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Latimer SL, Bone M, Walker RM, Thalib L, Gillespie BM. Inter-device agreement of sacral subepidermal oedema measurement in healthy adults during prolonged 60° head of bed elevation. Nurs Open 2024; 11:e2103. [PMID: 38391104 PMCID: PMC10830921 DOI: 10.1002/nop2.2103] [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: 02/27/2023] [Revised: 09/13/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To investigate the level of agreement between the SEM 200 and Provisio® subepidermal moisture sacral delta measurements, which may indicate increased pressure injury risk, in healthy adults during 120 min of prolonged 60° head of bed elevation. This position, which requires the elevation of the patient's upper body at a 60° angle above the horizontal plane for an extended period, is used by clinicians to prevent or manage a patient's medical or surgical conditions. DESIGN This prospective exploratory study recruited 20 healthy adults during October 2021 and collected sacral subepidermal moisture delta measurements using the SEM 200 and Provisio® devices. METHODS Delta measurements were taken at 20-min intervals over 120 min resulting in seven data collection timepoints. Descriptive statistics and a Bland Altman plot analysis were conducted. RESULTS A total of 280 sacral subepidermal moisture delta measurements were gathered or 140 per device. There were good levels of agreement between the two devices at baseline (T0) [mean 0.025; SD 0.137] and following 60- (T3) [mean 0.025; SD 0.111], 80- (T4) [mean -0.01; SD 0.177] and 100 min (T5) [mean 0.01; SD 0.129] of prolonged 60° head of bed elevation. Head of bed elevations can increase a patient's risk of sacral pressure injuries. In some countries, nurses have access to the SEM 200 and/or the Provisio® device, so our findings may increase nurses' confidence in the interchangeability of the device measurements, although further research is needed to confirm this. The SEM 200 and Provisio® subepidermal moisture scanners show promise in gathering similar objective pressure injury risk data which could prompt clinicians to implement prevention strategies. IMPACT Current pressure injury risk assessment is largely subjective in nature. This quantitative study on healthy human sacral tissue found a good level of agreement in the SEM 200 and Provisio® subepidermal moisture scanners, which may increase nurses' confidence in the interchangeability of the devices in clinical practice.
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Affiliation(s)
- Sharon L. Latimer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversitySouthportQueenslandAustralia
| | - Madeline Bone
- School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia
| | - Rachel M. Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversityNathanQueenslandAustralia
- Metro South HealthBrisbaneQueenslandAustralia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of MedicineIstanbul Aydin UniversityIstanbulTurkey
| | - Brigid M. Gillespie
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversitySouthportQueenslandAustralia
- Gold Coast Hospital and Health ServiceSouthportQueenslandAustralia
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2
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Dabas M, Kreychman I, Katz T, Gefen A. Testing the effectiveness of a polymeric membrane dressing in modulating the inflammation of intact, non-injured, mechanically irritated skin. Int Wound J 2024; 21:e14347. [PMID: 37568272 PMCID: PMC10777768 DOI: 10.1111/iwj.14347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
We investigated the inflammatory (IL-1 alpha) and thermal (infrared thermography) reactions of healthy sacral skin to sustained, irritating mechanical loading. We further acquired digital photographs of the irritated skin (at the visible light domain) to assess whether infrared imaging is advantageous. For clinical context, the skin status was monitored under a polymeric membrane dressing known to modulate the inflammatory skin response. The IL-1 alpha and infrared thermography measurements were consistent in representing the skin status after 40 min of continuous irritation. Infrared thermography overpowered conventional digital photography as a contactless optical method for image processing inputs, by revealing skin irritation trends that were undetectable through digital photography in the visual light, not even with the aid of advanced image processing. The polymeric membrane dressings were shown to offer prophylactic benefits over simple polyurethane foam in the aspects of inflammation reduction and microclimate management. We also concluded that infrared thermography is a feasible method for monitoring the skin health status and the risk for pressure ulcers, as it avoids the complexity of biological marker studies and empowers visual skin assessments or digital photography of skin, both of which were shown to be insufficient for detecting the inflammatory skin status.
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Affiliation(s)
- Mai Dabas
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Ida Kreychman
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Tomer Katz
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
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3
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Latimer SL, Bone M, Walker RM, Thalib L, Gillespie BM. The effect of prolonged 60° head of bed elevation on sacral subepidermal oedema in healthy adults: A quantitative prospective exploratory study. Int Wound J 2023; 20:3619-3627. [PMID: 37217227 PMCID: PMC10588321 DOI: 10.1111/iwj.14240] [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: 01/10/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Head of bed elevation is used to manage some medical and surgical conditions however this may increase a patient's risk of sacral pressure injuries. Novel point-of-care technologies that measure subepidermal moisture can identify changes in localised subepidermal oedema and potential pressure injury risk. This prospective exploratory study investigated variations in sacral subepidermal oedema in healthy adults during 120-min of 60° head of bed elevation. Sacral subepidermal oedema was measured at 20-min intervals using the Provisio® subepidermal moisture scanner. Descriptive analysis, one-way repeated measures analysis of variance and an independent t-test were conducted. Slightly more male volunteers (n = 11; 55%) were recruited and the sample mean age was 39.3 years (SD 14.7) with an average body mass index of 25.8 (SD 4.3). Little variation in the mean sacral subepidermal moisture of healthy adults was observed. There was a statistically significant difference in the mean sacral subepidermal moisture measurements between males and females (Mean difference 0.18; 95% confidence intervals: 0.02 to 0.35; P = .03). Healthy adults can tolerate prolonged 60° head of bed elevation without developing increased subepidermal sacral oedema. This warrants further investigation in other populations, in various positions and over different time periods.
