Risk assessment for perioperative pressure injuries

The correlation between sub-epidermal moisture measurement and other early indicators of pressure ulcer development-A prospective cohort observational study. Part 1. The correlation between sub-epidermal moisture measurement and ultrasound

The correlation between sub-epidermal moisture (SEM) and other early indicators of pressure ulcer (PU) development is yet to be determined. This three-part series aims to bridge this knowledge gap, through investigating SEM and its correlation with evidence-based technologies and assessments. This article focuses on the correlation between SEM and ultrasound. A prospective cohort observational study was undertaken between February and November 2021. Patients undergoing three surgery types were consecutively enrolled to the study following informed consent. Assessments were performed prior to and following surgery for 3 days at the sacrum, both heels and a control site, using a SEM scanner and high-frequency ultrasound scanner (5-15 MHz). Spearman's rank (rs ) explored the correlation between SEM and ultrasound. A total of 60 participants were included; 50% were male with a mean age of 58 years (±13.46). A statistically significant low to moderately positive correlation was observed between SEM and ultrasound across all anatomical sites (rs range = 0.39-0.54, p < 0.05). The only exception was a correlation between SEM and ultrasound on day 0 at the right heel (rs  = 0.23, p = 0.09). These results indicate that SEM and ultrasound agreed in the presence of injury; however, SEM was able to identify abnormalities before ultrasound.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Assessment of the risk factors for intraoperative pressure injuries in patients

AIM

This study was conducted to assess the risk factors for pressure injuries in patients during surgery.

METHODS

In this descriptive cross-sectional study, the risk of pressure injuries during surgery was evaluated in 250 patients in a university hospital. Data were collected through a Patient Descriptive Information Form (PDIF) and the 3S Intraoperative Pressure Injury Risk Assessment Scale (IPIRAS).

RESULTS

The mean age of the patients was 44.15 ± 17.00, and 52.4% were female. In addition, it was determined that the mean 3S IPIRAS score was higher in patients who were male, were aged ≥60 years, were obese, had a chronic disease, and had low serum albumin and hemoglobin levels (p < .05). During the surgery of the patients included in the study, support surfaces were used in 67.6%, positioning aids were used in 82.4%, and 55.6% had normal skin. Patients who underwent CVS procedures for more than 6 h, did not use support surfaces during surgery, had moist skin, or used vasopressors had higher and significantly different mean 3S IPIRAS scores (p < .05).

CONCLUSIONS

According to the results, all surgical patients were at risk for pressure injury in the intraoperative period. In addition, it was found that male gender was associated with risk factors and that being aged ≥60 years, obesity, chronic disease, low serum hemoglobin and albumin levels, CVS, operations lasting more than 6 h, moist skin, vasopressor drugs, and not using support surfaces during surgery increased the risk of pressure injuries significantly.

Retrospective evaluation of the effectiveness of using two different products in preventing the development of pressure injuries in patients undergoing lung lobectomy

AIM

This retrospective study aims to determine the impacts of two different products (barrier cream, barrier spray) routinely used before surgery on the development of postoperative pressure injuries in patients undergoing lung lobectomy.

MATERIALS AND METHODS

In the study, the researchers retrospectively examined the data of 60 patients who underwent lobectomy in a university hospital's thoracic surgery clinic between 12.02.2021 and 14.02.2022. The patients were divided into two groups: those to whom a barrier cream was applied (30) and those to whom a barrier spray was applied. The Patient Description Form and the Braden Risk Assessment Tool were used in data collection. The Mann-Whitney U and Kruskal-Wallis tests were conducted for statistical analyses.

RESULTS

In the study, the development rates of blanchable erythema and stage I pressure injuries in the sacral and dorsal regions were significantly higher in patients to whom a barrier spray was applied than in patients to whom a barrier cream was applied (p < 0.05). Pain intensity in the sacral and dorsal regions was significantly lower in patients to whom a barrier cream was applied than those to whom a barrier spray was applied (p < 0.05).

