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Jia YJ, Yu HR, Hu FH, Tang W, Zhang WQ, Ge MW, Shen LT, Du W, Cai B, Xu H, Xia XP, Chen HL. Body mass index and pressure injuries risk in hospitalized adult patients: A dose-response analysis. J Tissue Viability 2024; 33:405-411. [PMID: 38886143 DOI: 10.1016/j.jtv.2024.06.006] [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: 01/31/2024] [Revised: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The association between underweight and pressure injuries (PIs) has been established in several studies. However, there is a lack of well-designed research investigating the connection between overweight and obesity with these injuries. OBJECTIVE This meta-analysis aims to investigate the dose-response relationship between body mass index (BMI) and the risk of PIs in adult hospitalized patients. METHODS PubMed, Web of Science, and MEDLINE Databases were searched from inception to May 2024. Observational articles with at least three BMI categories were included in the study. BMI was defined as underweight, normal weight, overweight, and morbid obesity for the meta-analysis. The non-linear relationship between BMI and the risk of PIs in hospitalized adults was investigated using restricted cubic spline models. Fractional polynomial modeling was used. RESULTS Eleven articles reporting at least 3 categories of BMI met the inclusion criteria, including 31,389 participants. Compared to patients with normal weight, those with underweight, obesity, and morbid obesity exhibited an increased risk of PIs, with odds ratios of 1.70 (95%CI:1.50-1.91), 1.12 (95%CI:1.02-1.24), 1.70 (95%CI:1.13-2.55), respectively. A J-shaped dose-response model was established for the relationship between PI risk and BMI (Pnon-linearity < 0.001, Plinearity = 0.745). CONCLUSION The J-shaped dose-response pattern revealed that underweight, obesity and morbid obesity heightened the risk of PIs in hospitalized adults. Lower and higher BMI values may signify an increased risk for PIs, particularly among the elderly with lower BMI, providing valuable guidance for medical staff.
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Affiliation(s)
- Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Hai-Rong Yu
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Bo Cai
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Hong Xu
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Xiao-Peng Xia
- Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, PR China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China.
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Kebapci A, Tilki R. The effect of vasopressor agents on pressure injury development in intensive care patients. Intensive Crit Care Nurs 2024; 83:103630. [PMID: 38479195 DOI: 10.1016/j.iccn.2024.103630] [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: 09/28/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Vasopressors are life-saving agents that increase mean arterial pressure. The pharmacodynamic features of these agents and previous studies suggest that vasopressors may be an essential risk factor in developing pressure injuries. OBJECTIVE This study aimed to examine the effect of vasopressors in medical-surgical intensive care patients on pressure injury development. DESIGN AND SETTINGS This retrospective and correlational study was conducted between March 2021- May 2022. The electronic patient data were obtained from 148 surgical and medical patients exposed to vasopressor agents in the intensive care unit. Data on patients' demographic and clinical characteristics were evaluated using descriptive statistical methods (number, percentage, mean, standard deviation). Logistic regression modelling was used to assess independent relationships with pressure injury risk; results are reported as odds ratios (OR) and 95% confidence intervals (CI). RESULTS All patients were given norepinephrine agents, and dopamine infusion secondary to norepinephrine was found in only 28.3 % of patients (n = 42). Pressure injury incidence was 43.2 % (n = 64). Duration of norepinephrine infusion was recognized as an independent risk factor for ICU-acquired pressure injury development (OR 1.22, 95 % CI 1.11-1.35), while a medical admission diagnosis (instead of surgical) was protective against pressure injury risk (OR 0.24, 95 % CI 0.10-0.59). CONCLUSION This study indicated that duration of norepinephrine infusion is a significant risk factor for pressure injury development. IMPLICATIONS FOR CLINICAL PRACTICE Although norepinephrine use cannot be avoided entirely, its administration may be an early warning for nurses to increase pressure injury prevention strategies. Skin evaluation should be performed more frequently, and preventive strategies should be implemented meticulously. This study was registered on clincialtrials.gov (Identifier: NCT06163352).
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Affiliation(s)
- Ayda Kebapci
- Koç University School of Nursing, Koç University Hospital, Davutpaşa Cad. No: 4, Topkapı, Istanbul, Türkiye.
| | - Ruhat Tilki
- Koç University School of Health Sciences, Davutpaşa Cad. No: 4 Koç Üniversitesi Hastanesi, Topkapı, Istanbul, Turkey
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Munro CA, Jiang YH. Validity and Reliability Evidence of the Munro Scale for Perioperative Patients Part II: Construct Validity. J Nurs Meas 2024; 32:216-226. [PMID: 37348882 DOI: 10.1891/jnm-2022-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background and Purpose: The Munro Pressure Injury Risk Assessment Scale for Perioperative Patients (Munro Scale) is the first three-phase risk instrument designed specifically for perioperative patients. The purpose of this study was to establish validity and reliability evidence for the Munro Scale. This study also had a goal to reduce the data into more manageable constructs with fewer items. Methods: Exploratory and confirmatory factor analyses were used to test the hypothesized model for risk assessment using the Munro Scale to identify latent variables. A retrospective review of charts from 630 risk assessments was analyzed from two community acute care hospital settings. Results: The model explained 95% of the variance in the cumulative final risk level, R2 = .95, F(20, 588) = 501.88, p < .001. Six latent variables emerged in the model with a cumulative contribution rate of 56% of the variance. Similar results were obtained in studies with Chinese and Turkish translations of the Munro Scale. Conclusions: The validity and reliability evidence obtained in this study supports the implementation of the Munro Scale for clinical practice in the perioperative setting.
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Affiliation(s)
- Cassendra A Munro
- Stanford Health Care, Palo Alto, California, USA
- Munro Consulting, San Francisco, California, USA
| | - Ying Hong Jiang
- Program in Educational Leadership of School of Education, Azusa Pacific University, Azusa, California, USA
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Peng X, Xiao Y, He J. Risk Factors of Intraoperative Pressure Injury in Adult Patients Undergoing Neurologic Surgery. Adv Skin Wound Care 2024; 37:238-242. [PMID: 38648236 DOI: 10.1097/asw.0000000000000130] [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: 04/25/2024]
Abstract
GENERAL PURPOSE To present research investigating the incidence of and risk factors associated with intraoperative pressure injury in patients undergoing neurologic surgery at Xiangya Hospital, Central South University in China. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify the incidence of intraoperative pressure injuries (PIs) in patients undergoing neurologic surgery at Xiangya Hospital, Central South University in China.2. Describe risk factors for intraoperative PI.3. Outline strategies to help mitigate intraoperative PI risk.
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Munro CA, Jiang YH. Validity and Reliability Evidence of the Munro Scale for Perioperative Patients, Part I: Correlation, Multiple Regression, and Reliability. J Nurs Meas 2024; 32:69-81. [PMID: 37553161 DOI: 10.1891/jnm-2022-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Background and Purpose: Patients undergoing surgery are at risk of pressure injury development and should be assessed to ensure measures are taken for prevention. The study's purpose was to examine the causal relationships and reliability of the Munro Pressure Injury Risk Assessment Scale for Perioperative Patients (Munro Scale). The Munro Scale is the first dynamic risk scale available for this patient population in the acute clinical setting. Methods: This study was a retrospective review to explore the relationships of the variables in the Munro Scale, identify the strongest predictors, and measure the reliability of previously collected data from two northeastern community hospitals. A total of 630 risk assessments were analyzed to obtain regression, correlation, and reliability evidence for the Munro Scale. Results: The correlation analysis among the 15 risk variables and combined comorbidities revealed commonalities among the variables and significant relationships to the final postoperative injury score. The model as a whole is significant to predict the final level of risk. Coefficient alpha revealed a lower than anticipated reliability when compared to the Chinese, Turkish, and Brazilian versions of the Munro Scale. Conclusions: There are significant relationships among the variables, and the scale is acceptable for use in the acute perioperative practice setting. This study has both clinical and statistical significance.
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Affiliation(s)
- Cassendra A Munro
- Office of Research, Stanford Health Care, Palo Alto, CA, USA
- Munro Consulting, San Francisco, CA, USA
| | - Ying Hong Jiang
- School of Education, Azusa Pacific University, Azusa, CA, USA
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Uslu Y, Adıgüzel Akbaba M. Evaluation of perioperative pressure injury in adults 65 years and older: A prospective cohort study. J Tissue Viability 2024; 33:43-49. [PMID: 38000967 DOI: 10.1016/j.jtv.2023.11.005] [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: 06/03/2023] [Revised: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Old age is an important risk factor for the formation of pressure injury (PI). The aim of this study was to investigate the incidence, risk factors, characteristics of PI and suitability of risk assessment tools for patients aged 65 years and older. METHOD This prospective monocentric cohort study was conducted in Turkey between September 2022 and March 2023. Data were collected from a total of 240 surgical patients aged 65 years and older using a skin assessment form and the Braden and Munro scales for PI risk assessment. RESULTS The patients had a mean age of 72.90 ± 5.53 years, 123 (51 %) were male, 203 (85 %) had chronic diseases, and the mean operative time was 194.83 ± 99.45 min. PI occurred in 45 patients (18.8 %). PIs were most commonly stage I and located in the coccyx region. Postoperative Munro score, postoperative Braden score, and operative time were significant in univariate analyses (p < 0.001). According to the multiple logistic regression model, a postoperative Munro score ≥26 and postoperative Braden score ≤20 were independent factors associated with increased risk of PI. CONCLUSION Measures to prevent PI in surgical patients should begin in the preoperative period. Age alone may not be a risk factor in geriatric surgical patients. The Munro and Braden PI risk assessment scales can be used in geriatric surgical patients, but changes in cut-off score calculations may be required and additional age-related risk factors should be evaluated.
