The Effectiveness of the SKINCARE Bundle in Preventing Medical-Device Related Pressure Injuries in Critical Care Units: A Clinical Trial

Incidence and characteristics of device-related pressure injuries in intensive care: A four-year analysis

OBJECTIVES

To describe and analyse the incidence and characteristics of intensive care-acquired device-related pressure injuries.

DESIGN

Secondary data analysis of intensive care-acquired pressure injuries during 2019-2022.

SETTING

Single general intensive care unit in Brisbane, Australia.

MAIN OUTCOME MEASURES

Intensive care-acquired pressure injury incidence, device-related pressure injury incidence, non-device-related pressure injury incidence, pressure injury category and location, device associated with pressure injury.

RESULTS

During the 4-year period, there were 7343 intensive care admissions of whom 413 (5.6 %) patients developed an intensive care-acquired pressure injury. The incidence of device-related pressure injury was 4.0 % compared to 2.7 % non-device-related pressure injury. In total there were 461 device-related pressure injuries, which were mostly (55 %) associated with endotracheal tubes or the methods used to secure them. Consequently, the majority of injuries were found on the mucous membranes (lips, mouth and tongue). The other main devices associated with injuries were high-flow nasal prongs (9.3 %), indwelling urinary catheters (6.7 %), nasogastric tubes (6.5 %) and oxygen masks (5.0 %). Overall, device-related pressure injuries were less severe than non-device-related pressure injuries, however they occurred in a shorter time frame (median 4 days versus 6 days). A range of factors was associated with device-related pressure injuries but overall, their presence or duration was less than with non-device-related pressure injuries.

CONCLUSION

The study results provide rigorous evidence of the incidence and characteristics of device-related pressures injuries, that can be used to benchmark with other intensive care units nationally and internationally.

IMPLICATIONS FOR CLINICAL PRACTICE

Endotracheal tube-associated pressure injuries were the most common type of device-related injury, providing a clear focus for preventative intervention. Given the high proportion of these device-related injuries, effective interventions would have a significant impact on overall reduction of intensive care-acquired pressure injuries. Since most injuries occur within three days of device insertion, early preventative intervention is time-critical.

Transformative Insights into Community-Acquired Pressure Injuries Among the Elderly: A Big Data Analysis

PURPOSE

To investigate community-acquired pressure injuries (CAPIs) in older people by utilizing big data.

DESIGN

Retrospective data curation and analysis of inpatient data from two general medical centers between 1 January 2016 and 31 December 2018.

METHODS

Nursing assessments from 44,449 electronic medical records of patients admitted to internal medicine departments were retrieved, organized, coded by data engineers, and analyzed by data scientists. Potential explanatory patient characteristics tested were gender, age, admission indices, nursing assessments including CAPIs, CAPI type and location, vital signs, and the results of lab tests within the first 36 h of admission.

FINDINGS

Most CAPIs were located in the buttocks (56.9%), followed by the sacrum (11.8%), ankle (10.8%), trochanter (5.1%), and leg (3.9%). Tissue associated with CAPIs was described as necrotic, serotic, bloody, granolithic, epithelial, and infected. There were 31% of first-degree CAPIs, 41% second-degree, and 18% third-degree. Previously unacknowledged patient characteristics associated with CAPIs are as follows: age, oxygen use, intestinal function, the touch senses of heat and pain, albumin, RDW (red cell distribution width), and systolic blood pressure.

CONCLUSIONS

The novel indicators for CAPIs underscore the importance of data-driven approaches in detecting and preventing CAPIs in community care. These markers can detect and prevent pressure ulcers in the community, particularly among the elderly.

RELEVANCE FOR CLINICAL PRACTICE

Nursing management is called upon to integrate information about novel patient characteristics associated with CAPI into clinical practice. Assimilating the insights from this hospital nursing-led study into community nursing will enhance the safety and quality of care for the elderly.

Knowledge, attitude, and practice of clinical nurses towards medical device-related pressure injury prevention: A systematic review

OBJECTIVE

To evaluate clinical nurses' knowledge, attitude, and practice toward MDRPI prevention.

BACKGROUND

Medical device-related pressure injury (MDRPI) is a significant concern in healthcare, serving as a critical indicator of patient safety and the quality of nursing care.

METHODS

This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed on PubMed, Embase, Web of Science, the Cochrane Library, and CINAHL, as well as Chinese databases including China Biology Medicine Disc (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database using the relevant keywords, from the earliest available records to June 27, 2024. The quality of the studies was appraised using the Joanna Briggs Institute (JBI) literature evaluation tool.

