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Wilson H, Avsar P, McEvoy N, Byrne S, Brunetti G, Patton D, Moore Z. Integrating technologies to enhance risk assessment for the early detection and prevention of pressure ulcers. J Wound Care 2024; 33:644-651. [PMID: 39287040 DOI: 10.12968/jowc.2024.0126] [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: 09/19/2024]
Abstract
Pressure ulcers (PU) are a globally recognised healthcare concern, with their largely preventable development prompting the implementation of targeted preventive strategies. Risk assessment is the first step to planning individualised preventive measures. However, despite the long use of risk assessment, and the >70 risk assessment tools currently available, PUs remain a significant concern. Various technological advancements, including artificial intelligence, subepidermal moisture measurement, cytokine measurement, thermography and ultrasound are emerging as promising tools for PU detection, and subsequent prevention of more serious PU damage. Given the rise in availability of these technologies, this advances the question of whether our current approaches to PU prevention can be enhanced with the use of technology. This article delves into these technologies, suggesting that they could lead healthcare in the right direction, toward optimal assessment and adoption of focused prevention strategies.
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Affiliation(s)
- Hannah Wilson
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Healthcare Sciences, University of Wales, Cardiff, UK
| | - Natalie McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Sorcha Byrne
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Giulio Brunetti
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- School of Healthcare Sciences, University of Wales, Cardiff, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Department of Nursing, Lida Institute, Shanghai, China
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia
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Eberhardt TD, Lima SBD, Pozzebon BR, Santos KPD, Silveira LBD, Soares RSDÁ, Alves PJ. Heel skin microclimate control: Secondary analysis of a self-controlled randomized clinical trial. J Tissue Viability 2024; 33:305-311. [PMID: 38553355 DOI: 10.1016/j.jtv.2024.03.006] [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: 06/29/2023] [Revised: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 07/15/2024]
Abstract
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.
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Hara K, Uemura T, Tachibana R, Kumashiro R, Yamaguchi M, Kawahara I, Fujioka M. Prevention of Postoperative Skin Disorders and Pressure Injuries in the Neurosurgical Park Bench Position Surgery: A Prospective Cohort Study. Cureus 2024; 16:e58552. [PMID: 38765353 PMCID: PMC11102086 DOI: 10.7759/cureus.58552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
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.
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Affiliation(s)
- Kentaro Hara
- Operation Center Division, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
- Healthcare Management Research Center, Chiba University Hospital, Chiba, JPN
| | - Takahiro Uemura
- Operation Center Division, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Reika Tachibana
- Operation Center Division, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Ryosuke Kumashiro
- Operation Center Division, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Michiko Yamaguchi
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Ichiro Kawahara
- Department of Neurosurgery, Japan Community Health Care Organization Isahaya General Hospital, Nagasaki, JPN
| | - Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
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Bridges E, Whitney JD, Burr R, Tolentino E. Pressure Injury Mitigation in Prolonged Care: A Randomized Noninferiority and Superiority Trial. Mil Med 2024; 189:e205-e212. [PMID: 37185660 DOI: 10.1093/milmed/usad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Combat casualties are at increased risk for pressure injuries (PIs) during prolonged casualty care. There is limited research on operational PI risk mitigation strategies. The purpose of this study was to (1) compare a prototype mattress (AirSupport) designed for operational conditions versus the foldable Talon litter and Warrior Evacuation Litter Pad (WELP) on PI risk factors and (2) determine whether the Talon + AirSupport pad was noninferior and superior to the Talon + WELP on skin interface pressure. MATERIALS AND METHODS Healthy adults (N = 85; 20 men and 65 women), aged 18 to 55 years, were stratified based on body fat percentage and randomized into three groups: Talon (n = 15), Talon + AirSupport (n = 35), and Talon + WELP (n = 35). The participants were asked to lie in a supine position for 1 hour. The outcomes included skin interface pressure (body surface areas: Sacrum, buttocks, occiput, and heels), sacral and buttock skin temperature and moisture, and discomfort and pressure. The study was approved by the University of Washington Institutional Review Board. RESULTS Aim 1: The Talon had significantly higher peak skin interface pressure versus the AirSupport and WELP on the sacrum, buttocks, occiput, and heels. Skin temperature increase over the 1-hour loaded period was significantly lower on Talon versus AirSupport or WELP, reflecting a lower temperature-induced ischemic load. There was no significant difference in skin moisture changes or discomfort between the surfaces. Aim 2: The upper confidence limits for the difference in skin interface pressure (all body surface areas) for AirSupport versus WELP were below 25 mm Hg, establishing