Medical Device-Related Pressure Injuries in Infants and Children

Medical device-related pressure injuries in paediatric patients: An incidence study in a children's hospital

AIM

To determine the incidence of pressure injuries from medical devices in children.

BACKGROUND

Medical devices can cause pressure injuries on skin and soft tissues.

DESIGN

A prospective, descriptive study adhering to STROBE guidelines.

METHODS

This study was conducted in the third-level Paediatric Intensive Care Unit of Ege University Hospital in İzmir, Türkiye between April 2019 and October 2019 in Türkiye. Patients aged between 1 month and 18 years with medical devices were observed for pressure injuries using Braden scales and a specific monitoring form.

RESULTS

In this study, we followed 522 medical devices applied to 96 patients. The three most commonly used medical devices were the ECG probe (21%), the blood pressure cuff (16%) and the saturation probe. Out of the 522 medical devices followed, 36 caused pressure injuries (6.8%).

CONCLUSION

The incidence of medical device-related pressure injuries was found to be high. Effective training and implementation strategies need to be devised for paediatric nurses to prevent pressure injuries associated with medical devices.

RELEVANCE TO CLINICAL PRACTICE

The results of this study reveal that pressure injuries related to medical devices are an important health problem in paediatric hospitals. Therefore, awareness-raising and educational activities among health professionals and nurses should be accelerated.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution in the study.

Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital

BACKGROUND

Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital.

METHODS

This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies.

RESULTS

The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk.

CONCLUSION

HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies.

IMPACT

The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care.

REPORTING METHOD

STROBE guidelines.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution to the conduct of this study.

Evaluating the Effectiveness of Brief Training for Neonatal Intensive Care Nurses on the Prevention of Medical Device-Related Nasal Pressure Injury

OBJECTIVE

To evaluate the effectiveness of a brief training in medical device-related pressure injury (MDRPI) prevention for neonatal intensive care nurses.

METHODS

This single-group, pretest-posttest quasi-experimental study was conducted between April and October 2021 with 81 nurses working in the neonatal ICU of a city hospital. The participants completed a training program consisting of two 40-minute sessions that used a small-group problem-based learning approach developed in accordance with evidence-based research. Data were collected using a neonatal nurse information form, knowledge of MDRPI in preterm infants form, and training evaluation form, all of which were prepared for this study based on the literature. Data collection was performed before the training and repeated at 1 week and 1 month after the training. Data analysis was performed using the Number Cruncher Statistical System. Descriptive statistics, the Shapiro-Wilk test, Mann-Whitney U test, and Spearman correlation analysis were used.

RESULTS

The participants' mean score on the knowledge of MDRPI in premature infants form was 82.44 ± 7.26 before training and increased significantly to 94.57 ± 5.03 at 1 week and 94.67 ± 3.11 at 1 month after training (P = .001 and P = .001, respectively). No significant relationship was detected between the participants' descriptive characteristics and their knowledge scores before or after the training (P > .05).

CONCLUSIONS

Brief training on the prevention of nasal pressure injury caused by noninvasive ventilation increased nurses' knowledge level.

A scoping review and narrative synthesis of neonatal skin injury severity scales

BACKGROUND

Mechanical force skin injuries are common for critical care patients, especially neonates. Currently, identification and severity assessments of injuries are dependent on clinical experience and/or utilization of severity tools. Compared with adults, neonates sustain skin injuries in different anatomical locations and have decreased layers of healthy tissue (from 0.9 to 1.2 mm) creating questions around direct application of adult injury severity scales reliant on visual assessment.

AIMS

The aim of this scoping review (ScR) was to investigate severity scales used to report hospital acquired skin injuries for neonates.

METHODS

This study utilized the 2015 Joanna Briggs Institute methodology for scoping reviews and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews extension. PubMed, CINAHL, COCHRANE Central, Scopus, and the reference lists of included studies were searched for studies published between 2001 and 2023, that included severity scales use within neonatal population. Two authors independently identified studies for full review, data extraction, and quality assessment.

RESULTS

A systematic database search returned 1163 records. After full test review of 109 studies, 35 studies were included. A majority of studies included were cohort or action research and conducted in the United States of America. Most studies (57%, n = 20) reported skin injuries acquired throughout the body, 14 (40%) of the studies reported the nasal area alone and one study reported no anatomical location. A total of nine severity scales or combination of scales were utilized within studies (n = 31) and four studies did not report a scale. Various versions of scales from the National Pressure Ulcer Advisory Panel (n = 16), European Pressure Ulcer Advisory Panel (n = 8) or Neonatal Skin Condition Score (n = 4) were reported, compared with locally developed classifications/scales (n = 4). Scales were predominantly of ordinal grouping (74%, n = 26) or categorical assessment (14%, n = 5). Only one scale from 2004 was validated for neonates.