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Affiliation(s)
- Yasemin Uslu
- Faculty of Nursing, Istanbul University, Fatih, Istanbul, Turkey.
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Choi S, Kim YJ, Oh H, Yuh WT, Lee CH, Yang SH, Kim CH, Chung CK, Park HP. Factors Associated With Perioperative Hospital Acquired Pressure Injury in Patients Undergoing Spine Surgery in the Prone Position: A Prospective Observational Study. J Neurosurg Anesthesiol 2024; 36:45-52. [PMID: 36006663 DOI: 10.1097/ana.0000000000000867] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital acquired pressure injury (HAPI) is associated with poor clinical outcomes and high medical costs. Patients undergoing surgery in the prone position are particularly vulnerable to perioperative HAPI. This prospective observational study investigated the factors associated with HAPI in patients undergoing elective spine surgery in the prone position. METHODS Two hundred eighty-seven patients undergoing elective spine surgery participated in this study. Demographics, perioperative vital signs, laboratory findings, surgical data, and intraoperative data were prospectively recorded. The sites and stages of HAPI were investigated on postoperative day 2. The stages of HAPI were evaluated using the pressure injury staging system of the National Pressure Ulcer Advisory Panel. RESULTS Perioperative HAPI was observed in 71 (24.7%) patients (stage 1, 40; stage 2, 31). The most frequent site (number) of HAPI was the upper extremities (33), followed by the chest (32), lower extremities (20), face (18), pelvis (10), and abdomen (9). In multivariate analysis, the duration of prone positioning per hour (odds ratio [95% confidence interval], 1.48 [1.25-1.74]; P <0.001) and intraoperative pH ≤7.35 (1.98 [1.05-3.76]; P =0.036) were associated with perioperative HAPI. CONCLUSIONS The incidence of perioperative HAPI was 24.7% in patients undergoing elective spine surgery in the prone position. Long duration of prone positioning and intraoperative acidosis were associated with increased development of perioperative HAPI.
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Affiliation(s)
| | | | | | - Woon Tak Yuh
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hyun Lee
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Heon Yang
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Heon Kim
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Tang W, Li AP, Zhang WQ, Hu SQ, Shen WQ, Chen HL. Vasoconstrictor Agent Administration as a Risk Factor for Pressure Injury Development in Intensive Care Unit Patients: A Systematic Review and Meta-Analysis. Adv Wound Care (New Rochelle) 2023; 12:560-573. [PMID: 36448592 DOI: 10.1089/wound.2022.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Significance: Pressure injury (PI) is a common critical presentation in intensive care units (ICU) and is an important clinical concern in critical care settings. Some developing data support the vasoconstrictor agent administration as a potential risk factor; however, synthesis of available evidence has not been completed. Recent Advances: Comprehensive tactics were employed to search electronic databases PubMed, Web of Science, and Ovid Embase for data on vasoconstrictor agent administration associated with PI in ICU patients. Extraction was limited to studies that matched the inclusion criteria. The pooled odds ratio and 95% confidence intervals (95% CI) were calculated for dichotomous outcomes. Critical Issues: Twenty-six studies were included, involving 50,192 patients who matched the selection criteria. Around 5.8% of patients (2,523/43,210) got PI in total. PI occurred in 10.9% (1,496/13,675) of the vasoconstrictor agent administration population and 3.5% (1,027/29,503) of the drug-free population. The pooled unadjusted odds ratio was 2.83 (95% CI = 2.21-3.64, p < 0.001). The adjusted odds ratio was 1.83 (95% CI = 1.26-2.68, p = 0.002). Subgroup analysis and meta-regression found that the risk of PI did not vary with research design, time of occurrence, patient age, or male proportion. Future Directions: Vasoconstrictor agent administration raised the risk of PI in critical care patients by nearly twofold. More emphasis should be placed on the timely prevention of PI in patients receiving vasoconstrictor agent administration in the ICU.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Ai-Ping Li
- Taixing People's Hospital, Taizhou, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
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Özdemir ED, Uslu Y, Karabacak U, Eren D, Isabetli S. Pressure injuries in the operating room: who are at risk? J Wound Care 2023; 32:cxxviii-cxxxvi. [PMID: 37405971 DOI: 10.12968/jowc.2023.32.sup7a.cxxviii] [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: 07/07/2023]
Abstract
OBJECTIVE Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk factors of OR-related PIs. METHOD This study used a cohort design. The data were collected at Acıbadem Maslak Hospital in Istanbul between November 2018 and May 2019. The study population consisted of all patients undergoing surgery between these dates (n=612). The haphazard sampling method was used following application of the inclusion criteria. A patient identification form, the 3S intraoperative pressure ulcer risk assesment scale and the Braden Scale were used to collect data. RESULTS Within the scope of the study, data were collected from 403 patients, of which 57.1% (n=230) were female and 42.9% (n=173) were male; mean age was 47.90±18.15 years. During surgery, PIs were detected in 8.4% of patients. In total, 42 PIs were detected in patients in the study; 92.8% were stage 1 and 7.2% were stage 2. It was determined that the PIs observed in 11.8% (n=4) of the patients were related to device/instrument use and 23.5% (n=8) were related to the positioning device. Risk factors found to be significant in the development of PIs were sex (male) (p=0.049), large amount of bleeding during surgery (p=0.001), dry (p=0.020) and lighter skin (p=0.012), duration of surgery (p=0.001), type of anaesthesia (p=0.015), and medical devices used (p=0.001). CONCLUSION Early identification of risk factors may reduce OR-related PIs. Guidelines and procedures that focus on preoperative, intraoperative and postoperative evaluation can be developed to reduce and prevent surgery-related PIs and to standardise care.
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Affiliation(s)
- Ezgi Dilan Özdemir
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Yasemin Uslu
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Ukke Karabacak
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Dilek Eren
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Serpil Isabetli
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
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Kaya Ç, Erol Ursavaş F. Determining knowledge and attitudes related to pressure injury prevention among operating room nurses and associated factors. J Tissue Viability 2023:S0965-206X(23)00062-1. [PMID: 37258335 DOI: 10.1016/j.jtv.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/25/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
AIM To determine attitudes and levels of knowledge related to pressure injury (PI) prevention among operating room nurses and identify associated factors. METHODS This descriptive, cross-sectional study was conducted in Turkey with a sample of 112 operating room nurses recruited by the snowball method of convenience sampling. Data were collected online via Google Forms using a nurse data collection form, the Knowledge of Operating Room Nurses about Pressure Injuries Form, and the Attitude Towards Pressure Ulcer Prevention Instrument (APuP). RESULTS The operating room nurses' mean score for PI knowledge was 52.19 ± 17.01 out of 100, and their mean total APuP score was 42.28 ± 5.19 out of 52. Knowledge about PIs was negatively associated with being male (β = -0.287, p < 0.001) and positively associated with intervening to prevent PIs during surgery (β = 0.214, p = 0.008), using international PI guidelines as a reference in the operating room (β = -0.225, p = 0.005), and APuP score (β=.415, p < 0.001). Intervening to prevent PIs during surgery (β = 0.294, p = 0.003) was a significant predictor of attitude toward PI prevention. CONCLUSION Our results indicate that overall, operating room nurses have insufficient knowledge but positive attitudes about PI prevention. Female gender, using international PI reference guides in the operating room, and positive attitude toward PI prevention were identified as factors associated with higher PI knowledge level, while intervening to prevent PIs during surgery was positively associated with both knowledge level and attitude toward PI prevention.
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Affiliation(s)
- Çiğdem Kaya
- Department of Nursing, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey.
| | - Figen Erol Ursavaş
- Department of Nursing, Faculty of Health Sciences, Çankırı Karatekin University, Çankırı, Turkey.
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Incidence and risk factors for pressure injuries in patients who have undergone vascular operations: a scoping review. Eur J Med Res 2023; 28:77. [PMID: 36782315 PMCID: PMC9926840 DOI: 10.1186/s40001-023-01036-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Patients who have undergone vascular operations are thought to be at an increased risk for developing pressure injuries; however, the extent to which pressure injuries occur in this population is not clear. This scoping review sought to summarize what is known about the incidence of pressure injuries, and the risk factors for the development of pressure injuries in patients who have undergone vascular operations. MAIN: An initial search identified 2564 articles, and 9 English language studies were included. Results showed that due to study design limitations in the available literature preventing hospital-acquired and present on admission pressure injuries to be distinguished, it is difficult to ascertain the incidence rate of pressure injuries in this population. CONCLUSION Certain vascular procedures were found to be higher risk for the development of pressure injuries such as major amputations and lower extremity bypass surgery. In addition to procedural risk factors, patient factors were identified that may be associated with the development of pressure injuries in the vascular population, and these in the authors' view deserve further exploration. Overall, this scoping review identified an area ripe for future research, the results of which would have implications for wound care in healthcare institutions and at home.
