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Karadede Ö, Toğluk Yiğitoğlu E, Şeremet H, Özyilmaz Daştan Ç. Incidence and Risk Factors for Perioperative Pressure Injuries: Prospective Descriptive Study. J Perianesth Nurs 2024:S1089-9472(24)00379-4. [PMID: 39269408 DOI: 10.1016/j.jopan.2024.07.010] [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: 03/20/2024] [Revised: 07/12/2024] [Accepted: 07/25/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE Pressure injuries can often occur in patients undergoing surgical, diagnostic, or other invasive procedures, so it is important to assess patients in the perioperative period. This study was conducted to determine the incidence and risk factors of perioperative pressure injury. DESIGN A cross-sectional, prospective, and descriptive study. METHODS This study involved 158 patients who met the study's eligibility criteria between May 2022 and July 2022. The data were collected using the Patient Information Form, Munro Scale, Braden Scale, and pressure injury staging form. The patients were monitored postoperatively or for 3 days. FINDINGS Pressure injury developed in 13.9% of the patients. Perioperative risk factors were age, edema, mobilization time, parenteral nutrition, blood transfusion, and glucose level, while preoperative albumin level was lower in patients with pressure injury. In the postoperative period, the risk factors were duration of mobilization and transition to oral feeding, length of intensive care unit stay, and low Braden score. In multivariate analysis, the variables that showed significance with the risk of pressure injury were postoperative Munro score and edema. CONCLUSIONS It is crucial to evaluate the risk factors for pressure injury in patients who have undergone surgical procedures.
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Affiliation(s)
- Özkan Karadede
- Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
| | | | - Hatice Şeremet
- Institute of Graduate Studies, Istanbul Arel University, Istanbul, Türkiye
| | - Çağla Özyilmaz Daştan
- Surgical Medical Sciences, Monoblock Operating Room, Cerrahpasa Medical Faculty Hospital, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Chen X, Tang S, Qin Y, Zhou S, Zhang L, Huang Y, Chen Z. A Predictive Model of Pressure Injury in Children Undergoing Living Donor Liver Transplantation Based on Machine Learning Algorithm. J Adv Nurs 2024. [PMID: 39253783 DOI: 10.1111/jan.16449] [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: 01/22/2024] [Revised: 08/02/2024] [Accepted: 08/21/2024] [Indexed: 09/11/2024]
Abstract
AIMS The aim of our study was to formulate and validate a prediction model using machine learning algorithms to forecast the risk of pressure injuries (PIs) in children undergoing living donor liver transplantation (LDLT). DESIGN A retrospective cohort study. METHODS The research was carried out at China's largest paediatric liver transplantation centre. A total of 438 children who underwent LDLT between June 2021 and December 2022 constituted the study cohort. The dataset was partitioned randomly into 70% for training datasets (306 cases) and 30% for testing datasets (132 cases). Utilising four machine learning algorithms-Decision Tree, Random Forest, Gradient Boosting Decision Tree and eXtreme Gradient Boosting-we identified risk factors and constructed predictive models. RESULTS Out of 438 children, 42 developed PIs, yielding an incidence rate of 9.6%. Notably, 94% of these cases were categorised as Stage 1, and 54% were localised on the occiput. Upon evaluating the four prediction models, the Decision Tree model emerged as the most effective. The primary contributors to pressure injury in the Decision Tree model were identified as operation time, intraoperative corticosteroid administration, preoperative skin protection measures and preoperative skin conditions. A visualisation elucidating the logical inference process for the 10 variables within the Decision Tree model was presented. Ultimately, based on the Decision Tree model, a predictive system was developed. CONCLUSION Machine learning algorithms facilitate the identification of crucial factors, enabling the creation of an effective Decision Tree model to forecast pressure injury development in children undergoing LDLT. IMPACT With this predictive model at their disposal, nurses can assess the pressure injury risk level in children more intuitively. Subsequently, they can implement tailored preventive strategies to mitigate the occurrence of PIs. PATIENT OR PUBLIC CONTRIBUTION Paediatric patients contributed electronic health records datasets.
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Affiliation(s)
- Xiaomei Chen
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shi Tang
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yanwen Qin
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Sui Zhou
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lina Zhang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yile Huang
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zheying Chen
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Beriso HB, Zemene W, Tesfaye E. Prevalence of pressure ulcers and associated factors among adult patients admitted at Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Sci Rep 2024; 14:17290. [PMID: 39068246 PMCID: PMC11283476 DOI: 10.1038/s41598-024-67026-5] [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: 02/06/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024] Open
Abstract
Pressure ulcers are a serious concern in patients with prolonged bedtime and present with common complications following surgery. It is one of the key performance indicators of the quality of nursing care provided to patients. Several studies have reported the prevalence of pressure ulcers in Ethiopia, but the current study area has not yet been fully addressed. Hence, the study aims to assess pressure ulcers and their associated factors among adult patients admitted to the surgical ward. An institution-based, cross-sectional study was conducted from April 15 to May 15, 2023. A systematic random sampling technique was used to select 480 patients. A standardized, pre-tested, and structured questionnaire was used. The results were presented descriptively using tables and figures. A binary logistic regression was used to assess associated factors. From a total of 480, all patients have participated with a 100% response rate. The prevalence rate of pressure ulcers was 10.2%. Being smoker [95% CI AOR 7.46 (2.64, 21.06)], bedridden [95% CI AOR 3.92 (1.28, 11.66)], having a length of hospital stay of greater than 20 days [95% CI AOR 3.01 (1.13, 8.02)], experiencing pain [95% CI AOR 3.20 (1.06, 7.51)], or having friction and shear [95% CI AOR 5.71 (1.91, 17.08)], were significantly associated with pressure ulcers. This study showed that a considerable proportion of patients had pressure ulcers. Smoking, having pain, being bedridden, being exposed to friction and shear problems, and length of hospital stay were significantly associated with pressure ulcers. Healthcare providers should educate patients about smoking risks, pain management, mattress installation, and linen care.
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Affiliation(s)
- Habtamu Bekele Beriso
- School of Nursing, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Workie Zemene
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eleni Tesfaye
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kurt Y, Kaşikçi M, Malaska R. Nursing interventions to prevent pressure injury among open heart surgery patients: A systematic review. Nurs Crit Care 2024. [PMID: 38965753 DOI: 10.1111/nicc.13117] [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: 02/13/2024] [Revised: 05/20/2024] [Accepted: 06/15/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Nurses are vital in identifying and preventive pressure injuries (PIs) in hospitalized patients undergoing open heart surgery. Interventions to prevent PIs are crucial for every critical patient, and it's essential to recognize that preventing PIs involves a complex intervention. AIM To examine the nursing interventions for the prevention of PI in patients with open heart surgery. METHOD A systematic review study. Web of Science, Science Direct, PubMed, Scopus, MEDLINE Ultimate, CINAHL Ultimate, ULAKBIM, Cochrane Library, Google Scholar and university library databases were scanned. The initial search performed in the databases was updated on 4 February 2023, and on 7 April 2024, for potential publications included in that period. Data between February 2013 and April 2024 were scanned. The databases were searched with the keywords 'pressure injury', 'nursing interventions' and 'open heart surgery'. The systematic compilation process was carried out in accordance with the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. RESULTS Seventeen studies were examined using nursing interventions that applied to the selected study population. Care packages included an inflatable head pad, a pressure sensor mattress cover, multi-layer silicone foam, pressure-reducing coatings, endotracheal tube (ETT) repositioning and cuff pressure regulation. Interventions to reduce PI in open heart surgery patients are applied in the preadmission, perioperative and postoperative periods. CONCLUSION It was concluded that care packages, inflatable head pads, pressure sensor bedspreads, multi-layered silicone foam, pressure-reducing covers, ETT repositioning and cuff pressure regulation were effective in all nursing interventions. The strength of the available evidence was rated from strong to weak. RELEVANCE TO CLINICAL PRACTICE These findings reveal an efficient combination of multi-component nursing interventions for preventing PIs in planning patient care in the intensive care. The interventions that are used throughout the patient's entire care process are crucial for the prevention of PIs.