CONCLUSION

Blanchable erythema and intraoperative pressure injury were observed less in patients in whom a barrier cream was used before surgery. Surgical nurses should first evaluate the risk in the preoperative period in the clinics and benefit from the use of barrier cream to prevent the development of blanchable erythema and intraoperative pressure injury.

Determining the Risk of Intraoperative Pressure Injury in Patients Undergoing Elective Cranial Surgery

Purpose: Neurosurgical interventions are long and complex, and additional difficulties are encountered in positioning in the operating room.The aim of the study is to determine the risk of pressure injury development in the intraoperative period of patients undergoing elective cranial surgery. Methods: This descriptive cross-sectional study was conducted with 127 patients who met the inclusion criteria and underwent elective cranial surgery in a city hospital between September and October 2021. 3S Operating Room Pressure Injury Risk Diagnostic Scale were used to collect data. Results: It was determined that 55.1% of the patients were female, their mean age was 53.22±13.47 years, and 61.4% had at least one chronic disease. It was determined that 71.7% of the patients were operated with the diagnosis of cerebellar tumor. Stage 1 pressure ulcers were observed in 37% of the patients. It was determined that the total score obtained from the scale was 14.87±2.83 and the patients were at low risk for pressure injury. Age, body mass index and duration of the surgical procedure were found to be independent factors affecting the patients' operating room pressure ulcer risk assessment scale score. Conclusion:It was determined that the risk of pressure injury in patients who underwent cranial surgery was low level.

Magnitude of position-related soft tissue injuries and associated factors among elective adult surgical patients at Tikur anbessa specialized hospital, Addis ababa, Ethiopia

Background

Position-related soft tissue injuries are the cause of additional suffering for surgical patients, and increase treatment costs. Though its prevalence is underreported, its consequences range from acute mild injuries to lifelong disabilities.

Objective

To assess magnitude and associated factors of position-related soft tissue injuries among elective adult surgical patients at Tikur Anbessa Specialized Hospital, Addis Ababa.

Method

An institutional-based cross-sectional study design was conducted among 292 elective adult surgical patients at Tikur Anbesa specialized hospital from January 1, 2021, to May 30, 2021. A systematic random sampling technique was used and data was collected by pre-tested questionnaire through data retrieval from chart and patients observation in the post anesthesia care unit. Both bi-variable and multi-variable logistic regression analysis were done to evaluate the association between dependent and independent variables. The level of statistical significance was decided at p-value less than 0.05.

Results

The magnitude of position-related soft tissue injuries in our study was 9.6%. The lower Body Mass Index AOR = 6.12; 95%CI: (1.02–16.3), surgical duration more than 4 h AOR = 5.04; 95%CI:(1.19–21.2) and lateral position AOR = 8.01; 95% CI: (1.2–30.5) were found to be independently associated with position related soft tissue injury.

Conclusion

Our study found that the magnitude of position-related soft tissue injury was high. Surgical teams must develop the local protocol or adopt protocol to prevent the position-related soft tissue injury and factors associated should be identified a head of surgery.

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Magnitude of position-related soft tissue injury assessed at immediate post -operative period was 9.6% in this study.

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The BMI <18.5, surgical duration >4 h, prone and lateral positions were independently associated with development of position related soft tissue injury.

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Those patients should be identified before surgery and all necessary precaution should be taken.

Nurses' conceptions regarding patient safety during surgical positioning

OBJECTIVE

To know the conceptions regarding patient safety during their surgical positioning from the perspective of nurses in a Surgical Center.

METHOD

Qualitative descriptive exploratory study, with seven nurses from private hospital in southern Brazil in August 2018. Data generation using the Focus Group technique, with content analysis by Bardin.

RESULTS

From the data analysis, six categories emerged: "patient safety", "surgical patient risks", "nurses in the operating room", "training", "involvement of the interprofessional" team and application of the risk assessment scale. The development of injuries resulting from positioning was identified as the greatest risk for the surgical patient, highlighting the presence of the nurse in the operating room as essential for the prevention of this risk, through patient assessment and staff training.

FINAL CONSIDERATIONS

Nurses identified risk to patient safety in relation to surgical positioning and considered they presence in the operating room to be indispensable.

