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Alves P, Bååth C, Manuel T, Almeida S, Källman U. Pressure ulcers during the COVID-19 pandemic in intensive care:A multicenter cohort study. J Tissue Viability 2024:S0965-206X(24)00082-2. [PMID: 38937249 DOI: 10.1016/j.jtv.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
AIM The objective of the present study is twofold: to describe the prevalence and incidence of pressure ulcers (PUs) among ICU patients during the COVID-19 pandemic, and to identify the risk factors associated with the development of PUs in this cohort of ICU patients. MATERIALS AND METHODS Retrospective cohort study of adult critical care patients admitted in two general ICUs of two different countries (Sweden and Portugal) between March 1st, 2020, and April 30th, 2021, through the analysis of the electronic health record database. The prevalence and incidence were calculated, and a multivariate logistic-regression model was used to calculate odds ratios (ORs), of possible risk factors of PU development. RESULTS The sample consisted of 1717 patients. The overall prevalence of PU was 15.3 %, and the incidence of ICU-acquired PUs was 14.1 %. Most of the pressure ulcers documented in this study were at the anterior part of the body (45.35 %) and regarding classification, Category 2 (38.40 %) and Category 3 (22.71 %) pressure ulcers together accounted for over fifty percent of the cases recorded. In the multivariate logistic regression model for PU, age, having COVID-19 (OR = 1.58, 95 % CI: 1.20-2.09), use of mechanical ventilation (OR = 1.49, 95 % CI: 1.13 = 1.97), use of vasopressors (OR = 1.31, 95 % CI: 1.00-1.70), having a Braden risk score ≤16 at admission (OR = 1.63; 95 % CI: 1.04-2.56), and length of stay (LOS) (OR = 1.43, 95 % CI 1.03-2.00 if LOS 90-260 h, OR = 2.34, 95 % CI: 1.63-3.35 if LOS >260 h) were associated with the likelihood of developing an ICU-acquired PUs. CONCLUSION When adjusted for covariates patients with COVID-19 had a higher risk for PU development during the ICU stay compared to patients without COVID-19. Health care personnel in ICU may consider incorporating COVID-19, age, use of mechanical ventilation, vasopressors and estimated LOS in addition to a comprehensive risk assessment including both a risk score and clinical assessment.
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Affiliation(s)
- Paulo Alves
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal.
| | - Carina Bååth
- Karlstad University, Department of Health Sciences, Karlstad, Sweden; Østfold University College, Faculty of Health, Welfare and Organization, Fredrikstad, Norway
| | - Tânia Manuel
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal
| | - Sofia Almeida
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal
| | - Ulrika Källman
- Research Unit, FoUI Department, Södra Älvsborgs Hospital, Borås, Sweden; University of Gothenburg, Faculty of Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden
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Kilmer LH, Samuel A, Forster GL, Stranix JT, Black JS, Campbell CA, DeGeorge BR. Determinants of pressure injury development in patients with COVID-19. J Wound Care 2024; 33:156-164. [PMID: 38451788 DOI: 10.12968/jowc.2024.33.3.156] [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: 03/09/2024]
Abstract
OBJECTIVE Pressure injuries (PIs) often develop in critically ill patients due to immobility, and underlying comorbidities that decrease tissue perfusion and wound healing capacity. This study sought to provide epidemiological data on determinants and current managements practices of PI in patients with COVID-19. METHOD A US national insurance-based database consisting of patients with coronavirus or COVID-19 diagnoses was used for data collection. Patients were filtered by International Classification of Diseases (ICD) codes corresponding to coronavirus or COVID-19 diagnosis between 2019-2020. Diagnosis of PI following COVID-19 diagnosis was queried. Demographic data and comorbidity information was compared. Logistic regression analysis was used to determine predictors for both PI development and likelihood of operative debridement. RESULTS A total of 1,477,851 patients with COVID-19 were identified. Of these, 15,613 (1.06%) subsequently developed a PI, and 8074 (51.7%) of these patients had an intensive care unit (ICU) admission. The average and median time between diagnosis of COVID-19 and PI was 39.4 and 26 days, respectively. PI was more likely to occur in patients with COVID-19 with: diabetes (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.29-1.49; p<0.001); coronary artery disease (OR: 1.11, 95% CI: 1.04-1.18, p=0.002), hypertension (OR: 1.43, 95% CI: 1.26-1.64; p<0.001); chronic kidney disease (OR: 1.18, 95% CI: 1.10-1.26; p<0.001); depression (OR: 1.45, 95% CI 1.36-1.54; p<0.001); and long-term non-steroidal anti-inflammatory drug use (OR: 1.21, 95% CI: 1.05-1.40; p=0.007). They were also more likely in critically ill patients admitted to the ICU (OR: 1.40, 95% CI: 1.31-1.48; p<0.001); and patients requiring vasopressors (OR:1.25, 95% CI: 1.13-1.38; p<0.001), intubation (OR: 1.21, 95% CI 1.07-1.39; p=0.004), or with a diagnosis of sepsis (OR: 2.38, 95% CI 2.22-2.55; p<0.001). ICU admission, sepsis, buttock and lower back PI along with increasing Charlson Comorbidity Index (CCI) (OR: 1.04, 95% CI 1.00-1.08; p=0.043) was associated with surgical debridement. The vast majority of patients with COVID-19 did not undergo operative debridement or wound coverage. CONCLUSION PIs are widely prevalent in patients with COVID-19, especially in those who are critically ill, yet the vast majority do not undergo operative procedures. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Lee H Kilmer
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
| | - Ankita Samuel
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
| | - Grace L Forster
- University of Virginia School of Medicine, Charlottesville, VA, 22903, US
| | - John T Stranix
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
| | - Jonathan S Black
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
| | | | - Brent R DeGeorge
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
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Sengul T, Erden S, Karadağ A, Yilmaz D, Gokduman T. Overlooked Pain Assessment Records in Patients with Pressure Injuries During the COVID-19 Pandemic: A Retrospective Data Analysis. Adv Skin Wound Care 2024; 37:162-166. [PMID: 38393705 DOI: 10.1097/asw.0000000000000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, healthcare professionals focused on identifying the cause of hemodynamic instability in patients and may have neglected to assess pressure injury (PI)-related pain. Although pain is an early indicator of PI development, there has been no systematic evaluation of PI-related pain in patients. OBJECTIVE To review nurses' records of PI-related pain in patients who developed PIs during the COVID-19 pandemic. METHODS This retrospective, descriptive study included data from 510 patients at one hospital. Collected data included patient demographics (age, sex, diagnosis, and comorbidities), PI classification, and assessment of PI-related pain. Assessment data regarding PI-related pain included the characteristics of the pain, the type of analgesia (pharmacologic/nonpharmacologic) administered before and after PI management (debridement, dressing change, etc), the route of administration, and the frequency of pain assessment before and after analgesia. RESULTS The mean age of the patients (60.4% men) was 28.96 (SD, 5.82) years, and the mean length of hospital stay was 26.15 (SD, 16.1) days. Overall, 43.1% of the patients were treated in the ICU, 68.0% were conscious, and 18.6% tested positive for COVID-19. Deep-tissue injuries occurred in 57.5% of patients, with 48.6% developing stage 2 PI. The sacral region was the most common area for PI development (44.8%). The mean duration of repositioning in patients with PI was 23.03 (SD, 5.4) hours. Only 0.40% of patients (n = 2) were evaluated for pain, and only one patient was assessed for pain before and after analgesia was administered. CONCLUSIONS The findings suggest a lack of comprehensive evaluation and records concerning PI-related pain in patients with COVID-19.
