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Bavaresco T, Menegon DB, Macedo ABT, Tanaka RY, Candaten AE. Association between clinical characteristics of patients with pressure ulcer in the COVID-19 pandemic. Rev Gaucha Enferm 2024; 45:e20230086. [PMID: 38922229 DOI: 10.1590/1983-1447.2024.20230086.en] [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: 05/11/2023] [Accepted: 11/07/2023] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To analyze the associations between the clinical characteristics of patients hospitalized with pressure injuries (PI) during the COVID-19 pandemic. METHOD Cross-sectional study of 237 PI notifications in a hospital in southern Brazil. Collection took place in 2021 in an institutional management program, with interlocution to the patient's medical record. Analysis using descriptive statistics, Student's t-test, Pearson's chi-square and Wilcoxon. RESULTS The mean age was 59.4±14.4 years, with 59.7% male, 74.7% diagnosed with COVID-19. High risk (57.8%), stage 2 (80.2%), sacral region, intergluteal/gluteal region (73.0%) were predominant and death was the prevalent outcome (51.1%), with a median of 9.5 (0-217) days after notification. There was no association of death with diabetes, systemic arterial hypertension, smoking and reason for hospitalization. CONCLUSION The association between the clinical characteristics of hospitalized patients with pressure injuries reflects the systemic inflammation of patients affected by COVID-19.
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Affiliation(s)
- Taline Bavaresco
- Universidade Federal do Rio Grande do Sul. Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Dóris Baratz Menegon
- Hospital de Clínicas de Porto Alegre. Comissão de Prevenção e Tratamento de Feridas. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Raquel Yurika Tanaka
- Hospital de Clínicas de Porto Alegre. Comissão de Prevenção e Tratamento de Feridas. Porto Alegre, Rio Grande do Sul, Brasil
| | - Angela Enderle Candaten
- Hospital de Clínicas de Porto Alegre. Comissão de Prevenção e Tratamento de Feridas. Porto Alegre, Rio Grande do Sul, Brasil
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Alves P, Bååth C, Manuel T, Almeida S, Källman U. Pressure ulcers during the COVID-19 pandemic in intensive care:A multicenter cohort study. J Tissue Viability 2024:S0965-206X(24)00082-2. [PMID: 38937249 DOI: 10.1016/j.jtv.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
AIM The objective of the present study is twofold: to describe the prevalence and incidence of pressure ulcers (PUs) among ICU patients during the COVID-19 pandemic, and to identify the risk factors associated with the development of PUs in this cohort of ICU patients. MATERIALS AND METHODS Retrospective cohort study of adult critical care patients admitted in two general ICUs of two different countries (Sweden and Portugal) between March 1st, 2020, and April 30th, 2021, through the analysis of the electronic health record database. The prevalence and incidence were calculated, and a multivariate logistic-regression model was used to calculate odds ratios (ORs), of possible risk factors of PU development. RESULTS The sample consisted of 1717 patients. The overall prevalence of PU was 15.3 %, and the incidence of ICU-acquired PUs was 14.1 %. Most of the pressure ulcers documented in this study were at the anterior part of the body (45.35 %) and regarding classification, Category 2 (38.40 %) and Category 3 (22.71 %) pressure ulcers together accounted for over fifty percent of the cases recorded. In the multivariate logistic regression model for PU, age, having COVID-19 (OR = 1.58, 95 % CI: 1.20-2.09), use of mechanical ventilation (OR = 1.49, 95 % CI: 1.13 = 1.97), use of vasopressors (OR = 1.31, 95 % CI: 1.00-1.70), having a Braden risk score ≤16 at admission (OR = 1.63; 95 % CI: 1.04-2.56), and length of stay (LOS) (OR = 1.43, 95 % CI 1.03-2.00 if LOS 90-260 h, OR = 2.34, 95 % CI: 1.63-3.35 if LOS >260 h) were associated with the likelihood of developing an ICU-acquired PUs. CONCLUSION When adjusted for covariates patients with COVID-19 had a higher risk for PU development during the ICU stay compared to patients without COVID-19. Health care personnel in ICU may consider incorporating COVID-19, age, use of mechanical ventilation, vasopressors and estimated LOS in addition to a comprehensive risk assessment including both a risk score and clinical assessment.
