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Neill S, Martin D. Nursing care bundles in the prevention of medical device related pressure ulcers: An integrative review. J Tissue Viability 2024; 33:376-386. [PMID: 38641481 DOI: 10.1016/j.jtv.2024.04.003] [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: 02/25/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
The aim of this integrative review was to explore the effect of care bundles in the prevention of Medical Device Related Pressure Ulcers (MDRPU). An MDRPU is a wound that occurs on the skin or mucosal membranes because of pressure or pressure in combination with shear. Like other types of pressure ulcers, they will have negative consequences for patients and healthcare organisations alike. Many MDRPU's are preventable. A literature search was undertaken from computerised databases using key search terms, Pressure Ulcer* Pressure Injur* and Medical Device*. Databases included CINAHL; Medline and SocIndex. A total of seven studies were found that met the criteria for inclusion in this review. When compared to the widely recognised and trusted international guidelines there was variation found between the individual interventions selected within each study for inclusion within the bundle. Skin assessment and device repositioning were the most frequently included interventions in the bundles, followed by use of prophylactic dressings, appropriate device selection and fitting. The least common intervention was monitoring the tension of the device and/or its securements. All studies reported a reduction in the number of MDRPU's when care bundles were used in clinical practice. However, there is variation in bundle designs and study methodologies employed. This review has demonstrated the potential benefit of care bundles in reducing MDRPU. However, due to heterogeneity in the study methods employed and the interventions within the care bundles, further, more robust research is required to establish which interventions show the most clinical and patient benefit.
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Affiliation(s)
- Sharon Neill
- School of Nursing and Paramedic Science, Ulster University, Northern Ireland.
| | - Daphne Martin
- School of Nursing and Midwifery, Queens University Belfast, Northern Ireland.
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Lee H, Choi S. Protocols and their effects for medical device-related pressure injury prevention among critically ill patients: a systematic review. BMC Nurs 2024; 23:403. [PMID: 38886734 PMCID: PMC11181566 DOI: 10.1186/s12912-024-02080-y] [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: 05/19/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND A pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related to medical devices. Medical device-related pressure injuries occur in various sites and are difficult to detect. Even if it is detected, medical devices are essential to life for critically ill patients. Thus, it is difficult to remove or change the position of the medical device; therefore, prevention is essential. This study aims to integrate the literature on medical device-related pressure injury prevention protocols among critically ill patients. METHODS The literature inclusion criteria were (1) critically ill patients, (2) device-related pressure injury interventions, (3) randomized controlled trials and quasi-experimental designs, and (4) written in Korean or English. The literature search and selection were performed following the Cochrane Handbook for Systematic Reviews of Interventions with the support of the PRISMA Guidelines. RESULTS Twelve articles were finally selected. The incidence of medical device-related pressure injury decreased from 8.1-96.7% before intervention to 0.3-53.3% after intervention, respectively. Medical device-related pressure injury prevention was effective in reducing medical device-related pressure injury incidence when applied to patients of all ages, from neonates to adults, in a variety of intensive care units. Medical device-related pressure injury prevention strategies include nurse education, assessment, documentation, and interventions (hygiene, repositioning, emergent therapy such as protective dressing or designed equipment reducing pressure) of pressure injury. Pressure injury dressings primarily included hydrocolloid foam dressings, but transparent hydrocolloid formulations also effectively reduced medical device-related pressure injury incidence rates. CONCLUSIONS In the future, it is necessary to increase the level of evidence by applying specialized medical device-related pressure injury prevention methods for different medical devices and areas of pressure injuries, and verifying their effectiveness. TRIAL REGISTRATION The review protocol was registered (PROSPERO registration number: CRD42022346450).
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Affiliation(s)
- Haeyoung Lee
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-Gu, Seoul, 06974, South Korea
| | - Seunghye Choi
- College of Nursing, Gachon University, 191, Hambangmoe-ro, Yeonsu-gu, Incheon, 21936, South Korea.