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Affiliation(s)
- Yeter Kurt
- Faculty of Health Sciences, Fundamentals of Nursing Department, Karadeniz Technical University, Trabzon, Turkey
| | - Mağfiret Kaşikçi
- Fundamentals of Nursing Department, Head of the Nursing Faculty, Atatürk University, Erzurum, Turkey
| | - Reezena Malaska
- Nursing Professional Development Specialist, Gulf Coast Medical Center Lee Memorial, Fort Myers, Florida, USA
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Munro CA, Jiang YH. Validity and Reliability Evidence of the Munro Scale for Perioperative Patients Part II: Construct Validity. J Nurs Meas 2024; 32:216-226. [PMID: 37348882 DOI: 10.1891/jnm-2022-0052] [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] [Indexed: 06/24/2023]
Abstract
Background and Purpose: The Munro Pressure Injury Risk Assessment Scale for Perioperative Patients (Munro Scale) is the first three-phase risk instrument designed specifically for perioperative patients. The purpose of this study was to establish validity and reliability evidence for the Munro Scale. This study also had a goal to reduce the data into more manageable constructs with fewer items. Methods: Exploratory and confirmatory factor analyses were used to test the hypothesized model for risk assessment using the Munro Scale to identify latent variables. A retrospective review of charts from 630 risk assessments was analyzed from two community acute care hospital settings. Results: The model explained 95% of the variance in the cumulative final risk level, R2 = .95, F(20, 588) = 501.88, p < .001. Six latent variables emerged in the model with a cumulative contribution rate of 56% of the variance. Similar results were obtained in studies with Chinese and Turkish translations of the Munro Scale. Conclusions: The validity and reliability evidence obtained in this study supports the implementation of the Munro Scale for clinical practice in the perioperative setting.
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Affiliation(s)
- Cassendra A Munro
- Stanford Health Care, Palo Alto, California, USA
- Munro Consulting, San Francisco, California, USA
| | - Ying Hong Jiang
- Program in Educational Leadership of School of Education, Azusa Pacific University, Azusa, California, USA
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Efteli E, Çömez S. Effects of Web-Assisted Education on Nursing Students' Pressure Injury Knowledge Levels. Adv Skin Wound Care 2024; 37:1-5. [PMID: 38506585 DOI: 10.1097/asw.0000000000000116] [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: 03/21/2024]
Abstract
OBJECTIVE To investigate the effect of web-assisted education on the pressure injury knowledge levels of nursing students. METHODS The study was conducted with 106 first-year students in the Nursing Department. Those who received both web-assisted education and conventional education were assigned to the experimental group, and those who received only conventional education were assigned to the control group. The authors used arithmetic mean, percentages, Student t test, and χ2 test to analyze the data. RESULTS The rate of the correct responses given to the questions by the students was 97.55% in the experimental group and 85.15% in the control group. The comparison of the mean number of correct answers revealed a statistically significant difference between the two groups. CONCLUSIONS The authors conclude that the web-supported education given to nursing students in addition to the conventional education positively contributed to their learning level.
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Affiliation(s)
- Elçin Efteli
- In the Faculty of Health Sciences, Mehmet Akif Ersoy University, Burdur, Turkey, Elçin Efteli, PhD, RN, and Saadet Çömez, PhD, RN, are Assistant Professors
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Kumagai A, Ohno N, Miyati T, Sugama J. Prediction of tissue deformation based on mechanical and physiological factors in the prone position during surgery. J Tissue Viability 2024:S0965-206X(24)00008-1. [PMID: 38378353 DOI: 10.1016/j.jtv.2024.02.004] [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: 09/03/2023] [Revised: 12/16/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
AIM This study aimed to predict tissue deformation based on the pressure applied while lying in the prone position and physiological factors. METHODS Healthy volunteers were instructed to lie on mattresses of four different hardness levels (50, 87.5, 175, and 262.5 N). The order in which the mattresses were used was randomized per participant. Pressure at the iliac crests was measured using a pressure mapping sensor sheet. Participants were placed in the prone position for 10 min, with pressure data used from the latter 5 min. For the tissue deformation at the iliac crests, our previous study data were used. Multiple regression analysis was used to identify predictive mechanical and physiological factors. RESULTS The distance between the left and right greater trochanters, maximum interface pressure and age were significant predictors for compression of the skin and soft tissue. Significant predictors of internal soft tissue displacement were the distances between the left and right anterior superior iliac spines and greater trochanters. No factors predicted skin surface displacement. CONCLUSIONS Our study provided predictive factors that may be measured easily in a clinical setting to reduce the risk of pressure ulcers during surgery in the prone position.
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Affiliation(s)
- Ayumi Kumagai
- Faculty of Nursing and Social Welfare Science, Department of Nursing Science, Fukui Prefectural University, Eiheiji-Town, Fukui, Japan.
| | - Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junko Sugama
- Department of Gerontological Nursing, Faculty of Nursing, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan; Research Center for Implementation Nursing Science Initiative, Innovation Promotion Division, Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, Japan
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Tura İ, Arslan S, Türkmen A, Erden S. Assessment of the risk factors for intraoperative pressure injuries in patients. J Tissue Viability 2023; 32:349-354. [PMID: 37147205 DOI: 10.1016/j.jtv.2023.04.006] [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: 05/01/2022] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
AIM This study was conducted to assess the risk factors for pressure injuries in patients during surgery. METHODS In this descriptive cross-sectional study, the risk of pressure injuries during surgery was evaluated in 250 patients in a university hospital. Data were collected through a Patient Descriptive Information Form (PDIF) and the 3S Intraoperative Pressure Injury Risk Assessment Scale (IPIRAS). RESULTS The mean age of the patients was 44.15 ± 17.00, and 52.4% were female. In addition, it was determined that the mean 3S IPIRAS score was higher in patients who were male, were aged ≥60 years, were obese, had a chronic disease, and had low serum albumin and hemoglobin levels (p < .05). During the surgery of the patients included in the study, support surfaces were used in 67.6%, positioning aids were used in 82.4%, and 55.6% had normal skin. Patients who underwent CVS procedures for more than 6 h, did not use support surfaces during surgery, had moist skin, or used vasopressors had higher and significantly different mean 3S IPIRAS scores (p < .05). CONCLUSIONS According to the results, all surgical patients were at risk for pressure injury in the intraoperative period. In addition, it was found that male gender was associated with risk factors and that being aged ≥60 years, obesity, chronic disease, low serum hemoglobin and albumin levels, CVS, operations lasting more than 6 h, moist skin, vasopressor drugs, and not using support surfaces during surgery increased the risk of pressure injuries significantly.
