Prevention of pressure injury in the operating room: Heels operating room pressure injury trial

Nursing interventions to prevent pressure injury among open heart surgery patients: A systematic review

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.

Comparison of the predictive validity of the Braden, Munro and 3S scales in surgical patients

AIM OF THE STUDY

This research is a descriptive and cross-sectional study aimed at examining the use of three different scales to assess the risk of pressure injury (PI) in surgical patients.

MATERIALS AND METHODS

This study was conducted between February 1 and July 1, 2022. The study included patients who had planned surgery in general surgery clinic. The sample size was 388 patients. Patients who agreed to participate in the study were asked to fill out the " Introductory Information Form " and perform a risk assessment using the Braden, Munro and 3S Scales. The statistics program IBM SPSS Statistics 25.0 packaged software was used in the analyses of data.

RESULTS

It is evident that the relationship between the scales and the diagnosis of PI, as well as the strength of this relationship, are statistically significant (p < 0.05). The Munro Scale exhibited the highest value of Phi value and validity coefficient c, indicating a stronger association with the diagnosis of PI, thus suggesting its greater effectiveness in discrimination. According to the validity coefficients found, it can be stated that the correct classification percentages for Munro, Braden, and 3S Scales were 91 %, 71 %, and 66 %, respectively.

CONCLUSION

The findings of this study indicate that both the Braden, Munro, and 3S Scales can be used for PI risk assessment in surgical patients, but the Munro Scale exhibits superior predictive validity compared to the Braden and 3S Scales in terms of overall sensitivity and specificity.

Heel skin microclimate control: Secondary analysis of a self-controlled randomized clinical trial

OBJECTIVE

this study was undertaken to evaluate the efficacy of multilayer polyurethane foam with silicone (MPF) compared to transparent polyurethane film (TPF) dressings in the control of heel skin microclimate (temperature and moisture) of hospitalized patients undergoing elective surgeries.

METHOD

the study took of a secondary analysis of a randomized self-controlled trial, involving patients undergoing elective surgical procedure of cardiac and gastrointestinal specialties in a university hospital in southern Brazil, from March 2019 to February 2020. Patients served as their own control, with their heels randomly allocated to either TPF (control) or MPF (intervention). Skin temperature was measured using a digital infrared thermometer; and moisture determined through capacitance, at the beginning and end of surgery. The study was registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5.

RESULTS

significant difference in the microclimate variables were observed when the groups (intervention and control) and the timepoint of measurement (beginning and end of surgery) were compared. When assessing temperature, an increase (+3.3 °C) was observed with TPF and a decrease (-7.4 °C) was recorded with MPF. Regarding skin moisture, an increase in moisture (+14.6 AU) was recorded with TPF and a slight decrease (-0.3 AU) with MPF.

CONCLUSIONS

The findings of this study suggest that MPF is more effective than TPF in controlling skin microclimate (temperature and moisture) in heels skin of hospitalized patients undergoing elective surgeries. However, this control should be better investigated in other studies.

Impact of shear stress on sacral pressure injury from table rotation during laparoscopic colorectal surgery performed in the lithotomy position

This study aimed to evaluate the impact of shear stress on surgery-related sacral pressure injury (PI) after laparoscopic colorectal surgery performed in the lithotomy position. We included 37 patients who underwent this procedure between November 2021 and October 2022. The primary outcome was average horizontal shear stress caused by the rotation of the operating table during the operation, and the secondary outcome was interface pressure over time. Sensors were used to measure shear stress and interface pressure in the sacral region. Patients were divided into two groups according to the presence or absence of PI. PI had an incidence of 32.4%, and the primary outcome, average horizontal shear stress, was significantly higher in the PI group than in the no-PI group. The interface pressure increased over time in both groups. At 120 min, the interface pressure was two times higher in the PI group than in the no-PI group (PI group, 221.5 mmHg; no-PI group, 86.0 mmHg; p < 0.01). This study suggested that shear stress resulting from rotation of the operating table in the sacral region by laparoscopic colorectal surgery performed in the lithotomy position is the cause of PI. These results should contribute to the prevention of PI.