noninferiority of the AirSupport to the WELP. AirSupport was also superior to WELP for the peak interface pressure on the sacrum, occiput, and heels but not on the buttocks. Skin temperature changes (sacrum or buttocks) were not significantly different between the AirSupport and WELP. CONCLUSIONS The Talon litter presents a PI risk because of increased skin interface pressure, and hence, immediate action is warranted. The decreased PI risk associated with the lower skin interface pressures on the AirSupport and WELP was offset by the higher skin temperature, which may add the equivalent of 20 to 30 mm Hg pressure to the ischemic burden. Thus, any pressure redistribution intervention must be evaluated with a consideration for skin interface pressure, temperature, and moisture. Data from this study were applied to a predictive model for skin damage. Under operational conditions where resources and the environment may limit patient repositioning, it would be expected that casualties would suffer skin damage within 2 to 5 hours, with the occiput as the highest risk area. The severity of predicted skin damage is lowest on the AirSupport, which is consistent with the noninferiority and superiority of the AirSupport mattress compared to the WELP and Talon. Operational utility: The AirSupport and WELP, which were both superior to the Talon, are operationally feasible solutions to mitigate PI risk. The smaller size of the Talon (2.7 kgs compressible) versus the WELP (5 kgs noncompressible) may make them appropriate for different levels of the operational setting.
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Affiliation(s)
- Elizabeth Bridges
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA 98195, USA
| | - JoAnne D Whitney
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA 98195, USA
| | - Robert Burr
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA 98195, USA
| | - Ernie Tolentino
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA 98195, USA
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Yoshimura M, Kohno M, Okamoto Y, Tsuchiya S, Ogawa K, Fukuma A, Kurihara C, Miyama M, Matsumura H. The incidence of intraoperatively acquired pressure injuries in the park-bench position was reduced by applying soft silicone multilayer foam dressings. Int Wound J 2023; 21:e14407. [PMID: 37814469 PMCID: PMC10824620 DOI: 10.1111/iwj.14407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
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.
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Affiliation(s)
- Mine Yoshimura
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Michihiro Kohno
- Department of NeurosurgeryTokyo Medical UniversityTokyoJapan
| | - Yukako Okamoto
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Sakura Tsuchiya
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Kyoko Ogawa
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Akane Fukuma
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Chie Kurihara
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Mari Miyama
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
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Determining the Risk of Intraoperative Pressure Injury in Patients Undergoing Elective Cranial Surgery. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1063029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: Neurosurgical interventions are long and complex, and additional difficulties are encountered in positioning in the operating room.The aim of the study is to determine the risk of pressure injury development in the intraoperative period of patients undergoing elective cranial surgery.
Methods: This descriptive cross-sectional study was conducted with 127 patients who met the inclusion criteria and underwent elective cranial surgery in a city hospital between September and October 2021. 3S Operating Room Pressure Injury Risk Diagnostic Scale were used to collect data.
Results: It was determined that 55.1% of the patients were female, their mean age was 53.22±13.47 years, and 61.4% had at least one chronic disease. It was determined that 71.7% of the patients were operated with the diagnosis of cerebellar tumor. Stage 1 pressure ulcers were observed in 37% of the patients. It was determined that the total score obtained from the scale was 14.87±2.83 and the patients were at low risk for pressure injury. Age, body mass index and duration of the surgical procedure were found to be independent factors affecting the patients' operating room pressure ulcer risk assessment scale score.
Conclusion:It was determined that the risk of pressure injury in patients who underwent cranial surgery was low level.
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Abstract
OBJECTIVE To determine whether changes in skin temperature can affect the integrity of skin. METHODOLOGY The authors conducted a systematic literature search as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. They searched the CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, MEDLINE Complete, Academic Search Ultimate, and HyDi databases for articles examining the effects of skin temperature on skin integrity published through April 2020. Two independent reviewers scored the methodologic quality of the 13 included studies. RESULTS Only 11 studies were included in the qualitative analysis, as the other two articles had a critical risk of bias. There is strong evidence to indicate that an increase in skin temperature leads to changes in skin structure and function. However, ulcer formation was more affected by intrinsic and extrinsic factors, rather than by temperature alone. CONCLUSION Further high-quality randomized controlled trials are required to investigate the direct effect of skin temperature on ulceration.