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Affiliation(s)
- İlknur Tura
- "Cukurova University", Faculty of Health Sciences, Department of Nursing, Balcalı Campus, Adana, Postcode: 01380, Turkey.
| | - Sevban Arslan
- "Cukurova University", Faculty of Health Sciences, Department of Nursing, Balcalı Campus, Adana, Postcode: 01380, Turkey.
| | - Açelya Türkmen
- "Cukurova University", Faculty of Health Sciences, Department of Nursing, Balcalı Campus, Adana, Postcode: 01380, Turkey.
| | - Sevilay Erden
- "Cukurova University", Faculty of Health Sciences, Department of Nursing, Balcalı Campus, Adana, Postcode: 01380, Turkey.
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Sving EBM, Gunningberg LAC, Bååth CB, Björn CUS. Using pressure mapping intraoperatively to prevent pressure ulcers-A quasi-experimental study. Health Sci Rep 2023; 6:e1112. [PMID: 36817631 PMCID: PMC9930190 DOI: 10.1002/hsr2.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
Background and Aim Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.
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Affiliation(s)
- Eva B. M. Sving
- Centre for Research & DevelopmentUppsala University/Region GävleborgUppsalaSweden
- Department of Public Health and Caring Sciences, Caring SciencesUppsala UniversityUppsalaSweden
| | - Lena A. C. Gunningberg
- Department of Public Health and Caring Sciences, Caring SciencesUppsala UniversityUppsalaSweden
| | - Carina B. Bååth
- Department of Health Sciences, Faculty of Health, Science and TechnologyKarlstad UniversityKarlstadSweden
- Faculty of Health, Welfare and OrganisationØstfold University CollegeFredrikstadNorway
| | - Catrine U. S. Björn
- Centre for Research & DevelopmentUppsala University/Region GävleborgUppsalaSweden
- Department of Public Health and Caring Sciences, Caring SciencesUppsala UniversityUppsalaSweden
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Gokce Isikli A, Kızılcık Özkan Z. Retrospective evaluation of the effectiveness of using two different products in preventing the development of pressure injuries in patients undergoing lung lobectomy. J Tissue Viability 2023; 32:163-167. [PMID: 36351868 DOI: 10.1016/j.jtv.2022.10.003] [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: 04/23/2022] [Revised: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
AIM This retrospective study aims to determine the impacts of two different products (barrier cream, barrier spray) routinely used before surgery on the development of postoperative pressure injuries in patients undergoing lung lobectomy. MATERIALS AND METHODS In the study, the researchers retrospectively examined the data of 60 patients who underwent lobectomy in a university hospital's thoracic surgery clinic between 12.02.2021 and 14.02.2022. The patients were divided into two groups: those to whom a barrier cream was applied (30) and those to whom a barrier spray was applied. The Patient Description Form and the Braden Risk Assessment Tool were used in data collection. The Mann-Whitney U and Kruskal-Wallis tests were conducted for statistical analyses. RESULTS In the study, the development rates of blanchable erythema and stage I pressure injuries in the sacral and dorsal regions were significantly higher in patients to whom a barrier spray was applied than in patients to whom a barrier cream was applied (p < 0.05). Pain intensity in the sacral and dorsal regions was significantly lower in patients to whom a barrier cream was applied than those to whom a barrier spray was applied (p < 0.05). CONCLUSION Blanchable erythema and intraoperative pressure injury were observed less in patients in whom a barrier cream was used before surgery. Surgical nurses should first evaluate the risk in the preoperative period in the clinics and benefit from the use of barrier cream to prevent the development of blanchable erythema and intraoperative pressure injury.
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Affiliation(s)
- Ayse Gokce Isikli
- Thoracic Surgery, Health Research and Application Center, Trakya University, Edirne, Turkey.
| | - Zeynep Kızılcık Özkan
- Department of Surgical Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey.
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Risk Factors Associated With Pressure Injuries in Surgical Patients: A Retrospective Case-Control Study. J Wound Ostomy Continence Nurs 2022; 49:511-517. [PMID: 36417372 DOI: 10.1097/won.0000000000000925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to identify predictive risk factors for pressure injury (PI) occurring during surgery. DESIGN Retrospective case-control study. SUBJECTS AND SETTING Data on records of 6070 patients hospitalized for surgery at Seoul National University Bundang Hospital located in Seoul Korea. Data were collected between May 2013 and December 2014. METHODS Anonymized data from patients were accessed via electronic health records, nursing records, direct patient assessment, surgical, clinical laboratory, and anesthesia records, preanesthesia status evaluations, and PI incident reports, and transfusion and extracorporeal circulation reports. Descriptive and logistic regression analyses were conducted. RESULTS Three hundred eighty-one of the 6070 patients (6.3%) developed within 24 hours a PI that was associated with surgery. The most common locations for the PIs were the coccyx (15.1%; n = 75) and trunk (chest or abdomen; 15.1%; n = 75). All PIs were classified as stage 1 (66.6%; n = 331) or 2 (33.4%; n = 166). Based on logistic regression results, we found that the risk factors that were independently predictive of surgery-related PIs were patient position during surgery, admission to an intensive care unit after surgery, required blood transfusion during surgery, and duration of surgery. CONCLUSIONS This retrospective study identified several risk factors associated with a higher incidence of perioperative PIs in surgical patients. A PI prevention program accounting for these factors could potentially help prevent PIs and their costly complications.
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Karahan E, Ayri AU, Çelik S. Evaluation of pressure ulcer risk and development in operating rooms. J Tissue Viability 2022; 31:707-713. [PMID: 36153203 DOI: 10.1016/j.jtv.2022.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
AIM This study aimed to determine the risk and development of pressure ulcers in operating rooms. MATERIALS AND METHODS The sample of the study included a total of 250 patients. In the study, the risk of pressure ulcers was assessed before the operation, and the development of pressure ulcers was evaluated within 24 h after the operation. RESULTS The risk of pressure ulcers was low before the operation, and Stage I pressure ulcer developed in 12.8% of the patients within 24 h after the operation. The patients had pressure ulcers mostly in their sacrum. Their mean 3S Intraoperative Risk Assessment Scale of Pressure Sore score was 15.68 ± 4.84, suggesting that they were not at risk of developing pressure ulcers. Having a chronic disease (OR = 8.986; 95% CI = 3.697-21.845), undergoing general anesthesia (OR = 3.084; 95% CI = 1.323-7.194), and orthopedic surgery (OR = 10.172; 95% CI = 3.121-33.155) were statistically significant risk factors for pressure ulcers (p < 0.001). Additionally, moderately edematous skin (OR = 3.838; 95% CI = 1.024-14.386), overweight/underweight (OR = 16.333; 95% CI = 3.779-70.602), intraoperative bleeding greater than 800 ml (OR = 13.000; 95% CI = 3.451-48.969), operation time longer than 5 h (OR = 21.667; 95% CI = 2.122-221.223), moderate intraoperative stress (OR = 4.917; 95% CI = 0.425-56.916), body temperature higher than 38.3 °C or lower than 36.1 °C (OR = 5.462; 95% CI = 2.161-13.805), and intraoperative prone position (OR = 3.354; 95% CI = 1.386-8.115) were statistically significant risk factors for the development of pressure ulcers. CONCLUSION According to our preoperative pressure ulcer risk assessment, it is very important to take additional protective measures both during and after surgical operations to prevent pressure ulcers.