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Affiliation(s)
- Paulo Alves
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal.
| | - Carina Bååth
- Karlstad University, Department of Health Sciences, Karlstad, Sweden; Østfold University College, Faculty of Health, Welfare and Organization, Fredrikstad, Norway
| | - Tânia Manuel
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal
| | - Sofia Almeida
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal
| | - Ulrika Källman
- Research Unit, FoUI Department, Södra Älvsborgs Hospital, Borås, Sweden; University of Gothenburg, Faculty of Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden
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Kurtgöz A, Koç Z. Difficulties and obstacles experienced by intensive care unit nurses during the prevention and care of pressure injuries: A qualitative study. J Tissue Viability 2024:S0965-206X(24)00044-5. [PMID: 38604926 DOI: 10.1016/j.jtv.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 02/24/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
AIM This study aimed to examine the difficulties and obstacles experienced by nurses working in intensive care units during the prevention and care of pressure injuries (ulcers). MATERIALS AND METHODS A descriptive phenomenological study was designed, involving 13 nurses working in the intensive care unit of a hospital in Turkey. The data were collected through face-to-face interviews. The data were analyzed using thematic analysis. The findings were reported according to the Consolidated Criteria for Reporting Qualitative Studies criteria. RESULTS Through the data analysis, an overall theme "Prevention and Care of Pressure Injuries" and three main themes, namely "Obstacles Encountered", "Impacts on The Nurses", and "Needs and Recommendations" were identified. CONCLUSION This study identified institution-related issues (lack of resources, managers' attitudes, etc.), as well as lack of knowledge and training prevent the effective management of pressure injuries in intensive care units. The development of pressure injuries emotionally and professionally affects nurses. The primary needs of nurses were found to be equipment and material support, personnel training, positive attitudes of institution managers, and the establishment of a wound care unit within the hospital. The following recommendations were made based on the obtained findings: practical training should be given to all intensive care unit teams based on the latest information, modern, practical, diverse, and sufficient amount of equipment for pressure injuries should be provided, personnel shortage should be eliminated, institution managers should exhibit solution-oriented attitudes toward nurses rather than accusatory approaches, and a wound care unit should be established within the hospital. This study was limited to the nurses working in the ICU of a state hospital in Turkey. Since the study was carried out in a single hospital and due to the personal characteristics of the participants, the findings cannot be generalized to all ICU nurses and healthcare institutions.
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Affiliation(s)
- Aslı Kurtgöz
- Department of Therapy and Rehabilitation, Sabuncuoglu Serefeddin Health Services Vocational School, Amasya University, 05100, Turkey.
| | - Zeliha Koç
- Department of Midwifery, Health Science Faculty, Ondokuz Mayıs University, Samsun, 55000, Turkey.
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Azizoğlu F, Terzi B. Research topics on pressure injury prevention and measurement tools from 1997 to 2023: A bibliometric analysis using VOSviewer. Intensive Crit Care Nurs 2024; 80:103557. [PMID: 37804817 DOI: 10.1016/j.iccn.2023.103557] [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: 07/25/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES To identify and visualize studies on pressure injuries in intensive care units, prevention of pressure injuries and measurement tools, and reveal the global trends in this field. RESEARCH METHODOLOGY/DESIGN Descriptive and bibliometric analysis method study. SETTING Data were obtained from the "Web of Science Core Collection" database on July 12th, 2023. For bibliometric data, the Web of Science database was searched with the keywords "intensive care unit," "pressure injury," "prevention," "risk assessment tools," and critical care." Performance analysis, scientific mapping, and bibliometric analyses were completed using the VOSviewer (1.6.15) software program for a total of 326 publications. MAIN OUTCOME MEASURES Publication, cluster, link and network map on pressure injury, prevention and risk measurement tools. RESULTS As a result of the analysis, the most used keywords were "pressure injury," "pressure ulcer," "critical care," "pressure ulcers," "intensive care unit," and "pressure injuries." The journal with the highest number of publications (n = 55) was "Journal of Wound Ostomy Continence Nursing", the highest number of articles (n = 47) was published in 2022, the most active institution was "Queensland University of Technology Qut" (20 articles), the country that published the most was the United States of America (171 articles), the institution that provided the most funding was the "National Institutes of Health NIH USA" (20 articles), and Cox J. was the author who published the most articles. CONCLUSION This study highlights popular fields of research in pressure injury prevention and risk measurement tools aimed at improving quality of care in intensive care units. IMPLICATIONS FOR CLINICAL PRACTICE The bibliometric analysis method used in the study can lead nurses to conduct research to prevent pressure injuries in critical care patients and develop risk measurement tools to overcome deficiencies such as prevention tools and objective risk measurement tools in this field.
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Affiliation(s)
- Fatma Azizoğlu
- Haliç University, Faculty of Health Sciences, 5.Levent Mahallesi, 15 Temmuz Şehitler Caddesi, No: 14/12 34060, Eyüpsultan/İstanbul, Turkey
| | - Banu Terzi
- Akdeniz University, Faculty of Nursing, Fundamentals of Nursing Department, Akdeniz Üniversitesi Dumlupınar Bulvarı, Akdeniz Üniversitesi Yerleşkesi Konyaaltı, 07070 Antalya, Turkey.