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Vathulya M, Chattopadhyay D, Kandwal P, Nath UK, Kapoor A, Sinha M. Adipose Tissue in Peripheral Obesity as an Assessment Factor for Pressure Ulcers. Adv Wound Care (New Rochelle) 2022. [PMID: 36301930 DOI: 10.1089/wound.2020.1275] [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: 12/29/2022] Open
Abstract
Scope and Significance: Pressure ulcers are very difficult to treat and pose an economic burden, just below cancer and cardiovascular illness, at 4.82 billion U.S. dollars. It is important to understand the pathophysiology of the condition, risk stratification, and ways of preventing it. Prevention forms the most important aspect of their management. The authors systematically evaluated the existing risk prediction scales and explored the evidence from literature regarding the role of additional factors including body mass index, obesity, subcutaneous tissue thickness, and skin integrity in pressure ulcers. With this review it is hoped that the future management of pressure ulcers will concentrate on the preventable and alterable factors in its pathophysiology. Translational Relevance: The review focuses on how adipose tissue thickness can predict the occurrence of pressure ulcer. If adequately proved that a definite thickness of peripheral adipose tissue is efficient in prevention of pressure ulcers, then methods of maintaining the thickness of this tissue will be the next effective strategy in the management of this chronic issue. Clinical Relevance: The review addresses the management of pressure ulcers to wound care providers and emphasize on confounding parameters of obesity, subcutaneous tissue thickness, and skin integrity during the treatment regimen of pressure ulcers. Objectives: The main objective of this review is to draw a consensus concerning the role of adipose tissue in pressure ulcers, based on the published research. A review of the various preexisting predictive scales for pressure ulcers is a secondary objective to highlight the shortcomings in ulcer management. This review finally aims in the future at paving a way to refine our prognosticating scales for pressure sores based on these results. Accurate preventative injury risk scales are needed so that preventative resources can be directed to the patients for whom they are the most appropriate.
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Affiliation(s)
- Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Debarati Chattopadhyay
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Uttam Kumar Nath
- Department of Medical Oncology & Hematology, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Akshay Kapoor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Mithun Sinha
- Department of Surgery, IU Heath Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Taghiloo H, Ebadi A, Saeid Y, Jalali Farahni A, Davoudian A. Prevalence and factors associated with pressure injury in patients undergoing open heart surgery: A systematic review and meta‐analysis. Int Wound J 2022. [DOI: 10.1111/iwj.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Hamed Taghiloo
- Department of Operating Room and Anesthesiology School of Nursing and Midwifery, Zanjan University of Medical Sciences Zanjan Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Centre Life Style Institute, School of Nursing, Baqiyatallah University of Medical Sciences Tehran Iran
| | - Yaser Saeid
- Trauma Research Center and Faculty of Nursing Baqiyatallah University of Medical Sciences Tehran Iran
| | | | - Atefeh Davoudian
- Deputy of Research and Technology Zanjan University of Medical Sciences Zanjan Iran
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Risk Factors Associated With Pressure Injuries in Surgical Patients: A Retrospective Case-Control Study. J Wound Ostomy Continence Nurs 2022; 49:511-517. [PMID: 36417372 DOI: 10.1097/won.0000000000000925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to identify predictive risk factors for pressure injury (PI) occurring during surgery. DESIGN Retrospective case-control study. SUBJECTS AND SETTING Data on records of 6070 patients hospitalized for surgery at Seoul National University Bundang Hospital located in Seoul Korea. Data were collected between May 2013 and December 2014. METHODS Anonymized data from patients were accessed via electronic health records, nursing records, direct patient assessment, surgical, clinical laboratory, and anesthesia records, preanesthesia status evaluations, and PI incident reports, and transfusion and extracorporeal circulation reports. Descriptive and logistic regression analyses were conducted. RESULTS Three hundred eighty-one of the 6070 patients (6.3%) developed within 24 hours a PI that was associated with surgery. The most common locations for the PIs were the coccyx (15.1%; n = 75) and trunk (chest or abdomen; 15.1%; n = 75). All PIs were classified as stage 1 (66.6%; n = 331) or 2 (33.4%; n = 166). Based on logistic regression results, we found that the risk factors that were independently predictive of surgery-related PIs were patient position during surgery, admission to an intensive care unit after surgery, required blood transfusion during surgery, and duration of surgery. CONCLUSIONS This retrospective study identified several risk factors associated with a higher incidence of perioperative PIs in surgical patients. A PI prevention program accounting for these factors could potentially help prevent PIs and their costly complications.
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Buli B, Diriba T, W/Yohannes M, Tesfaye B. Magnitude of position-related soft tissue injuries and associated factors among elective adult surgical patients at Tikur anbessa specialized hospital, Addis ababa, Ethiopia. Ann Med Surg (Lond) 2022; 82:104592. [PMID: 36268291 PMCID: PMC9577522 DOI: 10.1016/j.amsu.2022.104592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/21/2022] Open
Abstract
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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Affiliation(s)
- Bekele Buli
- Department of Anesthesia, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Tesfaye Diriba
- Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Misrak W/Yohannes
- Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Biruk Tesfaye
- Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Evaluation of Vasopressor Dose and the Incidence of Pressure Injuries in Critically Ill Patients. Adv Skin Wound Care 2022; 35:550-554. [PMID: 35866867 DOI: 10.1097/01.asw.0000833604.12023.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate risk factors associated with vasopressor use and development of hospital-acquired pressure injuries (HAPIs). METHODS The researchers conducted a retrospective chart review in a 12-bed medical ICU at a community hospital. A total of 123 patients who received a minimum of 24 hours of continuous vasopressor administration between January 2017 and January 2019 were included. The primary outcomes assessed were vasopressor dose and HAPI incidence, with a subgroup analysis based on type. Secondary outcomes included quantity of vasopressors, duration, mean arterial pressure, mechanical ventilation, time to injury, severity, and location. RESULTS The overall incidence of HAPIs was 20.3%, with 17% incidence in the low-dose cohort and 22.4% in the high-dose cohort ( P = .317). There were no differences in the subgroup analysis based on vasopressor type. The most common locations for injuries were the sacrum and coccyx, with the majority being stage 1 or 2 based on the National Pressure Injury Advisory Panel severity staging. No correlations were found between HAPI incidence and factors such as multiple vasopressors use, mechanical ventilation, mean arterial pressure, or duration of vasopressor administration. The documentation of time to injury was significantly shorter in the high-dose cohort compared with the low-dose cohort (157.58 vs 330.86 hours, P < .05). CONCLUSIONS The incidence of HAPIs did not differ between the low- and high-dose vasopressor cohorts. However, patients who received higher doses of vasopressors had documented pressure injuries sooner than the low-dose cohort, emphasizing the importance of close monitoring for HAPIs in patients receiving vasopressors.
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Ding L, Hu X, Wei L, Sun M, Sun G, Jiang G, Li H. Risk factors for hospital-acquired and community-acquired pressure injuries: a multicentre mixed case-control study. BMJ Open 2022; 12:e057624. [PMID: 35437253 PMCID: PMC9016407 DOI: 10.1136/bmjopen-2021-057624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To separately examine and comprehensively compare the risk factors for hospital-acquired (HAPIs) and community-acquired pressure injuries (CAPIs). DESIGN A mixed case-control study. SETTING Four medical centres in China. PARTICIPANTS Inclusion criteria included patients who were (1) aged ≥18 years on admission; (2) admitted between January 2014 and December 2018, and (3) diagnosed with HAPIs (cases) or with no HAPIs (controls) during hospitalisation in the HAPIs study, and confirmed with CAPIs (cases) or with no PIs (controls) on admission in the CAPIs study. The exclusion criteria were as follows: (1) admitted for childbirth, psychiatric reasons or rehabilitation; (2) admitted for observation; (3) transferred from another hospital and (4) confirmed to have suffered PIs from previous hospitalisations in the CAPIs study. In total, 320 cases and 1657 controls were included in the HAPIs study, and 1763 cases and 1786 controls were included in the CAPIs study. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome variable was the occurrence of PIs. RESULTS The existence of PIs or scars from previous PIs on admission, presence of forced posture, use of medical devices and surgery during hospitalisation were found to be independent risk factors for HAPIs, as evidenced by the corresponding OR and 95% CI values of 51.931 (34.241 to 78.763), 2.006 (1.405 to 2.864), 3.226 (1.709 to 6.089) and 2.161 (1.452 to 3.215), respectively. Age, sex, Braden rating and diabetes were found to be independent risk factors for CAPIs, as evidenced by the corresponding OR and 95% CI values of 1.031 (1.026 to 1.036), 0.810 (0.698 to 0.941), 1.235 (1.167 to 1.307) and 2.059 (1.332 to 3.184), respectively. CONCLUSIONS The existence of PIs or scars from previous PIs on admission, presence of forced posture, use of medical devices and surgery during hospitalisation are suggested to be included as independent items for the risk assessment of PIs, together with the Braden scale. The Braden rating plays different roles in the development of CAPIs and HAPIs.