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Affiliation(s)
- Tuba Sengul
- Tuba Sengul, PhD, RN, CWON, is Associate Professor, School of Nursing, Koç University, Istanbul, Turkey. Sevilay Erden, PhD, RN, is Associate Professor, Çukurova University, Adana, Turkey. Ayişe Karadağ, PhD, RN, ET/WOCN, is Dean and Professor, School of Nursing, Koç University. At Koç University Hospital, Dilek Yilmaz, MSc, RN, and Tugba Gokduman, RN, are Wound and Ostomy Care Nurses. Acknowledgments: The authors thank the nurses and institutions who took part in the study. The authors have disclosed no financial relationships related to this article. Submitted February 1, 2023; accepted in revised form April 26, 2023
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Baran Z, Özden D. Retrospective investigation of pressure injury in COVID-19 patients followed on invasive mechanical ventilator support. J Tissue Viability 2024; 33:144-149. [PMID: 38184472 DOI: 10.1016/j.jtv.2023.10.001] [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: 01/16/2023] [Revised: 08/31/2023] [Accepted: 10/08/2023] [Indexed: 01/08/2024]
Abstract
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.
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Affiliation(s)
- Zilan Baran
- Faculty of Nursing, The Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkiye.
| | - Dilek Özden
- Fundamentals of Nursing Department, The Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkiye.
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Choi S, Kim YJ, Oh H, Yuh WT, Lee CH, Yang SH, Kim CH, Chung CK, Park HP. Factors Associated With Perioperative Hospital Acquired Pressure Injury in Patients Undergoing Spine Surgery in the Prone Position: A Prospective Observational Study. J Neurosurg Anesthesiol 2024; 36:45-52. [PMID: 36006663 DOI: 10.1097/ana.0000000000000867] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital acquired pressure injury (HAPI) is associated with poor clinical outcomes and high medical costs. Patients undergoing surgery in the prone position are particularly vulnerable to perioperative HAPI. This prospective observational study investigated the factors associated with HAPI in patients undergoing elective spine surgery in the prone position. METHODS Two hundred eighty-seven patients undergoing elective spine surgery participated in this study. Demographics, perioperative vital signs, laboratory findings, surgical data, and intraoperative data were prospectively recorded. The sites and stages of HAPI were investigated on postoperative day 2. The stages of HAPI were evaluated using the pressure injury staging system of the National Pressure Ulcer Advisory Panel. RESULTS Perioperative HAPI was observed in 71 (24.7%) patients (stage 1, 40; stage 2, 31). The most frequent site (number) of HAPI was the upper extremities (33), followed by the chest (32), lower extremities (20), face (18), pelvis (10), and abdomen (9). In multivariate analysis, the duration of prone positioning per hour (odds ratio [95% confidence interval], 1.48 [1.25-1.74]; P <0.001) and intraoperative pH ≤7.35 (1.98 [1.05-3.76]; P =0.036) were associated with perioperative HAPI. CONCLUSIONS The incidence of perioperative HAPI was 24.7% in patients undergoing elective spine surgery in the prone position. Long duration of prone positioning and intraoperative acidosis were associated with increased development of perioperative HAPI.
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Affiliation(s)
| | | | | | - Woon Tak Yuh
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hyun Lee
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Heon Yang
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Heon Kim
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Padula WV, Crawford SA, Kennerly SM, Yap TL. Estimating the value of repositioning timing to streamline pressure injury prevention efforts in nursing homes: A cost-effectiveness analysis of the 'TEAM-UP' clinical trial. Int Wound J 2023; 21:e14452. [PMID: 37909183 PMCID: PMC10895199 DOI: 10.1111/iwj.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023] Open
Abstract
Pressure injury (PrI) prevention guidelines recommend 2-h repositioning intervals in healthcare settings, requiring significant nursing time investment. We analysed the cost-effectiveness of PrI prevention protocols with 2-, 3- and 4-h repositioning intervals in US nursing homes according to 'Turn Everyone and Move for Ulcer Prevention' (TEAM-UP) randomized controlled trial findings. Markov modelling compared 2-, 3- and 4-h repositioning intervals, controlling for other practice guidelines, to prevent PrIs in nursing home residents from a US health sector perspective over one year using TEAM-UP trial data for model structure, sampling and parameterization. Costs, captured in 2020 US dollars, and quality-adjusted life years (QALYs) were used to derive an incremental cost-effectiveness ratio and net monetary benefit (NMB) at $50 000/QALY-$150 000/QALY cost-effectiveness thresholds. Sensitivity analyses tested model uncertainty. Repositioning intervals between 3 and 4 h were cost-effective based on reduced costs at slightly lower QALYs than 2 h at a $50 000/QALY threshold, and the NMB of 4-h repositioning was also more efficient than at 3 h ($9610). Repositioning labour cost and prevention routines were among the most sensitive parameters. Sensitivity analyses demonstrated that 3- and 4-h intervals were cost-effective in over 65% of simulations at any cost-effectiveness threshold. Repositioning intervals of 3 to 4 h have potential to reduce nursing time costs without significant decrements in clinical benefits to nursing home residents. Clinical guidelines for PrI prevention should be updated to reflect TEAM-UP clinical and economic findings. Facilities can use cost-savings recuperated from nursing time to deploy to other patient safety priorities without seriously jeopardizing PrI safety.