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Affiliation(s)
- Sharon L. Latimer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, and NHMRC Centre for Research Excellence Wiser Wounds CareGriffith UniversitySouthportQueenslandAustralia
| | - Madeline Bone
- School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia
| | - Rachel M. Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland, and NHMRC Centre for Research Excellence Wiser Wounds CareGriffith UniversityNathanQueenslandAustralia
- Metro South HealthBrisbaneQueenslandAustralia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of MedicineIstanbul Aydin UniversityIstanbulTurkey
| | - Brigid M. Gillespie
- School of Nursing and Midwifery, Menzies Health Institute Queensland, and NHMRC Centre for Research Excellence Wiser Wounds CareGriffith UniversitySouthportQueenslandAustralia
- Gold Coast Hospital and Health ServiceSouthportQueenslandAustralia
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4
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Brunetti G, Patton D, Moore Z, Palomeque-Chavez JC, O'Brien FJ, Boyle CJ. Validation of a sub-epidermal moisture scanner for early detection of pressure ulcers in an ex vivo porcine model of localized oedema. J Tissue Viability 2023; 32:508-515. [PMID: 37442720 DOI: 10.1016/j.jtv.2023.06.008] [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] [Received: 02/21/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Pressure ulcers (PUs) remain a chronic health problem with severe impacts on healthcare systems. Early detection is crucial to providing effective interventions. However, detecting PUs currently relies on subjective tissue evaluations, such as visual skin assessment, precluding interventions prior to the development of visible tissue damage. There is an unmet need for solutions that can detect early tissue damage before visual and tactile signs occur. Assessments based on sub-epidermal moisture (SEM) measurements represent an opportunity for robust and objective early detection of PUs, preventing broken skin PUs in more high-risk patients at high-risk anatomical locations. While SEM assessment technology has been validated in computational, bench and tissue phantom models, validation in soft tissue was absent. In this study, we successfully validated the ability of a commercially available SEM assessment device to measure and detect sub-epidermal moisture changes in a novel ex vivo porcine soft tissue model of localised oedema. When controlled and incremental fluid volumes (Phosphate Buffer Solution) were injected into porcine soft tissues, statistically significant differences were found in SEM values between fluid-injected sites, representing an inflammatory oedematous condition, and healthy tissue control sites, as measured by the SEM device. The device provided reproducible readings by detecting localised oedema changes in soft tissues, reflecting the build-up of fluid as small as 1 ml into the underlying tissue. Spatial characterization experiments described the ability of the device technology to differentiate between healthy and oedematous tissue. Our findings validate the use of SEM assessment technology to measure and quantify localized oedema.
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Affiliation(s)
- G Brunetti
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland.
| | - D Patton
- Skin Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - Z Moore
- Skin Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - J C Palomeque-Chavez
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - F J O'Brien
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - C J Boyle
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
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Posnett JW, Moss JWE, Michaelwaite LI. Modelling the cost-effectiveness of subepidermal moisture measurement as part of a process of assessment and intervention to prevent hospital-acquired pressure ulcers. Int Wound J 2023; 20:2688-2699. [PMID: 37203247 PMCID: PMC10410331 DOI: 10.1111/iwj.14143] [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: 12/08/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 05/20/2023] Open
Abstract
Skin tissue assessment is traditionally used to identify early signs of pressure damage from changes observed at the skin surface. However, the early onset of tissue damage induced by pressure and shear forces is likely to be on soft tissues beneath the surface of the skin. Subepidermal moisture (SEM) is a biophysical marker for the detection of early and deep pressure-induced tissue damage. Measurement of SEM can detect early pressure ulcers up to 5 days before visible skin changes occur. The aim of this study was to evaluate the cost-effectiveness of SEM measurement compared with visual skin assessment (VSA). A decision-tree model was developed. Outcomes are the incidence of hospital-acquired pressure ulcers, quality-adjusted life-years (QALYs) and costs to the UK National Health Service. Costs are at 2020/21 prices. The effects of parameter uncertainty are tested in univariate and probabilistic sensitivity analysis. In a representative NHS acute hospital, the incremental cost of SEM assessment as an adjunct to VSA is -£8.99 per admission, and SEM assessment is expected to reduce the incidence of hospital-acquired pressure ulcers by 21.1%, reduce NHS costs and lead to a gain of 3.634 QALYs. The probability of cost-effectiveness at a threshold of £30 000 per quality-adjusted life year is 61.84%. Pathways that include SEM assessment make it possible to implement early and anatomy-specific interventions which have the potential to improve the effectiveness of pressure ulcer prevention and reduce healthcare costs.