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Affiliation(s)
- Lei Ding
- Department of Quality Management and Evaluation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xia Hu
- Department of Human Resources, Qingdao Endocrine and Diabetes Hospital, Qingdao, Shandong, China
- Department of Disease Prevention and Health Care, Qingdao Endocrine and Diabetes Hospital, Qingdao, Shandong, China
| | - Lili Wei
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mojian Sun
- Center for Medical Record Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guixia Sun
- Department of Quality Management and Evaluation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangfeng Jiang
- Department of Medical Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Huanting Li
- Department of Medical Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Weng PW, Lin YK, Seo JD, Chang WP. Relationship between predisposing and facilitating factors: Does it influence the risk of developing peri-operative pressure injuries? Int Wound J 2022; 19:2082-2091. [PMID: 35373448 DOI: 10.1111/iwj.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022] Open
Abstract
This study examined the relationship between the personal predisposing factors of patients and the severity of pressure injuries (PIs) developed during surgery. This retrospective cohort study collected 439 cases of peri-operative PIs. Using binary logistic regression to identify the variables associated with PI severity, the effects of interactions between associated variables were then tested. The results of this study revealed that among the personal predisposing factors, only higher patient age (P = .001) and higher body mass index (P < .001) posed a greater risk of stage 2 PIs or higher. Among the surgery-related facilitating factors, only patients who were placed in the prone position during surgery and patients who lost ≥1000 mL of blood during surgery were at greater risk of stage 2 PIs or higher, compared, respectively, to those placed in the supine position and those who lost ≤100 mL of blood. Furthermore, the amount of blood lost during surgery moderated the influence of age on PI severity. For elderly patients who are expected to lose a large blood volume during surgery or lose an immeasurable amount of blood due to the use of cardiopulmonary bypass, taking more precautionary measures to prevent PIs is recommended.
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Affiliation(s)
- Pei-Wei Weng
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan City, Taiwan
| | - Jang-Dong Seo
- Department of Statistics, Indiana University, Bloomington, Indiana, USA
| | - Wen-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Grade IV Sacral Sore Treated with an Ointment Rich in PUFAs, Ceramides, and Antimicrobial Peptides. Case Rep Dermatol Med 2022; 2022:4445055. [PMID: 35295787 PMCID: PMC8920691 DOI: 10.1155/2022/4445055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/14/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
This report presents the case of a 57-year-old male patient with a history of hypertension, obesity, dyslipidemia, and coronary disease that after a prolonged postcoronary surgery hospitalization developed a sacral butterfly-shaped sore, with asymmetric involvement of the base of both buttocks, grade III on the left and grade IV on the right sides. The lesion was very painful and had a negative impact on the patient's sleep and mood. Following the initial surgical debridement and treatment with collagenase ointment, the wound showed delayed healing, an increase in necrotic tissue, and purulent discharge, requiring a second surgical debridement that revealed a deeper involvement of the wound. After a month with poor therapeutic response, it was decided to change the treatment to the application of gauzes embedded in an ointment rich in polyunsaturated fatty acids (PUFAs), ceramides, and antimicrobial peptides, Curefini® ointment. After 30 days of treatment, a 50% reduction of the initial wound diameter was obtained with a positive impact on the patient's quality of life, together with a reduction of incidental and spontaneous local pain resulting in better night rest and a return of appetite and strength. During the treatment course, the patient did not suffer any local or systemic infection in connection with the wound. After one month, the patient could discontinue the use of opioid analgesics. A 95% closure of the lesion was achieved in 45 days. This case highlights the therapeutic efficacy of the treatment of cavitated wounds with a product based on natural ingredients that helps reduce pain and promotes granulation and reepithelialization.
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Martins de Oliveira AL, O'Connor T, Patton D, Strapp H, Moore Z. Sub-epidermal moisture versus traditional and visual skin assessments to assess pressure ulcer risk in surgery patients. J Wound Care 2022; 31:254-264. [PMID: 35199594 DOI: 10.12968/jowc.2022.31.3.254] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the predictive ability of subepidermal moisture (SEM) measurement versus traditional risk assessment and visual skin assessment (VSA) as means of detecting early pressure ulcer (PU) damage development among adults undergoing surgery. METHOD A non-experimental, comparative, descriptive cohort study design was used. Following ethical approval, participants who had given their informed written consent had their skin assessed over the areas that were weight-bearing during surgery, using VSA and the SEM measurement. Visual PUs were graded according to the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel ulcer grading system. Assessments took place preoperatively, then daily on the ward, beginning on day one postoperatively and continuing for three days or until discharge. RESULTS Of the 231 participants, who had a mean age of 57.50 years, 55.8% (n=129) were male. The most common comorbidity was cardiology/vascular (n=42; 18.2%). Just over half (52.4%; n=121) underwent orthopaedic surgery and 47.6% (n=110) underwent non-orthopaedic surgery; 70% (n=163) received a general anaesthetic and 43% (n=100) were in the supine decubitus position during surgery. PU incidence was 51% (n=116), according to SEM measurement, and 3% (n=7) according to VSA. Among the seven participants who developed a visual PU, 10 PUs at stage 1 developed (31%); some patients developed more than one PU. Of the participants who had assessments for three days postoperatively, 94% (n=61) had a persistently high SEM delta on day three. The variables that emerged as statistically significantly related to abnormal SEM measurement deltas among these participants were: surgery duration (p=0.038); having orthopaedic surgery (p=0.020); supine surgical position (p=0.003); spinal anaesthetic type (p=0.0001); and Waterlow and Braden mobility subscale day one postoperatively (p=0.0001). None of the variables had a statistically significant influence on abnormal VSA. CONCLUSION Surgical patients, because of immobility, are vulnerable to the action of compression and shear forces. These forces cause changes at a cellular level that trigger inflammation, which is a precursor to early tissue damage. SEM measurement can detect this tissue damage from the increase in the underlying tissue water content that results from inflammation. From the findings of this study, SEM measurement is very promising in the detection of early tissue damage in those at risk of PU development among the surgical population.
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Affiliation(s)
| | - Tom O'Connor
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,Lida Institute, Shanghai.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia
| | - Declan Patton
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Helen Strapp
- Tallaght University Hospital, Ireland.,SWaT Research Network, RCSI University of Medicine and Health Sciences, Ireland
| | - Zena Moore
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Lida Institute, Shanghai.,University of Wales, Wales.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia
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Şengül T, Gül A, Yilmaz D, Gokduman T. Translation and validation of the ELPO for Turkish population: Risk assessment scale for the development of pressure injuries due to surgical positioning. J Tissue Viability 2022; 31:358-364. [DOI: 10.1016/j.jtv.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/04/2022] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
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22
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Zhou F, Wu Z, Yu Y, Xu L. Establishment and Application of Pressure Injury Assessment Module in Operating Room Based on Information Management System. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1463826. [PMID: 35047148 PMCID: PMC8763524 DOI: 10.1155/2022/1463826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022]
Abstract
A pressure injury is a common and painful health condition, particularly among people who are elderly or surgical patients. In order to explore how to use the information management system to optimize the pressure injury management process of surgical patients, this work establishes an integrated pressure injury management information platform for surgical patients, which can effectively control the key links in the process and realize the multistep full-process monitoring of surgical patients from admission to discharge. A total of 578 patients before the operation of the information platform were selected as the control group (CG), and after the operation of the information platform, 662 cases became the observation group (OG). Various evaluation metrics are employed to evaluate pressure injury in terms of single-pass rate, high-risk pressure injury, transfer skin condition description matching rate, hospital pressure injury incidence, and incidence of pressure injury in surgical patients at various stages. The results showed that the qualified rate of the pressure injury assessment in the OG was 99.2%, the accuracy rate of high-risk pressure injury screening and reporting was 100.0%, and the matching rate of the transfer skin description was 100.0%, which was higher than that of the CG. The integrated pressure injury management information platform for surgical patients based on the information management system realizes the full, continuous, accurate, and dynamic evaluation and monitoring of patients' skin. Furthermore, it can effectively improve the quality of pressure injury care and facilitate care management.
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Affiliation(s)
- Fangfang Zhou
- Operating Theatre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Zheng Wu
- Operating Theatre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Ying Yu
- Operating Theatre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Lili Xu
- Operating Theatre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
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Kim P, Aribindi VK, Shui AM, Deshpande SS, Rangarajan S, Schorger K, Aldrich JM, Lee H. Risk Factors for Hospital-Acquired Pressure Injury in Adult Critical Care Patients. Am J Crit Care 2022; 31:42-50. [PMID: 34972856 DOI: 10.4037/ajcc2022657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Relative contributions of risk factors for the incidence of pressure injury in adult critical care patients are not well understood. OBJECTIVE To develop and validate a model to identify risk factors associated with hospital-acquired pressure injuries among adult critical care patients. METHODS This retrospective cohort study included 23 806 adult patients (28 480 encounters) with an intensive care unit stay at an academic quaternary care center. Patient encounters were randomly split (7:3) into training and validation sets. The training set was used to develop a multivariable logistic regression model using the least absolute shrinkage and selection operator method. The model's performance was evaluated with the validation set. RESULTS Independent risk factors identified by logistic regression were length of hospital stay, preexisting diabetes, preexisting renal failure, maximum arterial carbon dioxide pressure, minimum arterial oxygen pressure, hypotension, gastrointestinal bleeding, cellulitis, and minimum Braden Scale score of 14 or less. On validation, the model differentiated between patients with and without pressure injury, with area under the receiver operating characteristic curve of 0.85, and performed better than a model with Braden Scale score alone (P < .001). CONCLUSIONS A model that identified risk factors for hospital-acquired pressure injury among adult critical care patients was developed and validated using a large data set of clinical variables. This model may aid in selecting high-risk patients for focused interventions to prevent formation of hospital-acquired pressure injuries.