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Affiliation(s)
- Elif Karahan
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartın, Turkey.
| | - Aysun Uslu Ayri
- Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey.
| | - Sevim Çelik
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartın, Turkey.
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13
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Martins de Oliveira AL, O'Connor T, Patton D, Strapp H, Moore Z. Sub-epidermal moisture versus traditional and visual skin assessments to assess pressure ulcer risk in surgery patients. J Wound Care 2022; 31:254-264. [PMID: 35199594 DOI: 10.12968/jowc.2022.31.3.254] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the predictive ability of subepidermal moisture (SEM) measurement versus traditional risk assessment and visual skin assessment (VSA) as means of detecting early pressure ulcer (PU) damage development among adults undergoing surgery. METHOD A non-experimental, comparative, descriptive cohort study design was used. Following ethical approval, participants who had given their informed written consent had their skin assessed over the areas that were weight-bearing during surgery, using VSA and the SEM measurement. Visual PUs were graded according to the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel ulcer grading system. Assessments took place preoperatively, then daily on the ward, beginning on day one postoperatively and continuing for three days or until discharge. RESULTS Of the 231 participants, who had a mean age of 57.50 years, 55.8% (n=129) were male. The most common comorbidity was cardiology/vascular (n=42; 18.2%). Just over half (52.4%; n=121) underwent orthopaedic surgery and 47.6% (n=110) underwent non-orthopaedic surgery; 70% (n=163) received a general anaesthetic and 43% (n=100) were in the supine decubitus position during surgery. PU incidence was 51% (n=116), according to SEM measurement, and 3% (n=7) according to VSA. Among the seven participants who developed a visual PU, 10 PUs at stage 1 developed (31%); some patients developed more than one PU. Of the participants who had assessments for three days postoperatively, 94% (n=61) had a persistently high SEM delta on day three. The variables that emerged as statistically significantly related to abnormal SEM measurement deltas among these participants were: surgery duration (p=0.038); having orthopaedic surgery (p=0.020); supine surgical position (p=0.003); spinal anaesthetic type (p=0.0001); and Waterlow and Braden mobility subscale day one postoperatively (p=0.0001). None of the variables had a statistically significant influence on abnormal VSA. CONCLUSION Surgical patients, because of immobility, are vulnerable to the action of compression and shear forces. These forces cause changes at a cellular level that trigger inflammation, which is a precursor to early tissue damage. SEM measurement can detect this tissue damage from the increase in the underlying tissue water content that results from inflammation. From the findings of this study, SEM measurement is very promising in the detection of early tissue damage in those at risk of PU development among the surgical population.
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Affiliation(s)
| | - Tom O'Connor
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,Lida Institute, Shanghai.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia
| | - Declan Patton
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Helen Strapp
- Tallaght University Hospital, Ireland.,SWaT Research Network, RCSI University of Medicine and Health Sciences, Ireland
| | - Zena Moore
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Lida Institute, Shanghai.,University of Wales, Wales.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia
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14
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Zhou F, Wu Z, Yu Y, Xu L. Establishment and Application of Pressure Injury Assessment Module in Operating Room Based on Information Management System. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1463826. [PMID: 35047148 PMCID: PMC8763524 DOI: 10.1155/2022/1463826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022]
Abstract
A pressure injury is a common and painful health condition, particularly among people who are elderly or surgical patients. In order to explore how to use the information management system to optimize the pressure injury management process of surgical patients, this work establishes an integrated pressure injury management information platform for surgical patients, which can effectively control the key links in the process and realize the multistep full-process monitoring of surgical patients from admission to discharge. A total of 578 patients before the operation of the information platform were selected as the control group (CG), and after the operation of the information platform, 662 cases became the observation group (OG). Various evaluation metrics are employed to evaluate pressure injury in terms of single-pass rate, high-risk pressure injury, transfer skin condition description matching rate, hospital pressure injury incidence, and incidence of pressure injury in surgical patients at various stages. The results showed that the qualified rate of the pressure injury assessment in the OG was 99.2%, the accuracy rate of high-risk pressure injury screening and reporting was 100.0%, and the matching rate of the transfer skin description was 100.0%, which was higher than that of the CG. The integrated pressure injury management information platform for surgical patients based on the information management system realizes the full, continuous, accurate, and dynamic evaluation and monitoring of patients' skin. Furthermore, it can effectively improve the quality of pressure injury care and facilitate care management.
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Affiliation(s)
- Fangfang Zhou
- Operating Theatre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Zheng Wu
- Operating Theatre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Ying Yu
- Operating Theatre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Lili Xu
- Operating Theatre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
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15
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Cho KS, Lee JH. Incidence and prevalence of pressure ulcers in hospitals: 10-year cohort study. J Wound Care 2021; 30:S38-S45. [PMID: 34882008 DOI: 10.12968/jowc.2021.30.sup12.s38] [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: 11/11/2022]
Abstract
OBJECTIVE Pressure ulcers (PUs) are a serious problem in patients with multiple comorbidities and are associated with a longer duration of hospital stay and higher medical costs. The aetiology and rate of PU occurrence in South Korea remains unclear. Therefore, we aimed to determine the incidence, prevalence, mortality and common comorbidities of hospitalised patients with PUs in the South Korean healthcare system. METHOD A 10-year cohort study using the healthcare insurance reimbursement claims from the South Korean National Health Insurance System database. Patients diagnosed with a PU on admission to hospital [ICD-10: L89 + procedure code] between January 2002 and December 2016 were included and their comorbidities evaluated. Patients <20 years of age and recurrent PU cases were excluded. RESULTS Incidence, prevalence, survival rate and risk factors related to survival rate of patients with PUs were determined. The study population in 2006 was 36,195,121 (all patients admitted to hospital that year), which changed yearly because of the inclusion of additional patients who met the study inclusion criteria, and removal of patients who had died during the year. Standardised PU incidence rate decreased from 17.1 in 2006 to 14.9 in 2015 per 10,000 people. Standardised PU prevalence also showed a slightly decreasing trend from 20.2 in 2006 to 18.9 in 2015 per 10,000 people. CONCLUSION This findings of this 10-year study showed that incidence and prevalence of PUs markedly increased with age after the seventh decade. Incidence of PUs increased in patients with pneumonia, cerebral infarction, sepsis, femoral neck fracture and malignant neoplasm of the bronchus. Patients with femoral neck fracture and cerebral infarction showed a higher rate of survival than those with other high-risk comorbidities.
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Affiliation(s)
- Kyu Sang Cho
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
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16
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Abstract
OBJECTIVE Pressure ulcers (PUs) are one of the most commonly occurring complications in hospitalised patients. Knowing the size of the problem and its risk factors will help in preventing it. The aim of this study is to measure the incidence of PUs in acute care settings in Jordan and to explore associated risk factors. METHOD A prospective incidence study for hospitalised patients in Jordan according to the European Pressure Ulcer Advisory Panel methodology. All patients admitted into four Jordanian hospitals over a period of six months were included. RESULTS The cumulative incidence rate was 0.48%. Using multivariate analysis, a low albumin level, elevated white blood cells, incontinence and having more chronic illnesses were significantly associated with acquiring PUs. CONCLUSION Incidence of PUs in Jordan is lower when compared with other parts of the world; this could be related to the relatively younger Jordanian population compared with other populations. DECLARATION OF INTEREST The author has no conflicts of interest to declare.
