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Gou Y, Hu L, Liao X, He J, Liu F. Advances of antimicrobial dressings loaded with antimicrobial agents in infected wounds. Front Bioeng Biotechnol 2024; 12:1431949. [PMID: 39157443 PMCID: PMC11327147 DOI: 10.3389/fbioe.2024.1431949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/23/2024] [Indexed: 08/20/2024] Open
Abstract
Wound healing is a complex process that is critical for maintaining the barrier function of the skin. However, when a large quantity of microorganisms invade damaged skin for an extended period, they can cause local and systemic inflammatory responses. If left untreated, this condition may lead to chronic infected wounds. Infected wounds significantly escalate wound management costs worldwide and impose a substantial burden on patients and healthcare systems. Recent clinical trial results suggest that the utilization of effective antimicrobial wound dressing could represent the simplest and most cost-effective strategy for treating infected wounds, but there has hitherto been no comprehensive evaluation reported on the efficacy of antimicrobial wound dressings in promoting wound healing. Therefore, this review aims to systematically summarize the various types of antimicrobial wound dressings and the current research on antimicrobial agents, thereby providing new insights for the innovative treatment of infected wounds.
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Affiliation(s)
- Yifan Gou
- Department of Stomatology, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Liwei Hu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xuejuan Liao
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jing He
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fan Liu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Cseh B, Balogh Z, Takács J, Túri G, Dózsa CL. Organizational development and management factors involved in the prevention and effective therapy of pressure ulcers: The results of the national survey conducted among Hungarian public hospitals. Int Wound J 2024; 21:e14655. [PMID: 38272822 PMCID: PMC10805534 DOI: 10.1111/iwj.14655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
The prevention of pressure ulcer (PU) or pressure injury (PI) wounds is of public health importance in developed countries, including Hungary. The study aimed to assess the PU/PI prevention and care practices of Hungarian public hospitals and identify organizational and management factors. In 2022, a national, questionnaire-based survey of inpatient institutions relevant to PU/PI care was conducted, providing a picture of the practices of 86 hospitals for the year 2019. The questionnaire was processed using descriptive statistics and regression analysis. The survey results show that good practices in Hungary are isolated, the reporting system is inhomogeneous, and documentation is not uniform across our institutional system. Of the 86 institutions, 71.0% operate a PU prevention team, 64.0% use prophylactic dressings, and 88.3% use an anti-decubitus mattress, with an average ratio of 26.1% to the number of beds. Less than half of the institutions reported the incidence of hospital acquired pressure injuries (HAPIs). In this sample, we found no significant association between hospital type and hospital size with the incidence of full-thickness HAPIs (stage III and IV wounds). Developing a comprehensive PU/PI reporting system and updating the national PU/PI prevention and care guidelines are essential in Hungary.
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Affiliation(s)
- Borbála Cseh
- Schools of PhD Studies, Health Sciences DivisionSemmelweis UniversityBudapestHungary
- Department of Theoretical Health SciencesUniversity of MiskolcMiskolcHungary
- Med‐Econ Human Services LtdBudapestHungary
| | - Zoltán Balogh
- Department of Nursing, Faculty of Health SciencesSemmelweis UniversityBudapestHungary
| | - Johanna Takács
- Department of Social Sciences, Faculty of Health SciencesSemmelweis UniversityBudapestHungary
| | - Gergő Túri
- Med‐Econ Human Services LtdBudapestHungary
- Epidemiology and Surveillance CentreSemmelweis UniversityBudapestHungary
- Synthesis Health Research FoundationBudapestHungary
- Doctoral School of Health SciencesUniversity of DebrecenDebrecenHungary
| | - Csaba László Dózsa
- Department of Theoretical Health SciencesUniversity of MiskolcMiskolcHungary
- Med‐Econ Human Services LtdBudapestHungary
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Romito K, Talbot LA, Metter EJ, Smith AL, Hartmann JM, Bradley DF. Perioperative Pressure Injury Prevention Program in a Military Medical Treatment Facility: A Quality Improvement Project. Mil Med 2023; 189:51-56. [PMID: 37956330 DOI: 10.1093/milmed/usad321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/02/2023] [Accepted: 07/31/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION The incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning. METHODS We used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding. RESULTS There was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented. CONCLUSION This project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.