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Affiliation(s)
- Phillip Kim
- Phillip Kim is a postdoctoral fellow, Department of Surgery, University of California, San Francisco
| | - Vamsi K. Aribindi
- Vamsi K. Aribindi is a postdoctoral fellow, Department of Surgery, University of California, San Francisco
| | - Amy M. Shui
- Amy M. Shui is a senior statistician, Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sharvari S. Deshpande
- Sharvari S. Deshpande is a biomedical engineer, Department of Surgery, University of California, San Francisco
| | - Sachin Rangarajan
- Sachin Rangarajan is a biomedical engineer, Department of Surgery, University of California, San Francisco
| | - Kaelan Schorger
- Kaelan Schorger is a lab research supervisor and research and development engineer, Department of Surgery, University of California, San Francisco
| | - J. Matthew Aldrich
- J. Matthew Aldrich is a clinical professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco
| | - Hanmin Lee
- Hanmin Lee is a professor and chief of the Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco
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Abstract
Supplemental Digital Content is available in the text. Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Time-dependent risk factors for pressure injury development in the adult intensive care unit setting are not well understood.
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Forni C, Cerantola N, Ferrarelli G, Lombrosi L, Bolzon A, Natali E, D'Alessandro F, Morri M. Factors associated with pressure ulcer onset after knee replacement. J Wound Care 2021; 30:924-929. [PMID: 34747215 DOI: 10.12968/jowc.2021.30.11.924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to find the rate of pressure ulcers (PUs) in patients with knee replacements and identify predictive factors. The ability of the Braden scale to predict the onset of PUs was also investigated. METHOD A retrospective prognostic cohort study was carried out involving all consecutive patients undergoing knee replacement surgery. The data were collected from patient records. The variables collected were grouped into two categories: those connected to the patient's own characteristics; and those linked to the care methods used. RESULTS The total number of patients included in the study was 565. Of these, 2.3% had developed a PU: 0.5% at the heel and 1.8% at the sacrum. Multivariate analysis showed that the variables actually correlated to the outcome were age (p=0.074; odds ratio (OR)=1.08), body mass index (BMI, p=0.037; OR=1.13) and Braden scale (p=0.029; OR=0.72). A combination of these three parameters showed better predictivity of PUs (area under the curve (AUC) 84%). CONCLUSION Age, BMI and preoperative Braden score were shown to be independent predictive factors of the onset of PUs in patients with knee replacements. The combined use of all three variables increased the ability to identify the patients at most risk of developing a PU. DECLARATION OF INTEREST The study was financed by the Professional Nurse Register of Bologna as winner of a competition for research projects in the province of Bologna. The authors declare no conflicts of interest.
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Affiliation(s)
- Cristiana Forni
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Nicola Cerantola
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Gianfranco Ferrarelli
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Luana Lombrosi
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Andrea Bolzon
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Emanuela Natali
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Fabio D'Alessandro
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Mattia Morri
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italia
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Association of overweight and obesity with the prevalence and incidence of pressure ulcers: A systematic review and meta-analysis. Clin Nutr 2021; 40:5089-5098. [PMID: 34455268 DOI: 10.1016/j.clnu.2021.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022]
Abstract
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.
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Tang Z, Li N, Xu J. Construction of a Risk Prediction Model for Intraoperative Pressure Injuries: A Prospective, Observational Study. J Perianesth Nurs 2021; 36:473-479. [PMID: 34417103 DOI: 10.1016/j.jopan.2020.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To explore the incidence and risk factors of intraoperatively acquired pressure injuries (IAPIs) in patients transferred to the intensive care unit (ICU) after surgery and establish a risk factor prediction model for IAPIs for guiding clinical intervention. DESIGN A prospective, observational study was conducted. METHODS This study was conducted in the West China Hospital of Sichuan University. A total of 648 patients who were transferred to the ICU after surgery were recruited from May 1, 2019, to October 30, 2020. Data were collected preoperatively, intraoperatively, and postoperatively (3 days after transfer to the ICU). The enrolled patients underwent well-developed preventive measures to prevent IAPIs in the operating room and ICU. A sociodemographic and clinical characteristic questionnaire, the Braden pressure injuries risk assessment scale, the activity of daily living scale, and the Nutrition Risk Screening-2002 were used. Descriptive, bivariate, and logistic regression analyses were conducted. FINDINGS The incidence rate of IAPIs within 3 days was 18.67%. The Braden pressure injuries score, preoperative fasting blood glucose level, emergency surgery, and types of vasoactive drugs in the ICU were significant factors for increased risk. The risk factor prediction model was established using the perioperative Braden pressure injuries score (P = 0.027, odds ratio [OR] = 0.901), preoperative fasting blood glucose level (P = 0.027, OR = 1.111), emergency surgery (P < 0.01, OR = 5.054), types of vasoactive drugs in the ICU (P = 0.038, OR = 1.668), and surgery time (P = 0.021, OR = 2.434). The area under the receiver operating characteristic curve was 0.74; 95% confidence interval was 0.671 to 0.810; sensitivity was 0.635; specificity was 0.860; and the Youden index was 0.495. CONCLUSIONS In patients transferred to the ICU after surgery, high fasting blood glucose level before surgery, emergency surgery, types of vasoactive drugs, and surgery time should be treated as predisposing factors in the prevention and control of IAPIs. However, the predictive effect of the perioperative Braden pressure injuries risk assessment scale on the risk of IAPIs needs to be further verified.
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Affiliation(s)
- Zhihong Tang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Na Li
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Xu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Abstract
Identification of the appropriate pressure injury (PI) risk factors is the first step in successful PI prevention. Measuring PI risk through formalized PI risk assessment is an essential component of any PI prevention program. Major PI risk factors identified in the empirical literature in the critical care population include age, diabetes, hypotension, mobility, prolonged intensive care unit admission, mechanical ventilation and vasopressor administration. Future risk assessment using sophisticated data analytics available in the electronic medical record may result in earlier, targeted PI prevention and will improve our understanding of risk factors that may contribute to unavoidable PIs.
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Nasiri E, Mollaei A, Birami M, Lotfi M, Rafiei MH. The risk of surgery-related pressure ulcer in diabetics: A systematic review and meta-analysis. Ann Med Surg (Lond) 2021; 65:102336. [PMID: 33996066 PMCID: PMC8091875 DOI: 10.1016/j.amsu.2021.102336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objective Postoperative pressure ulcers are known as the most important quality indicators of intraoperative care that create critical and costly complications during hospital care. Accordingly, this study was performed to determine the risk factor for diabetes in postoperative pressure ulcers. Materials and methods The present study is a systematic review of PubMed, Scopus and the Web of Science databases with using standardized keywords of the performed English language articles between Jan 2010 to Jan 2020. The articles were searched independently by two related researchers to avoid possible biases. Then, all collected articles were reviewed, and articles with inclusion criteria were evaluated using a data collection table. It should be noted that the data were analyzed using STATA software version 11.1. Results Overall, the results showed that 19724 patients were identified from 15 studies conducted in Asia (six), the America (four), Europe (four), and Australia (one) from 1989 to 2019. The results showed that patients with diabetes were more likely to experience surgery-related pressure ulcers than patients without diabetes (The odds ratio of 1.52; the 95% confidence interval: 1.25–1.85). Conclusion In general, patients with diabetes increased the risk of surgery-related pressure ulcers about 1.5 times more than others. Accordingly, the reduction of surgery-induced pressure ulcers should be more extensively considered in patients with diabetes. What is already known about the topic?Diabetes as a preoperative comorbidity should be added to risk assessment instruments for perioperative pressure ulcers, which may increase the accuracy of the prediction. The excess risk of pressure ulcers associated with pre-existing diabetes was significantly higher in patients undergoing surgery, specifically in patients receiving cardiac surgery.
What this paper adds.Diabetes increases the risk of surgery-related pressure ulcers about 1.5 times. Therefore, it is necessary to provide Planned Cares to prevent, overcome, and decrease surgery-related pressure ulcers in patients with diabetes. Previous meta-analysis reported that the risk of surgery-related pressure ulcers in diabetic patients was higher than non-diabetic patients in cardiac surgeries, while evidence for this claim was not observed in this study. Considering the long duration of liver resection surgery, the risk of pressure ulcers is higher than heart surgery It is advised that standard wound measuring tools will apply for measuring wounds in the next prospective studies. It is also better to evaluate pressure ulcers at a specific time after surgery toward more carefully investigate the issue.