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Chaboyer W, Harbeck EL, Walker RM, Latimer S, Deakin J, Probert R, Gillespie BM. Variations in sacral sub-epidermal moisture measurements in hospitalized medical and surgical patients: A longitudinal observational sub-study. Int J Nurs Stud 2023; 145:104545. [PMID: 37369147 DOI: 10.1016/j.ijnurstu.2023.104545] [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: 02/08/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Pressure injury risk assessment tools have several well-known limitations. As a result, new methods of assessing risk are emerging, including the use of sub-epidermal moisture measurement to detect localized edema. AIMS To assess the daily variation in sacral sub-epidermal moisture measurement over five days and establish if age and prophylactic sacral dressing use influenced these measurements. METHODS As part of a larger randomized controlled trial of the use of prophylactic sacral dressings, a longitudinal observational substudy was undertaken in hospitalized medical and surgical adult patients at risk of pressure injury. The substudy was conducted in consecutively recruited patients from 20 May 2021 to 9 November 2022. Using the SEM 200 (Bruin Biometrics LLC), daily sacral sub-epidermal measurements for up to five days were completed. Two measurements were generated, the most recent sub-epidermal moisture measurement and, after at least three measurements, a delta value, the difference between the highest and lowest values. The delta measurement was the outcome, with a delta of ≥0.60 considered abnormal, increasing the risk of pressure injury development. A mixed analysis of covariance was undertaken to determine if there was any change in delta measurements over the five days and to determine if age and sacral prophylactic dressing use influenced sub-epidermal moisture delta measurement. RESULTS A total of 392 participants were included in this study; 160 (40.8%) patients had completed five consecutive days of sacral sub-epidermal moisture delta measurements. In total, 1324 delta measurements were undertaken across the five study days. In total, 325 of 392 patients (82.9%) had experienced one or more abnormal delta. Furthermore, 191 (48.7%) and 96 (24.5%) of patients experienced abnormal deltas for two or more and three or more consecutive days. There was no statistically significant variation in sacral sub-epidermal moisture delta measurements over time; increasing age and prophylactic dressing use did not influence sub-epidermal moisture deltas over the five days. CONCLUSION If only one abnormal delta was used as a trigger, about 83% of patients would have received additional pressure injury prevention strategies. But, if a more nuanced approach to responding to abnormal deltas is taken, between 25 and 50% of patients may receive additional pressure injury prevention, representing a more time and resource efficient approach. TWEETABLE ABSTRACT Sub-epidermal moisture delta measurements did not vary over 5 days; increasing age and prophylactic dressing use did not influence these measurements.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia.
| | - Emma L Harbeck
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
| | - Rachel M Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University and Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia. https://twitter.com/rachelmwalker
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia. https://twitter.com/SharonLLatimer
| | - Jodie Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia. https://twitter.com/jodie_deakin3
| | - Rosalind Probert
- Stomal Therapy and Wound Management Department in the Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University and Gold Coast University Hospital, Southport, Queensland, Australia. https://twitter.com/bgillespie6
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7
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Black J, Cox J, Capasso V, Bliss DZ, Delmore B, Iyer V, Massaro J, Munro C, Pittman J, Ayello EA. Current Perspectives on Pressure Injuries in Persons with Dark Skin Tones from the National Pressure Injury Advisory Panel. Adv Skin Wound Care 2023; 36:470-480. [PMID: 37590446 DOI: 10.1097/asw.0000000000000032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colors/tones in education materials is apparent. OBJECTIVE To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones. METHODS The following elements will be discussed through the lens of skin tone: (1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, (2) epidemiology of PI, (3) anatomy and physiology of the skin, (3) skin tone assessment and measurement, (4) augmented visual assessment modalities, (5) PI prevention, (6) PI healing, (7) social determinants of health, and (8) gaps in clinician education. CONCLUSIONS This article highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones. Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.