FINDINGS

A total of 8847 clinical nurses from 18 studies were included. Of these, 6502 working in intensive care units. While nurses generally exhibited a positive attitude, their knowledge and practice were insufficient. Several factors positively influenced nurses' knowledge, attitude, and practice regarding MDRPI prevention, which include the level of education, work experience, previous training on MDRPU, caring for MDRPI patients, being an ICU specialist nurse, working in tertiary hospitals, and holding wound care certifications.

CONCLUSION

This review underscores the critical need to develop educational training programs to enhance nurses' competencies in MDRPI prevention. It also highlights the importance of addressing the challenges in implementing these strategies to ensure their effectiveness in clinical practice.

Nurses' knowledge of medical device-related pressure injuries and risk factors: A descriptive study at a large medical centre from Palestine

BACKGROUND

Nurses' knowledge of pressure injuries causes and risk factors helps to prevent their occurrences and protect the patient.

AIM

To assess the level of knowledge of medical device-related pressure injuries and to identify risk factors that affect the knowledge.

METHODS

A cross-sectional design was used in this study considering a convenience sample from critical care nurses. The nurses were invited to complete the Medical Device-Related Pressure Injuries Knowledge Questionnaire.

RESULTS

About 71 nurses participated in the study. The mean score of MDRPI_KQ was 23.28 ± 4.14 out of 36. Mann-Whitney Test did not show statistically significant relationships between the MDRPI_KQ mean score and related variables (p > 0.05). The regression results indicated that the three predictors explained 46.4% of the variance (R2 = 0.215, F(3, 6.114) = 3.75, p = 0.001). It was found that the Frequency of encountering a patient with MDRPIs significantly predicted MDRPI_KQ score, job position, and assuming the care responsibility for MDRPIs in the department.

CONCLUSIONS

Poor knowledge of pressure injuries can negatively affect patient care so training programs and policies should be developed based on the level of knowledge and practices of the staff to be more effective.

Development of a care package to prevent medical device-related pressure injuries using the Delphi Method: A maintenance care package development study

AIM

The purpose is to develop a care package for the prevention of medical device-related pressure injuries using the Delphi Method.

DESIGN

The study is a methodological.

METHOD

The care package was developed using the Delphi Method, a consensus-based technique. Two expert groups were selected to develop the care package to prevent medical device-related pressure injuries. The invitation letter and the questionnaire consisting of two questions were sent to the relevant experts via email and completed in three rounds after receiving responses. The scores from the experts were uploaded to the SPSS 25.0 software package. The range (R) was calculated as R = Q3-Q1. The differences (R) between the quartiles were examined. Items with R < 1.2 were accepted as having reached a consensus.

RESULTS

As a result of the evaluation, it was organized as 83 items. As a result of the analysis of the scores of the second round of the Delphi Method, the range values of each item were examined. In the third round of the Delphi Method, it was found that consensus was reached in the third round on items 18, 29, and 56, on which consensus could not be reached in the second round, and the care package was accepted with 83 items.

CONCLUSION

An 83-item care package was created to prevent medical device-related pressure injuries in children.

Clinical nurses' attitudes towards medical device-related pressure injuries and an analysis of relevant influencing factors: A cross-sectional study in China

This study aimed to explore Chinese clinical nurses' attitudes towards medical device-related pressure injuries (PIs) and analyse the relevant influencing factors. Between December 2023 and January 2024, a cross-sectional survey of 1740 clinical nurses from three tertiary hospitals, three secondary hospitals and five community hospitals in Shanghai, China, was conducted via the Chinese version of the Attitude towards medical device-related pressure ulcers/injuries questionnaire. A total of 1693 nurses participated in this study. Nurses' total score regarding their attitudes towards medical device-related PIs was 36.60 ± 8.97, and multiple linear regression analysis revealed that clinical nurses' highest level of education (p < 0.001), professional title (p < 0.001), position (p = 0.001), years of work experience (p < 0.001) and participation in medical device-related pressure injury (PI) training (p < 0.001) influenced their attitudes towards medical device-related PIs. Nurses' attitudes towards medical device-related PIs ranged between negative and positive. Therefore, it is essential to focus on the highest level of education, professional title, position and years of work experience. Increasing the frequency of medical device-related pressure injury (PI) prevention training will improve nurses' attitudes towards medical device-related PIs.