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Dirgar E, Gider NY, Tosun B. Determination of Incidence and Risk Factors of Medical Device-Related Pressure Injury in the ICU: A Descriptive Study. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38393711 DOI: 10.1097/asw.0000000000000113] [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
OBJECTIVE To determine the incidence and risk factors of medical device-related pressure injury (MDRPI) in the ICU. METHODS In this descriptive study, the researchers collected data through systematic observation of patients (n = 58) in the ICU. The patients were evaluated within 24 hours of ICU admission and then followed up until they were discharged. A total of 482 patient-days were followed. The researchers used the MDRPI follow-up form, the patient descriptive form, the MDRPI follow-up form, and the Braden Scale for Predicting Pressure Sore Risk for data collection. RESULTS Overall, 39.7% of the 58 patients hospitalized in the ICU developed an MDRPI, and 5.2% of the MDRPIs were evaluated as stage 2. These injuries occurred in an average of 5 days after the patient was admitted to the ICU. Among the MDRPIs that developed, 31.9% were located in the nose, 21.3% in the mouth, and 14.9% on the cheeks. Intubation tubes were used in 7.3% of the patients, nasogastric tubes in 22.4% of the patients, and radial artery catheters in 10.5% of the patients. CONCLUSIONS The development of MDRPI is correlated with the type of medical device used. Providers should establish a planned care protocol based on the anatomic placement of the medical device and take necessary precautions to prevent MDRPI.
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Affiliation(s)
- Ezgi Dirgar
- Ezgi Dirgar, PhD, RN, is Assistant Professor, Department of Midwifery, Faculty of Health Sciences, Gaziantep University, Turkey. Neslihan Yağmur Gider, MSc, RN, is Nurse, Ceyhan State Hospital, Adana, Turkey. Betül Tosun, PhD, RN, is Associate Professor, Department of Nursing, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey. The authors have disclosed no financial relationships related to this article. Submitted April 4, 2023; accepted in revised form July 24, 2023
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Reuvekamp H, Hekman E, van der Heide E, Matthews D. Strategies in surface engineering for the regulation of microclimates in skin-medical product interactions. Heliyon 2024; 10:e25395. [PMID: 38370189 PMCID: PMC10869805 DOI: 10.1016/j.heliyon.2024.e25395] [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: 08/14/2023] [Revised: 10/17/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
There is a growing number of personal healthcare devices that are in prolonged contact with the skin. The functionality of these products is linked to the interface formed by the contact between the medical apparatus and the skin. The interface can be characterised by its topology, compliance, and moisture and thermal regulating capabilities. Many devices are, however, described to have suboptimal and occlusive contacts, resulting in physiological unfavourable microclimates at the interface. The resulting poor management of moisture and temperature can impact the functionality and utility of the device and, in severe cases, lead to physical harm to the user. Being able to control the microclimate is therefore expected to limit medical-device related injuries and prevent associated skin complications. Surface engineering can modify and potentially enhance the regulation of the microclimate factors surrounding the interface between a product's surface and the skin. This review provides an overview of potential engineering solutions considering the needs for, and influences on, regulation of temperature and moisture by considering the skin-medical device interface as a system. These findings serve as a platform for the anticipated progress in the role of surface engineering for skin-device microclimate regulation.
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Affiliation(s)
- H. Reuvekamp
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E.E.G. Hekman
- Biomedical Device Design and Production Lab, Department of Biomechanical Engineering (BE), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E. van der Heide
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - D.T.A. Matthews
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
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Yalçin M, Güneş Ü. A point prevalence study of medical device-associated pressure injuries: A cross-sectional study. J Clin Nurs 2023; 32:7618-7625. [PMID: 37726592 DOI: 10.1111/jocn.16831] [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: 12/08/2022] [Revised: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 09/21/2023]
Abstract
AIM AND OBJECTIVE The aim of this cross-sectional study was to determine the point prevalence and associated risk factors of medical device-related pressure injuries (MDRPI) in intensive care patients in Turkey. BACKGROUND MDRPI remain a clinical problem that has garnered the attention of healthcare professionals. DESIGN This study used a cross-sectional design and was conducted over a single day in all intensive care units. METHOD Data were collected through face-to-face interviews, observation, skin examination and detailed diagnosis of MDRPI development and influencing factors. Presence of pressure injuries on the skin in the areas where the patient's medical device was placed was defined. The study was reported according to the STROBE declaration. RESULTS MDRPI developed in 65 out of 200 patients included in the study (32.5%). The most frequent locations were on the face (71%). The MDRPIs were commonly associated with nasogastric tube (29.2%), endotracheal tube (18.5%) and CPAP mask (15.4%). A significant proportion of these injuries were mucosal (53.8%, n = 35). The majority of the skin pressure injuries were classified as Stage II (18.5%, n = 12). The risk increased 14 times in patients who were hospitalised for 9-16 days and 13 times in those who received mechanical ventilator support. CONCLUSION The study findings suggest that MDRPI developed in approximately one of three patients hospitalised in the intensive care unit, and the length of hospital stay and mechanical ventilator support were important determining risk factors. The high prevalence of MDRPI may indicate inadequate nursing care quality. Therefore, it is recommended that nurses be aware of risk factors and evaluate the suitability and safety of medical devices. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was involved in this study.