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Affiliation(s)
- Joyce Black
- Joyce Black, PhD, RN, FAAN, is President, National Pressure Injury Advisory Panel, and Florence Niedfelt Professor of Nursing, College of Nursing, University of Nebraska, Lincoln, USA. Jill Cox, PhD, RN, APN-C, CWOCN, FAAN, is Member, Board of Directors, National Pressure Injury Advisory Panel; Clinical Professor, Rutgers University School of Nursing, New Jersey; and Wound/Ostomy/Continence Advanced Practice Nurse, Englewood Health, New Jersey. Virginia Capasso, PhD, CNP, CNS, CWS, FAAN, is Member, Board of Directors, National Pressure Injury Advisory Panel; Instructor in Surgery, Harvard Medical School, Boston, Massachusetts; and Advanced Practice Nurse and Nurse Scientist, Massachusetts General Hospital, Boston. Donna Z. Bliss, PhD, RN, FAAN, is School of Nursing Foundation Professor of Nursing Research, and Chair, Adult and Gerontological Health Cooperative, University of Minnesota School of Nursing, Minneapolis. Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC, FAAN, is Alumna, Board of Directors, National Pressure Injury Advisory Panel, and Senior Nurse Scientist and Clinical Assistant Professor, NYU Langone Health, New York. Vignesh Iyer, MS, is Director, Medical Affairs, Bruin Biometrics, Los Angeles, California. Jacqueline Massaro, MSN, RN, CWOCN, is Wound/Ostomy/Continence Nurse, Brigham and Women's Hospital, Boston, Massachusetts. Cassendra Munro, PhD, RN, CNOR, is Nurse Scientist, Office of Research Patient Care Services, Stanford Health Care, Palo Alto, California. Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, is Alumna, Board of Directors, National Pressure Injury Advisory Panel, and Associate Professor, College of Nursing, University of South Alabama, Mobile. Elizabeth A. Ayello, PhD, RN, CWON, MAPWCA, FAAN, is Alumna, Board of Directors, and Past President, National Pressure Injury Advisory Panel, and President, Ayello, Harris & Associates, Inc, New York
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Byrne S, Patton D, Avsar P, Strapp H, Budri A, O'Connor T, Nugent L, Moore Z. Sub epidermal moisture measurement and targeted SSKIN bundle interventions, a winning combination for the treatment of early pressure ulcer development. Int Wound J 2023; 20:1987-1999. [PMID: 36575149 PMCID: PMC10333035 DOI: 10.1111/iwj.14061] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022] Open
Abstract
This study aimed to investigate the impact of sub epidermal moisture (SEM) measurement and targeted pressure ulcer (PU) prevention, versus visual skin assessment and usual care, on mean SEM delta scores and early pressure ulcer development in acute hospital patients. A quantitative quasi-experimental observational approach was used. A total of 149 at risk acute hospital patients took part, 78 treatment, and 71 control. SEM deltas were recorded daily for a maximum of 5 days using the SEM Scanner (Bruin Biometrics LLC, Los Angeles, California), on three sites: the sacrum, the right heel, and the left heel, with enhanced and targeted PU prevention interventions occurring in those with an elevated SEM delta scores in the treatment group. Intention to treat analysis was used to guide the final composition of results. SEM PU represents PU development as identified by 2 days of sustained abnormal SEM delta scores, ≥0.5, after day one. The mean number of days completed by participants was just under 4 days, participants had many different comorbidities, with the most common being: hypertension, cancer, and chronic obstructive pulmonary disease. Results showed that following the introduction of SEM guided targeted treatments, participants in the treatment group yielded a statistically significant reduction in mean SEM delta scores (MD: 0.49; 95% CI: 0.59, 0.39; P < .0001), and in the odds of developing a SEM PU (OR: 0.59, 95% CI: 0.24 to 1.00; P = .05). In the treatment group, none of the participants developed a visual PU, whereas, in the control group, 1.41% (n = 1/71) developed a visual PU. Based on all the results, the following is concluded, (1). There was a greater reduction in mean SEM delta scores among those cared for using SEM measurement and targeted PU prevention, versus those cared for using visual skin assessment and usual care, and (2). the mean SEM delta scores was statistically significantly lower at the study end for those who received targeted treatments based on abnormal SEM scores. More research is now needed in other and larger at-risk groups to further validate what was found in this study.
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Affiliation(s)
| | - Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Pinar Avsar
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | | | - Aglecia Budri
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Lida InstituteShanghaiChina
| | - Linda Nugent
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
| | - Zena Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Lida InstituteShanghaiChina
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- University of WalesCardiffUK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandGriffithQueenslandAustralia
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9
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The effect of sub-epidermal moisture on pressure injury prevention strategies and incidence of pressure injuries: A feasibility pilot randomised controlled trial. J Tissue Viability 2022; 31:776-782. [PMID: 35934637 DOI: 10.1016/j.jtv.2022.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022]
Abstract
AIM Sub-epidermal moisture scanning (SEMS) is a novel point-of-care technology that measures localised oedema and detects early tissue damage that may develop into a pressure injury (PI). It provides objective data that may assist PI prevention (PIP) decision making. This study aimed to determine the feasibility of undertaking a definitive randomised controlled trial (RCT) to test the effectiveness of SEMS. MATERIALS AND METHODS This pilot RCT recruited medical and surgical patients at risk of developing a PI in one Australian hospital. All participants received routine PIP care and daily visual skin assessment to determine the presence of a PI. The intervention group also received daily SEMS. Clinical staff were told if the sub-epidermal moisture (SEM) value was abnormal but were not given advice for PIP. Blinding of patients, care staff and outcome assessors was not practical. Feasibility outcomes included recruitment, retention, intervention fidelity, and patient outcomes. RESULTS Of 1185 patients screened prior to eligibility, 950 were excluded (80%); 235 were then assessed for eligibility and 160 met the inclusion criteria (68.1%); 100 were recruited (70.0%) and randomised and 99 completed the trial (intervention n = 50; control n = 49) with one person withdrawn due to inappropriate recruitment (100% retention). Of the 657 expected SEMS observations, 598 were completed (91% intervention fidelity). Only 34 of 454 (7.4%) patient outcome data points were missing. CONCLUSIONS Most feasibility criteria were met, indicating a definitive trial to assess the effectiveness of SEMS in a medical-surgical patient population is realistic. However, recruitment may be resource intensive and require specific strategies.