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Affiliation(s)
- Kenneth Romito
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Laura A Talbot
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Amber L Smith
- Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - J Michael Hartmann
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - David F Bradley
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Aloweni FBAB, Lim SH, Agus NLB, Ang SY, Goh MM, Yong P, Fook-Chong S, Tucker-Kellogg L, Soh CR. Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients. AORN J 2023; 118:306-320. [PMID: 37882600 DOI: 10.1002/aorn.14021] [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: 06/17/2021] [Revised: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 10/27/2023]
Abstract
The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P < .001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Wang JC, Fort CL, Matl CM, Harvey BD, Demke JC, Thomas JR, Sidle DM. Effects of Essential Oils on Scars and Wound Healing: A Systematic Review. Facial Plast Surg 2023; 39:173-179. [PMID: 36070793 DOI: 10.1055/a-1938-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Essential oils (EOs) have been considered as a potential alternative therapy for wound healing and scar reduction. The aim of this article was to provide a comprehensive review examining the effects of EOs on wound healing and scars. PubMed, Cochrane, Ovid, and Embase computerized searches were performed through June 2020. Two independent reviewers conducted data extraction, with search results reviewed by the senior author following the PRISMA protocol. Three manuscripts examining three different EO-containing topical agents were analyzed. Outcomes include healing rate, erythema, pain, pruritus, patient discomfort, physician satisfaction, percent wound reduction, wound/scar surface perimeter area, and qualitative dermatological evaluation. All articles concluded that the EO-containing topical agents resulted in either superior or noninferior outcomes in comparison with controls. Hypericum-Calendula oil obtained lower wound surface perimeter area. Erythema (p = 0.001) was significantly decreased by the peppermint EO-containing topical agent. Physicians also reported greater satisfaction (p < 0.001) in wound appearance with use of the peppermint EO-containing topical agent. A paucity of studies have examined EO use for wound healing and scar reduction. Treatment with EO-containing topical agents resulted in decreased erythema with increased physician satisfaction of wound appearance. Future studies should assess what level of purity is needed for improved results and which EO, or combination of EOs, is most beneficial.
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Affiliation(s)
- James C Wang
- Department of Otolaryngology - Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois
- Department of Otolaryngology - Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Callie L Fort
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Christina M Matl
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Bailey D Harvey
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joshua C Demke
- Department of Otolaryngology - Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - J Regan Thomas
- Department of Otolaryngology - Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois
| | - Douglas M Sidle
- Department of Otolaryngology - Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois
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Lin F, Dawson D. Pressure injury: Reflecting on previous publications in Intensive and Critical Care Nursing and a call for papers. Intensive Crit Care Nurs 2023; 75:103379. [PMID: 36566142 DOI: 10.1016/j.iccn.2022.103379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Frances Lin
- University of the Sunshine Coast, Queensland, Sippy Downs 4556, Queensland, Australia.
| | - Deborah Dawson
- Ventilator Unit, Royal Hospital for Neuro-disability West Hill, London SW15 3SW, United Kingdom.