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Affiliation(s)
- William V. Padula
- Department of Pharmaceutical & Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Acute & Chronic Care, School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Samuel A. Crawford
- Department of Pharmaceutical & Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Susan M. Kennerly
- College of NursingEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Tracey L. Yap
- School of NursingDuke UniversityDurhamNorth CarolinaUSA
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McFee K, Murdoch JM, Spitzer M. Implementation of a Pressure Injury Prevention Protocol for Intensive Care Unit Patients Undergoing Prone Positioning. Crit Care Nurse 2023; 43:41-48. [PMID: 37777249 DOI: 10.4037/ccn2023987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
BACKGROUND Pressure injuries remain the most common hospital-acquired condition, according to the Agency for Healthcare Research and Quality. Patients hospitalized with COVID-19 are at especially high risk for pressure injuries, including those related to medical devices, because of their lower tissue tolerance, prolonged intubation, and common treatment with prone positioning. LOCAL PROBLEM The COVID-19 pandemic brought an increased incidence of hospital-acquired pressure injury. A 350-bed hospital in St. Joseph, Missouri, recognized that an intervention to lower the risk of pressure injury for these patients was needed. METHODS A quality improvement project was initiated to reduce the incidence of pressure injuries in patients with COVID-19 in the intensive care unit. A protocol was implemented for patients with COVID-19 undergoing prone positioning that included the use of dressing packets. The incidence of hospital-acquired pressure injury during the 1-year periods before and after implementation of the protocol were determined. RESULTS Before implementation of the new protocol, 18 of 155 intensive care unit patients with COVID-19 who were placed in a prone position (11.6%) experienced a hospital-acquired pressure or medical device-related injury, compared with 3 of 111 patients (2.7%) after protocol implementation, a reduction of 76.7% (P = .008). CONCLUSIONS The risk of hospital-acquired pressure injuries can be reduced with additional education and the use of appropriate products and protocols. All patients who undergo prone positioning, regardless of diagnosis, may benefit from implementation of a pressure injury prevention protocol that includes the use of dressing packets.
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Affiliation(s)
- Kelly McFee
- Kelly McFee is Director of Wound Care, Mosaic Wound Care and Hyperbaric Medicine, St. Joseph, Missouri
| | - Julie M Murdoch
- Julie M. Murdoch is Global Clinical Strategy Director, Global Clinical and Medical Affairs, Smith and Nephew, Watford, United Kingdom
| | - Mandy Spitzer
- Mandy Spitzer is a senior clinical strategy manager, Global Clinical and Medical Affairs, Smith and Nephew, Fort Worth, Texas
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Zhu F, Su H, Kong Y, Xu B, Lv Q, Lin J, Yi L, Xie J. Evaluation of dressings preventing facial medical device-related pressure injury in medical staff during the COVID-19 pandemic: A systematic review and network meta-analysis. J Clin Nurs 2023; 32:5988-5999. [PMID: 37082837 DOI: 10.1111/jocn.16721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/06/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
AIM This study systematically compared the efficacy of various dressings that may prevent facial medical device-related pressure injury (MRDPI) in medical staff during the COVID-19 pandemic. BACKGROUND During the COVID-19 pandemic, medical staff who are required to wear masks, goggles and other personal protective equipment (PPE) are susceptible to facial MRDPI, which exacerbates working conditions. Dressings can effectively prevent or alleviate MRDPI, but it is unclear which dressings are most effective. DESIGN A systematic review and network meta-analysis, in accordance with PRISMA. METHODS A comprehensive literature search was conducted in four English and four Chinese databases to identify relevant studies published up to 8 September 2022. The selected studies were randomised controlled trials, with populations comprising medical staff who wore PPE during the COVID-19 pandemic and included an observation and control group. RESULTS The network meta-analysis of the 12 selected articles showed that foam dressing, hydrocolloid dressing and petrolatum gauze were better than conventional protection for preventing MRDPI. The surface under the cumulative ranking curve indicated that foam dressing was the best preventative. CONCLUSION Foam dressing is more effective than other dressings in preventing facial MRDPI in medical staff. When PPE must be worn for many hours, such as during the COVID-19 pandemic, medical staff can use foam dressings to prevent MRDPI. RELEVANCE TO CLINICAL PRACTICE The results support the use of dressings, especially foam dressings, to prevent MRDPI in healthcare workers. The appropriate dressings are recommended to prevent MRDPI associated with wearing PPE.
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Affiliation(s)
- Fangfang Zhu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Honghong Su
- Nursing College, Fuzhou Institute of Technology, Fuzhou, China
| | - Yue Kong
- Teaching and Research Department, Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of Joint Logistic Support Force, PLA), Fuzhou, China
| | - Baoling Xu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qian Lv
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiamin Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Luanxing Yi
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jieling Xie
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; 36:421-434. [PMID: 37471447 DOI: 10.1097/asw.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19-related variables and hospital-acquired pressure injury (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as "COVID-19," "hospital-acquired pressure injuries," "pressure ulcer," "pressure injury," "decubitus ulcer," and "hospitalization." STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. Articles were included in the review if they were peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously, and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS The authors carried out a narrative synthesis of the extracted data because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should use more robust methodology and focus on quantitative modeling to iteratively improve inpatient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD, MAPWCA, JM is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022; published ahead of print January 27, 2023. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com )
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Teixeira-Vaz A, Rocha JA, Oliveira M, Almeida e Reis D, Simões Moreira T, Silva AI, Paiva JA. The PRINCOVID Retrospective Study: A Predictive Model of Pressure Injuries for Critical COVID-19 Patients. Am J Phys Med Rehabil 2023; 102:707-714. [PMID: 36722899 PMCID: PMC10368159 DOI: 10.1097/phm.0000000000002195] [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: 02/02/2023]
Abstract
OBJECTIVE The aim of the study is to characterize pressure injuries, identify risk factors, and develop a predictive model for pressure injuries at intensive care unit admission for critical COVID-19 patients. DESIGN This study was a retrospective analysis of a consecutive sample of patients admitted to intensive care unit between May 2020 and September 2021. Inclusion criteria encompassed the diagnosis of acute respiratory distress syndrome due to SARS-CoV-2, requiring invasive mechanical ventilation more than 48 hrs. The following predictors were evaluated: sociodemographic characteristics, comorbidities, as well as clinical and laboratory findings at intensive care unit admission. The primary outcome was the presence of pressure injuries. RESULTS Two hundred five patients were included, mostly males (73%) with a mean age of 62 yrs. Pressure injury prevalence was 58%. On multivariable analysis, male sex, hypertension, hemoglobin, and albumin at intensive care unit admission were independently associated with pressure injuries, constituting the PRINCOVID model. The model reached an area under the receiver operating characteristic curve of 0.71, surpassing the Braden scale ( P = 0.0015). The PRINCOVID score ranges from 0 to 15, with two risk groups: "at risk"(≤7 points) and "high risk"(>7 points). CONCLUSIONS This study proposes PRINCOVID as a multivariable model for developing pressure injuries in critical COVID-19 patients. Based on four parameters (sex, hypertension, hemoglobin, and albumin at intensive care unit admission), this model fairly predicts the development of pressure injuries. The PRINCOVID score allows patients' classification into two groups, facilitating early identification of high-risk patients.