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Affiliation(s)
- Ebrahim Nasiri
- Department of Anesthesiology and Operating Room, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aghil Mollaei
- Faculty of Health, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Moslem Birami
- School of Allied Medical Sciences, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hossein Rafiei
- School of Allied Medical Sciences, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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Abstract
GENERAL PURPOSE To outline a conceptual schema describing the relationships among the empirically supported risk factors, the etiologic factors, and the mitigating measures that influence pressure injury (PI) development in the critical care population. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Choose a static intrinsic factor that increases the risk for the development of PI. 2. List several dynamic intrinsic risk factors for developing a PI. 3. Identify dynamic extrinsic risk factors that may predispose a patient to developing a PI. 4. Explain the pathophysiology of PI development.
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Neo TG, Koo SH, Chew STH, Png GK, Lacuesta MJ, Wu MYL, Tay RYC, Singh PA, Chandran R. A randomized controlled trial to compare the interface pressures of alternating pressure overlay with gel pad versus gel pad alone during prolonged surgery. J Tissue Viability 2021; 30:222-230. [PMID: 33612359 DOI: 10.1016/j.jtv.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Prolonged surgery is a known risk of pressure ulcer formation. Pressure ulcers affect the quality of life, are a significant cause of morbidity and mortality, and pose a burden on the healthcare system. This study aimed to compare the effectiveness of an alternating pressure (AP) overlay with Gel pad against the Gel pad in reducing interface pressure (IP) during prolonged surgery. METHODS A total of 180 participants from a tertiary hospital were randomized to AP overlay with Gel pad group (n = 90) and Gel pad group (n = 90). Patients were placed supine on the pressure redistributing surfaces, and IP data under the sacrum and ischial tuberosities were collected at an interval of 30 min from 0 min up to a maximum of 570 min. RESULTS Based on data from 133 participants, the average IPs during all the deflation cycles of the AP overlay (with Gel pad) were significantly lower than the average continuous IP recorded for Gel pad throughout the measuring period (p < 0.001). Only three patients (2.26% of study participants) - Gel pad group (n = 2; 2.99%) and AP overlay with Gel pad group (n = 1; 1.52%) developed post-operative pressure ulcer (p = 0.5687). CONCLUSIONS The lower IP during deflation cycles of the AP overlay (with Gel pad) suggests its potential effectiveness in preventing pressure ulcer formation in patients undergoing prolonged surgery. The prevention and reduction of pressure ulcers will have a considerable impact on the improved quality of life and cost savings for the patient. The study findings may facilitate the formulation of policies for preventing pressure ulcer development in the perioperative setting.
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Affiliation(s)
- Tze Guan Neo
- Department of Nursing, Changi General Hospital, Singapore
| | - Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | | | - Gek Kheng Png
- Department of Nursing, Changi General Hospital, Singapore
| | | | | | | | - Prit Anand Singh
- Department of Anaesthesia and Surgical Intensive Care Changi General Hospital, Singapore
| | - Rajkumar Chandran
- Department of Anaesthesia and Surgical Intensive Care Changi General Hospital, Singapore.
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Guzman S, Allegretti AL, Kormos RL, Brienza DM. A comparison of air-cell and gel surgical table pads and an evaluation of the influence of pressure distribution and other factors on pressure injury prevention. J Tissue Viability 2021; 30:9-15. [PMID: 33468340 DOI: 10.1016/j.jtv.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/01/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
Guidelines for pressure injury prevention consider the use of pressure-redistributing pads to prevent tissue deformation. However, limited research exists to assess the pressure distribution provided by the operating tables and the effectiveness of pressure-redistributing pads in preventing pressure injuries. In this study, we compared the pressure distribution properties of two surgical table pads and identified parameters influencing pressure injury outcomes after a lengthy surgical procedure. Twenty-seven patients undergoing left ventricular assist device implantation surgery participated in the study. Participants were randomly assigned to use either an air cell-based pad or a gel pad. Interface pressure was recorded during the surgery. We analyzed the effect of surgical table pad type, interface pressure distribution and pressure injury outcomes and analyzed what characteristics of the patients and the interface pressure are most influential for the development of pressure injuries. Comparing the interface pressure parameters between the air-cell group and the gel group, only the peak pressure index x time was significantly different (p < 0.05). We used univariate logistic regression analysis to identify significant predictors for the pressure injury outcome. The support surface was not significant. And, among patient characteristics, only age and BMI were significant (p ≤ 0.05). Among the interface pressure parameters, pressure density maxima, peak pressure index x time, and coefficient of variation were significant for pressure injury outcome (p ≤ 0.05). Peak pressure index, average pressure, and the surgery length were not statistically significant for pressure injury outcomes.
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Affiliation(s)
- Sandra Guzman
- University of Pittsburgh, School of Health and Rehabilitation Sciences, 6425 Penn Ave, Suite 401, Pittsburgh, PA, 15206, USA.
| | - Ana L Allegretti
- UT Health San Antonio, Department of Occupational Therapy, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Robert L Kormos
- University of Pittsburgh, Cardiothoracic Surgery, 802 Rough Hollow Drive, Austin, TX, 78734, USA.
| | - David M Brienza
- School of Health and Rehabilitation Sciences, Department of Rehabilitation Science and Technology, School of Engineering, Dept of Bioengineering, 6425 Penn Ave, Suite 401, Pittsburgh, PA, 15206, USA.
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Suh D, Kim SY, Yoo B, Lee S. An exploratory study of risk factors for pressure injury in patients undergoing spine surgery. Anesth Pain Med (Seoul) 2020; 16:108-115. [PMID: 33348948 PMCID: PMC7861899 DOI: 10.17085/apm.20081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/23/2020] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- DaeHee Suh
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Su Yeon Kim
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byunghoon Yoo
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Eberhardt TD, de Lima SBS, de Avila Soares RS, Silveira LBTD, Rossarola Pozzebon B, Reis CR, Dos Santos KPP, Alves PJP. Prevention of pressure injury in the operating room: Heels operating room pressure injury trial. Int Wound J 2020; 18:359-366. [PMID: 33314605 PMCID: PMC8243998 DOI: 10.1111/iwj.13538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022] Open
Abstract
The objective was to evaluate the efficacy of multi‐layered silicone foam (intervention) compared with transparent polyurethane film (control) in preventing heel pressure injuries caused by surgical positioning of individuals undergoing elective surgery. It was designed an intra‐patient, open, parallel, randomised controlled trial was conducted in a university hospital in southern Brazil, from March 2019 to February 2020, with patients undergoing elective surgeries of cardiac and gastrointestinal specialties. The patients who met the selection criteria constituted, simultaneously, a single group receiving the intervention and active control, through paired analysis of the cutaneous sites (right heel and left heel). The outcome was the occurrence of PI, within the follow‐up period was 72 hours. Brazilian Registry of Clinical Trials: RBR‐5GKNG5. There was analysis of 135 patients/270 heels, with an overall incidence of 36.7%. The pressure injury incidence was significantly lower in the intervention group (26.7%), compared with the control group (P = .001); relative risk of 0.57. In the intervention group, the estimated pressure injury‐free time (survival) was 57.5 hours and in the control group, 43.9 hours. It was concluded that Multi‐layered silicone foam (intervention) is more efficacious than transparent polyurethane film (control) in the prevention of pressure injuries caused by surgical positioning of individuals undergoing elective surgery.
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Affiliation(s)
- Thaís Dresch Eberhardt
- Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.,Instituto de Ciências Biológicas, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | | | | | | | | | - Cassia Ribeiro Reis
- Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Alderden J, Cowan LJ, Dimas JB, Chen D, Zhang Y, Cummins M, Yap TL. Risk Factors for Hospital-Acquired Pressure Injury in Surgical Critical Care Patients. Am J Crit Care 2020; 29:e128-e134. [PMID: 33130863 DOI: 10.4037/ajcc2020810] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hospital-acquired pressure injuries disproportionately affect critical care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined in relation to the risk for hospital-acquired pressure injuries. OBJECTIVE To identify factors associated with hospital-acquired pressure injuries among surgical critical care patients. The specific aim was to analyze data obtained from routine nursing skin assessments alongside other potential risk factors identified in the literature. METHODS This retrospective cohort study included 5101 surgical critical care patients at a level I trauma center and academic medical center. Multivariate logistic regression using the least absolute shrinkage and selection operator method identified important predictors with parsimonious representation. Use of specialty pressure redistribution beds was included in the model as a known predictive factor because specialty beds are a common preventive intervention. RESULTS Independent risk factors identified by logistic regression were skin irritation (rash or diffuse, nonlocalized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P < .001), minimum Braden Scale score (odds ratio, 0.858; 95% CI, 0.818-0.899; P < .001), and duration of intensive care unit stay before the hospital-acquired pressure injury developed (odds ratio, 1.003; 95% CI, 1.003-1.004; P < .001). CONCLUSIONS The strongest predictor was irritated skin, a potentially modifiable risk factor. Irritated skin should be treated and closely monitored, and the cause should be eliminated to allow the skin to heal.