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Sugrue C, Avsar P, Moore Z, Patton D, O'Connor T, Nugent L, Budri A. The Effect of Prophylactic Silicone Dressings on the Incidence of Pressure Injuries on Patients in the Acute Care Setting: A Systematic Review and Meta-analysis. J Wound Ostomy Continence Nurs 2023; 50:115-123. [PMID: 36867034 DOI: 10.1097/won.0000000000000953] [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: 03/04/2023]
Abstract
PURPOSE To explore the effect of silicone dressings on the prevention of pressure injuries in patients cared for in the acute care setting. Three main comparisons were explored: silicone dressing versus no dressing, all anatomical areas; silicone dressing versus no dressing on the sacrum; and silicone dressing versus no dressing on the heels. METHODS Using a systematic review methodology, published randomized controlled trials and cluster randomized controlled trials were included. The search was conducted from December 2020 to January 2021 using CINAHL, full text on EBSCOhost, MEDLINE on EBSCOhost, and Cochrane databases. The search returned 130 studies; 10 met inclusion criteria. Data were extracted using a predesigned extraction tool. The Cochrane Collaboration tool was used to assess the risk of bias and the certainty of the evidence was appraised using a software program specifically designed for this purpose. RESULTS Silicone dressings probably reduce the incidence of pressure injuries compared to no dressings (relative risk [RR]: 0.40, 95% confidence interval [CI]: 0.31-0.53; moderate certainty evidence). Furthermore, silicone dressings probably reduce the incidence of pressure injuries on the sacrum compared to no dressings (RR: 0.44, 95% CI: 0.31-0.62; moderate certainty evidence). Finally, silicone dressings probably reduce the incidence of pressure injuries on the heels compared to no dressings (RR: 0.44, 95% CI: 0.31-0.62; moderate certainty evidence). CONCLUSION There is moderate certainty evidence of the effect of silicone dressings as a component of a pressure injury prevention strategy. The main limiting factor in the study designs was a high risk of performance and detection bias. Although this is a challenge to achieve in trials such as these, consideration should be given to how the effect of this could be minimized. A further issue is the lack of head-to-head trials that limits clinicians' abilities to determine whether any of the products in this category are more effective than others.
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Affiliation(s)
- Claire Sugrue
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Pinar Avsar
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Aglecia Budri
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
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Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:4-13. [PMID: 35680115 DOI: 10.1016/j.enfcle.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/01/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Preventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings. METHODS A literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. Evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model. RESULTS Of the 1056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95% CI: 0.19-0.45, P<0.01). We found no significant difference between results of studies conducted in intensive care settings (RR=0.25, 95% CI: 0.15-0.43, P<0.01) and non-intensive care settings (RR=0.38, 95% CI: 0.17-0.83, P=0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95% CI: 0.20-0.48, P<0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95% CI: 0.01-0.73, P=0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27). CONCLUSION The present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.
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10
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Kennepp L. 2023 Resolutions: It's time to revamp your pressure injury prevention programs. Healthc Manage Forum 2023; 36:5-14. [PMID: 36510467 DOI: 10.1177/08404704221137542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The success of any quality improvement project begins with acknowledging problems, defining and addressing each issue in detail, and setting goals. In the case of pressure injuries, the answer is fairly simple. Reduce the number of pressure injuries. Yet, the process yielding a "means to the end" is quite complex. It not only requires a team of interdisciplinary healthcare providers and leaders to ensure success; it requires continuous effort. The intention of this article is to highlight the importance of a comprehensive Pressure Injury Prevention (PIP) program and offer guidance based on evidence. Utilizing an organized framework for planning will help healthcare providers ensure all critical steps are completed. The Standardized Pressure Injury Prevention Protocol (SPIPP) provides detail surrounding the necessary steps toward compliance with best practice guidelines. A comprehensive checklist provided within the SPIPP article is designed to discuss specific details of the PIP program. The author of this article offers a broader framework and checklist, The Pressure Injury Prevention Implementation Checklist (PIPIC) based on blending several quality improvement methodologies. Challenges associated with pressure injuries continue to affect the lives of both patients and caregivers. Entering a new year, new month, or even new day brings the opportunity for change and improvement. Revamping a PIP program requires careful thought, planning, and dedication, but it is not insurmountable. Organizing a team to address the issues and approach the task with an organized, evidence-based plan will improve the overall PIP program success.