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Relationship between skin temperature and medical device-related pressure injury in intensive care unit. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.07.003] [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]
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De Cassai A, Geraldini F, Zarantonello F, Sella N, Negro S, Andreatta G, Salvagno M, Boscolo A, Navalesi P, Munari M. A practical guide to patient position and complication management in neurosurgery: a systematic qualitative review. Br J Neurosurg 2021; 36:583-593. [PMID: 34726549 DOI: 10.1080/02688697.2021.1995593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Adequate patient positioning is of paramount importance in neurosurgery. Complications related to the position are common and make up for more than 16% of the claims towards anaesthesiologists and neurosurgeons. This paper aims to provide the anaesthesiologist with a practical guide to avoid common pitfalls related to the patient positioning process. METHOD We performed a systematic review of the medical literature for the identification, screening, and inclusion of articles. The bibliographic search was conducted on June 1st, 2021 by two of the authors. In this review, we included articles indexed by MEDLINE, Cochrane Library, or Google Scholar. RESULTS We retrieved a total of 5706 unique papers from our initial search. However, after the initial screening, 5363 papers were removed is not related to our research leaving a total of 343 papers. We examined the full text of all the 343 articles including 68 of them in the final qualitative analysis. DISCUSSION In this review we examine the most common neurosurgical positions: supine, sitting, lateral, park-bench, prone, jack-knife, and knee-chest. For each of them, the proper positioning and related complications are described. Particular attention is given to the prevention and management of these complications, providing a practical guide for clinicians.
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Affiliation(s)
- Alessandro De Cassai
- Anesthesia and Intensive Care Unit, University-Hospital of Padova, Padova, Italy
| | - Federico Geraldini
- Anesthesia and Intensive Care Unit, University-Hospital of Padova, Padova, Italy
| | | | - Nicolò Sella
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Sebastiano Negro
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Giulio Andreatta
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Michele Salvagno
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Annalisa Boscolo
- Anesthesia and Intensive Care Unit, University-Hospital of Padova, Padova, Italy
| | - Paolo Navalesi
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Marina Munari
- Anesthesia and Intensive Care Unit, University-Hospital of Padova, Padova, Italy
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Marotta DA, Brazdzionis J, Fiani B, Duong J, Noel J, Siddiqi J. Perioperative Positioning in Neurosurgery: A Technical Note on Park Bench Positioning for the Obese Patient Using the "Arrowhead" Technique. Cureus 2021; 13:e16932. [PMID: 34513502 PMCID: PMC8412889 DOI: 10.7759/cureus.16932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
Complex neurosurgical procedures, such as those traversing the posterior fossa, require optimization of the operative corridor with advanced patient positioning methods. Even seemingly small changes in the location of intracranial mass lesions can require a more dramatic operative trajectory. Modifications of traditional lateral, semi-sitting, and park-bench approaches have been described in the literature to access these lesions; however, technical considerations with respect to enlarged body habitus have yet to be fully explored. Herein, we describe a technique for positioning obese patients in the park bench position, which is referred to as the “Arrowhead technique,” along with a literature review of positional complications and considerations in the setting of obesity.