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Aldughayfiq B, Ashfaq F, Jhanjhi NZ, Humayun M. YOLO-Based Deep Learning Model for Pressure Ulcer Detection and Classification. Healthcare (Basel) 2023; 11:healthcare11091222. [PMID: 37174764 PMCID: PMC10178524 DOI: 10.3390/healthcare11091222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Pressure ulcers are significant healthcare concerns affecting millions of people worldwide, particularly those with limited mobility. Early detection and classification of pressure ulcers are crucial in preventing their progression and reducing associated morbidity and mortality. In this work, we present a novel approach that uses YOLOv5, an advanced and robust object detection model, to detect and classify pressure ulcers into four stages and non-pressure ulcers. We also utilize data augmentation techniques to expand our dataset and strengthen the resilience of our model. Our approach shows promising results, achieving an overall mean average precision of 76.9% and class-specific mAP50 values ranging from 66% to 99.5%. Compared to previous studies that primarily utilize CNN-based algorithms, our approach provides a more efficient and accurate solution for the detection and classification of pressure ulcers. The successful implementation of our approach has the potential to improve the early detection and treatment of pressure ulcers, resulting in better patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Bader Aldughayfiq
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
| | - Farzeen Ashfaq
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - N Z Jhanjhi
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - Mamoona Humayun
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
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Putri IL, Tungga AAA, Pramanasari R, Wungu CDK. Characteristics of Patients with Pressure Injuries in a COVID-19 Referral Hospital. Adv Skin Wound Care 2023; 36:1-6. [PMID: 36940381 DOI: 10.1097/01.asw.0000919956.83713.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
OBJECTIVE This retrospective study aimed to describe the characteristics of patients treated at a COVID-19 referral hospital from March 2020 to June 2021 who experienced pressure injuries (PIs) either before or after admission. METHODS The researchers collected and analyzed data on patients' demographic characteristics, symptoms, comorbidities, location and severity of PI, laboratory values, oxygen therapy, length of stay, and vasopressor use. RESULTS During the study period, 1,070 patients were hospitalized for COVID-19 with varying degrees of severity, and 12 patients were diagnosed with PI. Eight (66.7%) of the patients with PI were men. The median age was 60 (range, 51-71) years, and half of the patients had obesity. Eleven of the patients with PI (91.4%) had at least one comorbid condition. The sacrum and gluteus were the two most commonly affected sites. Those with stage 3 PI had a substantially greater median d-dimer value (7,900 ng/mL) than patients with stage 2 PI (1,100 ng/mL). The average length of stay was 22 (range, 9.8-40.3) days. CONCLUSIONS Health professionals should be aware of an increase in d-dimer in patients with COVID-19 and PI. Even though PIs in these patients might not result in mortality, an increase in morbidity can be avoided with the right care.
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Affiliation(s)
- Indri Lakhsmi Putri
- Indri Lakhsmi Putri, MD, PhD, is Plastic Surgeon, Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, East Java, Indonesia, and Craniofacial Consultant, Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University. Also at Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Aldrich Alexander Afeli Tungga, MD, is Surgical Intern, and Rachmaniar Pramanasari, MD, is Plastic Surgeon. In the Faculty of Medicine at Airlangga University, Citrawati Dyah Kencono Wungu, MD, PhD, is Medical Staff, Department of Physiology and Medical Biochemistry
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13
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Zang C, Hou Y, Schenck E, Xu Z, Zhang Y, Xu J, Bian J, Morozyuk D, Khullar D, Nordvig A, Shenkman E, Rothman R, Block J, Lyman K, Zhang Y, Varma J, Weiner M, Carton T, Wang F, Kaushal R. Risk Factors and Predictive Modeling for Post-Acute Sequelae of SARS-CoV-2 Infection: Findings from EHR Cohorts of the RECOVER Initiative. RESEARCH SQUARE 2023:rs.3.rs-2592194. [PMID: 36945608 PMCID: PMC10029117 DOI: 10.21203/rs.3.rs-2592194/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Background Patients who were SARS-CoV-2 infected could suffer from newly incidental conditions in their post-acute infection period. These conditions, denoted as the post-acute sequelae of SARS-CoV-2 infection (PASC), are highly heterogeneous and involve a diverse set of organ systems. Limited studies have investigated the predictability of these conditions and their associated risk factors. Method In this retrospective cohort study, we investigated two large-scale PCORnet clinical research networks, INSIGHT and OneFlorida+, including 11 million patients in the New York City area and 16.8 million patients from Florida, to develop machine learning prediction models for those who are at risk for newly incident PASC and to identify factors associated with newly incident PASC conditions. Adult patients aged 20 with SARS-CoV-2 infection and without recorded infection between March 1st, 2020, and November 30th, 2021, were used for identifying associated factors with incident PASC after removing background associations. The predictive models were developed on infected adults. Results We find several incident PASC, e.g., malnutrition, COPD, dementia, and acute kidney failure, were associated with severe acute SARS-CoV-2 infection, defined by hospitalization and ICU stay. Older age and extremes of weight were also associated with these incident conditions. These conditions were better predicted (C-index >0.8). Moderately predictable conditions included diabetes and thromboembolic disease (C-index 0.7-0.8). These were associated with a wider variety of baseline conditions. Less predictable conditions included fatigue, anxiety, sleep disorders, and depression (C-index around 0.6). Conclusions This observational study suggests that a set of likely risk factors for different PASC conditions were identifiable from EHRs, predictability of different PASC conditions was heterogeneous, and using machine learning-based predictive models might help in identifying patients who were at risk of developing incident PASC.
