their disease process (e.g., shock), sometimes exacerbated by vasoconstriction caused by various drugs (e.g., noradrenaline). CONCLUSIONS We have developed a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time and have named them SI-SLTSs, distinguishing between SI-MODSs and SI-ESVs. CLINICAL RELEVANCE This new conceptual framework may help clinicians understand the mechanisms and the pathophysiology of skin injuries that develop in terminally ill and/or dying patients associated with multi-organ failure. Through this new framework these injuries can be identified and differentiated from pressure injuries or other dependence-related skin lesions.
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Brennan MR, Grahn E, Oropallo A, Probst N, Reynolds D, Rivera J. A HAPI Opinion Commentary. Adv Skin Wound Care 2021; 34:569-571. [PMID: 34669658 DOI: 10.1097/01.asw.0000792936.94123.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mary R Brennan
- At the North Shore University Hospital, Manhasset, New York, Mary R. Brennan, MBA, RN, CWON, is Clinical Development Educator; Elizabeth Grahn, MSN, NP-C, CWOCN, is Senior Manager, Wound and Ostomy Services. Alisha Oropallo, MD, FACS, FAWPCA, is Director, Comprehensive Wound Healing Center, Lake Success, New York. Nicole Probst, MS, RN, AGNP-C, CWOCN, is Manager, Patient Care, Huntington Hospital, Huntington, New York. Deborah Reynolds, BA, RN, CWOCN, is Clinical Professional Development Educator, Phelps Memorial Hospital, Sleepy Hollow, NY. Julie Rivera, MSN, RN, NPD-BC, CWOCN, is Clinical Professional Development Educator, Lenox Hill Hospital, New York City, NY
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Bromley M, Marsh S, Layton A. Dermatological complications of critical care. BJA Educ 2021; 21:408-413. [PMID: 34707885 DOI: 10.1016/j.bjae.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - S Marsh
- Harrogate District Hospital, Harrogate, UK
| | - A Layton
- Harrogate District Hospital, Harrogate, UK
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Dalgleish L, Campbell J, Finlayson K, Barakat-Johnson M, Beath A, Ingleman J, Parker C, Coyer F. Understanding Skin Failure: A Scoping Review. Adv Skin Wound Care 2021; 34:542-550. [PMID: 34175867 DOI: 10.1097/01.asw.0000755844.87283.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To map the use of the term "skin failure" in the literature over time and enhance understanding of this term as it is used in clinical practice. DATA SOURCES The databases searched for published literature included PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature, and Google Scholar. The search for unpublished literature encompassed two databases, Open Gray and ProQuest Dissertation and Theses. STUDY SELECTION Search terms included "skin failure," "acute skin failure," "chronic skin failure," and "end stage skin." All qualitative and quantitative research designs, editorial, opinion pieces, and case studies were included, as well as relevant gray literature. DATA EXTRACTION Data collected included author, title, year of publication, journal name, whether the term "skin failure" was mentioned in the publication and/or in conjunction with other skin injury, study design, study setting, study population, sample size, main focus of the publication, what causes skin failure, skin failure definition, primary study aim, and primary outcome. DATA SYNTHESIS Two main themes of skin failure were identified through this scoping review: the etiology of skin failure and the interchangeable use of definitions. CONCLUSIONS Use of the term "skin failure" has increased significantly over the past 30 years. However, there remains a significant lack of empirical evidence related to skin failure across all healthcare settings. The lack of quality research has resulted in multiple lines of thinking on the cause of skin failure, as well as divergent definitions of the concept. These results illustrate substantial gaps in the current literature and an urgent need to develop a globally agreed-upon definition of skin failure, as well as a better understanding of skin failure etiology.
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Affiliation(s)
- Lizanne Dalgleish
- At the School of Nursing, Queensland University of Technology, Brisbane, Australia, Lizanne Dalgleish, PhD, RN, is PhD Candidate; Jill Campbell, PhD, RN, is Senior Research Fellow; Kathleen Finlayson, PhD, RN, is Lecturer; Jessica Ingleman, MSN, RN, is Lecturer; Christina Parker, PhD, RN, is Senior Lecturer; and Fiona Coyer, PhD, RN, is Professor. Michelle Barakat-Johnson, PhD, RN, is Senior Lecturer, University of Sydney, Camperdown. Amy Beath, BSN, RN, is Transitional Nurse Practitioner-Wounds, Murrumbidgee Local Health District, New South Wales. The authors have disclosed no financial relationships related to this article. Submitted June 21, 2020; accepted in revised form December 1, 2020; published online ahead of print June 23, 2021
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Ramalho ADO, Rosa TDS, Santos VLCDG, Nogueira PC. ACUTE SKIN FAILURE E LESÃO POR PRESSÃO EM PACIENTE COM COVID-19. ESTIMA 2021. [DOI: 10.30886/estima.v19.1007_pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objetivo:relatar o caso de um paciente crítico com COVID-19 e mostrar os principais achados relacionados à lesão considerada Acute skin failure (ASF), bem como realizar seu diagnóstico diferencial com lesão por pressão (LP) evitável. Método: estudo observacional do tipo relato de caso, desenvolvido em um hospital de São Paulo, na unidade de terapia intensiva (UTI) exclusiva a pessoas diagnosticadas com COVID-19. Os dados foram coletados de um único paciente, entre os meses de março e setembro de 2020. Resultados: paciente com complicações da COVID-19 evoluiu com lesão de pele, inicialmente definida como LP e posteriormente reclassificada como ASF. Os seguintes achados corroboraram o diagnóstico: ventilação mecânica invasiva prolongada, insuficiências respiratória, renal e cardíaca e sepse de foco respiratório. Além disso, outros fatores agravantes, como o uso de droga vasoativa, instabilidade hemodinâmica com intolerância ao mínimo reposicionamento, jejum prolongado e coagulopatia intravascular disseminada associada à infecção pelo coronavírus. Conclusão: o relato mostra que existem dificuldades para o diagnóstico diferencial entre ASF e LP na prática clínica. Trata-se de conceito novo, sendo fundamental que o profissional de saúde reconheça os principais fatores associados ao aparecimento da ASF, muitos dos quais também estão relacionados ao desenvolvimento das LP, ressaltando a necessidade de análise individualizada dessas lesões, e garantia da implementação de intervenções adequadas para prevenção e tratamento.