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Affiliation(s)
- Melek Yalçin
- Ege University Hospital Chest Clinic, Izmir, Turkey
| | - Ülkü Güneş
- Department of Fundamental of Nursing, Faculty of Nursing, Ege University, Izmir, Turkey
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Medical device-related pressure injury prevention related to fixation of nutritional and derivative probes: a best practice implementation project. JBI Evid Implement 2022; 20:S32-S40. [PMID: 36372791 DOI: 10.1097/xeb.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The main objective was to improve the provision of clinical care in pressure injury prevention related to the use of medical devices focused on nasogastric probes. INTRODUCTION The insertion of nasogastric probes could lead to the formation of medical device-related pressure injuries (MDRPI). The risk increases with the length of the probe insertion and is higher in patients in intensive care. MDRPI prevention is mostly based on appropriate skin and mucosa membrane and tissue monitoring and positioning of the medical devices. METHODS The project has been conducted based on JBI Implementation approach for promoting change in healthcare practice. A baseline audit on MDRPI prevention was undertaken and involved 21 nurses and 12 patients using a questionnaire for nurses and a record sheet for patient's monitoring. The intervention included education, clinical practice training, consultation, and other strategies. A follow-up audit was undertaken, including all original participants. Results data on changes in compliance were measured using descriptive statistics embedded in JBI-PACES in the form of percentage changes from baseline. RESULTS There were significantly improved outcomes across all best practice criteria. The level of knowledge of nurses increased. Skin barrier creams and mass-supplied fixation are now used to prevent skin injuries on the nose. The new monitoring and documentation is more accurate and in line with evidence-based practice. CONCLUSION Overall, the project achieved an improvement in evidence-based practice in the prevention of MDRPI in patients with nasogastric probes based on nurses' increased level of knowledge and usage of appropriate preventative measures.
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Brophy S, Moore Z, Patton D, O'Connor T, Avsar P. What is the incidence of medical device-related pressure injuries in adults within the acute hospital setting? A systematic review. J Tissue Viability 2021; 30:489-498. [PMID: 34272123 DOI: 10.1016/j.jtv.2021.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/04/2020] [Accepted: 03/08/2021] [Indexed: 02/06/2023]
Abstract
Medical devices provide effective therapeutic care for patients. However, medical device-related pressure injuries (MDRPI) are caused by prolonged pressure or shear from a medical device on any location on the body, including mucosal cavities. The primary outcome of this quantitative systematic review was to identify the incidence of MDRPIs in adults within the acute hospital setting. Secondary outcomes include grading, anatomical location and devices that caused such injuries. Electronic databases (CINAHL Plus with Full Text, MEDLINE, EBSCO Host, Health Business Elite Web of Science, PsychINFO, Google Scholar, and Research Gate) were searched for all potential primary studies between November 2019-January 2020. Studies were refined to the English language only, had no time limit from publication, and had to include participants over the age of 18 years with an MDRPI in the acute hospital setting and 720 potential primary studies were identified. Fourteen articles were identified that matched the predefined criteria and were included in the review. All included studies were critically appraised using the evidence-based librarianship critical appraisal tool and data analysis and narrative synthesis were completed. The incidence of MDRPIs in adults within the acute care setting was 28.1% (SD: 29.1%, min: 1.14%, max: 100%). 71.3% of studies documented anatomical locations of MDRPIs, 36.2% included grading of MDRIs, and 71.4% studies documented the offending medical devices. The mean quality appraisal percentage of all included studies was 76.67% (SD: 4.61%; min: 66.6%, max: 83.3%). Despite the heterogeneity of the studies, the review has identified that MDRPIs are prevalent among individuals cared for within the acute hospital setting. Thus, given the morbidity associated with these wounds, it is important to develop strategies to reduce the scope of this problem.