CONCLUSION

Neonatal skin injuries will continue to be reported subjectively until severity scales are consistently applied or other measurements are identified to support assessment. Additionally, without skin injury assessment uniformity, critical examination of effectiveness of skin care treatment practices will have subjective comparison. This review suggests there is a need for consistent skin assessment and severity scales that are valid for the neonatal population and their unique skin considerations.

Predictive validity and reliability of two pressure injury risk assessment scales at a neonatal intensive care unit

To compare the predictive ability and reliability of two pressure injury (PI) assessment tools, the Neonatal/Infant(N/I) Braden Q and Braden QD scale, in neonates. A prospective and cross-sectional study. This study was conducted in the neonatal intensive care unit (NICU) of a tertiary-level university hospital in China between April and June 2023. A total of 410 patients were included in this study. Risk assessment was performed with the N/I Braden Q scale, followed immediately with the Braden QD scale once daily. Risk assessment was terminated when the PI developed or the patient was discharged from the NICU or died. Each patient's final risk assessment was considered in the data analysis. The area under the curve (AUC) of the two scales was 0.879 and 0.857, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and Cronbach's α coefficient of the N/I Braden Q Scale scores were 0.844, 0.833, 0.30, 0.984 and 0.806, respectively. The Braden QD scale scores were 0.938, 0.733, 0.229, 0.993 and 0.727, respectively. Both scales are valid and reliable in predicting the risk of PI in the NICU. The N/I Braden Q Scale was better to distinguish patients at PI risk and not at PI risk than the Braden QD scale. The literature is limited on this topic. This study provides insight into the comparison of different pressure injury risk assessment scales. The findings of this study may guide nurses to choose a suitable tool to assess the risk of pressure injury in neonates.

The incidence and prevalence of medical device-related pressure injuries in pediatric patients: Systematic review and meta-analysis

PROBLEM

To determine the pooled incidence and prevalence rate of medical device-related pressure injuries(MDRPIs) using the Braden QD scale, medical devices that frequently cause MDRPIs, and anatomical locations that are vulnerable to them.

ELIGIBILITY CRITERIA

Using the Braden QD scale, being published in English between 01/01/2018-and 01/03/2023.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations and registered in the International Prospective Register of Systematic Reviews database (No: CRD42021276501).

SAMPLE

A total of 7 studies with 25,742 pediatric patients were included.

RESULTS

The pooled prevalence and cumulative incidence of hospital-acquired pressure injuries(HAPIs) were 7.8% (95% CI: 5.2-11.4%) and 3.9% (95% CI: 0.5-24.6%) respectively, and the incidence rate was 8.2/1000 person-days (95% CI: 2.4-14.2/1000 person-days). The pooled prevalence and cumulative incidence of MDRPIs were 7% (95% CI: 5.5-8.8%) and 5% (95% CI: 3.2-7.8%) respectively, and the incidence rate was 6.7/1000 person-days (95% CI, 0.11-13.4/1000 person-days). The most affected anatomical locations were the face (29.1%), ankle/foot (20.1%), and head (15.7%). Medical devices that frequently caused MDRPIs were external monitoring devices (24.5%), respiratory devices (22.8%), and supportive/securing devices (14.9%).

CONCLUSIONS

According to the current systematic review and meta-analyses, the incidence and prevalence of HAPIs and MDRPIs are moderate to high.

IMPLICATIONS

The findings suggested that healthcare providers should pay more attention to reducing HAPIs and MDRPIs and future studies should be conducted to understand their characteristics and risk factors.

Analysis of the prevalence and risk factors of pressure injuries in the hospitalized pediatric population: A retrospective study

BACKGROUND

Pressure injury (PI) is an essential indicator of the quality of nursing care and affects hospitalized newborns and children. However, studies on the prevalence of PI and associated risk factors in children are limited.

AIMS

This study aimed to analyze the prevalence of PI and risk factors affecting the development of PI in the hospitalized pediatric population.

METHODS

This was a descriptive, retrospective study. Data were obtained via electronic medical records of 6350 pediatric patients admitted to a university hospital between January 2019 and April 2022. Ethics committee approval was obtained. Patient medical records and data associated with PI and medical treatment were collected through the 'Information Form,' 'Braden Scale,' 'Braden Q Scale,' 'Pressure Ulcer Staging Form,' and 'Pediatric Nutrition Risk Score (PNRS).' Data were analyzed using descriptive statistics, correlation analysis, Mann-Whitney U test, Kruskal Wallis test, and Multilinear Regression analysis.