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11
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Rezvani Ghomi E, Niazi M, Ramakrishna S. The evolution of wound dressings: From traditional to smart dressings. POLYM ADVAN TECHNOL 2022. [DOI: 10.1002/pat.5929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Erfan Rezvani Ghomi
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering College of Design and Engineering Singapore Singapore
| | - Mina Niazi
- Department of Biomedical Engineering National University of Singapore Singapore Singapore
| | - Seeram Ramakrishna
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering College of Design and Engineering Singapore Singapore
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12
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Al-Majid S, Vuncanon B, Kiyohara M, Rakovski C. Using Continuous Intraoperative Pressure Mapping to Describe Patterns of Tissue Interface Pressure. AORN J 2022; 116:231-247. [PMID: 36005880 DOI: 10.1002/aorn.13767] [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: 08/30/2021] [Revised: 01/13/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to describe patterns of intraoperative tissue interface pressure, identify the amount of time during which the pressure at four anatomical locations exceeded 32 mm Hg, and examine associations between patient- and surgery-related variables and peak tissue interface pressure. We used a pressure mapping system to measure the intraoperative tissue interface pressure of 150 patients. We implemented linear mixed-effects models to assess trends in the mean and peak tissue interface pressure. The percentage of time during which the interface pressure exceeded 32 mm Hg at the scapulae, interscapular area, and sacral area was 70%, 70%, and 90%, respectively. Body mass index, length of surgery, and intraoperative position were major predictors of increased pressure. Understanding patterns of tissue interface pressure of patients during surgery may help perioperative nurses develop strategies to attenuate pressure and protect skin integrity.
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13
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Li J, Zhu C, Liu Y, Li Z, Sun X, Bai Y, Song B, Jin J, Liu Y, Wen X, Cheng S, Wu X. Critical care nurses' knowledge, attitudes, and practices of pressure injury prevention in China: A multicentric cross-sectional survey. Int Wound J 2022; 20:381-390. [PMID: 35906851 PMCID: PMC9885482 DOI: 10.1111/iwj.13886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/25/2022] [Indexed: 02/03/2023] Open
Abstract
Pressure injury is a serious and preventable problem in intensive care units. Translating guidelines into clinical practice can reduce the incidence of pressure injury. Identifying clinical status, barriers and facilitators contribute to guideline implementation. To identify the knowledge, attitudes, and practices of pressure injury prevention in Chinese critical care nurses. Secondary data were extracted from a multicentric clinical trial. Knowledge and attitudes toward pressure injury prevention were assessed by a fourteen-item questionnaire. The observed practices were recorded using a case report form. The report complies with the STROBE statement. A total of 950 critical care nurses in 15 hospitals from six provinces of China were investigated. A total of 53.1% of nurses received a median score of 6 points or less. Knowledge regarding the repositioning procedure, risk assessment, and heel pressure injury prevention was insufficient. Over 99% of nurses strongly or somewhat agreed that pressure injury prevention was very important and that they were willing to take measures to prevent pressure injury. A total of 27 781 patient days of pressure injury prevention practice were recorded. Repositioning was the most commonly used prevention measure, followed by support surfaces and prophylactic dressings. A combination of repositioning, support surface, and prophylactic dressing was lacking. Chinese critical nurses showed a low level of knowledge and a positive attitude toward pressure injury prevention. Practices of pressure injury prevention were unsatisfactory. There is a clear gap between the guidelines and clinical practices. The barrier (low-level knowledge) and facilitator (positive attitude) were identified in this study. According to these findings, strategies need to be developed to promote guideline implementation.
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Affiliation(s)
- Jiamin Li
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Ying Liu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Zhaoyu Li
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Xiangyu Sun
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yunfeng Bai
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Baoyun Song
- Department of NursingHenan Provincial People's HospitalZhengzhouChina
| | - Jingfen Jin
- Department of NursingZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Yilan Liu
- Department of NursingWuhan Union HospitalWuhanChina
| | - Xianxiu Wen
- Department of NursingSichuan Academy of Medical Sciences and Sichuan People's HospitalChengduChina
| | - Shouzhen Cheng
- Department of NursingSun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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14
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Holder H, Aningalan AM, Walker S, Cato K, Gannon B“R. Feasibility of nasal bridge pressure injury prevention using a protective dressing and the Halyard Fluidshield® N95 mask in a COVID-positive environment. Int Wound J 2022; 20:278-284. [PMID: 35851746 PMCID: PMC9349906 DOI: 10.1111/iwj.13871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 02/03/2023] Open
Abstract
The purpose of this study was to prevent nasal bridge pressure injury among fit-tested employees, secondary to long-term wear of the N95 mask during working hours. A prospective, single-blinded, experimental cohort design. Participants were enrolled using the convenience sampling methods and randomisation was utilised for group assignment. Eligibility was determined by a COVID Anxiety Scale score and non-COVID clinical assignment. Participants with a history of previous skin injury or related condition were excluded. The experimental group was assigned Mepilex Lite® and the control group used Band- Aid®. Formal skin evaluations were done by Nurse Specialists who are certified in wound and ostomy care by the Wound, Ostomy, Continence, Nursing Certification Board (WOCNCB®). Fit test logs were provided to participants to measure subjective user feedback regarding mask fit and level of comfort. The results of this feasibility trial are promising in supporting the use of a thin polyurethane foam dressing as a safe and effective dressing to apply beneath the N95 mask. Additional research is needed to validate results due to limited data on efficacy and safety of the various barrier dressings as a potential intervention to prevent skin breakdown to the nasal bridge.