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Affiliation(s)
- Ma'en Aljezawi
- Al al-Bayt University Faculty of Nursing, P.O. Box 130040, Mafraq, 25113, Jordan
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17
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Prevención de lesiones por presión en pacientes sometidos a cirugía traumatológica prolongada, un desafío para enfermería. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.09.006] [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] Open
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18
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Tarigan S, Yusuf S, Syam Y. Effect of interface pressure and skin surface temperature on pressure injury incidence: a turning schedule pilot study. J Wound Care 2021; 30:632-641. [PMID: 34382846 DOI: 10.12968/jowc.2021.30.8.632] [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: 11/11/2022]
Abstract
OBJECTIVE This study aimed to evaluate the interface pressure and skin surface temperature in relation to the incidence of pressure injury (PI) using three different turning schedules. METHOD This was a pilot study with a three-armed randomised clinical trial design. Participants at risk of PI and treated in the high dependency care unit in a regional hospital in Makassar, Indonesia participated in this study. Patients were repositioned at three different turning schedules (two-, three- and four-hourly intervals). Interface pressure measurement and skin surface temperature were measured between 14:00 and 18:00 every three days. The incidence of PI was assessed during the two-week observation period. RESULTS A total of 44 participants took part in the study. A one-way ANOVA test revealed no difference in interface pressure among the three different turning schedule groups within two weeks of observations: day zero, p=0.56; day four, p=0.95; day seven, p=0.56; day 10, p=0.63; and day 14, p=0.92. Although the average periumbilical temperature and skin surface temperature were not significant (p>0.05), comparison between these observation sites was significant on all observation days (p<0.05). Regarding the incidence of PI, the proportional hazard test for the development of PI in the three groups was considered not different (hazard ratio: 1.46, 95% confidence interval: 0.43-4.87, p=0.54). CONCLUSION No difference in interface pressure and incidence of PI on the three turning schedules was observed; however, there was a potential increase in skin surface temperature in comparison with periumbilical temperature for all three turning schedules.
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Affiliation(s)
- Sumiati Tarigan
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia.,Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Saldy Yusuf
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Yuliana Syam
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
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19
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Choi MA, Kim MS, Kim C. Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room. J Tissue Viability 2021; 30:331-338. [PMID: 34154878 DOI: 10.1016/j.jtv.2021.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
AIM We aimed to investigate the incidence rate and risk factors of medical device-related pressure injuries (MDRPIs) among patients undergoing prone position spine surgery. MATERIALS AND METHODS This was a prospective observational study of 147 patients who underwent spine surgery in an orthopaedic hospital in Korea. The incidence of MDRPI according to intrinsic and extrinsic factors was assessed using the independent t-, χ2 -, or Fisher's exact tests. A logistic regression analysis was performed exclusively for MDRPI areas with an incidence rate >5%. RESULTS The mean incidence rate of overall MDRPI was 27.4%, while that of MDRPI by Wilson frame, bi-spectral index, and endotracheal tube (ETT) was 56.5%, 52.4%, and 9.5%, respectively. The risk factors under Wilson frame were operation time and body mass index classification. Compared to their normal weight counterparts, those who were underweight, overweight, and obese had a 46.57(95% CI: 6.37-340.26), 3.96 (95% CI: 1.13-13.86), and 5.60 times (95% CI: 1.62-19.28) higher risk of developing MDRPI, respectively. The risk factors by bi-spectral index were sex, operation time, and the American Society of Anaesthesiologists classification. Compared to ETT intubation of <2 h, the risk of MDRPI increased by 7.16 times (95% CI: 1.35-38.00) and 7.93 times (95% CI: 1.45-43.27) for<3 and ≥3 h' duration, respectively. CONCLUSION The difficulty of device repositioning can increase the incidence of MDRPI, and prolonged surgery was a significant risk factor. Thus, appropriate planning and correct equipment utilization is needed during prone position spine surgeries.
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Affiliation(s)
- Mi Ae Choi
- Master, Unit Manager, Operating Room, Department of Nursing, Busan Korea Hospital, Busan, South Korea
| | - Myoung Soo Kim
- Professor, Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Cheol Kim
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Spine Center, Busan Korea Hospital, Busan, South Korea
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20
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Aslan Basli A, Yavuz Van Giersbergen M. Comparison of interface pressures on three operating table support surfaces during surgery. J Tissue Viability 2021; 30:410-417. [PMID: 33994285 DOI: 10.1016/j.jtv.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
AIM OF THE STUDY To investigate the effect of support surface usage and positions on interface pressure during surgery. MATERIALS AND METHODS This randomized controlled experimental study was conducted between October 2018 and June 2019. The study included patients who had planned surgery in supine and prone positions. The sample size was 72 patients. Patients were assigned to three groups (gel support surface, viscoelastic support surface and standard operating table) according to the determined randomization table. During the surgery, the pressure in the patients' body was recorded. The statistics program IBM SPSS Statistics 25.0 packaged software was used in the analyses of data. RESULTS There was no statistically significant difference between the total body average interface pressure (mmHg) values between the supporting surfaces in the prone position. There was a statistically significant difference between the total body average interface pressure (mmHg) values between the support surfaces in the supine position, and the average interface pressure measured on the viscoelastic foam support surface was significantly lower than the gel support surface and the standard operating table. CONCLUSION In the study, the use of viscoelastic foam support surface was found to be more effective than the use of a standard operating table and gel support surface. Viscoelastic foam support surface is recommended for patients at risk for pressure injury in the operating room.
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Affiliation(s)
- Arzu Aslan Basli
- Department of Surgical Nursing, Manisa Celal Bayar University Faculty of Health Science, Manisa, Turkey.
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21
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Nasiri E, Mollaei A, Birami M, Lotfi M, Rafiei MH. The risk of surgery-related pressure ulcer in diabetics: A systematic review and meta-analysis. Ann Med Surg (Lond) 2021; 65:102336. [PMID: 33996066 PMCID: PMC8091875 DOI: 10.1016/j.amsu.2021.102336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objective Postoperative pressure ulcers are known as the most important quality indicators of intraoperative care that create critical and costly complications during hospital care. Accordingly, this study was performed to determine the risk factor for diabetes in postoperative pressure ulcers. Materials and methods The present study is a systematic review of PubMed, Scopus and the Web of Science databases with using standardized keywords of the performed English language articles between Jan 2010 to Jan 2020. The articles were searched independently by two related researchers to avoid possible biases. Then, all collected articles were reviewed, and articles with inclusion criteria were evaluated using a data collection table. It should be noted that the data were analyzed using STATA software version 11.1. Results Overall, the results showed that 19724 patients were identified from 15 studies conducted in Asia (six), the America (four), Europe (four), and Australia (one) from 1989 to 2019. The results showed that patients with diabetes were more likely to experience surgery-related pressure ulcers than patients without diabetes (The odds ratio of 1.52; the 95% confidence interval: 1.25–1.85). Conclusion In general, patients with diabetes increased the risk of surgery-related pressure ulcers about 1.5 times more than others. Accordingly, the reduction of surgery-induced pressure ulcers should be more extensively considered in patients with diabetes. What is already known about the topic?Diabetes as a preoperative comorbidity should be added to risk assessment instruments for perioperative pressure ulcers, which may increase the accuracy of the prediction. The excess risk of pressure ulcers associated with pre-existing diabetes was significantly higher in patients undergoing surgery, specifically in patients receiving cardiac surgery.