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10
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Moore Z, McEvoy NL, Avsar P, Byrne S, Vitoriano Budri AM, Nugent L, O'Connor T, Curley G, Patton D. Measuring subepidermal moisture to detect early pressure ulcer development: a systematic review. J Wound Care 2022; 31:634-647. [PMID: 36001704 DOI: 10.12968/jowc.2022.31.8.634] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim was to assess evidence related to the measuring of subepidermal moisture (SEM) to detect early, nonvisible development of pressure ulcers (PUs). METHOD Using systematic review methodology, all quantitative animal and human research studies written in English were considered. In January 2021, PubMed, CINAHL, SCOPUS, Cochrane and EMBASE databases were searched. The primary outcome of interest was the validity of SEM measurement to detect early PU development. The secondary outcome was time to PU detection, sensitivity and specificity of SEM measurement, and the impact of SEM measurements on PU prevention. Data analysis was undertaken using RevMan and narrative synthesis. RESULTS A total of 17 articles met the inclusion criteria. In all studies, a consistent abnormal deviation in SEM measurements corresponded with evidence of visual PU development. Time to PU development, explored in four studies, showed earlier detection of PU development using SEM measurement. RevMan analysis identified the mean difference in time to PU development (SEM measurement versus visual skin assessment, VSA) was 4.61 days (95% confidence interval: 3.94-5.28; p=0.0001) in favour of SEM measurements. The sensitivity of SEM measurements was reported in four studies, and scores varied from 48.3% to 100.0%. Specificity was also reported in four studies and scores ranged from 24.4% to 83.0%. The impact of the detection of abnormal SEM measurements on PU prevention was explored by one study. Results showed a 93% decrease in PU rates when staff acted on the results of the SEM readings. CONCLUSION The findings of this review identified that SEM measurement detects PU development earlier than VSA. Furthermore, when staff responded to abnormal SEM measurements, prevention strategies were enhanced, with a subsequent reduction in visible PU development. SEM measurement may therefore be a useful addition to PU prevention strategies. DECLARATION OF INTEREST The School of Nursing & Midwifery, RCSI has a research agreement with Bruin Biometrics. Funding for the study was through an Irish Research Council PhD Enterprise Partnership Scheme with Bruin Biometrics. The authors have no other conflicts of interest.
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Affiliation(s)
- Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Professor, School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Visiting Professor, School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland.,Professor, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Honorary Professor, Lida Institute, Shanghai, China.,Cardiff University, Wales.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Natalie L McEvoy
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin
| | - Pinar Avsar
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin
| | - Sorcha Byrne
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin
| | - Aglecia Moda Vitoriano Budri
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin
| | - Linda Nugent
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Professor, School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Honorary Professor, Lida Institute, Shanghai, China.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Gerard Curley
- Department of Anaesthesia and Critical Care, RCSI University of Medicine and Health Sciences, Dublin
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Professor, School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Australia
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11
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Wang N, Lv L, Yan F, Ma Y, Miao L, Foon Chung LY, Han L. Biomarkers for the early detection of pressure injury: A systematic review and meta-analysis. J Tissue Viability 2022; 31:259-267. [PMID: 35227559 DOI: 10.1016/j.jtv.2022.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pressure injury imposes a significant burden for patients and healthcare systems and the majority of pressure injuries are preventable. The early identification of pressure injury is critical for its prevention. As an objective measure, biomarkers have preliminarily shown the potential to identify individuals at risk for developing pressure injury before it is visually observed to occur. However, these results have not been synthesized. OBJECTIVE To assess and synthesise the predictive effect of different biomarkers in the early detection of pressure injury formation. DESIGN A systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, CINAHL Complete and the Cochrane Library were comprehensively searched for articles up to June 2021. No restrictions were applied to study design type, language, country, race or date of publication. REVIEW METHODS Two reviewers independently extracted data from all original eligible studies using a specified data extraction form, resolved disagreements through discussion and the involvement of an additional reviewer. Methodological quality of all included studies was independently appraised by two authors with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Newcastle-Ottawa Quality Assessment Scale (NOS). Heterogeneity of each study was estimated using the I2 statistic, and the data was synthesized using StataSE15. RESULTS Eight observational studies involving 10595 participants were included. The overall pooled area under curve (AUC) and the 95% confidence intervals (CIs) of Serum albumin (Alb) was 0.66(0.62-0.70), and the Serum haemoglobin (Hb) was 0.67(0.60-0.74). The AUC and 95% CI of C-reactive protein (CRP) was 0.62(0.50-0.74), Braden score was 0.56 (0.429-0.691), Waterlow score was 0.729(0.654-0.803), Alb with Waterlow was 0.741(0.694-0.787), and the combination of Hb, CRP, Alb, Age and Gender was 0.79(0.682-0.898). Besides, the chemokine interferon-γ-induced protein of 10kd/CXCL10, cytokine interferon-α, tumor necrosis factor-alpha (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-15 (IL-15) and combination of creatine kinase (CK), myoglobin (Mb), heart-type fatty acid binding protein (H-FABP) and CRP may prove potential for detecting pressure injury. CONCLUSION The findings suggest the combination of Hb, CRP, Alb, Age and Gender is superior to other biomarkers. However, the predictive effect of biomarkers needs to be confirmed by more researches and patient-level data.