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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; Publish Ahead of Print:00129334-990000000-00021. [PMID: 36705972 DOI: 10.1097/01.asw.0000919408.20614.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19 related variables and hospital-acquired pressure injuries (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as COVID-19, hospital-acquired pressure injuries, pressure ulcer, pressure injury, decubitus ulcer, and hospitalization. STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. This included peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS A narrative synthesis of the extracted data was carried out because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should employ more robust methodology and focus on quantitative modeling to iteratively improve in-patient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022
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15
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Su H, Zhou W, Kong Y, Zhu F, Xu B, Shen X, Zhang W, Zhou Q, Lv Q. Incidence of facial pressure injuries in health-care professionals during the COVID-19 pandemic: A systematic review and meta-analysis. Int J Nurs Pract 2022; 29:e13125. [PMID: 36535903 PMCID: PMC9877937 DOI: 10.1111/ijn.13125] [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] [Received: 06/14/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the incidence of facial pressure injuries in health-care professionals during the COVID-19 pandemic in a meta-analysis. METHODS Related studies were obtained through electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) Chinese Scientific Journal (VIP) China Biomedical Literature service systems (CBM) and Wanfang Data (from inception to 27 November 2021). The pooled incidence and the 95% confidence interval of facial pressure injuries were calculated with Review Manager v5.4 software. RESULTS Overall, 16 studies with 14 430 health-care professionals were included. Pooled results showed that the pooled incidence of facial pressure injury in health-care professionals was 58.8% (95% CI: 49.0%-68.7%; p < 0.01). The results of the subgroup analysis showed that the incidence of facial pressure injury in these staff was high, and predominantly stage I pressure injury, in the following cases: in health-care professionals who wore personal protective equipment for longer than 4 h, in those without any training experience, and on the nose. CONCLUSION Administrators and researchers should pay attention to preventing facial pressure injury related to the wearing of personal protective equipment (PPE) by ensuring all health-care professionals receive training and by limiting prolonged periods of use.
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Affiliation(s)
- Honghong Su
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Wenguang Zhou
- Department of EquipmentChenggong Hospital of Xiamen University (the 73th Group Military Hospital of the People's Liberation Army)XiamenChina
| | - Yue Kong
- Teaching and Research DepartmentFuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of Joint Logistic Support Force, PLA)FuzhouChina
| | - Fangfang Zhu
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Baoling Xu
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Xianying Shen
- School of NursingFujian Medical UniversityFuzhouChina
| | - Weiqin Zhang
- School of NursingFujian Medical UniversityFuzhouChina
| | - Qijun Zhou
- Medical CollegeQiqihar Medical UniversityQiqiharChina
| | - Qian Lv
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
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16
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Rani M, Uniyal A, Akhilesh, Tiwari V. Decrypting the cellular and molecular intricacies associated with COVID-19-induced chronic pain. Metab Brain Dis 2022; 37:2629-2642. [PMID: 35849300 PMCID: PMC9289353 DOI: 10.1007/s11011-022-01048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/23/2022] [Indexed: 10/25/2022]
Abstract
Pain is one of the clinical manifestations that can vary from mild to severe symptoms in COVID-19 patients. Pain symptoms can be initiated by direct viral damage to the tissue or by indirect tissue injury followed by nociceptor sensitization. The most common types of pain that are reported to occur in COVID-19 patients are headache, myalgia, and chest pain. With more and more cases coming in the hospitals, many new and unique symptoms of pain are being reported. Testicular and abdominal pain are rare cases of pain that are also being reported and are associated with COVID-19. The SARS-CoV-2 virus has a high affinity for angiotensin-converting enzyme-2 receptor (ACE-2) which acts as an entry point for the virus. ACE-2/ Ang II/AT 1 receptor also participates directly in the transmission of pain signals from the dorsal horn of the spinal cord. It induces a series of complicated responses in the human body. Among which the cytokinetic storm and hypercoagulation are the most prominent pathways that mediate the sensitization of sensory neurons facilitating pain. The elevated immune response is also responsible for the activation of inflammatory lipid mediators such as COX-1 and COX-2 enzymes for the synthesis of prostaglandins (PGs). PG molecules especially PGE2 and PGD2 are involved in the pain transmission and are found to be elevated in COVID-19 patients. Though arachidonic acid pathway is one of the lesser discussed topics in COVID-19 pathophysiology, still it can be useful for explaining the unique and rarer symptoms of pain seen in COVID-19 patients. Understanding different pain pathways is very crucial for the management of pain and can help healthcare systems to end the current pandemic situation. We herein review the role of various molecules involved in the pain pathology of COVID-19.
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Affiliation(s)
- Mousmi Rani
- Neuroscience and Pain Research Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, 221005, Uttar Pradesh, India
| | - Ankit Uniyal
- Neuroscience and Pain Research Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, 221005, Uttar Pradesh, India
| | - Akhilesh
- Neuroscience and Pain Research Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, 221005, Uttar Pradesh, India
| | - Vinod Tiwari
- Neuroscience and Pain Research Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, 221005, Uttar Pradesh, India.
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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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From Skin to Cytokine Storm and Clots. Adv Skin Wound Care 2022; 35:415. [PMID: 35856609 DOI: 10.1097/01.asw.0000840644.71235.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Amini M, Mansouri F, Vafaee K, Janbakhsh A, Mahdavikian S, Moradi Y, Fallahi M. Factors affecting the incidence and prevalence of pressure ulcers in COVID-19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study. Int Wound J 2022; 19:2039-2054. [PMID: 35322547 PMCID: PMC9111574 DOI: 10.1111/iwj.13804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
The pandemic of coronavirus (COVID‐19) has significantly increased the admission of patients with extensive complications, especially for respiratory support, to intensive care units (ICUs) worldwide. These patients also suffer from pressure ulcers (PUs) as another complication that occurs due to increased length of hospitalisation and acute conditions of patients. Therefore, this study aimed to evaluate the incidence and prevalence of PU and the factors affecting it in COVID‐19 patients admitted to ICUs. This cohort retrospective study used registry data in Imam Reza Hospital located in west of Iran. Four hundred and forty‐five COVID‐19 patients older than 20 years hospitalised in corona ICUs from 20 March 2020 to 30 December 2020, with a Braden score of less than 14 were included in the study. To investigate the relationship between variables in rate prevalence, univariate logistic regression analysis was used to calculate odds ratio, and for incidence rate in estimating PU risk generated in ICUs, hazard ratio was calculated using cox regression. One hundred and eighty‐three (41.12%) patients were male. The mean age of patients was 63 (SD = ±9.78) years. A total of 1152 cases of PU were generated, with the highest prevalence of PU with 234 cases in the sacrum. One hundred and seventy‐six (55.87%) patients underwent non‐invasive ventilation ulcers. The prevalence of PU was 79.7%. The highest prevalence was found in people over 80 years with 90.67%. The incidence ratio was 46.74%. The highest number of new cases was seen in diabetic patients with 60.96%. First‐degree ulcers were the most common degree of ulceration in 252 (55.38%) patients. Incidence and prevalence excluding first‐degree wounds were 24.04% and 49.66%, respectively. Age, Braden score, BMI, comorbidity, diabetes mellitus, stool incontinence, Glasgow coma scale, vasopressor, and length of hospital stay were significantly associated with PU (P < .05). The incidence and prevalence of PU in patients were high in this study. The length of hospitalisation and Braden score were the most important factors in the development of PU. The widespread prevalence of COVID‐19 and the relatively long stay of patients in the ICU created unfavourable conditions for patients and the treatment system, therefore, it emphasised the use of appropriate measures to prevent PU to avoid double costs and longer stays.