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Affiliation(s)
- Dario A Marotta
- Research, Alabama College of Osteopathic Medicine, Dothan, USA.,Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, USA
| | - James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Jason Duong
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.,Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - Jerry Noel
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - Javed Siddiqi
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
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Supervised machine learning-based prediction for in-hospital pressure injury development using electronic health records: A retrospective observational cohort study in a university hospital in Japan. Int J Nurs Stud 2021; 119:103932. [PMID: 33975074 DOI: 10.1016/j.ijnurstu.2021.103932] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In hospitals, nurses are responsible for pressure injury risk assessment using several kinds of risk assessment scales. However, their predictive validity is insufficient to initiate targeted preventive strategy for each patient. The use of electronic health records with machine learning technique is a promising strategy to provide automated clinical decision-making aid. OBJECTIVE The purpose of this study was to construct a predictive model for pressure injury development which included feature variables that can be collected on the first day of hospitalization by nurses who routinely input the data to electronic health records. DESIGN Retrospective observational cohort study. SETTING This study was conducted at a university hospital in Japan. PARTICIPANTS This study used electronic health records, which include entry/discharge records, basic nursing records, and pressure injury management documents (N = 75,353). METHODS The outcome measure was the pressure injuries which developed outside of an operation theatre and frequently appeared on the specific body parts at high risk of pressure injury development. We utilized four major classifiers: logistic regression, random forest, linear support vector machine, and extreme gradient boosting (XGBoost) with 5-fold cross-validation technique. The area under the receiver operating characteristic curve (AUC) was used for evaluating predictive performance. RESULTS The proportion of hospital-acquired pressure injuries was 0.52%. The receiver operating characteristic curves revealed the best predictive performance for the XGBoost model, achieving the highest sensitivity of 0.78±0.03 and AUC of 0.80±0.02 amongst four types of classifiers. Variables related to difficulty in activities of daily living, anorexia, and respiratory or cardiac disorders were extracted as important features. CONCLUSIONS Our findings suggest that routinely collected health data by nurses on the first day of patient admission have the potential to help determine high-risk patients for pressure injury development. Tweetable abstract: Machine learning models on routinely collected electronic health records data successfully predict pressure injury development during hospitalization. FUNDING This work was supported by a JSPS KAKENHI Grant-in-Aid for Exploratory Research (16K15865).
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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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Neo TG, Koo SH, Chew STH, Png GK, Lacuesta MJ, Wu MYL, Tay RYC, Singh PA, Chandran R. A randomized controlled trial to compare the interface pressures of alternating pressure overlay with gel pad versus gel pad alone during prolonged surgery. J Tissue Viability 2021; 30:222-230. [PMID: 33612359 DOI: 10.1016/j.jtv.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Prolonged surgery is a known risk of pressure ulcer formation. Pressure ulcers affect the quality of life, are a significant cause of morbidity and mortality, and pose a burden on the healthcare system. This study aimed to compare the effectiveness of an alternating pressure (AP) overlay with Gel pad against the Gel pad in reducing interface pressure (IP) during prolonged surgery. METHODS A total of 180 participants from a tertiary hospital were randomized to AP overlay with Gel pad group (n = 90) and Gel pad group (n = 90). Patients were placed supine on the pressure redistributing surfaces, and IP data under the sacrum and ischial tuberosities were collected at an interval of 30 min from 0 min up to a maximum of 570 min. RESULTS Based on data from 133 participants, the average IPs during all the deflation cycles of the AP overlay (with Gel pad) were significantly lower than the average continuous IP recorded for Gel pad throughout the measuring period (p < 0.001). Only three patients (2.26% of study participants) - Gel pad group (n = 2; 2.99%) and AP overlay with Gel pad group (n = 1; 1.52%) developed post-operative pressure ulcer (p = 0.5687). CONCLUSIONS The lower IP during deflation cycles of the AP overlay (with Gel pad) suggests its potential effectiveness in preventing pressure ulcer formation in patients undergoing prolonged surgery. The prevention and reduction of pressure ulcers will have a considerable impact on the improved quality of life and cost savings for the patient. The study findings may facilitate the formulation of policies for preventing pressure ulcer development in the perioperative setting.
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Affiliation(s)
- Tze Guan Neo
- Department of Nursing, Changi General Hospital, Singapore
| | - Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | | | - Gek Kheng Png
- Department of Nursing, Changi General Hospital, Singapore
| | | | | | | | - Prit Anand Singh
- Department of Anaesthesia and Surgical Intensive Care Changi General Hospital, Singapore
| | - Rajkumar Chandran
- Department of Anaesthesia and Surgical Intensive Care Changi General Hospital, Singapore.