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Wu PL, Li YJ, Pai HC, Liu CC. Factors associated with facial pressure injury in patients receiving non-invasive positive pressure ventilation mask: A retrospective case-control study. J Clin Nurs 2024; 33:149-161. [PMID: 36380461 DOI: 10.1111/jocn.16585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/15/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to investigate factors associated with facial pressure injury (FPI) in patients receiving non-invasive positive pressure ventilation (NIPPV) during hospitalisation in the intensive care unit (ICU) and to identify predictors of FPI. BACKGROUND Non-invasive positive pressure ventilation is a method of treating patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable nasal-oral NIPPV masks and discomfort in contact with the skin surface. DESIGN A retrospective case-control study. METHODS From January 2018 to October 2020, a total of 397 patients admitted to a national hospital in Taiwan were enrolled. Patients received NIPPV and routinely used under-mask prophylactic dressings during hospitalisation. Patients were divided into the non-FPI group (n = 357) and the FPI group (n = 40). Demographic, clinical characteristics, acute physiology and chronic health evaluation II scores, and Braden Scale scores were collected from medical records. Logistic regression analysis was performed to examine the contribution of each factor to the FPI, and odds ratios were reported. The STROBE checklist was used in this retrospective case-control study. RESULTS There were significant differences between the groups in age, serum albumin, C-reactive protein, body mass index (BMI), disease severity, Braden Scale score, length of stay, duration of mechanical ventilation and use of corticosteroids. Logistic regression analysis revealed that the risk factor for FPI was the Braden Scale score [OR = 1.630 (1.176-2.260)], BMI [OR = 0.396 (0.210-1.784)] and corticosteroids [OR = 0.394 (0.159-1.811)], which were predictors of FPI in patients with NIPPV. CONCLUSIONS Facial pressure injury may still occur in patients who routinely use prophylactic dressings under NIPPV masks. This study provides information on continuing education training for FPI to more accurately identify high-risk and timely preventive measures to reduce FPI. RELEVANCE TO CLINICAL PRACTICE Addressing FPI-related factors to prevent facial skin damage and reduce comorbidities in patients using NIPPV masks.
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Affiliation(s)
- Pei-Ling Wu
- Department of Nursing, Chung Shan Medical University, Taichung City, Taiwan
- Department of Nursing, Chuang Shan Medical University Hospital, Taichung City, Taiwan
| | - Yi-Jou Li
- Miaoli Hospital, Ministry of Health and Welfare, Miaoli County, Taiwan
| | - Hsiang-Chu Pai
- Department of Nursing, Chung Shan Medical University, Taichung City, Taiwan
- Department of Nursing, Chuang Shan Medical University Hospital, Taichung City, Taiwan
| | - Chien-Chi Liu
- Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung City, Taiwan
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Argenti G, Ishikawa G, Fadel CB. The Direct Effects of Norepinephrine Administration on Pressure Injuries in Intensive Care Patients: A Retrospective Cohort Study. Adv Skin Wound Care 2023; 36:1-12. [PMID: 37603319 DOI: 10.1097/asw.0000000000000027] [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: 08/22/2023]
Abstract
OBJECTIVE To estimate the direct effects of norepinephrine administration on pressure injury (PI) incidence in intensive care patients. METHODS This is a secondary and exploratory analysis of a retrospective cohort study of intensive care patients discharged in 2017 to 2018. Observational cases only included patients who received primary PI preventive care during intensive care (N = 479). As a first-choice vasopressor drug, norepinephrine administration was approximated with days of norepinephrine. Linear path models were examined from norepinephrine administration to PI development. The identification of confounding variables and instrumental variables was grounded on directed acyclic graph theory. Direct effects were estimated with instrumental variables to overcome bias from unobserved variables. As models were re-specified with data analysis, the robustness of path identification was improved by requiring graph invariance with sample split. RESULTS Norepinephrine caused PI development from one stage to another after 4.0 to 6.3 days of administration in this cohort as a total effect (90% CI). The direct effect was estimated to advance the stage of PI at a rate of 0.140 per day of norepinephrine administered (standard error, 0.029; P < .001). The direct effect accounted for about 70% of the total effect on PI development. CONCLUSIONS Estimations with instrumental variables and structural equation modeling showed that norepinephrine administration directly and substantially affected hospital-acquired PI incidence in intensive care patients in this cohort.