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Affiliation(s)
- Jenny Alderden
- Jenny Alderden is an assistant professor and Mollie Cummins is a professor, University of Utah College of Nursing, Salt Lake City
| | - Linda J. Cowan
- Linda J. Cowan is associate director, VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida
| | - Jonathan B. Dimas
- Jonathan B. Dimas is a PhD candidate, University of Utah College of Nursing, and a clinical nurse and analyst, University of Utah Health, Salt Lake City
| | - Danli Chen
- Danli Chen is a biostatistician II and Yue Zhang is an associate professor, Division of Epidemiology, University of Utah, Salt Lake City
| | - Yue Zhang
- Danli Chen is a biostatistician II and Yue Zhang is an associate professor, Division of Epidemiology, University of Utah, Salt Lake City
| | - Mollie Cummins
- Jenny Alderden is an assistant professor and Mollie Cummins is a professor, University of Utah College of Nursing, Salt Lake City
| | - Tracey L. Yap
- Tracey L. Yap is an associate professor, Duke University School of Nursing, Durham, North Carolina
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Alderden JG, Shibily F, Cowan L. Best Practice in Pressure Injury Prevention Among Critical Care Patients. Crit Care Nurs Clin North Am 2020; 32:489-500. [PMID: 33129409 DOI: 10.1016/j.cnc.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pressure injuries are areas of damage to the skin and underlying tissue caused by pressure or pressure in combination with shear. Pressure injury prevention in the critical care population necessitates risk assessment, selection of appropriate preventive interventions, and ongoing assessment to determine the adequacy of the preventive interventions. Best practices in preventive interventions among critical care patients, including skin and tissue assessment, skin care, repositioning, nutrition, support surfaces, and early mobilization, are described. Unique considerations in special populations including older adults and individuals with obesity are also addressed.
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Affiliation(s)
- Jenny G Alderden
- University of Utah College of Nursing, 10 2000 East, Salt Lake City, UT 84112, USA.
| | - Faygah Shibily
- Faculty of Nursing, King Abdulaziz University, P.O.Box 42828, Jeddah 21551, Saudi Arabia
| | - Linda Cowan
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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Sala JJ, Mayampurath A, Solmos S, Vonderheid SC, Banas M, D'Souza A, LaFond C. Predictors of pressure injury development in critically ill adults: A retrospective cohort study. Intensive Crit Care Nurs 2020; 62:102924. [PMID: 32859479 DOI: 10.1016/j.iccn.2020.102924] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this research was to identify predictors of pressure injury, using data from the electronic health records of critically ill adults. METHODOLOGY A retrospective cohort study was conducted using logistic regression models to examine risk factors adjusted for age, gender, race/ethnicity and length of stay. SETTING The study cohort included 1587 adults in intensive care units within an urban academic medical centre. MAIN OUTCOME MEASURES The presence or absence of a hospital-acquired pressure injury was determined during monthly skin integrity prevalence surveys. All pressure injuries were independently confirmed by two Certified Wound Care Nurses. RESULTS Eighty-one (5.1%) of the 1587 cohort patients developed pressure injuries. After adjusting for confounders, the clinical variables associated with pressure injury development included mean arterial pressure <60 mmHg and lowest Total Braden score up to two weeks prior to the date of HAPI development or date of prevalence survey for the comparison group. CONCLUSIONS This study provides a more comprehensive understanding about pressure injury risk in critically ill adults, identifying extrinsic and intrinsic factors associated with pressure injury development. Prospective multisite studies are needed to further examine these potential contributors to pressure injury development within the context of adherence to prevention interventions.
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Affiliation(s)
| | - Anoop Mayampurath
- Center for Research Informatics, The University of Chicago, United States; Department of Pediatrics, The University of Chicago Medicine, United States
| | - Susan Solmos
- The University of Chicago Medicine, United States
| | | | | | - Alexandria D'Souza
- Center for Research Informatics, The University of Chicago, United States
| | - Cynthia LaFond
- The University of Chicago Medicine, United States; Rush University Medical Center, United States.
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Celik B, Karayurt Ö, Ogce F. The Effect of Selected Risk Factors on Perioperative Pressure Injury Development. AORN J 2020; 110:29-38. [PMID: 31246295 DOI: 10.1002/aorn.12725] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients undergoing operative and other invasive procedures are at high risk for developing pressure injuries. This study aimed to determine the incidence of perioperative pressure injuries in patients who underwent procedures lasting two hours or more in Turkey and the risk factors that affect the development of pressure injuries. Data were collected during the perioperative period. The incidence of perioperative pressure injuries was 40.4%. The results of univariate logistic regression analysis showed that intraoperative vasopressor use, skin turgor, and diastolic blood pressure less than or equal to 60 mm Hg were significantly related to the development of pressure injuries. There was no significant difference between patients who developed pressure injuries and patients who did not when comparing their preoperative Braden Scale scores. Perioperative nurses should assess each patient for pressure injury risk and perform interventions to prevent pressure injuries during each stage of the patient's perioperative course.
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Nascimento FCLD, Rodrigues MCS. Risk for surgical positioning injuries: scale validation in a rehabilitation hospital. Rev Lat Am Enfermagem 2020; 28:e3261. [PMID: 32401901 PMCID: PMC7217622 DOI: 10.1590/1518-8345.2912.3261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/26/2019] [Indexed: 11/22/2022] Open
Abstract
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.
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Cox J, Schallom M, Jung C. Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients. Am J Crit Care 2020; 29:204-213. [PMID: 32355967 DOI: 10.4037/ajcc2020243] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Critically ill patients have a variety of unique risk factors for pressure injury. Identification of these risk factors is essential to prevent pressure injury in this population. OBJECTIVE To identify factors predicting the development of pressure injury in critical care patients using a large data set from the PhysioNet MIMIC-III (Medical Information Mart for Intensive Care) clinical database. METHODS Data for 1460 patients were extracted from the database. Variables that were significant in bivariate analyses were used in a final logistic regression model. A final set of significant variables from the logistic regression was used to develop a decision tree model. RESULTS In regression analysis, cardiovascular disease, peripheral vascular disease, pneumonia or influenza, cardiovascular surgery, hemodialysis, norepinephrine administration, hypotension, septic shock, moderate to severe malnutrition, sex, age, and Braden Scale score on admission to the intensive care unit were all predictive of pressure injury. Decision tree analysis revealed that patients who received norepinephrine, were older than 65 years, had a length of stay of 10 days or less, and had a Braden Scale score of 15 or less had a 63.6% risk of pressure injury. CONCLUSION Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics.
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Affiliation(s)
- Jill Cox
- Jill Cox is an associate clinical professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse and certified wound, ostomy, and continence nurse at Englewood Health, Englewood, New Jersey
| | - Marilyn Schallom
- Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Christy Jung
- Christy Jung is a research analyst in the Office of Institutional Research and Assessment, Rutgers University School of Nursing
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Grap MJ, Schubert CM, Munro CL, Wetzel PA, Burk RS, Lucas V, Pepperl A. OR Time and Sacral Pressure Injuries in Critically Ill Surgical Patients. AORN J 2020; 109:229-239. [PMID: 30694547 DOI: 10.1002/aorn.12583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Critically ill patients are at risk for developing pressure injuries during operative and other invasive procedures. The purpose of this secondary analysis was to explore the relationship of OR time to sacral pressure injuries in critically ill patients using high frequency ultrasound as a method of assessment. The 41 participants examined in this study had both time in the OR and up to eight days of pressure injury data. The multivariable model containing OR bed time, body mass index, and Braden Scale score produced the best prediction of pressure injury (area under the curve = 0.859). A higher body mass index (P = .09), shorter OR bed time (P = .01), and lower Braden Scale score (P = .05) were associated with a greater chance of pressure injury. These results suggest that use of high frequency ultrasound may identify tissue changes before observable skin changes, leading to earlier pressure injury prevention strategies.
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Haisley M, Sørensen JA, Sollie M. Postoperative pressure injuries in adults having surgery under general anaesthesia: systematic review of perioperative risk factors. Br J Surg 2020; 107:338-347. [PMID: 31960958 DOI: 10.1002/bjs.11448] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/24/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pressure injuries (PIs) after surgery affect thousands of people worldwide. Their management is expensive, a cost that can be reduced with proper preventive measures. Patients having surgery under general anaesthesia are at risk of developing PI, yet no specific tool has been developed to assess the risk in these patients. This review aimed to summarize the published data on perioperative risk factors associated with the development of PI in adults having surgery under general anaesthesia. METHODS All studies reporting on risk factors associated with the development of PI were included. Data were extracted from all articles and meta-analysis was performed when three or more studies reported on a specific variable. RESULTS The analysis identified five factors significantly associated with the development of PIs: cardiovascular disease, respiratory disease, diabetes mellitus, low haemoglobin level and longer duration of surgery. Factors not associated included serum albumin concentration, use of vasopressors during surgery, use of corticosteroids, sex and age. CONCLUSION Cardiovascular disease, respiratory disease, diabetes mellitus, anaemia and duration of surgery should be taken into consideration when trying to identify surgical patients at high risk of developing PIs. These factors could be used to predict PIs after surgery.