Implementing a Hospital-Acquired Pressure Injury Prevention Bundle in Critical Care

ABSTRACT

The emerging field of implementation science (IS) facilitates the sustainment of evidence-based practice in clinical care. This article, the third in a series on applying IS, describes how a nurse-led team at a multisite health system used IS concepts, methods, and tools to implement a hospital-acquired pressure injury (HAPI) prevention bundle on six critical care units, with the aim of decreasing HAPI incidence.

The effect of short intervention training for nurses about pediatric pressure injuries on their knowledge and on pressure injuries: A randomized controlled trial

PURPOSE

This study aimed to evaluate the effect of Stop Pediatric Pressure Injury (SPPI) Short Intervention training sessions given to pediatric intensive care nurses on their level of knowledge and on pediatric pressure injuries.

METHOD

The study, conducted with a randomized controlled trial design, included 55 pediatric intensive care nurses (experimental group = 27, control group = 28). The nurses in the experimental group received the SPPI Short Intervention training. Data were collected using the Nurse Data Collection Form, the SPPI Short Intervention Evaluation Form, and the Pediatric Pressure Injury Assessment Form. The data obtained were evaluated using chi-squared test, the dependent and independent samples t-test, the Mann-Whitney U test, and the two-way repeated measures ANOVA.

RESULTS

The SPPI Short Intervention training led to a significant increase in the pediatric pressure injury knowledge levels of the experimental group (p < .01). In patients cared for by the experimental group, the prevalence of injuries decreased by 50 %, and the number of severe injury stages also decreased. The Braden Q and PUSH scores of the patients cared for by both the experimental and control groups decreased significantly (p < .05).

CONCLUSION

The SPPI Short Intervention training was found to be effective in increasing the level of pediatric intensive care unit nurses' knowledge of pediatric pressure injury. Providing pediatric nurses with training that includes the stop pediatric pressure injury training is recommended as an effective approach to prevent and manage pediatric pressure injury.

PRACTICAL IMPLICATIONS

Pediatric intensive care unit nurses should be trained to become competent in dealing with pediatric pressure injury.

Nursing care bundles in the prevention of medical device related pressure ulcers: An integrative review

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.

Protocols and their effects for medical device-related pressure injury prevention among critically ill patients: a systematic review

BACKGROUND

A pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related to medical devices. Medical device-related pressure injuries occur in various sites and are difficult to detect. Even if it is detected, medical devices are essential to life for critically ill patients. Thus, it is difficult to remove or change the position of the medical device; therefore, prevention is essential. This study aims to integrate the literature on medical device-related pressure injury prevention protocols among critically ill patients.

METHODS

The literature inclusion criteria were (1) critically ill patients, (2) device-related pressure injury interventions, (3) randomized controlled trials and quasi-experimental designs, and (4) written in Korean or English. The literature search and selection were performed following the Cochrane Handbook for Systematic Reviews of Interventions with the support of the PRISMA Guidelines.

RESULTS

Twelve articles were finally selected. The incidence of medical device-related pressure injury decreased from 8.1-96.7% before intervention to 0.3-53.3% after intervention, respectively. Medical device-related pressure injury prevention was effective in reducing medical device-related pressure injury incidence when applied to patients of all ages, from neonates to adults, in a variety of intensive care units. Medical device-related pressure injury prevention strategies include nurse education, assessment, documentation, and interventions (hygiene, repositioning, emergent therapy such as protective dressing or designed equipment reducing pressure) of pressure injury. Pressure injury dressings primarily included hydrocolloid foam dressings, but transparent hydrocolloid formulations also effectively reduced medical device-related pressure injury incidence rates.

CONCLUSIONS

In the future, it is necessary to increase the level of evidence by applying specialized medical device-related pressure injury prevention methods for different medical devices and areas of pressure injuries, and verifying their effectiveness.

TRIAL REGISTRATION

The review protocol was registered (PROSPERO registration number: CRD42022346450).

Incidence of medical device-related pressure injuries in the intensive care unit and related risk factors

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.

Interventions and strategies to prevent medical device-related pressure injury in adult patients: A systematic review

BACKGROUND

Current evidence shows that medical device-related pressure injury (MDRPI) has a high prevalence (10%) and incidence (12%), and much research has been done to prevent MDRPI in recent years. However, to our knowledge, there is limited systematic review available on interventions and strategies to prevent MDRPI.

AIM

To synthesise research evidence on interventions and strategies used to prevent MDRPI.