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Affiliation(s)
- Graziela Argenti
- Graziela Argenti, MSc, RN, is Professor, Department of Nursing, Universidade Estadual de Ponta Grossa, Brazil. Gerson Ishikawa, DEng, is Associate Professor, Department of Production Engineering, Universidade Tecnologica Federal do Parana, Ponta Grossa. Also at Universidade Estadual de Ponta Grossa, Cristina Berger Fadel, DMD, is Associate Professor, Department of Dentistry. Acknowledgment: This research project was submitted and registered as CAAE 21591719.7.0000.0105 in PlataformaBrasil of Conselho Nacional de Saude and approved by the research ethics committee of Universidade Estadual de Ponta Grossa (resolution 3.604.604). The authors have disclosed no financial relationships related to this article. Submitted May 2, 2022; accepted in revised form December 1, 2022
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Ramalho ADO, Santiago LM, Meira L, Marin A, de Oliveira LB, Püschel VADA. Pressure injury prevention in adult critically ill patients: best practice implementation project. JBI Evid Implement 2023; 21:218-228. [PMID: 36374975 DOI: 10.1097/xeb.0000000000000352] [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: 11/15/2022]
Abstract
OBJECTIVE This study assessed compliance with the best practices for pressure injury prevention among ICU patients at a tertiary hospital in São Paulo, Brazil. INTRODUCTION Intensive care patients are at high risk of developing a pressure injury; preventing this requires a best practice protocol. METHOD This best practice implementation project was conducted in a Brazilian tertiary hospital in three phases following the JBI Model of Evidence-based Healthcare. Ten criteria derived from the best available evidence were audited and monitored before and after best practice implementation. RESULTS The baseline and follow-up audits evaluated 28 patients at each step. A total of 448 h of care were analyzed using a monitoring camera and medical records. Compliance with all 10 audited criteria increased, with a 50% reduction in the prevalence of pressure injuries in intensive care. Of the 223 employees, 71% claimed to have some knowledge of pressure injury prevention, and 66% reported adequate adherence to prevention protocols. CONCLUSION The audit and feedback strategy improved compliance with the criteria. Future audits are needed to promote the sustainability of evidence-based practice.
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Affiliation(s)
- Aline de Oliveira Ramalho
- Sociedade Beneficente de Senhoras Hospital Sírio-Libanês
- School of Nursing, University of São Paulo (EEUSP)
| | | | - Luciana Meira
- Sociedade Beneficente de Senhoras Hospital Sírio-Libanês
| | | | | | - Vilanice Alves de Araújo Püschel
- School of Nursing, University of São Paulo (EEUSP)
- Brazilian Centre for Evidence-based Healthcare: A JBI Centre of Excellence (JBI Brazil), São Paulo, Brazil
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Cox J, Thomas Hawkins C. Racial Disparities and Pressure Injuries Among Hospitalized Patients. Adv Skin Wound Care 2023; 36:78-84. [PMID: 36662040 DOI: 10.1097/01.asw.0000904460.94583.51] [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: 01/21/2023]
Abstract
OBJECTIVE To describe the demographic factors, hospitalization-related factors, comorbid states, and social determinants of health among racial groups in a sample of patients with a primary or secondary diagnosis of pressure injury (PI) admitted to New Jersey hospitals during the year 2018. METHODS Researchers conducted a retrospective analysis of the Health Care Utilization Project's 2018 New Jersey State Inpatient Database. Patients with a primary or secondary diagnosis of PI (sacrum, buttocks, or heels; N = 17,781) were included in the analytic sample. Analysis compared patients who identified as Black (n = 3,515) with all other racial groups combined (n = 14,266). RESULTS A higher proportion of Black patients were admitted for a PI (P < .001) and had higher proportions of stage 4 PIs (P < .001) but a lower proportion of stage 1 PIs (P < .001). Higher proportions of Black patients were younger, resided in lower income communities, and identified Medicaid as their primary payor source. CONCLUSIONS Results highlight the racial disparities that exist among patients with PIs in this diverse state and may represent a much larger problem. Clinical research examining the impact of skin tone rather than by racial group is needed. The impact of racial disparities on social determinants of health with regard to PIs remains largely unknown, but its importance cannot be underestimated.