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Affiliation(s)
- Mahin Amini
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Feizollah Mansouri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Vafaee
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Mahdavikian
- Nursing Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences Sciences, Kermanshah, Iran
| | - Yasaman Moradi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Fallahi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Baron MV, dos Santos MP, Werle TM, Scherer GD, Santos MMD, Dominguez LML, Brandenburg C, Feltez G, Sampaio AR, de Mello Pinto MV, Carvalho S, Meyer PF, Picariello F, Pacheco EF, Reinheimer IC, Sancho AG, da Costa BEP. Does COVID-19 infection increase the risk of pressure injury in critically ill patients?: A narrative review. Medicine (Baltimore) 2022; 101:e29058. [PMID: 35356924 PMCID: PMC10513310 DOI: 10.1097/md.0000000000029058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/24/2022] [Indexed: 02/02/2023] Open
Abstract
ABSTRACT Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.
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Affiliation(s)
- Miriam Viviane Baron
- Correspondence: Miriam Viviane Baron, Graduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul 90619-900, Brazil (e-mail: ).
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21
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Ashktorab H, Russo T, Oskrochi G, Latella G, Massironi S, Luca M, Chirumamilla LG, Laiyemo AO, Brim H. Clinical and Endoscopic Outcomes in Coronavirus Disease-2019 Patients With Gastrointestinal Bleeding. GASTRO HEP ADVANCES 2022; 1:487-499. [PMID: 35287301 PMCID: PMC8907011 DOI: 10.1016/j.gastha.2022.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/17/2022] [Indexed: 01/11/2023]
Abstract
Background and Aims Over 404 million people worldwide have been infected with coronavirus disease-2019 (COVID-19), 145 million in the United States (77 million) and Europe (151 million) alone (as of February 10, 2022). This paper aims to analyze data from studies reporting gastrointestinal bleeding (GIB) and/or endoscopic findings in COVID-19 patients in Western countries. Methods We conducted a systematic review of articles on confirmed COVID-19 cases with GIB in Western countries published in PubMed and Google Scholar databases from June 20, 2020, to July 10, 2021. Results A total of 12 studies reporting GIB and/or endoscopic findings in 808 COVID-19 patients in Western countries were collected and analyzed. Outcomes and comorbidities were compared with 18,179 non-GIB COVID-19 patients from Italy and the United States. As per our study findings, the overall incidence of GIB in COVID-19 patients was found to be 0.06%. When compared to the non-GIB cohort, the death rate was significantly high in COVID-19 patients with GIB (16.4% vs 25.4%, P < .001, respectively). Endoscopic treatment was rarely necessary, and blood transfusion was the most common GIB treatment. The most common presentation in GIB patients is melena (n = 117, 47.5%). Peptic, esophageal, and rectal ulcers were the most common endoscopic findings in upper (48.4%) and lower (36.4%) endoscopies. The GIB cohort had worse outcomes and higher incidence of hypertension (61.1%), liver disease (11.2%), and cancer (13.6%) than the non-GIB cohort. Death was strongly associated with hypertension (P < .001, r = 0.814), hematochezia (P < .001, r = 0.646), and esophagogastroduodenoscopy (P < .001, r = 0.591) in COVID-19 patients with GIB. Conclusions Overall, the incidence of GIB in COVID-19 patients is similar to that estimated in the overall population, with melena being the most common presentation. The common endoscopic findings in GIB COVID-19 patients were ulcers, esophagitis, gastritis, and colitis. Patients with GIB were more prone to death than non-GIB COVID-19 patients.
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Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
| | - Tiziano Russo
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
| | - Giovanni Latella
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Martina Luca
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Lakshmi G. Chirumamilla
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
| | - Adeyinka O. Laiyemo
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
| | - Hassan Brim
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
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22
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Nieto-García L, Carpio-Pérez A, Moreiro-Barroso MT, Ruiz-Antúnez E, Nieto-García A, Alonso-Sardón M. Are there differences between COVID-19 and non-COVID-19 inpatient pressure injuries? Experiences in Internal Medicine Units. PLoS One 2022; 17:e0263900. [PMID: 35176083 PMCID: PMC8853574 DOI: 10.1371/journal.pone.0263900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/29/2022] [Indexed: 12/25/2022] Open
Abstract
Background Pressure Injuries (PIs) are major worldwide public health threats within the different health-care settings. Objective To describe and compare epidemiological and clinical features of PIs in COVID-19 patients and patients admitted for other causes in Internal Medicine Units during the first wave of COVID-19 pandemic. Design A descriptive longitudinal retrospective study. Setting This study was conducted in Internal Medicine Units in Salamanca University Hospital Complex, a tertiary hospital in the Salamanca province, Spain. Participants All inpatients ≥18-year-old admitted from March 1, 2020 to June 1, 2020 for more than 24 hours in the Internal Medicine Units with one or more episodes of PIs. Results A total of 101 inpatients and 171 episodes were studied. The prevalence of PI episodes was 6% and the cumulative incidence was 2.9% during the first-wave of COVID-19. Risk of acute wounds was four times higher in the COVID-19 patient group (p<0.001). Most common locations were sacrum and heels. Among hospital acquired pressure injuries a significant association was observed between arterial hypertension and diabetes mellitus in patients with COVID-19 diagnosis. Conclusion During the first wave of COVID-19, COVID-19 patients tend to present a higher number of acute wounds, mainly of hospital origin, compared to the profile of the non-COVID group. Diabetes mellitus and arterial hypertension were identified as main associated comorbidities in patients with COVID-19 diagnosis.