RESULTS

More patients (66.2%) were males, and 49.2% of the children were 0-12 months old. 2368 out of 6350 pediatric patients were treated in the PICU. It was determined that a total of 143 PI occurred in 59 patients from PICU. The PI prevalence was 2.25% for all patients and 6.04% for PICU patients. Twenty-one percent of the patients had medical device-related PI (MDRPIs), 35.7% of PI occurred in the occiput, 13.3% in the coccyx/sacrum, and 67.1% of PI was Deep Tissue Injury. In the multiple regression model, children's albumin level, hemoglobin level, PNRS scores, Body Mass Index, and length of hospital stay significantly affected BRADEN scores. They were explained 30.3% of their scores of Braden.

CONCLUSION

Despite the limitations of the retrospective study, the prevalence of PI in the pediatric population in this study was lower than that reported in previous studies, but the prevalence of MDRPIs was higher. Based on the study results, it is recommended to implement preventive interventions for MDRPIs and plan prospective studies.

Replacing Monitoring Electrodes on Infant Skin Every 12 Versus 24 Hours

OBJECTIVE

To examine the effect of varying the frequency of monitoring electrode replacement on skin moisture and condition of infants hospitalized in the pediatric ICU.

METHODS

The population of the study consisted of 1- to 12-month-old infants receiving treatment in the pediatric ICU. The control group of the study (n = 33) included infants whose monitoring electrodes were replaced every 24 hours during monitoring, and the experimental group (n = 33) included infants whose monitoring electrodes were replaced every 12 and 24 hours during monitoring. Before assessment, the skin moisture of the monitoring areas was measured and evaluated with the Skin Condition Assessment Scale.

RESULTS

When the difference in skin moisture was compared for all measurement areas of the infants before monitoring and at the 24-hour mark, an increase in moisture was seen in both groups, and the difference in the experimental group was greater than that in the control group. Increased moisture is a risk factor for medical device-related pressure injuries. When comparing between-group differences in skin condition, the researchers noted a greater increase in skin condition score in the experimental group. An increased score indicates that the infant's skin condition is worsening.

CONCLUSIONS

Replacing the monitoring electrodes every 24 hours positively affected skin moisture and condition, whereas replacing them every 12 hours negatively affected skin moisture and condition.

Development and psychometric property testing of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool

AIMS

We aimed to develop and test the psychometric properties of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool.

BACKGROUND

Assessment of nurses' knowledge and practices is critical in the prevention of Medical Device-related Pressure Injuries.

DESIGN

This was an instrument development and testing study.

METHODS

The sample of the study consisted of nurses (n = 189). The study was conducted in three phases between January and February 2021. In the first phase, multiple-choice items contained within Aetiology/Risk Factors, Prevention Interventions, and Staging domains were created. In the second phase, content validity and criterion validity were evaluated, and the tool was pre-tested. The third phase examined item difficulty, discrimination index and distractor quality. The test-retest method was used for reliability.

RESULTS

The Content Validity Index was found to be 0.75, 0.86 and 0.96 for the domains of Aetiology/Risk Factors, Prevention and Staging, respectively. The item difficulty values of the items were between 0.18 and 0.96. A positive, strong and significant relationship was found between the results and a positive, moderate and significant relationship between the tools administered for the proof of scale validity. The Cronbach's alpha reliability coefficient was found to be 0.54.

CONCLUSIONS

The tool is a suitable measurement instrument for use in nursing education, research and clinical settings.

Oxygen saturation probe-related pressure injury prevention in children on an inpatient pediatric unit: a best practice implementation project

OBJECTIVES

The aim of this project was to increase compliance with rotation and documentation of rotation of oxygen saturation probes to reduce medical-device-related pressure injuries in children on a pediatric inpatient unit.

INTRODUCTION

There are a multitude of factors that place hospitalized children at an increased risk for medical-device-related pressure injuries. Evidence supports the rotation of medical devices, if appropriate, at least twice daily to minimize the risk of medical-device-related pressure injuries in hospitalized children.

METHODS

The project used JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for encouraging evidence-based practices. A baseline audit was conducted, followed by the implementation of targeted strategies. The project was completed with a follow-up audit to determine change in practice.

RESULTS

The baseline audit revealed significant deficits in two of the seven audit criteria. Barriers to the rotation of oxygen saturation probes and the assessment of skin under oxygen saturation probes were identified by the project team and an electronic health record (EHR) documentation change was implemented. Follow-up audits were not conducted on the five criteria that showed high compliance at baseline. For the remaining two audit criteria, data revealed no improvement in one of the criteria (3% compliance at both baseline and follow-up audits) and an increase from 0% compliance to 43% compliance in the second criterion.