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Cai F, Jiang X, Hou X, Wang D, Wang Y, Deng H, Guo H, Wang H, Li X. Application of infrared thermography in the early warning of pressure injury: A prospective observational study. J Clin Nurs 2021; 30:559-571. [PMID: 33258199 DOI: 10.1111/jocn.15576] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES To verify the ability of infrared thermography in objectively identifying pressure injury and its application value in the early warning of pressure injury. BACKGROUND There is subjectivity in assessing the risk of pressure injury as well as diagnosis in clinical settings, which makes early detection and prevention difficult. DESIGN Prospective, cohort study. METHOD Four hundred and fifteen patients admitted to the adult intensive care units were enrolled by a convenience sampling method, and they received a follow-up monitoring for 10 days. The risk of pressure injury was assessed via Braden scale, and thermal images of sacral area were obtained by infrared thermal imager once a day. The predictive effects of infrared thermography and Braden scale on pressure injury were compared by the receiver operating characteristic curve from which the optimal cut-off value of skin temperature for predicting pressure injury was determined. The effect of skin temperature on pressure injury was described and compared, using Kaplan-Meier curve and Cox proportional hazard regression model, respectively. We followed STROBE checklist for reporting the study. RESULTS The relative temperature of sacral area was negatively correlated with the risk of pressure injury. The efficiency of infrared thermography for diagnosing pressure injury was better than that of Braden scale. Based on the relative temperature optimal cut-off value (-0.1°C), Kaplan-Meier curve and Cox proportional hazard regression model analysis showed the incidence of pressure injury with relative temperature below -0.1°C was higher than the group with relative temperature above -0.1°C. CONCLUSIONS Infrared thermography can objectively and accurately identify local hypothermia warnings of pressure injury before visual recognition. The application of infrared thermography into routine pressure injury risk assessment provides a timely and reliable method for nursing practitioners. RELEVANCE TO CLINICAL PRACTICE Infrared thermography has great value of clinical application in daily pressure injury assessment. It is of great significance to make a faster and more objective clinical judgement for patients at risk of pressure injury.
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Affiliation(s)
- Fuman Cai
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China.,School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xiaoqiong Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xiangqing Hou
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yu Wang
- Medical Engineering Office, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haisong Deng
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hailei Guo
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haishuang Wang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
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Geng J, Zhao Y, Wang Z, Wang M, Wei Z. Dressing interventions to heal pressure ulcers: A protocol for an overview of systematic reviews and meta-analysis. Medicine (Baltimore) 2020; 99:e22699. [PMID: 33031342 PMCID: PMC7544375 DOI: 10.1097/md.0000000000022699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pressure ulcer (PU) is defined as a lesion or trauma to the skin and underlying tissue resulting from unrelieved pressure, shear, friction, moisture, or a combination of all these, usually appearing over a bony prominence. We aim to evaluate the credibility of systematic reviews and meta-analyses that assess the effectiveness, safety, and economy of the dressing treatments for PU through an overview. METHODS We searched the following electronic bibliographic databases: PubMed, Embase, Cochrane Library, CINAHL Complete, PsycARTICLES, PsycINFO, DynaMed Plus, as well as the Chinese databases without any language restriction. We will include meta-analyses that dressings treatments in the management of PUs. For each meta-analysis, we will estimate the effect size of a treatment through the random-effect model and the fixed-effect model, and we will evaluate between-study heterogeneity (Cochrane's Q and I statistics) and small-study effect (Egger's test); we will also estimate the evidence of excess significance bias. Methodological quality of each meta-analysis will be evaluated by using Assessment of Multiple Systematic Reviews 2. RESULTS This study is ongoing and the results will be submitted to a peer-reviewed journal for publication. ETHICS AND DISSEMINATION Ethical approval is not applicable, since this is an overview based on published articles. PROTOCOL REGISTRATION NUMBER The protocol has been registered on PROSPERO under the number CRD42020161232.
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16
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Gefen A, Creehan S, Black J. Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review. Int Wound J 2020; 17:1405-1423. [PMID: 32496025 DOI: 10.1111/iwj.13408] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/30/2022] Open
Abstract
An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning-related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Sue Creehan
- Wound/Ostomy Program Team, VCU Health System, Richmond, Virginia, USA
| | - Joyce Black
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
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17
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The cutaneous microbiome in hospitalized patients with pressure ulcers. Sci Rep 2020; 10:5963. [PMID: 32249804 PMCID: PMC7136253 DOI: 10.1038/s41598-020-62918-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/05/2020] [Indexed: 11/23/2022] Open
Abstract
This study investigated whether there are differences in the composition of the cutaneous microbiome of the unaffected skin between patients with pressure ulcers compared with those without pressure ulcers. The cutaneous microbiome of the unaffected skin of 15 patients with sacral pressure ulcers compared to 15 patients without pressure ulcers was analysed. It demonstrated that the inter-individual variation in skin microbiota of patients with pressure ulcers was significantly higher (P = 0.01). The abundance of 23 species was significantly different with Staphylococcus aureus and unclassified Enterococcus the most abundant species in patients with pressure ulcers. Random Forest models showed that eight species were associated with pressure ulcers occurrence in 81% of the patients. A subset of four species gave the strongest interaction. The presence of unclassified Enterococcus had the highest association with pressure ulcer occurrence. This study is the first to demonstrate that the cutaneous microbiome is altered in patients with pressure ulcers.