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Affiliation(s)
- Ning Wang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Lin Lv
- Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou City, 730000, Gansu Province, China.
| | - Fanghong Yan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Lizhen Miao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Loretta Yuet Foon Chung
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China.
| | - Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, 730000, Gansu Province, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, 730000, Gansu Province, China.
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12
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Ousey K, Stephenson J, Blackburn J. Sub-epidermal moisture assessment as a prompt for clinical action in treatment of pressure ulcers in at-risk hospital patients. J Wound Care 2022; 31:294-303. [DOI: 10.12968/jowc.2022.31.4.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: This study assesses anonymous patient-level data on the use of sub-epidermal moisture (SEM) assessment technology as a tool in the prevention of pressure ulceration in at-risk hospital patients. Method: The relationship between technology-generated prompts for clinical action (patient turning, application of pressure redistributing equipment, heel protection or cream) and consequent clinical action was evaluated using data cross-tabulations (using data aggregated over multiple anatomical sites); in a multilevel model with patients clustered within wards, clustered in turn within hospitals, and controlling for additional patient- and institution-level factors; and using receiver operating characteristic (ROC) analyses of anatomy-specific data. The ability of the SEM assessment technology to detect deep and early-stage pressure ulcers/injuries on specific anatomical areas of a patient's body on admission, earlier than visual and tactile skin tissue assessments (STA), was assessed. Results: A total of 15,574 patient assessments (‘cases’) were reported on 1995 patients. Most incidences of nurse action were in response to a prompt from SEM assessments (4944/5494; 90.0%). An SEM delta (Δ)≥0.6 resulted in nurse action in 4944/13,071 cases (37.8%). The multilevel model revealed strong evidence that SEM Δ prompts were significantly associated with nurse action (p<0.001; adjusted odds ratio: 1.99). Conclusion: In this study, SEM assessment technology effectively prompted nurse action moreso than skin reddening diagnosed via trained clinician judgement and STAs. While baseline responses of nurses' actions remained low, with or without SEM Δ prompts, findings verified the ‘clinical utility’ of SEM assessment technology as an objective prompt for early clinical action over and above existing mechanisms.