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Affiliation(s)
- Sarah Brophy
- Tissue Viability and Wound Management, General Nursing, Ireland.
| | - Zena Moore
- Royal College of Surgeons in Ireland (RCSI), University of Medicine and Science, Ireland; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Lida Institute, Shanghai, China; University of Wales, United Kingdom; School of Nursing, Fakeeh College, Jeddah, Saudi Arabia
| | - Declan Patton
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Science, Ireland; Faculty of Science, Medicine and Health, University of Wollongong, Australia; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Tom O'Connor
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Science, Ireland; Faculty of Science, Medicine and Health, University of Wollongong, Australia; Monash University, Melbourne, Australia
| | - Pinar Avsar
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Science, Ireland; Skin Wounds and Trauma Research Centre, RCSI, Ireland
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Tayyib N, Asiri MY, Danic S, Sahi SL, Lasafin J, Generale LF, Malubay A, Viloria P, Palmere MG, Parbo AR, Aguilar KE, Licuanan PM, Reyes M. The Effectiveness of the SKINCARE Bundle in Preventing Medical-Device Related Pressure Injuries in Critical Care Units: A Clinical Trial. Adv Skin Wound Care 2021; 34:75-80. [PMID: 33443912 DOI: 10.1097/01.asw.0000725184.13678.80] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of a medical device-related pressure injury (MDRPI) prevention bundle/mnemonic on the incidence of acquired MDRPIs in critically ill patients. METHODS This study used a prospective, single-arm, open-label clinical design and was carried out from January to April 2020 in CCUs in a Saudi Arabian tertiary hospital. All participants received the SKINCARE bundle intervention, which is based on the best available evidence for MDRPI prevention in CCUs. The primary outcome was the development of MDRPI. RESULTS The MDRPI cumulative incidence was significantly lower after the implementation of the SKINCARE bundle (0.89%, 90% lower than historic incidence). CONCLUSIONS The SKINCARE bundle demonstrates significant improvement of skin care through decreased cumulative incidence of acquired MDRPI.
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Affiliation(s)
- Nahla Tayyib
- Nahla Tayyib, PhD, RN, is Assistant Professor, Faculty of Nursing, Umm-AlQura University, Makkah, Saudi Arabia. At the Wound Care-Support Services, Prince Sultan Military Medical City, Riyadh, Mousa Yahya Asiri, MSN, RN, is Head of Wound Care; and Sanja Danic, RN; Sharmaine L. Sahi, RN; Joem Lasafin, RN; Leah Flor Generale, RN; Ana Malubay, RN; Peter Viloria, RN; Marie Grace Palmere, RN; Angelica Rose Parbo, RN; Kethleen Eingie Aguilar, RN; Patty Mae Licuanan, RN; and Marinette Reyes, RN, are Wound Care Nurses. The authors have disclosed no financial relationships related to this article. Submitted July 15, 2020; accepted in revised form October 16, 2020
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Al Mutair A, Ambani Z, Al Obaidan F, Al Salman K, Alhassan H, Al Mutairi A. The effectiveness of pressure ulcer prevention programme: A comparative study. Int Wound J 2020; 17:214-219. [PMID: 31696665 PMCID: PMC7948995 DOI: 10.1111/iwj.13259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/04/2019] [Accepted: 10/17/2019] [Indexed: 12/01/2022] Open
Abstract
Hospital-acquired pressure ulcers (HAPUs) affect patients during hospitalisation, putting patients at risk for further complications. HAPU is one of the hospital quality indicators that require quality initiatives or programmes to minimise its occurrence and consequences. The aim of this study was to assess the effectiveness of a developed quality improvement programme in preventing HAPUs. This is a retrospective comparative study, which tracked the outcomes of pressure ulcer prevention programme (PUPP) for 5 years from 2014 to 2018. Data from 50 441 patients were collected from different units in a tertiary hospital in the eastern region of Saudi Arabia. The programme focused on building a wound care team; providing education to hospital staff, patients, and their families; and continuous data monitoring, in addition to follow-up visits after discharge. Implementation of the programme was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The PUPP was effective in reducing the percentage of pressure ulcer cases. The programme can be extended and implemented in other hospitals.
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Affiliation(s)
- Abbas Al Mutair
- Research CenterDr Sulaiman Al Habib Medical GroupRiyadhSaudi Arabia
- School of NursingWollongong UniversityAustralia
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
| | - Zainab Ambani
- College of NursingKing Saud bin Abdulaziz University for Health SciencesAl AhsaSaudi Arabia
| | | | - Khulud Al Salman
- Nursing DepartmentAl Jaber Hospital for eye, Ear, Nose and Throat, Ministry of HealthSaudi Arabia
| | | | - Alya Al Mutairi
- Faculty of Science, Department of MathematicsTaibah UniversitySaudi Arabia
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