CONCLUSION

Optimizing EHR documentation, specifically ease and efficiency of EHR documentation, has the potential to positively impact clinical practice.

Characteristics and risk factors of nasal mucosal pressure injury in intensive care units

AIMS AND OBJECTIVES

This study aimed to understand the risk factors that contribute to medical device-related (MDR) nasal mucosal membrane pressure injuries (MM PI) in ICU patients.

BACKGROUND

ICU patients require substantial tube-based life support such as oxygen tubes, tracheal intubation and indwelling gastric tubes. As a result, there is an increased risk of PI occurrence; however, few studies have assessed the risk factors associated with nasal mucosal MDR-MMPI in ICU patients.

DESIGN

A cross-sectional study design was performed.

METHODS

From January 2019 to June 2020, data from 912 patients treated in the ICU of a tertiary first-class a hospital in China were collected. The occurrence of PI of the nasal mucosa was obtained by nasopharyngoscope when replacing the nasal catheter fixation patch every day. The study methods were followed by the STROBE guidelines.

RESULTS

The incidence of nasal mucosal MDR-MM PI was 10.9%. The degree of nasal mucosal MM PI was mainly grade 1 (62cases, 62.6%), and no grade 4 were observed. The columella (58 cases, 58.6%) was the most common site of nasal mucosal MM PI followed by the anterior septum (18 cases, 18.2%). A high patient APACHE-Ⅱ score, the disturbance of consciousness, a history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and the use of vasoconstrictors were identified as significant influencing factors of nasal MM PI in ICU patients (p < .05).

CONCLUSIONS

A high APACHE-Ⅱ score, disturbance of consciousness, history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and use of vasoconstrictive drugs were risk factors for nasal mucosal MDR-MM PI in ICU patients. This study informs on the risk factors of nasal mucosal MM PI that will allow medical support staff to carry out key interventional measures to prevent nasal mucosal MM PI.

RELEVANCE TO CLINICAL PRACTICE

This study illustrates the characteristics and risk factors of nasal mucosal pressure injury in intensive care units, potentially contributing to the prevention of the incidence of nasal mucosal MDR-PI in ICU patients.

Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation

OBJECTIVE

To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants.

METHODS

This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries.

RESULTS

Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01).The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04).

CONCLUSION

Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

ADAPTAÇÃO TRANSCULTURAL E VALIDAÇÃO DO INSTRUMENTO BRADEN QD SCALE PARA USO EM NEONATOS NO BRASIL

RESUMO Objetivo: adaptar transculturalmente e validar o instrumento Braden QD Scale para uso em neonatos no Brasil. Método: estudo metodológico de adaptação transcultural e estudo transversal observacional de validação, realizado entre dezembro de 2017 a agosto de 2021. Participaram 10 especialistas, 38 enfermeiros e 105 recém-nascidos. O processo de adaptação transcultural envolveu a tradução inicial, síntese, retrotradução, comitê de especialistas, pré-teste e aprovação da versão adaptada pela autora do instrumento original. A validação verificou as propriedades psicométricas de validade, confiabilidade e consistência interna, a partir da aplicação do instrumento adaptado por dois avaliadores, de forma simultânea e independente, e avaliação temporal a partir de vídeo de cinco neonatos em dois momentos distintos. Os testes estatísticos foram o Índice de Validade de Conteúdo, alfa de Cronbach e coeficiente Kappa. Resultados: o processo de tradução da Braden QD scale resultou na versão em português adaptada para a cultura brasileira. O índice de validade de conteúdo do comitê de especialistas foi ≥0.90 e do pré-teste foi ≥0.80. Na confiabilidade interobservador todos os itens obtiveram coeficiente Kappa >0,90. O alfa de Cronbach do avaliador 1 foi de 0,773 e do Avaliador 2 foi de 0,769, sendo confiável o alfa de Cronbach >0,6. Na concordância intraobservador a média dos escores, na prática, não foram diferentes. Conclusão: o instrumento foi adaptado transculturalmente para uso em neonatos e crianças no Brasil. A versão brasileira apresentou níveis estatísticos de validade e confiabilidade, mostrando-se válida para uso em neonatos no Brasil.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE BRADEN QD SCALE FOR USE WITH NEONATES IN BRAZIL