Pressure injuries in surgical patients: a comparison of Norton, Braden and Waterlow risk assessment scales

OBJECTIVE

This study aims to determine the predictive power of the Norton, Braden and Waterlow scales in determining risk of pressure injury (PI) in surgical patients.

METHOD

This prospective study was carried out in the surgery clinic of a training and research hospital in Istanbul, Turkey between January and April 2017. The study sample consisted of adult patients aged ≥18 years and who did not have PI on admission to the clinic, had abdominal surgery under general anaesthesia and who stayed in the clinic for at least 48 hours. The data were collected using the Turkish versions of the Norton, Braden and Waterlow risk assessment scales. The predictive validity of PI risk assessment tools was assessed based on their sensitivity, specificity, positive and negative predictive values and the area under the receiver operating characteristic (ROC) curve. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals (CI).

RESULTS

The study sample included 250 patients, and the incidence of PI was 12%. The sensitivity, specificity, positive predictive value and negative predictive value were: 83.3%, 45.4%, 17.2% and 95.2%, respectively, for the Norton scale (a cut-off point of 14); 100%, 40.4%, 18.6% and 100%, respectively, for the Braden scale (a cut-off point of 16); and 100%, 48.1%, 20.8% and 100%, respectively, for the Waterlow scale (a cut-off point of 10). The areas under the ROC curve were 0.749 for the Norton, 0.771 for the Braden and 0.971 for the Waterlow scales. This study's findings produced the following predictive capacity indicators: Norton (RR=3.62; 95%CI=1.43-9.14), Braden (RR=33.88; 95%CI=2.09-547.66); and Waterlow (RR=45.01; 95%CI=2.78-727.97).

CONCLUSION

In this study, the Waterlow scale demonstrated the best values of predictive validity among the three scales in the assessment of PI risk. However, all three scales had low specificity despite high sensitivity in terms of a good risk prediction. No definitive decision could be reached on the predictive capacities of the scales because of wide CIs.

Pressure Injury Risk Assessment and the Use of Intraoperative Polyurethane Foams to Prevent the Pressure Injuries

BACKGROUND: Patients undergoing surgery are at risk of developing pressure sores up to 72 h after surgery. The incidence of pressure injury can affect patient outcomes and quality of care. Pressure injuries have many risk factors and causes. The Munro Pressure Ulcer Risk Assessment Scale for Perioperative Patients was used to assess risk factors for developing a pressure injury. One of the interventions to prevent pressure injuries during and after surgery is polyurethane foams. AIM: The study aimed to describe the risk of pre-operative pressure injury, the use of intraoperative polyurethane foams, and the incidence of post-operative pressure injury in a private hospital in western Indonesia. METHODS: A cross-sectional quantitative descriptive study was conducted among 81 patients undergoing surgery using purposive sampling. The pre-operative risk assessment was conducted with the Munro scale for the pre-operative phase. The use of polyurethane foams during surgery and pressure injury incidence was observed. RESULTS: The results showed that 62 (76.5%) respondents were at moderate risk for pressure injury. 42 (51.9%) respondents used polyurethane foams in the intraoperative phase. Based on observation 72 h postoperatively, there was no pressure injury incidence. CONCLUSION: Pressure injuries can be prevented by identifying risk factors before the surgery. Nurses and surgeons need to be aware of the risk of pressure ulcers in the pre-, inter-, and post-operative phases. The use of polyurethane foams during surgery can be considered an intervention to prevent pressure injury.

Concepções das enfermeiras em relação a segurança do paciente durante o posicionamento cirúrgico

RESUMO Objetivo: Conhecer as concepções em relação à segurança do paciente durante seu posicionamento cirúrgico sob a ótica das enfermeiras de um Centro Cirúrgico. Método: Estudo exploratório descritivo qualitativo, com sete enfermeiras de hospital privado da região sul do Brasil, no mês de agosto de 2018. Geração de dados pela técnica de Grupo Focal, com análise de conteúdo de Bardin. Resultados: Da análise dos dados emergiram seis categorias: “segurança do paciente”, “riscos do paciente cirúrgico”, “enfermeiro em sala cirúrgica”, “capacitação”, “envolvimento da equipe interprofissional” e “implementação da escala de avaliação de risco”. Identificou-se como maior risco o desenvolvimento de lesões decorrentes do posicionamento, sendo a presença do enfermeiro em sala cirúrgica destacada como fundamental para prevenção deste risco, através da avaliação do paciente e capacitação da equipe. Considerações finais: As enfermeiras identificaram riscos à segurança do paciente em relação ao posicionamento cirúrgico, considerando indispensável a presença dos mesmos em sala cirúrgica.