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Affiliation(s)
- M Haisley
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - J A Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M Sollie
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Tschannen D, Anderson C. The pressure injury predictive model: A framework for hospital-acquired pressure injuries. J Clin Nurs 2020; 29:1398-1421. [PMID: 31889342 DOI: 10.1111/jocn.15171] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 11/19/2019] [Accepted: 12/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite decades of research, pressure injuries continue to be a source of significant pain and delayed recovery for patients and substantial quality and cost issues for hospitals. Consideration of the current thinking around pressure injury risk must be evaluated to improve risk assessments and subsequent nursing interventions aimed at reducing hospital-acquired pressure injuries. DESIGN This is a discursive paper using Walker and Avant's (2005) theory synthesis framework to examine the relevance of existing pressure injury models as they align with the current literature. METHODS PubMed and CINAHL indexes were searched, first for conceptual models and then for pressure injury research conducted on hospitalised patients for the years 2006-2016. A synthesis of the searches culminated into a new pressure injury risk model. CONCLUSIONS Gaps in previous models include lack of attention to the environment, contributing episode-of-care factors and the dynamic nature of injury risk for patients. Through theory synthesis, the need for a new model representing the full risk for pressure injury was identified. The Pressure Injury Predictive Model is a representation of the complex and dynamic nature of pressure injury risk that builds on previous models and addresses new patient, contextual and episode-of-care process influences. The Pressure Injury Predictive Model (PIPM) provides a more accurate picture of the complexity of contextual and process factors associated with pressure injury development. RELEVANCE TO CLINICAL PRACTICE Using the PIPM to determine risk can result in improved risk identification. This information can be used to implement targeted, evidence-based pressure injury prevention interventions specific to the patient risk profile, thus limiting unwarranted and unnecessary care.
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Affiliation(s)
- Dana Tschannen
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Examining Social Risk Factors in a Pressure Ulcer Quality Measure for Three Post-Acute Care Settings. Adv Skin Wound Care 2020; 33:156-163. [DOI: 10.1097/01.asw.0000651456.30210.8a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Babamohamadi H, Ansari Z, Nobahar M, Mirmohammadkhani M. The effects of peppermint gel on prevention of pressure injury in hospitalized patients with head trauma in neurosurgical ICU: A double-blind randomized controlled trial. Complement Ther Med 2019; 47:102223. [PMID: 31780037 DOI: 10.1016/j.ctim.2019.102223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of peppermint gel on the prevention of pressure injuries in patients with head trauma admitted to neurosurgical intensive care units. DESIGN This double blind, randomized, controlled clinical trial study was conducted on 150 patients with head trauma admitted to the ICU. Using sealed envelopes, patients were assigned randomly into two intervention (n = 75) and control (n = 75) groups. SETTING The study was conducted in the ICUs of a university hospital and a general hospital in Shiraz, Iran. INTERVENTION The intervention group received peppermint gel three times a day up to 14 days during the skin care as a layer on the skin areas exposed to the risk of pressure injuries. The control group used a placebo gel. PRIMARY OUTCOMES The expected outcome in this study was the incidence of pressure injuries stage I, which once daily was evaluated by pairs of observers with the National Pressure Ulcer Advisory Panel. RESULTS The incidence rate of pressure injuries was 22.8% and 77% in the intervention and the control groups, respectively. The chi-square test result showed a significant deference between two groups (P < 0.001). Sacrum was the most common site for incidence of the pressure injuries. CONCLUSION The findings showed that the peppermint gel has a positive effect in the prevention of pressure injuries in the patients with head trauma admitted to ICUs. So, the use of this gel is suggested as an easy and low-cost method for prevention of pressure injuries in the patients admitted to ICUs.
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Affiliation(s)
- Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
| | - Zahra Ansari
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran, Iran.
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran; Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Epidemiology and Statistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
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Kaylor J, Bankieris K, Johnson A, Hooper V. Sacral Pressure Injury Study Commentary. AORN J 2019; 110:356-357. [DOI: 10.1002/aorn.12823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Park SK, Park HA, Hwang H. Development and Comparison of Predictive Models for Pressure Injuries in Surgical Patients. J Wound Ostomy Continence Nurs 2019; 46:291-297. [DOI: 10.1097/won.0000000000000544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Xu X, Ma Y, Yao Z, Zhao Y. Prevalence and Risk Factors for Pressure Ulcers in Patients with Enterocutaneous Fistula: A Retrospective Single-Center Study in China. Med Sci Monit 2019; 25:2591-2598. [PMID: 30964125 PMCID: PMC6476408 DOI: 10.12659/msm.913261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Prevalence and associated risk factors for pressure ulcers (PU) vary in different body areas and diseases. Few studies have focused on PU in patients with enterocutaneous fistula (ECF). The aim of the present study was to investigate the prevalence and risk factors for PU in patients with ECF. MATERIAL AND METHODS From January 2016 to June 2016, medical records of 140 patients with ECF who were transferred to the Enterocutaneous Fistula Treatment Center, Jinling Hospital, were reviewed and analyzed. The prevalence of PU was investigated. To evaluate the risk factors for PU in patients with ECF, 5 patients with PU before admission were excluded, and the remaining 135 patients were divided into 2 groups: the PU group and the non-PU group. The risk factors for PU were confirmed by multivariate logistic regression analysis of characteristics on admission. RESULTS There were 42 cases with PU (5 cases with PU before admission, 37 cases with PU in the treatment after admission), and the prevalence of PU in patients with ECF was 30%. In addition, Braden risk score <19 (OR=9.33, CI: 2.80-31.08, p<0.001); underweight (BMI<18.5) (OR=5.21, CI: 1.65-16.39, p=0.005); onset of duodenal fistula (OR=4.86, CI: 1.33-17.78, p=0.017); diabetes (OR=4.95, CI: 1.03-23.85, p=0.046); and APACHE II score (OR=1.34, CI: 1.04-1.72, p=0.019) were associated with PU. CONCLUSIONS The PU prevalence was 30% in patients with ECF. Braden risk score <19, underweight, onset of duodenal fistula, diabetes, and APACHE II score were risk factors for PU in patients with ECF.
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Yu Y, Shen J, Fang G, Wang L, Lei S, Cai D, Shi Y, Jin S, Lu Q, Wang S, Sun Y, Yao J, Hu P, Wu X, He X. Use of autologous platelet rich fibrin-based bioactive membrane in pressure ulcer healing in rats. J Wound Care 2019; 28:S23-S30. [PMID: 30975063 DOI: 10.12968/jowc.2019.28.sup4.s23] [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
OBJECTIVE To verify the feasibility of treating pressure ulcers (PUs) with autologous platelet-rich fibrin-based (PRF) bioactive membrane, both in vitro and in vivo. METHOD An animal model using adult male Sprague-Dawley rats was used. Pressure was periodically exerted on the skin to induce localised ischaemia by using an external magnet and transplanted metal disc. After a PU developed, the rats were divided into two groups: a treatment group and a control group. Rats in the treatment group were then treated with PRF bioactive membrane every three days. RESULTS A total of 20 rats were used in this study. At days three and seven, the PU area in the PRF bioactive membrane-treated group was significantly smaller than that in the control group, and after 14 days of treatment, the PUs in the PRF bioactive membrane treatment group had healed. Haemotoxylin and eosin staining, immunohistochemistry and Western blot results indicated that PRF bioactive membrane induced wound healing by increasing the thickness of the regenerated epidermis and by upregulating vascular endothelial growth factor expression. Further, we found that different concentrations of rat autologous PRF soluble factors extraction components could significantly promote rat aortic endothelial cell proliferation, wound healing and migration ability in vitro. CONCLUSION Overall, results indicate that PRF bioactive membrane promotes PU healing in rats. Thus, it may represent a natural and effective wound-healing tool for use in the treatment of clinical skin PUs in humans in the future.
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Affiliation(s)
- Yajuan Yu
- ICU Specialty Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Jian Shen
- Technologist-in-charge, Department of Blood Transfusion, Zhejiang Provincial People's Hospital; People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Guizhen Fang
- Lead Nurse Advanced Nurse Practitioner, Nursing Department of Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Lingcong Wang
- Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Shu Lei
- Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Danli Cai
- Associate Chief Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Ying Shi
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Shuifang Jin
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Qiaoli Lu
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Sisi Wang
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Yunlei Sun
- Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Jinmei Yao
- Associate Senior Technician, Department of Laboratory Medicine, Key Laboratory of Clinical In vitro Diagnostic Techniques of Zhejiang Province First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Peiya Hu
- ICU Specialty Nurse, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
| | - Xiaofei Wu
- Senior Nurse; Department of Central Vein Maintenance Center, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hubin Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Xujun He
- Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China
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Sharp CA, Schulz Moore JS, McLaws ML. Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse? JOURNAL OF BIOETHICAL INQUIRY 2019; 16:17-34. [PMID: 30671872 PMCID: PMC6474851 DOI: 10.1007/s11673-018-9892-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress.
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Affiliation(s)
- Catherine A Sharp
- School of Public Health and Community Medicine, University of New South Wales, 3rd Floor Samuels Building, Sydney, NSW, 2052, Australia
| | | | - Mary-Louise McLaws
- School of Public Health and Community Medicine, University of New South Wales, 3rd Floor Samuels Building, Sydney, NSW, 2052, Australia.
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