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Ramalho ADO, Rosa TDS, Santos VLCDG, Nogueira PC. ACUTE SKIN FAILURE AND PRESSURE INJURY IN THE PATIENT WITH COVID-19. ESTIMA 2021. [DOI: 10.30886/estima.v19.1007_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective:report the case of a critical patient with COVID-19 and show the main findings related to the injury considered acute skin failure (ASF), as well as perform his differential diagnosis with preventable pressure injury (PI). Method: observational, longitudinal, case report type study, developed in a hospital in São Paulo, in the intensive care unit (ICU) exclusively for people diagnosed with COVID-19. Data were collected from a single patient between March and September 2020. Results: A patient with complications from COVID-19 developed a skin lesion, initially defined as PI and later reclassified as ASF. The following findings corroborated the diagnosis: prolonged invasive mechanical ventilation, respiratory, renal and cardiac insufficiency and sepsis of respiratory focus. In addition, other aggravating factors, such as the use of vasoactive drugs, hemodynamic instability with intolerance to minimal repositioning, prolonged fasting and disseminated intravascular coagulopathy associated with coronavirus infection. Conclusion: the report shows that there are difficulties for the differential diagnosis between ASF and PI in clinical practice. This is a new concept, and it is essential that health professionals recognize the main factors associated with the appearance of ASF, many of which are also related to the development of PI, highlighting the need for individualized analysis of these injuries, and ensuring the implementation of interventions for prevention and treatment.
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Pittman J, Beeson T, Dillon J, Yang Z, Mravec M, Malloy C, Cuddigan J. Hospital-Acquired Pressure Injuries and Acute Skin Failure in Critical Care: A Case-Control Study. J Wound Ostomy Continence Nurs 2021; 48:20-30. [PMID: 33427806 PMCID: PMC8078725 DOI: 10.1097/won.0000000000000734] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to examine clinical characteristics and risk factors for critically ill patients who develop pressure injuries and identify the proportion of validated unavoidable pressure injuries associated with the proposed risk factors for acute skin failure (ASF). DESIGN Retrospective case-control comparative study. SUBJECTS AND SETTING The sample comprised adult critically ill participants hospitalized in critical care units such as surgical, trauma, cardiovascular surgical, cardiac, neuro, and medical intensive care and corresponding progressive care units in 5 acute care hospitals within a large Midwestern academic/teaching healthcare system. Participants who developed hospital-acquired pressure injuries (HAPIs) and patients without HAPIs (controls) were included. METHODS A secondary analysis of data from a previous study with HAPIs and matching data for the control sample without HAPIs were obtained from the electronic health record. Descriptive and multivariate logistic regression analyses were conducted. RESULTS The sample comprised 475 participants; 165 experienced a HAPI and acted as cases, whereas the remaining 310 acted as controls. Acute Physiology and Chronic Health Evaluation (APACHE II) mean score (23.8, 8.7%; P < .001), mortality (n = 45, 27.3%; P = .002), history of liver disease (n = 28, 17%; P < .001), and unintentional loss of 10 lb or more in 1 month (n = 20, 12%; P = .002) were higher in the HAPI group. Multivariate logistic regression analysis identified participants with respiratory failure (odds ratio [OR] = 3.00; 95% confidence interval [CI], 1.27-7.08; P = .012), renal failure (OR = 7.48; 95% CI, 3.49-16.01; P < .001), cardiac failure (OR = 4.50; 95% CI, 1.76-11.51; P = .002), severe anemia (OR = 10.89; 95% CI, 3.59-33.00; P < .001), any type of sepsis (OR = 3.15; 95% CI, 1.44-6.90; P = .004), and moisture documentation (OR = 11.89; 95% CI, 5.27-26.81; P <.001) were more likely to develop a HAPI. No differences between unavoidable HAPI, avoidable HAPI, or the control group were identified based on the proposed ASF risk factors. CONCLUSION This study provides important information regarding avoidable and unavoidable HAPIs and ASF. Key clinical characteristics and risk factors, such as patient acuity, organ failure, tissue perfusion, sepsis, and history of prior pressure injury, are associated with avoidable and unavoidable HAPI development. In addition, we were unable to support a relationship between unavoidable HAPIs and the proposed risk factors for ASF. Unavoidability of HAPIs rests with the documentation of appropriate interventions and not necessarily with the identification of clinical risk factors.
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Affiliation(s)
- Joyce Pittman
- Indiana University Health- Academic Health Center, Indianapolis, IN
| | - Terrie Beeson
- Indiana University Health- Academic Health Center, Indianapolis, IN
| | - Jill Dillon
- Indiana University Health- Academic Health Center, Indianapolis, IN
| | - Ziyi Yang
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Caeli Malloy
- Indiana University School of Nursing, Indianapolis, IN
| | - Janet Cuddigan
- University of Nebraska Medical Center, College of Nursing, Omaha, NE
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