Incidence of and Risk Factors for Self-load-related and Medical Device-related Pressure Injuries in Critically Ill Patients: A Prospective Observational Cohort Study

Everyday Prevention: The Impact of Daily Comprehensive Skin Assessments on Pressure Injury Healing in the General ICU

OBJECTIVE

To investigate the effect of daily versus weekly comprehensive skin assessments on wound healing status in patients with pressure injuries (PIs) treated in the general ICU.

METHODS

This quasi-experimental study was conducted at a foundation hospital from November 15, 2022, to March 15, 2023. The sample consisted of 193 patients with PIs who met the inclusion criteria. The Braden Scale, Nutritional Risk Scale 2002 (NRS-2002), and Pressure Ulcer Scale for Healing (PUSH) were used. The intervention group (n = 98) underwent comprehensive skin assessment every day, whereas the control group (n = 95) followed routine procedures. The study findings were reported according to TREND (Transparent Reporting of Evaluations with Non-randomized Designs) guidelines.

RESULTS

Patients were older adults, with a mean age of 70 ± 15.45 years in the intervention group and 71 ± 13.20 years in the control group. The mean NRS-2002 score was 3 ± 2.01 in the intervention group and 2 ± 1.38 in the control group. Medical device-related PI incidence was high in both groups (intervention: 36.8%, control: 24.5%). In the intervention (14.3%) and control (50%) groups, PIs developed mostly due to antiembolic stockings. Deep-tissue PIs were the most common (intervention: 56.8%, control: 62.2%). The last PUSH scores decreased in both groups. The difference between the PUSH scores of the intervention and control groups was statistically significant (P < .05).

CONCLUSIONS

The findings of this study demonstrate the critical role of daily comprehensive skin assessment in the healing process of PIs. Especially in ICUs, the study provides compelling evidence for the need to prioritize and implement regular skin assessments to prevent PIs and support the healing process.

Retrospective investigation of pressure injury in COVID-19 patients followed on invasive mechanical ventilator support

AIM

In this study, we aimed to investigate pressure injury (PI) and its associated factors in COVID-19 patients receiving invasive mechanical ventilation (IMV).

METHODS

This was designed as a retrospective, descriptive and correlational study. In this study, there was no sample selection, and the data were collected by reviewing the files of 438 patients who had been followed up on IMV in the intensive care unit (ICU) with a diagnosis of COVID-19 between April 30, 2020, and April 30, 2022. The collected data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS) program.

RESULTS

A total of 305 pressure injuries occurred in 36.3% of 438 patients receiving IMV. It was found that the length of IMV stay of the patients accelerated the occurrence of PI and that the length of stay in the intensive care unit, albumin and hemoglobin levels, Braden Pressure Sore Risk Assessment Score, APACHE-II value, nutritional status, glutamine supplementation, and vasopressor use were found to be significantly correlated with the incidence of PI (p < 0.05).

CONCLUSIONS

Patients with COVID-19 who were followed up on IMV had a high incidence of PI, and prolonged ICU stays and intubations duration as well as low albumin and hemoglobin levels increased the occurrence of PI. Hence, it is recommended that the PI risk levels of COVID-19 patients followed up on IMV should be evaluated frequently and nursing interventions should be implemented according to the evaluations.

Wound drainage measurements: a narrative review

Drainage from chronic wounds can significantly negatively impact a patient's quality of life. Change in severity of wound drainage is an important measure of treatment efficacy for wounds. This study reviews existing tools used to assess wound drainage. Qualitative drainage tools are overall less burdensome, and however, differences in user interpretation may reduce inter-rater reliability. Quantitative drainage tools enable more reliable comparisons of drainage severity and treatment response between patients but sometimes require equipment to administer, increasing responder burden. Gaps in the current wound drainage measurement landscape are highlighted. Many of the existing scales have not been validated in robust studies. There is also a lack of validated global drainage measurement tools for patients with chronic inflammatory skin disorders with drainage, such as hidradenitis suppurativa or pyoderma gangrenosum. Development of a succinct drainage measurement tool for inflammatory skin diseases where drainage is a prominent symptom will improve monitoring of meaningful treatment response.