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18
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A quantitative study of hydration level of the skin surface and erythema on conventional and microclimate management capable mattresses and hospital beds. J Tissue Viability 2020; 29:2-6. [DOI: 10.1016/j.jtv.2019.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/23/2019] [Accepted: 12/08/2019] [Indexed: 11/22/2022]
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19
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Schwartz D, Gefen A. An integrated experimental-computational study of the microclimate under dressings applied to intact weight-bearing skin. Int Wound J 2020; 17:562-577. [PMID: 31991530 DOI: 10.1111/iwj.13309] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/21/2019] [Accepted: 01/10/2020] [Indexed: 12/15/2022] Open
Abstract
Pressure ulcers (PUs) are one of the most prevalent adverse events in acute and chronic care. The root aetiological cause of PUs is sustained cell and tissue deformations, which triggers a synergistic tissue damage cascade that accelerates over relatively short time periods. Changes in skin microclimate conditions are known to indirectly contribute to PU-risk levels or to exacerbation of existing wounds. It is therefore surprising that information concerning heat accumulation under dressings is poor. Here, we aimed to investigate the effects of dressings on the microclimate of weight-bearing buttocks skin in 1-hour supine lying sessions. Using a novel and originally developed experimental-computational approach, we compared the combined influence of the mechanical and thermal properties of a polymeric membrane dressing (PolyMem, Ferris Mfg. Corp., Fort Worth, TX) on skin microclimate under and near the dressings with those of a standard placebo foam dressing. We specifically identified the thermal conductivity properties of dressings as being highly important in the context of protective dressing performances, given its association with potential heat accumulation under dressings. Accordingly, this article highlights, for the first time in the literature, the relevance of thermal properties of a dressing in effectively mitigating the risk of developing PUs or aggravating an injury, and offers a systematic, methodological bioengineering process for assessing the thermal performances of dressings.
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Affiliation(s)
- Dafna Schwartz
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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20
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Soares RSA, Lima SBS, Eberhardt TD, Rodrigues LR, Martins RS, Silveira LBTD, Alves PJP. Skin temperature as a clinical parameter for nursing care: a descriptive correlational study. J Wound Care 2019; 28:835-841. [DOI: 10.12968/jowc.2019.28.12.835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To identify the skin temperature in different body areas of hospitalised individuals in the surgical unit, without risk of developing a pressure ulcer (PU). Methods: A descriptive, correlational and cross-sectional study, carried out May–October 2017, in a surgical unit of a university hospital in southern Brazil. Temperature was measured at the bony prominences including scapula, elbow, trochanters and heels, on both sides of the body, as well as occipital and sacral regions. Results: A total of 230 patients took part in the study. All regions of the body measured presented differences in temperatures. The sacral region presented the highest mean temperature (34.2±0.1°C). Patients (aged 18–59 years) had higher skin temperatures in the sacral region than older patients (aged 60–88 years). There was a symmetry in temperatures on both sides of the body. There was a low degree of correlation between age, room temperature, room humidity and skin temperature in some body regions. Conclusion: The study established mean values for skin temperature in specific body regions in patients without risk of developing a PU, hospitalised in a surgical unit. It also demonstrates how skin temperature can be used as a clinical parameter in practice to support the prevention of PUs.