What this paper adds.Diabetes increases the risk of surgery-related pressure ulcers about 1.5 times. Therefore, it is necessary to provide Planned Cares to prevent, overcome, and decrease surgery-related pressure ulcers in patients with diabetes. Previous meta-analysis reported that the risk of surgery-related pressure ulcers in diabetic patients was higher than non-diabetic patients in cardiac surgeries, while evidence for this claim was not observed in this study. Considering the long duration of liver resection surgery, the risk of pressure ulcers is higher than heart surgery It is advised that standard wound measuring tools will apply for measuring wounds in the next prospective studies. It is also better to evaluate pressure ulcers at a specific time after surgery toward more carefully investigate the issue.
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Affiliation(s)
- Ebrahim Nasiri
- Department of Anesthesiology and Operating Room, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aghil Mollaei
- Faculty of Health, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Moslem Birami
- School of Allied Medical Sciences, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hossein Rafiei
- School of Allied Medical Sciences, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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22
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Lesão por pressão decorrente do posicionamento cirúrgico e fatores associados. ACTA PAUL ENFERM 2021. [DOI: 10.37689/acta-ape/2021ao00642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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23
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Bouyer-Ferullo S, O'Connor C, Kinnealey E, Wrigley P, Osgood PM. Adding a Visual Communication Tool to the Electronic Health Record to Prevent Pressure Injuries. AORN J 2021; 113:253-262. [PMID: 33646585 DOI: 10.1002/aorn.13323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 02/02/2023]
Abstract
Health care organizations no longer receive reimbursement for stage 3, stage 4, and unstageable hospital-acquired pressure injuries, which are never events that require interdisciplinary collaboration to treat and prevent. Perioperative patients are at risk for developing pressure injuries that may not manifest until five or more days after surgery. This quality improvement project aimed to inform inpatient nursing and health care professionals of the potential areas of skin breakdown after surgery using an annotated image (AI) depicting intraoperative patient positioning. To gauge OR nurses' use of the AI, we tracked image addition to the patient records weekly from May 2018 to May 2019 and found an overall average participation rate of 80% to 90%. Adding the AI of surgical positioning and pressure points raised awareness of the potential for skin breakdown and became a valuable communication tool for the inpatient nurses who were providing postoperative care to prevent pressure injuries.
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24
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Eberhardt TD, de Lima SBS, de Avila Soares RS, Silveira LBTD, Rossarola Pozzebon B, Reis CR, Dos Santos KPP, Alves PJP. Prevention of pressure injury in the operating room: Heels operating room pressure injury trial. Int Wound J 2020; 18:359-366. [PMID: 33314605 PMCID: PMC8243998 DOI: 10.1111/iwj.13538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022] Open
Abstract
The objective was to evaluate the efficacy of multi‐layered silicone foam (intervention) compared with transparent polyurethane film (control) in preventing heel pressure injuries caused by surgical positioning of individuals undergoing elective surgery. It was designed an intra‐patient, open, parallel, randomised controlled trial was conducted in a university hospital in southern Brazil, from March 2019 to February 2020, with patients undergoing elective surgeries of cardiac and gastrointestinal specialties. The patients who met the selection criteria constituted, simultaneously, a single group receiving the intervention and active control, through paired analysis of the cutaneous sites (right heel and left heel). The outcome was the occurrence of PI, within the follow‐up period was 72 hours. Brazilian Registry of Clinical Trials: RBR‐5GKNG5. There was analysis of 135 patients/270 heels, with an overall incidence of 36.7%. The pressure injury incidence was significantly lower in the intervention group (26.7%), compared with the control group (P = .001); relative risk of 0.57. In the intervention group, the estimated pressure injury‐free time (survival) was 57.5 hours and in the control group, 43.9 hours. It was concluded that Multi‐layered silicone foam (intervention) is more efficacious than transparent polyurethane film (control) in the prevention of pressure injuries caused by surgical positioning of individuals undergoing elective surgery.
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Affiliation(s)
- Thaís Dresch Eberhardt
- Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.,Instituto de Ciências Biológicas, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | | | | | | | | | - Cassia Ribeiro Reis
- Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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25
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Serpa LF, Ortiz MM, Lima AC, Bueno L, Nogueira PC, Ferri C, Santos VLCDG. Incidence of hospital-acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo, Brazil. Wound Repair Regen 2020; 29:79-86. [PMID: 33047424 DOI: 10.1111/wrr.12868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 04/19/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022]
Abstract
This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.
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Affiliation(s)
- Leticia Faria Serpa
- School of Health Sciences Education, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Margarita Maria Ortiz
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anne Chaves Lima
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Línea Bueno
- Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paula Cristina Nogueira
- Department of Medical-Surgical Nursing and Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cleusa Ferri
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
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26
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Celik B, Karayurt Ö, Ogce F. The Effect of Selected Risk Factors on Perioperative Pressure Injury Development. AORN J 2020; 110:29-38. [PMID: 31246295 DOI: 10.1002/aorn.12725] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients undergoing operative and other invasive procedures are at high risk for developing pressure injuries. This study aimed to determine the incidence of perioperative pressure injuries in patients who underwent procedures lasting two hours or more in Turkey and the risk factors that affect the development of pressure injuries. Data were collected during the perioperative period. The incidence of perioperative pressure injuries was 40.4%. The results of univariate logistic regression analysis showed that intraoperative vasopressor use, skin turgor, and diastolic blood pressure less than or equal to 60 mm Hg were significantly related to the development of pressure injuries. There was no significant difference between patients who developed pressure injuries and patients who did not when comparing their preoperative Braden Scale scores. Perioperative nurses should assess each patient for pressure injury risk and perform interventions to prevent pressure injuries during each stage of the patient's perioperative course.
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27
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Grap MJ, Schubert CM, Munro CL, Wetzel PA, Burk RS, Lucas V, Pepperl A. OR Time and Sacral Pressure Injuries in Critically Ill Surgical Patients. AORN J 2020; 109:229-239. [PMID: 30694547 DOI: 10.1002/aorn.12583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Critically ill patients are at risk for developing pressure injuries during operative and other invasive procedures. The purpose of this secondary analysis was to explore the relationship of OR time to sacral pressure injuries in critically ill patients using high frequency ultrasound as a method of assessment. The 41 participants examined in this study had both time in the OR and up to eight days of pressure injury data. The multivariable model containing OR bed time, body mass index, and Braden Scale score produced the best prediction of pressure injury (area under the curve = 0.859). A higher body mass index (P = .09), shorter OR bed time (P = .01), and lower Braden Scale score (P = .05) were associated with a greater chance of pressure injury. These results suggest that use of high frequency ultrasound may identify tissue changes before observable skin changes, leading to earlier pressure injury prevention strategies.