Process modeling: technological innovation to control the risk for perioperative positioning injury

OBJECTIVES

to report the construction of a process model to support the decision making of operating room nurses to control the risk for perioperative positioning injury.

METHODS

experience report on a process model that helps nurses with decision making regarding clients at risk for perioperative positioning injury. By following the steps, it was possible to identify intrinsic and extrinsic variables of the literature and of the workflows of teams involved in the positioning of the client for surgery. The Business Process Model and Notation, the Bizagi Modeler software and terms from the International Classification for Nursing Practice were used in the model.

RESULTS

the experience allowed the observation of the knowledge integration between different areas, which enabled the process modeling and its validation.

CONCLUSIONS

process modeling is an innovative option for the development of support systems for clinical nursing decisions.

Association of overweight and obesity with the prevalence and incidence of pressure ulcers: A systematic review and meta-analysis

BACKGROUND & AIM

Pressure ulcers challenge the health status, complicate medical conditions, and affect quality of life. The aim of this systematic review and meta-analysis was to investigate the role of obesity and body weight status, as potentially modifiable risk factors, in the incidence and prevalence of pressure ulcers.

METHODS

A systematic search of observational studies was performed to assess documents published between January 1990 and December 2019 in PubMed and Scopus. Finally, 17 articles with total sample size of 2228724 in the prevalence and 218178 in the incidence study were included in the meta-analysis.

RESULTS

The pooled data analysis showed no significant effect of obesity on odds of pressure ulcers' prevalence (OR 0.91, 95% CI 0.65 to 1.27, P = 0.579, I² = 84.8%) or incidence (OR 0.97, 95% CI 0.56 to 1.66, P = 0.905, I² = 89.8%) compared with non-obese individuals. Overweight was associated with significantly lower odds of prevalence of pressure ulcers compared to non-overweight individuals (OR 0.54, 95% CI 0.33 to 0.88, P = 0.014, I² = 90.2%). The subgroup analyses showed significantly higher odds of prevalence (OR 2.38, 95% CI 1.72 to 3.29, P < 0.001, I² = 63.4%) and incidence (OR 2.28, 95% CI 1.77 to 2.94, P < 0.001, I² = 27.9%) of pressure ulcers in the underweight compared to normal weight groups. Pooled data analyses showed significantly lower odds of prevalence (OR 0.6, 95% CI 0.37 to 0.96, P = 0.034, I² = 82%) and incidence (OR 0.72, 95% CI 0.53 to 0.98, P = 0.039, I² = 67.1%) of pressure ulcers in the overweight than normal weight individuals. The findings showed no significant differences in the odds of prevalence or incidence of pressure ulcers in the obese and morbidly obese compared to normal weight individuals.

CONCLUSION

This systematic review and meta-analysis showed no significant effect of obesity or morbid obesity on the odds of pressure ulcers. Additionally, overweight was associated with lower odds of pressure ulcers while underweight significantly increased the odds of pressure injuries.

Risk Factors for Facial Pressure Ulcers in Patients Who Underwent Prolonged Prone Orthopedic Spine Surgery

MINI

This study evaluated incidence and risk factors associated with the development of facial pressure ulcers (FPU) in patients who underwent spine surgery in prone position. A total of 300 cases were studied. The incidence of FPU after prone spine surgery using head padded device >3 hours was 27.3%. Hypotension, higher temperature, prolonged operation time, and much crystalloid therapy were the independent risk factors.