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Affiliation(s)
- Jill Cox
- Jill Cox, PhD, RN, APN-C, CWOCN, FAAN, is Clinical Professor, Rutgers University School of Nursing, and Wound/Ostomy/Continence Advanced Practice Nurse, Englewood Health, Englewood, New Jersey. Charlotte Thomas Hawkins, PhD, RN, FAAN, is Associate Professor, Rutgers University School of Nursing, and Associate Dean, Nursing Science. Acknowledgment: Funding was provided by Rutgers University Center for Health Services Research and Policy. The authors have disclosed no other financial relationships related to this article. Submitted May 2, 2022; accepted in revised form June 15, 2022
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Bridges E, Whitney J, Metter D, Burr R. Prevention of pressure injuries during military aeromedical evacuation or prolonged field care: A randomized trial. Nurs Outlook 2022; 70:S115-S126. [PMID: 36585058 DOI: 10.1016/j.outlook.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND During military aeromedical evacuation (AE) and prolonged field care (PFC), casualties are at increased pressure injury (PI) risk. Operational PI mitigation strategies research is limited. PURPOSE Using multiple factors, this study examined Mepilex/LiquiCell effects on PI risk under simulated AE/PFC. METHODS Healthy adults were stratified by body fat (%) and randomized to six groups on three surfaces. Set A: Warrior Evacuation Litter Pad (WELP) with/without Mepilex; Set B: Vacuum Spine Board (VSB) with/without Mepilex; Set C: Talon litter with/without LiquiCell. Two hours supine (loaded) was needed. OUTCOMES Sacral skin transcutaneous tissue oxygen (TcPO2), temperature, moisture, interface pressure, interleukin-1α/Total Protein. FINDINGS 54 participants. Sets A/B: No Mepilex effects; temperature increased 2.5°C. Set C: No LiquiCell effects. Significant ΔTcPO2 (unloaded-loaded), with 100% impaired perfusion; temperature increased 1.2°C. DISCUSSION Multiple risk factors for PI mitigating strategies must consider. Talon with increased pressure/impaired perfusion but smaller temperature/moisture changes; WELP/VSB with increased temperature/moisture but lower pressure/adequate perfusion.
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Affiliation(s)
- Elizabeth Bridges
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle Washington, USA; United States Air Force Nurse Corps (ret).
| | - JoAnne Whitney
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle Washington, USA
| | - Debra Metter
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle Washington, USA
| | - Robert Burr
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle Washington, USA
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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.
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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
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Abstract
The COVID-19 pandemic has produced an abundance of new and evolving evidence related to providing care for this complex patient population. Keeping up with the rapid flow of published information can be challenging and time-consuming, even for those skilled at interpreting the literature. To help clinical nurses readily apply standardized, evidence-based recommendations in a rapidly changing healthcare environment, the Good Samaritan Medical Center Education Team created a nursing-specific guideline for care of patients with COVID-19.
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Cox J, Edsberg LE, Koloms K, VanGilder CA. Pressure Injuries in Critical Care Patients in US Hospitals: Results of the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:21-28. [PMID: 35040812 PMCID: PMC9200225 DOI: 10.1097/won.0000000000000834] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to examine pressure injury (PI) prevalence, PI risk factors, and prevention practices among adult critically ill patients in critical care units in the United States using the International Pressure Ulcer Prevalence™ (IPUP) Survey database from 2018 to 2019. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 41,866 critical care patients drawn from a sample of 296,014 patients in US acute care facilities who participated in the 2018 and/or 2019 IPUP surveys. The mean age among critical care patients was 63.5 years (16.3) and 55% were male. All geographic regions of the United States were represented in this sample, with the greatest percentages from the Southeast (47.5%) and Midwest (17.5%) regions. METHODS Overall critical care PI prevalence and hospital-acquired PI (HAPI) rates were obtained and analyzed using the 2018/2019 IPUP survey database. Critical care PI risk factors included in the database were analyzed using frequency distributions. Prevention practices among critically ill patients were analyzed to evaluate differences in practices between patients with no PIs, superficial PIs (stage 1, stage 2), and severe PIs (stage 3, stage 4, unstageable, deep tissue pressure injury). RESULTS The overall PI prevalence for critical care patients was 14.3% (n = 5995) and the overall HAPI prevalence was 5.85% (n = 2451). In patients with severe HAPIs, the most common risk factors were diabetes mellitus (29.5%), mechanical ventilation (27.6%), and vasopressor agents (18.9%). Significant differences between patients with no PIs as compared to those with superficial or severe HAPIs (P = .000) for all prevention practices were found. CONCLUSIONS Study findings support the gaps elucidated in previous critical care studies on PI development in this population. The 2 most persistent gaps currently challenging critical care practitioners are (1) accurate risk quantification in this population and (2) the potential for unavoidability in PI development among critically ill patients.
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Affiliation(s)
- Jill Cox
- Correspondence: Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, 180 University Ave. Newark, NJ 07102 ()
| | - Laura E. Edsberg
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Kimberly Koloms
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Catherine A. VanGilder
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
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