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Patel R, Rhee PC. Team Approach: Multidisciplinary Perioperative Care in Upper-Extremity Reconstruction for Adults with Spasticity and Contractures. JBJS Rev 2020; 8:e0164. [DOI: 10.2106/jbjs.rvw.19.00164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Perioperative Nursing of Patients with Reoperation of Recurrent Parathyroid Carcinoma Invading the Upper Digestive or Respiratory Tract. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6946048. [PMID: 32149123 PMCID: PMC7054761 DOI: 10.1155/2020/6946048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/12/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to summarize the perioperative nursing care of patients with recurrent parathyroid carcinoma. Methods A retrospective analysis of 10 patients with recurrent parathyroid carcinoma was performed. The clinical data, diagnosis, treatment process, and nursing process (including clinical nursing intervention of various complications) were analyzed. The nursing experience and methods were discussed, summarized, and analyzed. Results A total of 10 patients were reviewed (male : female 7 : 3; aged 48.6 ± 14.60 years). The mean interval between the initial operation and reoperation was 2.23 ± 1.65 years. The mean number of operations was 4.00 ± 1.41. Invasion of the trachea or esophagus was evident in 7 patients, larynx in 6 patients, recurrent laryngeal nerve in 1 patient, and cyclic cartilage in 2 patients. Serum calcium range was 3.20-4.68 mmol/L, and parathyroid hormone (PTH) range was 860-2830 pg/ml at admission. 6 patients underwent prophylactic tracheostomy, 2 patients underwent partial laryngectomy, and 2 patients underwent total laryngectomy. 1 patient experienced temporary water-electrolyte disorder and hypoproteinemia. The median serum calcium was 2.28 mmol/L (1.66-3.18 mmol/L) and median PTH level was 82.60 pg/ml (63.70-900.00 pg/ml) postoperatively. Serum PTH and calcium were still higher than the upper limit of normal in 2 patients after surgery. 2 of the other 8 patients relapsed within 8-11 months, and 6 patients remained normal for 11-40 months. Conclusion For patients with reoperation of recurrent parathyroid carcinoma, high-quality, reasonable, and careful perioperative nursing ensured a successful operation and optimized outcome.
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30
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Haisley M, Sørensen JA, Sollie M. Postoperative pressure injuries in adults having surgery under general anaesthesia: systematic review of perioperative risk factors. Br J Surg 2020; 107:338-347. [PMID: 31960958 DOI: 10.1002/bjs.11448] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/24/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pressure injuries (PIs) after surgery affect thousands of people worldwide. Their management is expensive, a cost that can be reduced with proper preventive measures. Patients having surgery under general anaesthesia are at risk of developing PI, yet no specific tool has been developed to assess the risk in these patients. This review aimed to summarize the published data on perioperative risk factors associated with the development of PI in adults having surgery under general anaesthesia. METHODS All studies reporting on risk factors associated with the development of PI were included. Data were extracted from all articles and meta-analysis was performed when three or more studies reported on a specific variable. RESULTS The analysis identified five factors significantly associated with the development of PIs: cardiovascular disease, respiratory disease, diabetes mellitus, low haemoglobin level and longer duration of surgery. Factors not associated included serum albumin concentration, use of vasopressors during surgery, use of corticosteroids, sex and age. CONCLUSION Cardiovascular disease, respiratory disease, diabetes mellitus, anaemia and duration of surgery should be taken into consideration when trying to identify surgical patients at high risk of developing PIs. These factors could be used to predict PIs after surgery.
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Affiliation(s)
- M Haisley
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - J A Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M Sollie
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Tschannen D, Anderson C. The pressure injury predictive model: A framework for hospital-acquired pressure injuries. J Clin Nurs 2020; 29:1398-1421. [PMID: 31889342 DOI: 10.1111/jocn.15171] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 11/19/2019] [Accepted: 12/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite decades of research, pressure injuries continue to be a source of significant pain and delayed recovery for patients and substantial quality and cost issues for hospitals. Consideration of the current thinking around pressure injury risk must be evaluated to improve risk assessments and subsequent nursing interventions aimed at reducing hospital-acquired pressure injuries. DESIGN This is a discursive paper using Walker and Avant's (2005) theory synthesis framework to examine the relevance of existing pressure injury models as they align with the current literature. METHODS PubMed and CINAHL indexes were searched, first for conceptual models and then for pressure injury research conducted on hospitalised patients for the years 2006-2016. A synthesis of the searches culminated into a new pressure injury risk model. CONCLUSIONS Gaps in previous models include lack of attention to the environment, contributing episode-of-care factors and the dynamic nature of injury risk for patients. Through theory synthesis, the need for a new model representing the full risk for pressure injury was identified. The Pressure Injury Predictive Model is a representation of the complex and dynamic nature of pressure injury risk that builds on previous models and addresses new patient, contextual and episode-of-care process influences. The Pressure Injury Predictive Model (PIPM) provides a more accurate picture of the complexity of contextual and process factors associated with pressure injury development. RELEVANCE TO CLINICAL PRACTICE Using the PIPM to determine risk can result in improved risk identification. This information can be used to implement targeted, evidence-based pressure injury prevention interventions specific to the patient risk profile, thus limiting unwarranted and unnecessary care.
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Affiliation(s)
- Dana Tschannen
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Baradaran Bagheri A, Sadati L, Beyrami A, Fatollahi S, Nouri Khanegah Z, Torkamandi H. Postoperative Skin Complications after Spine Surgery in the Prone Position. JOURNAL OF CLINICAL AND BASIC RESEARCH 2019. [DOI: 10.29252/jcbr.3.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Incidence and Risk Factors of Pressure Injuries in Surgical Spinal Patients. J Wound Ostomy Continence Nurs 2019; 46:397-400. [DOI: 10.1097/won.0000000000000570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McCosker L, Tulleners R, Cheng Q, Rohmer S, Pacella T, Graves N, Pacella R. Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters. Int Wound J 2019; 16:84-95. [PMID: 30259680 PMCID: PMC7948920 DOI: 10.1111/iwj.12996] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022] Open
Abstract
Chronic wounds are a significant problem in Australia. The health care-related costs of chronic wounds in Australia are considerable, equivalent to more than AUD $3.5 billion, approximately 2% of national health care expenditure. Chronic wounds can also have a significant negative impact on the health-related quality of life of affected individuals. Studies have demonstrated that evidence-based care for chronic wounds improves clinical outcomes. Decision analytical modelling is important in confirming and applying these findings in the Australian context. Epidemiological and clinical data on chronic wounds are required to populate decision analytical models. Although epidemiological and clinical data on chronic wounds in Australia are available, these data have yet to be systematically summarised. To address these omissions and clarify the state of existing evidence, we conducted a systematic review of the literature on key epidemiological and clinical parameters of chronic wounds in Australia. A total of 90 studies were selected for inclusion. This paper presents a synthesis of the evidence on the prevalence and incidence of chronic wounds in Australia, as well as rates of infection, hospitalisation, amputation, healing, and recurrence.
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Affiliation(s)
- Laura McCosker
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Ruth Tulleners
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Qinglu Cheng
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Stefan Rohmer
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Tamzin Pacella
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Nick Graves
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
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Ullman AJ, Mihala G, O'Leary K, Marsh N, Woods C, Bugden S, Scott M, Rickard CM. Skin complications associated with vascular access devices: A secondary analysis of 13 studies involving 10,859 devices. Int J Nurs Stud 2018; 91:6-13. [PMID: 30658228 DOI: 10.1016/j.ijnurstu.2018.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vascular access devices are widely used in healthcare settings worldwide. The insertion of a vascular access device creates a wound, vulnerable to irritation, injury and infection. Vascular access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. OBJECTIVES To estimate the incidence of vascular access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. DESIGN Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of vascular access devices in clinical settings between 2008 and 2017. SETTINGS Six hospitals (metropolitan and regional) in Queensland, Australia. PARTICIPANTS The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous access (n = 585) devices. ANALYSIS Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p < 0.01 to reduce the effect of multiple comparisons. RESULTS Over 12% of devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial devices (95% confidence interval, CI 42.1-50.7), and 22.5 per 1000 catheter days for central devices (95% CI 16.5-306). The most common skin complications were bruising (peripheral n = 134, 3.7%; central n = 33, 6.8%), and swelling due to infiltration for peripheral devices (n = 296; 2.9%), and dermatitis for central devices (n = 13; 2.2%). The significant risk factors for these complications were predominantly related to device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. CONCLUSIONS Significant skin complications can develop during the life of peripheral and central vascular access devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with vascular access devices.