Incidence, prevalence and risk factors of device-related pressure injuries in adult intensive care unit: A meta-analysis of 10,084 patients from 11 countries

Device-related pressure injuries (DRPIs) prevail in the intensive care unit (ICU) and have much to do with medical devices and patients' conditions. This meta-analysis aims to systematically assess the incidence, prevalence and risk factors related to DRPIs among adults in ICU. Web of Science, Cochrane Library, MEDLINE, PubMed and CINAHL were searched from inception to March 2023. Observational studies were included, and the Newcastle-Ottawa scale (NOS) was used to assess literature quality. The primary outcomes were the incidence, prevalence and risk factors regarding DRPIs among adults in ICU. The 19 studies conformed to the criteria for inclusion in the review. The estimated pooled incidence of DRPIs was 14.7% (95% CI: 9.7%-19.6%) in 10 studies (4866 participants). The estimated pooled prevalence of DRPIs was 19.0% (95% CI: 13.6%-24.3%) in 9 studies (5218 participants). The most significant risk factor for DRPIs was using mechanical ventilation. The pooled analysis of the four studies showed that DRPIs were more likely to occur in patients who required mechanical ventilation compared with patients who did not use mechanical ventilation (OR: 9.67, 95% CI: 5.03-18.61, p < 0.001) and using vasopressors, age, length of ICU stays, APACHE II score, Braden score, fever, sex, oedema, diabetes and number of medical devices, SOFA score was also related to pressure injuries risk. The incidence and prevalence of DRPIs in adult ICU were high, and the most significant risk factor for DRPIs was using mechanical ventilation. It is imminent to identify patients of increased risk with DRPIs early.

Developing the Baptist Health Injury Risk Assessment Phase 1: Exploring Risk Factors

OBJECTIVES

The aim of this study was to explore risk factors for developing hospital-acquired pressure injuries (HAPIs) among critically ill adult inpatients.

BACKGROUND

Hospital-acquired pressure injuries remain a priority quality focus for Magnet ® organizations. Recent studies cite medical devices as a primary cause, yet published risk assessments lack inclusion of those threats.

METHODS

Nurses at a 434-bed, 4-time Magnet ® -designated hospital led a retrospective study acros 9 American Nurses Credentialing Center-designated facilities. Using a chart review tool, data were collected within 48 hours of a confirmed HAPI.

RESULTS

Of 207 HAPIs reported, 54% (n = 113) involved deep tissue pressure injuries and 50.2% (n = 104) involved 19 medical devices. Individuals with a HAPI also used 1 or more of 7 distinct types of mobility-limiting medical equipment.

CONCLUSIONS

Study findings support the development of a critical care risk assessment with inclusion of a medical device and mobility-limiting medical equipment as risk factors. A secondary study is underway for specificity and sensitivity testing of this assessment.

Prediction of internal changes in the sacral region on immobility using bio-mechanical and bio-thermal modelling

Pressure injury usually develop in the bony prominence of immobile bedridden subjects. Predicting pressure injuries based on the subjects’ physiological information will reduce the burden of the caretakers in adjusting the frequency of repositioning such subjects. Visual assessment, diagnostic, and prognostic approaches only provide pressure injury information after onset. Therefore, the objective of this unique modeling technique is to predict the internal alterations that take place in human tissues before the onset of pressure injuries. In this approach the bio-mechanical and bio-thermal properties was integrated to predict the internal changes of skin, fat, and muscle layers when subjects were self-loaded continuously for one hour in the sacrum region. A change in temperature of all the layers, as well as the distribution of Von-Mises stress in these layers, was observed. The inflammation caused by the changes in the temperature and the stress was measured from the simulation model. Ultrasound measurements was also taken for the same subjects in the supine position in the sacral region, before and after one hour by applying a self-load. An identical change in the thickness of the above-mentioned layers due to thermal expansion was noticed. Hence this computational model is hypothesized to give identical thermal expansion in comparison with the ultrasound measurements. There was an agreement between the thermal expansion using the simulation technique and the ultrasound technique which was assessed through Bland-Altman analysis, with a 96% confidence interval.