METHODS

This systematic review adhered to the PRISMA Guidelines. We searched six databases including Medline, CINAHL, EMBASE, Cochrane library, Web of Science and ProQuest with no restriction to year of publication. Data were extracted and checked by two authors independently. A narrative summary technique was used to describe the findings. Implementation strategies were grouped into six classifications: dissemination/implementation process/integration/capacity building/sustainability/scale-up strategies.

RESULTS

Twenty-four peer-reviewed papers met the inclusion criteria, which comprised of 11 quality improvement projects and 13 original research. Types of devices included respiratory devices (non-invasive ventilation mask, CPAP/BiPAP mask, endotracheal tube), gastrointestinal/urinary devices and other devices. Interventions used included the use of dressing, hyperoxygenated fatty acids, full-face mask, training, and/or multidisciplinary education, use of special securement devices or tube holder, repositioning, application of stockinette, early removal and foam ring use. Common implementation strategies included ongoing staff education, audit and standardising documentation or guideline development.

CONCLUSION

Much work on MDRPI prevention strategies has been undertaken. There were a variety of devices reported, however, it is evident that higher quality research is needed.

RELEVANCE TO CLINICAL PRACTICE

Current evidence shows that interventions including use of dressing or special securement device, repositioning, and training/multidisciplinary education can be beneficial for MDRPI prevention. High-quality research, such as randomised controlled trials are needed to test the effectiveness of the interventions and their implementation strategies. No patient or public contribution.

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

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.

Reduction in the Incidence Density of Pressure Injuries in Intensive Care Units after Advance Preventive Protocols

(1) Background: Patients who are critically ill or undergo major surgery are admitted to intensive care units (ICUs). Prolonged immobilization is the most likely cause of pressure injuries (PrIs) in the ICU. Previous studies of Western populations found that effective protocols could reduce the incidence of PrIs, and the efficacy of systemic targeted intervention protocols in preventing PrIs in the Chinese population needs to be surveyed. (2) Methods: We reviewed cases of PrIs in the ICUs of Taipei Veterans General Hospital from 2014 to 2019. The ICU nurses at the hospital began to implement targeted interventions in January 2017. The incidence density of PrIs was calculated by dividing the number of PrIs by person days of hospitalizations in the pre-bundle (2014-2016) and post-bundle (2017-2019) stages. Poisson regression was performed to compare the trend of incidence densities. (3) Results: The incidence density of PrIs was 9.37/1000 person days during the pre-bundle stage and 1.85/1000 person days during the post-bundle stage (p < 0.001). The relative risk (RR) was 0.197 (95% confidence interval: 0.149-0.26). The incidence densities of iatrogenic PrIs and non-iatrogenic PrIs decreased as the RRs decreased. (4) Conclusions: Targeted interventions could significantly reduce the incidence of PrIs. Healthcare providers must follow the bundle care protocol for PrI prevention to improve the quality of healthcare and promote patient health.

Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis

BACKGROUND

In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries.

OBJECTIVE

To evaluate the effectiveness of interventions to reduce tracheostomy-related pressure injury in the critical care setting.

METHODS

MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units conducted to evaluate interventions to reduce tracheostomy-related pressure injury. Reviewers independently extracted data on study and patient characteristics, incidence of tracheostomy-related pressure injury, characteristics of the interventions, and outcomes. Study quality was assessed using the Cochrane Collaboration's risk-of-bias criteria.

RESULTS

Ten studies (2 randomized clinical trials, 5 quasi-experimental, 3 observational) involving 2023 critically ill adult and pediatric patients met eligibility criteria. The incidence of tracheostomy-related pressure injury was 17.0% before intervention and 3.5% after intervention, a 79% decrease. Pressure injury most commonly involved skin in the peristomal area and under tracheostomy ties and flanges. Interventions to mitigate risk of tracheostomy-related pressure injury included modifications to tracheostomy flange securement with foam collars, hydrophilic dressings, and extended-length tracheostomy tubes. Interventions were often investigated as part of care bundles, and there was limited standardization of interventions between studies. Meta-analysis supported the benefit of hydrophilic dressings under tracheostomy flanges for decreasing tracheostomy-related pressure injury.

CONCLUSIONS

Use of hydrophilic dressings and foam collars decreases the incidence of tracheostomy-related pressure injury in critically ill patients. Evidence regarding individual interventions is limited by lack of sensitive measurement tools and by use of bundled interventions. Further research is necessary to delineate optimal interventions for preventing tracheostomy-related pressure injury.

Systematic review: Incidence and prevalence of mucous membrane pressure injury in adults admitted to acute hospital settings

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.