ABSTRACT Objective: to cross-culturally adapt and validate the Braden QD Scale for use with neonates in Brazil. Method: a methodological study of cross-cultural adaptation and observational cross-sectional validation study, carried out between December 2017 and August 2021. The participants were 10 specialists, 38 nurses and 105 newborns. The cross-cultural adaptation process involved the initial translation, synthesis, back-translation, expert committee, pre-test and approval of the adapted version of the original instrument by the author. Validation verified the validity, reliability and internal consistency psychometric properties, from simultaneous and independent application of the adapted instrument by two evaluators, and based on time evaluation from the video of five neonates at two different moments. The statistical tests performed were Content Validity Index, Cronbach's alpha and Kappa coefficient. Results: the Braden QD scale translation process resulted in the Portuguese version adapted for the Brazilian culture. The expert committee's Content Validity Index was ≥0.90 and that of the pre-test was ≥0.80. In interobserver reliability, all items obtained Kappa coefficients > 0.90. Cronbach's alpha was 0.773 and 0.769 for Evaluators 1 and 2, respectively, with Cronbach's alpha > 0.6 considered as reliable. In intraobserver agreement, the mean scores were not different in the practice. Conclusion: the instrument was cross-culturally adapted for use with neonates and children in Brazil. The Brazilian version presented statistical validity and reliability levels, proving to be valid for use in neonates in Brazil.

Performance of a Commonly Used Pressure Injury Risk Model Under Changing Incidence

BACKGROUND

Hospital-acquired pressure injuries (HAPIs) cause patient harm and increase health care costs. We sought to evaluate the performance of the Braden QD Scale-associated changes in HAPI incidence.

METHODS

Using electronic health records data from a quaternary children's hospital, we evaluated the association between Braden QD scores and patient risk of HAPI. We analyzed how this relationship changed during a hospitalwide quality HAPI reduction initiative.

RESULTS

Of 23,532 unique patients, 108 (0.46%, 95% confidence interval [CI] = 0.38%-0.55%) experienced a HAPI. Every 1-point increase in the Braden QD score was associated with a 41% increase in the patient's odds of developing a HAPI (odds ratio [OR] = 1.41, 95% CI = 1.36-1.46, p < 0.001). HAPI incidence declined significantly following implementation of a HAPI-reduction initiative (β = -0.09, 95% CI = -0.11 - -0.07, p < 0.001), as did Braden QD positive predictive value (β = -0.29, 95% CI = -0.44 - -0.14, p < 0.001) and specificity (β = -0.28, 95% CI = -0.43 - -0.14, p < 0.001), while sensitivity (β = 0.93, 95% CI = 0.30-1.75, p = 0.01) and the concordance statistic (β = 0.18, 95% CI = 0.15-0.21, p < 0.001) increased significantly.

CONCLUSION

Decreases in HAPI incidence following a quality improvement initiative were associated with (1) significant deterioration in threshold-dependent performance measures such as specificity and precision and (2) significant improvements in threshold-independent performance measures such as the concordance statistic. The performance of the Braden QD Scale is more stable as a tool that continuously measures risk than as a prediction tool.

Neonatal Intensive Care Nursing Pressure Injury Prevention Practices: A Descriptive Survey

PURPOSE

The purpose of this study was to explore neonatal nursing practices for neonatal pressure injury (PI) risk assessment, pressure redistribution surface use, and moisture management.

DESIGN

A descriptive survey.

SUBJECT/SETTINGS

A sample of 252 neonatal nurses mainly from the United States responded to a survey distributed electronically through the National Association of Neonatal Nurses, the Academy of Neonatal Nurses, and on the Wound Source Web site.

METHODS

Nurses responded to questions that explored what neonatal nurses used to assess PI risk, types of pressure redistribution surfaces used for neonates, and what moisture management strategies were used to prevent PIs. Descriptive statistics were used to describe nurses' practices.

RESULTS

When assessing risk, 78% (n = 197/252) reported using a risk assessment scale: the 2 most common scales were the Neonatal Skin Risk Assessment Scale and the Braden Q Scale. Sixty-nine percent (n = 174/252) reported using a rolled blanket or small soft object as pressure redistribution surfaces. In addition, 15% (n = 39) reported the use of different types of positioners such as a fluidized positioner as pressure redistribution surfaces; however, these are marketed as a positioning devices. It appears that these interventions were considered redistribution surfaces by the nurses. For moisture management, petrolatum-based products (6.7%; n = 17/252) and ostomy powders (6%; n = 16/252) were most frequently used.

CONCLUSIONS

Practices for PI prevention are different for neonatal patients due to their gestational age, size, and level of illness. Findings from this study create a beginning knowledge of and an opportunity for further research to determine how these practices affect outcomes such as PI incidence and prevalence.