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Affiliation(s)
- Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Queensland Children's Hospital, South Brisbane, QLD 4101, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia
| | - Kate O'Leary
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Christine Woods
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Simon Bugden
- Caboolture Hospital, Metro North Hospital and Health Service, North Brisbane, QLD 4510, Australia
| | - Mark Scott
- Caboolture Hospital, Metro North Hospital and Health Service, North Brisbane, QLD 4510, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Nathan, QLD 4111, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Queensland Children's Hospital, South Brisbane, QLD 4101, Australia
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Xiong C, Gao X, Ma Q, Yang Y, Wang Z, Yu W, Yu L. Risk factors for intraoperative pressure injuries in patients undergoing digestive surgery: A retrospective study. J Clin Nurs 2018; 28:1148-1155. [PMID: 30375697 DOI: 10.1111/jocn.14712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/20/2018] [Accepted: 10/16/2018] [Indexed: 12/28/2022]
Abstract
AIM AND OBJECTIVE To investigate the incidence of intraoperative blanchable erythema and pressure injuries in patients undergoing digestive surgery and to explore potential risk factors. BACKGROUND Pressure injuries pose significant economic and healthcare burden to patients and are used as one of the key indicators of nursing in the operation room with high incidence. DESIGN A retrospective observational study. METHODS Basic information and the results of 3S intraoperative risk assessment scale of pressure injury were obtained from the information system. And the patients with intraoperative blanchable erythema or pressure injuries were followed up for 72 hr by the information system. The clinical data were collected to analyse risk factors for intraoperative blanchable erythema and pressure injuries by univariate analysis and logistic regression analysis. STROBE checklist for cohort studies was applied in the preparation of the paper. RESULTS Of 5,136 surgical cases, 134 (2.61%) had blanchable erythema, 37 (0.72%) had intraoperative pressure injuries, and 8 (0.16%) had pressure injuries at 72-hr follow-up. Preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure were considered independent risk factors for intraoperative pressure injuries. CONCLUSION The incidence of pressure injuries in our study was lower than those reported in the previous studies. Accessing preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure was considered to be significant for preventing pressure injuries. RELEVANCE TO CLINICAL PRACTICE The findings suggest that preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure are associated with intraoperative pressure injuries in patients undergoing digestive surgery.
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Affiliation(s)
- Can Xiong
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinglian Gao
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiong Ma
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Yang
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengyan Wang
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjing Yu
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Yu
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Aloweni F, Ang SY, Fook-Chong S, Agus N, Yong P, Goh MM, Tucker-Kellogg L, Soh RC. A prediction tool for hospital-acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score. Int Wound J 2018; 16:164-175. [PMID: 30289624 DOI: 10.1111/iwj.13007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 12/26/2022] Open
Abstract
Surgical patients are prone to developing hospital-acquired pressure ulcers (HAPU). Therefore, a better prediction tool is needed to predict risk using preoperative data. This study aimed to determine, from previously published HAPU risk factors, which factors are significant among our surgical population and to develop a prediction tool that identifies pressure ulcer risk before the operation. A literature review was first performed to elicit all the published HAPU risk factors before conducting a retrospective case-control study using medical records. The known HAPU risks were compared between patients with HAPU and without HAPU who underwent operations during the same period (July 2015-December 2016). A total of 80 HAPU cases and 189 controls were analysed. Multivariate logistic regression analyses identified eight significant risk factors: age ≥ 75 years, female gender, American Society of Anaesthesiologists ≥ 3, body mass index < 23, preoperative Braden score ≤ 14, anaemia, respiratory disease, and hypertension. The model had bootstrap-corrected c-statistic 0.78 indicating good discrimination. A cut-off score of ≥6 is strongly predictive, with a positive predictive value of 73.2% (confidence interval [CI]: 59.7%-84.2%) and a negative predictive value of 80.7% (CI: 74.3%-86.1%). SPURS contributes to the preoperative identification of pressure ulcer risk that could help nurses implement preventive measures earlier.
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Affiliation(s)
- Fazila Aloweni
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | | | - Nurliyana Agus
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Patricia Yong
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Meh Meh Goh
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Lisa Tucker-Kellogg
- Cancer & Stem Cell Biology, and Centre for Computational Biology Duke-NUS Medical School, Singapore, Singapore
| | - Rick Chai Soh
- Department of Anaesthesia, SGH, Singapore, Singapore
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Kumta N, Coyer F, David M. Perioperative factors and pressure ulcer development in postoperative ICU patients: a retrospective review. J Wound Care 2018; 27:475-485. [PMID: 30086257 DOI: 10.12968/jowc.2018.27.8.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify variables during surgery that may contribute to the development of pressure ulcers (PUs) in postoperative, intensive care unit (ICU) patients within 72 hours of admission, as well as over their entire ICU admission. Furthermore, to investigate how these variables may impact on the number of PUs acquired. METHOD In a three-year retrospective audit, from 1 January 2014 to 31 December 2016, data from the electronic medical records of 3484 postoperative ICU patients in a major Australian metropolitan public hospital were retrieved and analysed to investigate associations between perioperative variables and PU occurrence. RESULTS A total of 69 ICU admissions (1.98%) out of 3484 resulted in at least one PU developing within the ICU. No specific variables were associated with the development of a PU within 72 hours of the patient's ICU admission. Multiple regression Cox analysis showed that length of time in the operating theatre (OT) (p=0.045), surgical specialty (p<0.001), 1-4 hypotensive episodes (p=0.017) and >5 hypotensive episodes (p<0.0005) were significantly associated with PU risk. Multivariable negative binomial regression demonstrated APACHE II score (p<0.01), OT time (p<0.01) and surgical specialty (p<0.01) were associated with PU number. CONCLUSION There are many risks to skin integrity at the perioperative period, and these risks may exert their effect well into the ICU admission period. It is imperative to identify and mitigate these factors in order to reduce PU incidence, morbidity and mortality.
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Affiliation(s)
- Neha Kumta
- Resident Medical Officer, Sunshine Coast University Hospital, Birtinya, QLD, Australia, University of Queensland, Brisbane, QLD, Australia
| | - Fiona Coyer
- Professor of Nursing; School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Michael David
- Biostatistical Consultant, Biostatistical Consultant, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Scientific and Clinical Abstracts From the WOCN® Society's 50th Annual Conference. J Wound Ostomy Continence Nurs 2018. [DOI: 10.1097/won.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kwak HR, Kang J. Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission. ACTA ACUST UNITED AC 2015. [DOI: 10.7475/kjan.2015.27.3.347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hye Ran Kwak
- Dong-A University Medical Center, CCU, Busan, Korea
| | - Jiyeon Kang
- Department of Nursing, Dong-A University, Busan, Korea
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