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Affiliation(s)
- Karen Ousey
- School of Human & Health Sciences, University of Huddersfield, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - John Stephenson
- School of Human & Health Sciences, University of Huddersfield, UK
| | - Joanna Blackburn
- School of Human & Health Sciences, University of Huddersfield, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
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13
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Chaboyer W, Coyer F, Harbeck E, Thalib L, Latimer S, Wan CS, Tobiano G, Griffin BR, Campbell JL, Walker R, Carlini JJ, Lockwood I, Clark J, Gillespie BM. Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting: A systematic review and meta-analysis. Int J Nurs Stud 2022; 128:104189. [PMID: 35217433 DOI: 10.1016/j.ijnurstu.2022.104189] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oedema measurement, also termed sub-epidermal moisture measurement is recommended as an adjunct pressure injury prevention intervention in international guidelines because it indicates early tissue damage. OBJECTIVE To determine the prognostic value of oedema measurement in predicting future pressure injury in adults in any care setting. DESIGN Systematic review and meta-analysis. SETTING Participants were recruited from nursing homes or aged care facilities, hospitals, or post-acute facilities. PARTICIPANTS Adults. METHODS A modified 2-week systematic review was undertaken. Study designs included cohort (prospective and retrospective), case-control, case series if relevant comparisons were reported, randomised controlled trials if the association between oedema measurement and pressure injury was reported, and registry data. Databases searched included: Medical Literature Analysis and Retrieval System Online, The Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica and the Cochrane Library from inception to 13 July 2021 with no language restrictions. Screening, data extraction using Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies - Prognostic Factors (CHARMS-PF) and quality assessment using Quality in Prognostic Factor Studies (QUIPS) were undertaken independently by ≥2 authors and adjudicated by another if required. Meta-analyses and meta-regression were undertaken. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Six studies (n = 483 total) were included. Two studies were set in nursing homes and four in either hospitals or post-acute facilities. Fives studies were prospective cohorts, and one was a randomised control trial. Two studies were assessed as low risk and four studies as moderate risk of bias. The pooled risk ratio in four studies (n = 388) for the relationship between oedema and pressure injury cumulative incidence was 18.87 (95% CI 2.13-38.29) and for time to pressure injury was 4.08 days (95% CI 1.64-6.52). Using GRADE, the certainty of the body of evidence was low for all outcomes. Meta-regression indicated that age, gender, and sample size were poor predictors for the association between oedema and pressure injury. CONCLUSIONS Measuring oedema as a predictor for pressure injury development is showing promise but a stronger body of evidence that takes into consideration other prognostic factors is needed to better understand its benefit. REGISTRATION PROSPERO CRD42021267834. TWEETABLE ABSTRACT Measuring oedema is a promising strategy to prevent pressure injuries but the certainty of evidence for this claim is low.
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Affiliation(s)
- Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia.
| | - Fiona Coyer
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Emma Harbeck
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia
| | - Lukman Thalib
- Department of Biostatistics Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Sharon Latimer
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, Australia; St Vincent's Hospital Melbourne, Australia; Australian Catholic University, Melbourne, Australia.
| | - Georgia Tobiano
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia; Gold Coast University Hospital, Gold Coast, Australia.
| | - Bronwyn R Griffin
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia.
| | - Jill L Campbell
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia.
| | - Rachel Walker
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia; The Princess Alexandra Hospital, Brisbane, Australia.
| | - Joan J Carlini
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia; Griffith Business School, Griffith University, Gold Coast, Australia.
| | - Ishtar Lockwood
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Brigid M Gillespie
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Griffith University, Building G01, Gold Coast, Queensland 4222, Australia; Gold Coast University Hospital, Gold Coast, Australia.
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14
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Lustig M, Schwartz D, Bryant R, Gefen A. A machine learning algorithm for early detection of heel deep tissue injuries based on a daily history of sub-epidermal moisture measurements. Int Wound J 2022; 19:1339-1348. [PMID: 35019208 PMCID: PMC9493225 DOI: 10.1111/iwj.13728] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/21/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022] Open
Abstract
Sub‐epidermal moisture is an established biophysical marker of pressure ulcer formation based on biocapacitance changes in affected soft tissues, which has been shown to facilitate early detection of these injuries. Artificial intelligence shows great promise in wound prevention and care, including in automated analyses of quantitative measures of tissue health such as sub‐epidermal moisture readings acquired over time for effective, patient‐specific, and anatomical‐site‐specific pressure ulcer prophylaxis. Here, we developed a novel machine learning algorithm for early detection of heel deep tissue injuries, which was trained using a database comprising six consecutive daily sub‐epidermal moisture measurements recorded from 173 patients in acute and post‐acute care settings. This algorithm was able to achieve strong predictive power in forecasting heel deep tissue injury events the next day, with sensitivity and specificity of 77% and 80%, respectively, revealing the clinical potential of artificial intelligence‐powered technology for hospital‐acquired pressure ulcer prevention. The current work forms the scientific basis for clinical implementation of machine learning algorithms that provide effective, early, and anatomy‐specific preventive interventions to minimise the occurrence of hospital‐acquired pressure ulcers based on routine tissue health status measurements.
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Affiliation(s)
- Maayan Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Schwartz
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Bryant
- Principal Research Scientist/Nursing and President, Association for the Advancement of Wound Care (AAWC), Abbott Northwestern Hospital, part of Allina Health, Minneapolis, MN, USA
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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15
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Raine G. Is it time to re-evaluate the inevitability of ulcers at the end of life? Int J Palliat Nurs 2021; 27:440-448. [PMID: 34846932 DOI: 10.12968/ijpn.2021.27.9.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevention of pressure injuries/ulcers (PI/PUs) in patients at the end of life is achievable, albeit challenging. Objective diagnostic tools, such as sub-epidermal moisture (SEM) scanning, support healthcare practitioners' clinical judgment in preventing PI/PUs. AIM A pragmatic study was conducted to assess the feasibility of preventing PI/PUs using SEM technology as an adjunct to routine care in a 22-bed inpatient hospice. METHODS Daily SEM scanning was introduced to support the device-trained practitioners' clinical judgment in detecting developing, non-visible PI/PUs. Preventive interventions were initiated by clinical judgment informed by Waterlow scores, visible, tactile skin and tissue assessments and scanner readings. RESULTS Prior to the study, the incidence of PI/PUs was 9%. The 6 month study period reported a 4.8% PI/PU incidence, 7/146 consenting patients developed a PI/PU, resulting in a 47% reduction in incidence rates. CONCLUSION Preventing the development of PI/PUs is possible with clinical judgment aided by SEM data.