Prevention of Postoperative Skin Disorders and Pressure Injuries in the Neurosurgical Park Bench Position Surgery: A Prospective Cohort Study

Background In neurosurgical procedures where the park bench position is employed, the risk of perioperative pressure injuries is elevated due to the limited contact surface area, with the head and part of the upper torso extending beyond the surgical table. This study aimed to examine the effects of preventative measures against such injuries, proposing a potential standard for postural fixation in these surgeries. Methods Conducted at a medical center, from January 2017 to March 2023, this prospective cohort study involved participants aged 20 and above who underwent neurosurgical procedures in the park bench position under general anesthesia. The focus was on comparing the incidence of pressure injuries between intervention and control groups. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results Out of 65 patients enrolled, 28 were assigned to each of the intervention and control groups. The control group experienced 17 instances of postoperative pressure injuries and skin disorders in areas prone to pressure, such as the axillary and greater trochanter regions. Conversely, the intervention group reported no such incidents, underscoring the efficacy of meticulous surgical positioning and management of bodily pressure, temperature, humidity, and microclimate. Conclusion Implementing preventive measures in neurosurgical park bench procedures significantly reduces the incidence of postoperative pressure injuries and skin disorders. These findings advocate for the adoption of standardized postural fixation protocols in such surgeries, potentially influencing global clinical practices in neurosurgery.

Validity and Reliability Evidence of the Munro Scale for Perioperative Patients, Part I: Correlation, Multiple Regression, and Reliability

Background and Purpose: Patients undergoing surgery are at risk of pressure injury development and should be assessed to ensure measures are taken for prevention. The study's purpose was to examine the causal relationships and reliability of the Munro Pressure Injury Risk Assessment Scale for Perioperative Patients (Munro Scale). The Munro Scale is the first dynamic risk scale available for this patient population in the acute clinical setting. Methods: This study was a retrospective review to explore the relationships of the variables in the Munro Scale, identify the strongest predictors, and measure the reliability of previously collected data from two northeastern community hospitals. A total of 630 risk assessments were analyzed to obtain regression, correlation, and reliability evidence for the Munro Scale. Results: The correlation analysis among the 15 risk variables and combined comorbidities revealed commonalities among the variables and significant relationships to the final postoperative injury score. The model as a whole is significant to predict the final level of risk. Coefficient alpha revealed a lower than anticipated reliability when compared to the Chinese, Turkish, and Brazilian versions of the Munro Scale. Conclusions: There are significant relationships among the variables, and the scale is acceptable for use in the acute perioperative practice setting. This study has both clinical and statistical significance.

Perioperative Pressure Injury Prevention Program in a Military Medical Treatment Facility: A Quality Improvement Project

INTRODUCTION

The incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning.

METHODS

We used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding.

RESULTS

There was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented.

CONCLUSION

This project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.

The incidence of intraoperatively acquired pressure injuries in the park-bench position was reduced by applying soft silicone multilayer foam dressings

The Park-Bench Position (PBP) is associated with a high incidence rate of intraoperatively acquired pressure injuries (IAPIs). Preventive measures must be established to prevent the development of IAPIs. We investigated the risk factors for PBP by applying a soft silicone multilayered foam dressing (SMD) under core temperature management to prevent IAPIs. We conducted a prospective, single-centre, open-label observational study of patients undergoing elective neurosurgery operations using PBP in a university hospital in Japan. The incidence rate of IAPIs in this study was compared with that in our two previous studies, in which a film dressing was applied and core temperature management was not performed. IAPIs developed in 90 patients (6.7%); in the lateral thoracic region in five patients and the iliac crest region in one patient. The operative time (every 1 h: p = 0.0001, OR: odds ratio 3.62, 95% CI: confidence interval 1.73-11.42) was significantly associated with the incidence of IAPIs. In our two previous studies, the incidence rate of IAPIs was 11.0% and 24.1%, respectively, when film dressing was used. SMD may weaken the involvement of risk factors in IAPIs.

Effect of a prophylactic dressing for sacral pressure injuries in non-critically ill patients after general surgery: A randomized controlled trial

BACKGROUND

Hospital-acquired pressure injuries are strongly associated with surgeries performed under general anesthesia.

AIMS

The aim of this study was to evaluate the effects of using a prophylactic multi-layer soft silicone foam dressing in non-critically ill patients with a Braden Scale score of ≤18 after undergoing routine surgery without sacral pressure injuries.