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Affiliation(s)
| | - Adela Carpio-Pérez
- Internal Medicine Service, University Hospital of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Tropical Disease Research Centre of the University of Salamanca (CIETUS), Salamanca, Spain
| | | | - Emilia Ruiz-Antúnez
- Training, Development and Innovation Area, University Hospital of Salamanca, Salamanca, Spain
| | - Ainhoa Nieto-García
- School of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Montserrat Alonso-Sardón
- Preventive Medicine and Public Health Area, University of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Tropical Disease Research Centre of the University of Salamanca (CIETUS), Salamanca, Spain
- * E-mail:
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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24
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Predictors of COVID-19 Disease Severity Augment the Braden Scale in the Prediction of Pressure Ulcer Development among COVID-19-Positive Intensive Care Unit Patients: A Case-Control Study. J Am Acad Dermatol 2022; 87:711-714. [PMID: 35219752 PMCID: PMC8872703 DOI: 10.1016/j.jaad.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 11/22/2022]
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25
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Cuevas-Gonzalez MV, Espinosa-Cristóbal LF, Donohue-Cornejo A, Tovar-Carrillo KL, Saucedo-Acuña RA, García-Calderón AG, Guzmán-Gastelum DA, Cuevas-Gonzalez JC. COVID-19 and its manifestations in the oral cavity: A systematic review. Medicine (Baltimore) 2021; 100:e28327. [PMID: 34941133 PMCID: PMC8701462 DOI: 10.1097/md.0000000000028327] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND SARS-CoV-2 is the virus responsible for coronavirus disease-19 (COVID-19) disease, which has been shown to trigger multiple affectations. One of the first tissue areas to come into contact with the virus is the oral cavity, which develops various alterations. Hence, the objective of this systematic review was to identify the main signs and symptoms of this disease in the oral cavity, and the following research question was established: What are the main oral signs and symptoms in COVID-19-positive persons? METHODS The electronic databases of PUBMED, SCOPUS, and SCIENCE DIRECT were analyzed, the keywords "ORAL DISEASES," "ORAL MANIFESTACTIONS," and "COVID-19" were used taking into account the following inclusion criteria: studies whose main objective was oral manifestations secondary to the confirmation of COVID-19, plus clinical cases, case series, and retrospective or prospective studies. For the assessment of the risk of bias the JBI Critical Appraisal Checklist for Case Series tool was used. RESULTS A total of 18 studies were included, the most common initial signs/symptoms after contagion of SARS-CoV-2 were dysgeusia, dry mouth, and burning mouth, and the main signs/symptoms were the presence of ulcerative lesions, dysgeusia, and Candida albicans infections. CONCLUSIONS It is very important to detect any alteration in the mucosa in patients with COVID-19 and to provide assertive treatment to avoid complications, and try to maintain adequate oral hygiene throughout the course of the disease to avoid the colonization of opportunistic microorganisms and to avoid complications both orally and systemically.
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Affiliation(s)
| | | | - Alejandro Donohue-Cornejo
- Institute of Biomedical Sciences, Autonomous University of Ciudad Juarez, Juarez City, Chihuahua, Mexico
| | | | - Rosa Alicia Saucedo-Acuña
- Institute of Biomedical Sciences, Autonomous University of Ciudad Juarez, Juarez City, Chihuahua, Mexico
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26
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Yip KH, Yip YC. Use of thin silicone dressings for prolonged use of filtering facepiece respirators: Lessons from the universal community testing programme during the COVID-19. Int Wound J 2021; 19:1188-1196. [PMID: 34729933 PMCID: PMC8652981 DOI: 10.1111/iwj.13714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 12/17/2022] Open
Abstract
A universal community testing programme (UCTP) was initiated by the government of the Hong Kong Special Administrative Region of the People's Republic of China, as part of a territory‐wide initiative to enhance the control of the coronavirus disease (COVID‐19) pandemic, to facilitate the early identification of asymptomatic patients in the community‐transmission chain. The authors (who were also engaged in this programme) observed that, at the end of their 6‐hour shift, most of the HCPs sustained medical device‐related pressure injuries (MDRPI), frequently on their faces, over the bridge of their nose, the upper cheeks, above the ears, lower jaws, and chin that caused pain and erythema. In this study, our team examined whether two different types of dressing (light silicone foam dressing and soft silicone perforated tape dressing) applied on the anatomical locations (including the bridge of the nose, upper cheek, above the ears, and lower jaw) would enable the wearer to pass the quantitative respirator fit testing that was conducted using a PortaCount Pro+ Respirator Fit Tester 8038. We also investigated if any skin reactions occurred after the participants worn the respirator with our applied dressing materials for 240 minutes in a safe laboratory setting. Lastly, we collected the qualitative feedback concerning how the participants felt about the performance of our dressing materials in preventing MDRPI associated with the prolonged use of tight‐fitting FFRs. A small convenience sample of HCPs (n = 24) who participated in the UCTP was recruited. We randomly selected 12 participants for one type of dressing, and the rest for the second type of dressing. Quantitative fit testing showed an adequate seal of the respirators with the use of both types of thin dressings that were available in the clinical settings. All of the participants except one tolerated the dressings for prolonged use without any report of adverse skin reactions. Our findings may move a step forward in assisting the process of developing feasible pre‐emptive skincare practice guidelines to reduce MDRPI during the prolonged use of nanofiber bacterial surgical respirators.
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Affiliation(s)
- Ka-Huen Yip
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, Hong Kong, China
| | - Yuk-Chiu Yip
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, Hong Kong, China
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27
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Bryant RA, Moore ZE, Iyer V. Clinical profile of the SEM Scanner - Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning. Expert Rev Med Devices 2021; 18:833-847. [PMID: 34338565 DOI: 10.1080/17434440.2021.1960505] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Pressure injuries (PIs) are a global health concern. Current PI care standards, including skin tissue assessments (STA) and health care professional (HCP) clinical judgment, diagnose visibly manifested PIs on the skin's surface, i.e. after the damage has already occurred. However, objective assessment of early-stage, non-visible, pressure-induced tissue damage is clinically impossible within the current standard of care. The SEM Scanner is the first device authorized by the Food and Drug Administration (FDA) that addresses this unmet clinical need. AREAS COVERED This review describes the novel sub-epidermal moisture (SEM) scanning technology of the device and summarizes the clinical safety and efficacy data that support the use of the scanner in routine PI care practice. EXPERT OPINION The clinical strategy for developing the SEM Scanner is noteworthy. SEM technology using anatomy-specific data enables HCPs to provide early PI prevention interventions before visible signs of tissue damage develop while the damage is still reversible. When adopted into routine practice, the device identifies an increased risk of developing PIs 5 days (median) earlier than STA. FDA clearance was based on bench studies and data from three foundational trials that demonstrate the diagnostic accuracy of the device algorithm significantly exceeding clinical judgment (p < 0.001).