An exploratory study of risk factors for pressure injury in patients undergoing spine surgery

Background

Perioperative patients are potentially at risk for pressure injuries due to anesthetic agents and surgical positioning. Pressure injury increases discomfort and pain in patients and causes complications, which lead to an increase in mortality and hospitalization duration. Most previous studies did not focus on specific types of surgery or surgical positioning. We tried to identify the incidence of perioperative pressure injury during spinal surgery and perioperative risk factors that contribute to pressure injury.

Methods

We retrospectively analyzed electronic medical records of 663 patients who underwent spinal surgery between March 2016 and May 2018. The primary outcome was occurrence of pressure injury. Potential risk factors of pressure injury were selected based on previous studies and expert opinion, and divided into two sub-categories: preoperative and intraoperative risk factors. We compared the clinical characteristics of patients in the pressure injury and non-injury groups. Perioperative risk factors for pressure injury were analyzed by logistic regression.

Results

Among 663 patients, the incidence of all stages of pressure injury was 5.9%. The face and inguinal regions were the most injured sites (both 28.6%). The pressure injury group showed a 13% longer hospitalization period. Preoperative plasma concentration of protein was associated with 0.5-fold lower pressure injury (OR: 0.50; 95% CI: 0.27 to 0.95; P = 0.034).

Conclusions

The incidence of pressure injury was similar to that previously reported and occurred in the direct weight-bearing areas, which led to longer hospitalization. We found that a lower preoperative serum protein level is significantly associated with intraoperative pressure injury occurrence during spinal surgery.

Estratégias de enfermagem para prevenção de lesão por pressão em pacientes cirúrgicos

Objetivo: Identificar na literatura as estratégias utilizadas pela equipe de enfermagem para prevenção de lesão por pressão em pacientes cirúrgicos. Métodos: Revisão integrativa, utilizando a estratégia PICo, tendo como questão norteadora: “quais as estratégias utilizadas pela equipe de enfermagem para prevenção de lesão por pressão em pacientes cirúrgicos?” As buscas foram realizadas nas bases de dados Web of Science, MEDLINE via PubMed, CINAHL, Cochrane, Scopus e no índice bibliográfico LILACS via BVS, sendo analisados 12 estudos. Resultados: O Brasil se destacou com quatro publicações e os estudos de coorte, com nível de evidência IV, prevaleceram em seis artigos. As intervenções tecnológicas para prevenção de lesão por pressão no centro cirúrgico foram colchões para distribuição de pressão, dispositivo para redução de pressão no calcâneo, instrumentos validados específicos para a classificação do risco de lesão por pressão em pacientes cirúrgicos, além de superfícies de apoio contendo polímero viscoelástico e outros utensílios para alívio da pressão decorrente do peso e de dispositivos médicos. Com relação às intervenções educativas, destacaram-se os protocolos, os treinamentos e a simulação realística. Conclusão: Observou-se que essas estratégias reduziram a incidência de lesão por pressão, além de diminuírem os custos e garantirem a satisfação dos pacientes.

Nursing strategies for pressure injury prevention in surgical patients

Objective: To identify in the literature the strategies used by nursing teams to prevent pressure injury in surgical patients. Methods: Integrative review, using the PICo strategy, with the guiding question: “What are the strategies used by the nursing team to prevent pressure injury in surgical patients?” The searches were performed in the Web of Science, MEDLINE via PubMed, CINAHL, Cochrane, Scopus and LILACS bibliographic index via VHL, from where 12 studies were analyzed. Results: Brazil stood out with four publications and cohort studies, with level of evidence IV, prevailed in six articles. Technological interventions for the prevention of Pressure Injury in the operating room were pressure distribution mattresses, a device to reduce pressure on the calcaneus, specific validated instruments for the classification of the risk of Pressure Injury in surgical patients, in addition to support surfaces containing polymer viscoelastic and other tools to relieve pressure from weight and medical devices. Regarding educational interventions, protocols, training and realistic simulation stood out. Conclusion: It was observed that these strategies reduced the incidence of pressure injury, in addition to reducing costs and ensuring patient satisfaction.

Risk for surgical positioning injuries: scale validation in a rehabilitation hospital

OBJECTIVE

to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital.

METHOD

analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics.

RESULTS

most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries.

CONCLUSION

the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.