METHODS

This randomized controlled trial included 156 patients who were admitted for surgery under general anesthesia in a tertiary general hospital. The patients were divided into a control group and an intervention group. A 5-layer soft silicone foam dressing was applied to the sacrum of patients in the intervention group immediately after surgery. For the control group, standard pressure injury prevention activities were performed alongside standard care without preventive dressings.

RESULTS

There were no significant differences in general and clinical characteristics between the two groups; however, the incidence of pressure injury and blanching erythema was higher in the control group, showing a significant difference from the experimental group. Factors influencing the development of pressure injuries and blanching erythema through multivariate regression analysis were prophylactic dressing application and Braden Scale score at the time of admission. A statistically significant difference was noted in survival time from pressure injury between both groups.

LINKING EVIDENCE TO ACTION

The incidence of pressure injuries and blanching erythema was lower when the prophylactic dressing was applied with standard protocol for general ward patients after surgery. Accurate evaluation of the patient's skin condition and pressure injury risk assessment before surgery are important. Progressive prophylactic dressings to prevent pressure injuries are effective, and tailored nursing interventions based on accurate assessment of patient's skin condition and risk factors are essential for maintaining skin integrity.

Preventing pressure injury in open-heart surgical patients: A systematic review

Background

Cardiac surgical patients are highly prone to developing surgery-related Pressure injuries (PIs). Prevention of PIs is an important patient safety priority in healthcare settings and patients care. So the aim of this study is to detect the effectiveness of prevention strategies to decrease PIs prevalence and incidence in patients undergoing open heart surgery.

Method

We identified studies through Web of Science, Scopus, PubMed, Cochrane, and ProQuest databases from inception through September 2022 with restrictions on the English language. Cochrane RoB 2, JBI, and NIH checklist were carried out as critical appraisal Tools to investigate the studies risk of bias. Finally, 10 studies with a total sample No. 1348, which fulfilled eligibility criteria were included in final systematic review.

Result

Most common interventions investigated in included studies were addressing impairments skin care which included the use of multilayer silicone foam, Care bundle and multiple intervention programs, alternative head inflatable pads, pressure-reducing foam mattresses, and electric bed frames as the effective PIs Prevention (PIP) strategies. While repositioning is one of the important causes mentioned in most PIP protocols, there was not adequate evidence to recommend any special turning regimens for PIP.

Conclusion

Given current evidence, multilayer silicone foam, Care bundle and multiple intervention programs, alternative inflatable head pads, pressure-reducing foam mattresses, and electric bed frames are effective strategies to prevent pressure ulcers. Further investigations are needed to specify the cost-effectiveness of mentioned strategies and RCTs to determine other PIP strategies such as repositioning and mobilization, nutritional supplementation, creams, and co-interventions effects.

Prevention Effects of Chain Management on Pressure Ulcers of Hospitalized Patients

The study focused on the preventive effects of the chain management model on pressure ulcers in the operating room. Sqoop big data collection module is used to collect patient information from various hospital information systems in a distributed manner. The data were from the clinical data center of the Zhongshan Hospital Xiamen University General Hospital, and 268 patients were selected as the research subjects. A chain management model is constructed, concerning the preventive measures, the management of each link, the perioperative pressure ulcer management, and the reporting of pressure ulcers. Then, the two groups were compared for the SAS and SDS scores before and after nursing, the pressure ulcer sites, pressure ulcer reporting rate, pressure ulcer staging, and nursing satisfaction. The results show that it is not that more collection modules will lead to better cluster performance and that the execution delay is caused by MapReduce requiring the JAVA virtual machine, and after reaching a certain point, the increase in the number of tasks will slow down the process, and as data size increases, DataNote has an expanded capability to analyze data. After nursing treatment, the SAS and SDS scores of the two groups of patients were significantly lower than before treatment (P < 0.05). The pressure ulcers were mainly distributed in the forehead, mandible, cheeks, front chest, and knees in the two groups, and the difference between the two groups was statistically significant (P < 0.05). The total satisfaction of the observation group was 93.28%, and the total satisfaction of the control group was 92.54%. The patients' satisfaction with the chain management model was higher than that of conventional nursing.

Prevention of pressure injury in the operating room: Heels operating room pressure injury trial

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.