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Affiliation(s)
- Ruth A Bryant
- Principal Research Scientist/Nursing, President, Association for the Advancement of Wound Care (AAWC), Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Zena Eh Moore
- Director of the Skin Wounds and Trauma (Swat)research Centre, MSc (Leadership in Health Professionals Education), MSc (Wound Healing & Tissue Repair), FFNMRCSI, Professor and Head of the School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Ireland.,Department is School of Medicine, Honorary Visiting Professor, Cardiff University, Cardiff, Wales.,Adjunct Professor, Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA.,Professor, Vakgroep Maatschappelijke Gezondheidkunde, Department of Public Health; Faculteit Geneeskunde En Gezondheidswetenschappen, Faculty of Medicine and Health Sciences, UGent, Ghent University, Belgium.,Department is School of Nursing, Honorary Professor, Lida Institute, Shanghai, China
| | - Vignesh Iyer
- MS Biotechnology and Clinical Lab Sciences, MSc Biotechnology, Senior Manager, Clinical R&D and Medical Affairs, Bruin Biometrics, LLC, Los Angeles, CA
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28
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Vowden K, Hill L. What is the impact of COVID-19 on tissue viability services and pressure ulceration? J Wound Care 2021; 30:522-531. [PMID: 34256597 DOI: 10.12968/jowc.2021.30.7.522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This paper explores and reviews the relevant literature and examines the impact that the first wave of the COVID-19 pandemic has had on the tissue viability service (TVS) and the incidence of pressure ulcers (PUs) in a large UK teaching hospital NHS trust. A comparison has been undertaken of referral data to the TVS during two time periods-Oct-Dec 2019 and April-June 2020. Data show that the PU rate per 1000 beds increased from a pre-pandemic level of around 1 to over 2.7 in the first month of the pandemic, with an increase in device and prone position-related PUs, particularly in the expanded critical care patient population. Even though the bed occupancy decreased, the proportion of ungradable PUs increased, but there was little change in the number of Category 1 and 2 PUs.
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Affiliation(s)
| | - Lisa Hill
- Leeds Teaching Hospitals Trust, Leeds, UK
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29
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Padula WV, Cuddigan J, Ruotsi L, Black JM, Brienza D, Capasso V, Cox J, Delmore B, Holden‐Mount S, Munoz N, Nie AM, Pittman J, Sonenblum SE, Tescher A. Best-practices for preventing skin injury beneath personal protective equipment during the COVID-19 pandemic: A position paper from the National Pressure Injury Advisory Panel. J Clin Nurs 2021; 32:625-632. [PMID: 33534939 PMCID: PMC8013459 DOI: 10.1111/jocn.15682] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/11/2020] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
COVID-19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID-19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear-ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non-porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence-based recommendations on prevention of device-related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long-term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.
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Affiliation(s)
- William V. Padula
- Leonard D. Schaeffer Center for Health Policy & EconomicsDepartment of Pharmaceutical & Health EconomicsSchool of PharmacyUniversity of Southern CaliforniaLos AngelesCAUSA,Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA
| | - Janet Cuddigan
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,College of NursingUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Lee Ruotsi
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,Saratoga Hospital Medical GroupSaratoga SpringsNYUSA
| | - Joyce M. Black
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,College of NursingUniversity of Nebraska Medical CenterOmahaNEUSA
| | - David Brienza
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,School of Health and Rehabilitation ScienceUniversity of PittsburghPittsburghPAUSA
| | - Virginia Capasso
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Jill Cox
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,School of NursingRutgers UniversityNewarkNJUSA
| | - Barbara Delmore
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,NYU Langone HealthNew YorkNYUSA
| | - Sarah Holden‐Mount
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,American Medical TechnologiesIrvineCAUSA
| | - Nancy Munoz
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,Southern Nevada VA Health SystemLas VegasNVUSA
| | - Ann Marie Nie
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,Children’s Hospitals and Clinics of MinnesotaMinneapolisMNUSA
| | - Joyce Pittman
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,College of NursingUniversity of South AlabamaMobileALUSA
| | - Sharon E. Sonenblum
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,The George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGAUSA
| | - Ann Tescher
- Board of DirectorsThe National Pressure Injury Advisory Panel (NPIAPBostonMAUSA,Mayo Clinic HospitalRochesterMNUSA
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30
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Padula W, Berke C, Bryant R. A Collaborative Call for Changes in Reimbursement Policies to Achieve Improvements in Hospital Safety Related to Pressure Injuries. J Patient Saf 2021; 17:e268. [PMID: 33994535 DOI: 10.1097/pts.0000000000000854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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31
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Sen CK. Human Wound and Its Burden: Updated 2020 Compendium of Estimates. Adv Wound Care (New Rochelle) 2021; 10:281-292. [PMID: 33733885 PMCID: PMC8024242 DOI: 10.1089/wound.2021.0026] [Citation(s) in RCA: 301] [Impact Index Per Article: 100.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
Significance: Chronic wounds impact the quality of life (QoL) of nearly 2.5% of the total population in the United States and the management of wounds has a significant economic impact on health care. Given the aging population, the continued threat of diabetes and obesity worldwide, and the persistent problem of infection, it is expected that chronic wounds will continue to be a substantial clinical, social, and economic challenge. In 2020, the coronavirus disease (COVID) pandemic dramatically disrupted health care worldwide, including wound care. A chronic nonhealing wound (CNHW) is typically correlated with comorbidities such as diabetes, vascular deficits, hypertension, and chronic kidney disease. These risk factors make persons with CNHW at high risk for severe, sometimes lethal outcomes if infected with severe acute respiratory syndrome coronavirus 2 (pathogen causing COVID-19). The COVID-19 pandemic has impacted several aspects of the wound care continuum, including compliance with wound care visits, prompting alternative approaches (use of telemedicine and creation of videos to help with wound dressing changes among others), and encouraging a do-it-yourself wound dressing protocol and use of homemade remedies/substitutions. Recent Advances: There is a developing interest in understanding how the social determinants of health impact the QoL and outcomes of wound care patients. Furthermore, addressing wound care in the light of the COVID-19 pandemic has highlighted the importance of telemedicine options in the continuum of care. Future Directions: The economic, clinical, and social impact of wounds continues to rise and requires appropriate investment and a structured approach to wound care, education, and related research.
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Affiliation(s)
- Chandan K. Sen
- Department of Surgery, Indiana University Health Comprehensive Wound Center, Indianapolis, Indiana, USA
- Editor-in-Chief, Advances in Wound Care
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