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Affiliation(s)
- Gillian Raine
- Lead Nurse, Marie Curie Hospice, Newcastle upon Tyne, UK
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16
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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: 19] [Impact Index Per Article: 6.3] [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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17
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Nightingale P, Musa L. Evaluating the impact on hospital acquired pressure injury/ulcer incidence in a United Kingdom NHS Acute Trust from use of sub-epidermal scanning technology. J Clin Nurs 2021; 30:2708-2717. [PMID: 34245066 DOI: 10.1111/jocn.15779] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of pressure injury/ulcers is persistent despite multiple prevention strategies in hospitals across the globe. Current standard of pressure injury/ulcer care supported by subjective skin tissue assessments, risk assessment tools and clinical judgement is ineffective in consistent pressure injury/ulcer prevention. AIM A pragmatic study, aligning with SQUIRE guidelines, was conducted at Chelsea and Westminster hospitals to measure the impact of adding scanning technology to the prevailing standard of care pathway on the incidence of category 2-4 hospital-acquired pressure injury/ulcers. METHODS Six hundred and ninety-seven mixed-population patients at risk for pressure injuries/ulcers with a Waterlow score of ≥10 and a mean age ≥65 years were enrolled across four wards over a 6-month period. Scanning technology was added to the prevailing standard of care as a device adjunctive to clinical judgement for the detection of deep and early-stage pressure-induced tissue damage. Ward staff completed comprehensive device training by the device manufacturer. Clinical interventions were initiated by clinical judgement informed by injury/ulcer risk assessments, skin and tissue assessments and scanner readings. Incidence of reportable category 2-4 pressure injuries/ulcers from the prior 12-month period from the same wards were used as a control comparator population. All diagnosed category 2-4 pressure injuries/ulcers, unstageable and deep-tissue injuries were recorded. RESULTS Prior study 12-month pressure injury/ulcer incidence was 0.6% (5/892 patients) in ward A, 4.4% (9/206 patients) in Ward B, 1.1% (12/1,123 patients) in Ward C and 2.6% (16/625 patients) in Ward D. Two pressure injury/ulcers in Ward B were recorded during the study. Zero pressure injuries/ulcers were recorded in the remaining three wards resulting in an 81% incidence reduction across all four wards. Improved clinical decisions from clinical judgement based on Sub-Epidermal Moisture (SEM) Scanner data were reported in 83% patients (n=578/697). CONCLUSION Implementing scanning technology into routine clinical practice achieves consistent reductions in pressure injury/ulcer incidence.
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Affiliation(s)
| | - Louisa Musa
- Chelsea and Westminster Hospital, London, UK
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18
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Musa L, Ore N, Raine G, Smith G. Clinical impact of a sub-epidermal moisture scanner: what is the real-world use? J Wound Care 2021; 30:198-208. [PMID: 33729842 DOI: 10.12968/jowc.2021.30.3.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The presence of sub-epidermal moisture (SEM) over a bony prominence is indicative of incipient pressure ulcer (pressure injury/decubitus/bedsore) (PU). Early identification of patients at increased risk of PU can prompt interventions that reduce the incidence and severity of hospital (or community)-acquired PUs (HAPUs). This study evaluated the clinical utility of a SEM Scanner device in HAPU management. METHOD The study used a pragmatic 'real-world' approach. HAPU data before and during SEM Scanner use were obtained through routine audit. Patients had regular visual and daily SEM Scanner skin assessments over the sacrum and heels. Nursing care otherwise followed standard of care according to the established protocols of individual participating sites. HAPU incidence rates were determined and feedback gathered from health professionals on how the device influenced HAPU-related clinical decision-making. RESULTS There were 15 participating sites: 13 acute care, one palliative care and one community care setting. The sample size was 1478 patients. All sites reported a substantial reduction in mean HAPU incidence: 87.2% in acute care settings; 46.7% in the palliative care setting and 26.7% in the community care setting. A 100% incidence reduction was reported in 10 (66.7%) sites. In the palliative care setting, SEM Scanner results changed HAPU-related clinical decision-making for 40% of patients scanned. The community care site demonstrated a 82% change in clinical decision-making. CONCLUSION In this study, SEM analysis fitted seamlessly into routine skin assessment and enabled early identification of increased risk of tissue damage, with clinically important reductions in the incidence of HAPU across all participating sites.
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Affiliation(s)
- Louisa Musa
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | - Nicky Ore
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | | | - Glenn Smith
- St. Helens Medical Centre, Isle of Wight, UK
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