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Affiliation(s)
- Rhea SA Soares
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Suzinara BS Lima
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Thaís D Eberhardt
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Liane R Rodrigues
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Robson S Martins
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | | | - Paulo JP Alves
- Universidade Católica Portuguesa, Porto, Porto, Portugal
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21
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A quantitative study of transepidermal water loss (TEWL) on conventional and microclimate management capable mattresses and hospital beds. J Tissue Viability 2019; 28:194-199. [DOI: 10.1016/j.jtv.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022]
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22
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Kitamura A, Yoshimura M, Nakagami G, Yabunaka K, Sanada H. Changes of tissue images visualised by ultrasonography in the process of pressure ulcer occurrence. J Wound Care 2019; 28:S18-S22. [DOI: 10.12968/jowc.2019.28.sup4.s18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mine Yoshimura
- Department of Nursing, Tokyo Medical University Hospital, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yabunaka
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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23
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Microclimate: A critical review in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2018; 59:62-70. [PMID: 30199821 DOI: 10.1016/j.clinbiomech.2018.09.010] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
Pressure ulcers are caused by sustained mechanical loading and deformation of the skin and subcutaneous layers between internal stiff anatomical structures and external surfaces or devices. In addition, the skin microclimate (temperature, humidity and airflow next to the skin surface) is an indirect pressure ulcer risk factor. Temperature and humidity affect the structure and function of the skin increasing or lowering possible damage thresholds for the skin and underlying soft tissues. From a pressure ulcer prevention research perspective, the effects of humidity and temperature next to the skin surface are inextricably linked to concurrent soft tissue deformation. Direct clinical evidence supporting the association between microclimate and pressure ulceration is sparse and of high risk of bias. Currently, it is recommended to keep the skin dry and cool and/or to allow recovery periods between phases of occlusion. The stratum corneum must be prevented from becoming overhydrated or from drying out but exact ranges of an acceptable microclimate are unknown. Therefore, vague terms like 'microclimate management' should be avoided but product and microclimate characteristics should be explicitly stated to allow an informed decision making. Pressure ulcer prevention interventions like repositioning, the use of special support surfaces, cushions, and prophylactic dressings are effective only if they reduce sustained deformations in soft tissues. This mode of action outweighs possible undesirable microclimate properties. As long as uncertainty exists efforts must be taken to use as less occlusive materials as possible. There seems to be individual intrinsic characteristics making patients more vulnerable to microclimate effects.
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24
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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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25
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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: 51] [Impact Index Per Article: 8.5] [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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Yoshimura M, Ohura N, Tanaka J, Ichimura S, Kasuya Y, Hotta O, Kagaya Y, Sekiyama T, Tannba M, Suzuki N. Soft silicone foam dressing is more effective than polyurethane film dressing for preventing intraoperatively acquired pressure ulcers in spinal surgery patients: the Border Operating room Spinal Surgery (BOSS) trial in Japan. Int Wound J 2016; 15:188-197. [PMID: 27928911 DOI: 10.1111/iwj.12696] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 11/28/2022] Open
Abstract
Preventing intraoperatively acquired pressure ulcers (IAPUs) in patients undergoing spinal surgery in the prone position using a Relton-Hall frame is challenging. We investigated the efficacy of soft silicone foam dressings in preventing IAPUs. A prospective dual-center sham study was conducted among patients undergoing elective spinal surgery in a general hospital and a university hospital in Japan. The incidence of IAPUs that developed when soft silicone foam dressings and polyurethane film dressings were used was compared on two sides in the same patient. IAPUs developed on the chest in 11 of 100 patients (11%). Polyurethane film dressings were associated with a significantly higher rate of IAPUs than soft silicone foam dressings (11 versus 3, P = 0·027). A multivariate logistic regression analysis revealed that a diastolic blood pressure of <50 mmHg (P = 0·025, OR 3·74, 95% confidence interval [CI] 1·18-13·08) and the length of surgery (by 1 hour: P = 0·038, OR 1·61, 95% CI 1·03-2·64) were independently associated with the development of IAPUs. The use of soft silicone foam dressings reduced the risk of IAPUs (P = 0·019, OR 0·23, 95% CI 0·05-0·79) and was more effective than film dressings for preventing IAPUs in spinal surgery patients.
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Affiliation(s)
- Mine Yoshimura
- Department of Nursing, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Norihiko Ohura
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Junko Tanaka
- Department of Epidemiology Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shoichi Ichimura
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yusuke Kasuya
- Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Oruto Hotta
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yu Kagaya
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Takuya Sekiyama
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Mitsuko Tannba
- Department of Nursing, Kyorin University Hospital, Tokyo, Japan
| | - Nao Suzuki
- Department of Nursing, Tokyo Metropolitan Police Hospital, Tokyo, Japan
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