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Affiliation(s)
- Hazel Holder
- NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
| | | | | | - Kenrick Cato
- School of NursingColumbia UniversityNew YorkNew YorkUSA,Department of Emergency MedicineColumbia University Irving School of MedicineNew YorkNew YorkUSA
| | - Brittany “Ray” Gannon
- NewYork‐Presbyterian HospitalNew YorkNew YorkUSA,School of NursingColumbia UniversityNew YorkNew YorkUSA
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15
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Lovegrove J, Fulbrook P, Miles SJ. Use of a Sacral Foam Dressing to Prevent Pressure Injury in At-Risk Subacute Hospitalized Older Adults: A Pilot Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2022; 49:322-330. [PMID: 35809008 DOI: 10.1097/won.0000000000000894] [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: 11/25/2022]
Abstract
PURPOSE The purpose of this pilot study was to inform a future trial aimed at comparing the effectiveness of a prophylactic sacral dressing plus standard care to standard care only to reduce sacral pressure injuries (PIs) in at-risk older adults admitted to a subacute hospital setting. DESIGN A pilot study with a pragmatic, open-label, randomized controlled trial design. SAMPLE AND SETTING One hundred thirty participants were randomized (intervention n = 66, 50.8%; control n = 64, 49.2%). Protocol violations occurred in 48 participants (intervention n = 33, 68.8%; control n = 15, 31.3%). The study setting was a subacute hospital inpatient care unit located in Queensland, Australia. METHODS Participants were randomly allocated 1:1 to the intervention (prophylactic dressing plus standard care) or control group (standard care). Standard care included regular PI risk and skin assessments, and selection and implementation of preventive interventions (eg, support surfaces and increased repositioning) from a PI prevention care plan. The sacral dressing was applied for intervention participants immediately following recruitment. Ward and research staff collected data and assessed skin integrity daily; participants were followed up until onset of a PI or up to 28 days without PI occurrence. In addition, retrospective chart reviews were undertaken to verify PI occurrences. Patient comfort and dressing utility were also evaluated. RESULTS Two (3.0%) participants in the intervention group and 1 (1.6%) in the control group developed a sacral PI. The difference was not statistically significant. Only 1 PI was recorded prospectively, while 2 PIs were identified via retrospective chart review. Participants rated dressing comfort highly, particularly during the first 2 weeks, and nurses rated utility highly. Based on the intention-to-treat results, a sample size of 1799 per arm would be required in a definitive trial. CONCLUSIONS A definitive trial is feasible and warranted. However, the large sample size required in a definitive trial indicates the need for multiple sites.
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Affiliation(s)
- Josephine Lovegrove
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Paul Fulbrook
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Sandra J Miles
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
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16
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Brienza D, Gefen A, Clark M, Black J. The vision and scope of the prophylactic dressing standard initiative of the European Pressure Ulcer Advisory Panel and National Pressure Injury Advisory Panel. Int Wound J 2022; 19:963-964. [PMID: 35698859 PMCID: PMC9284620 DOI: 10.1111/iwj.13859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- David Brienza
- Departments of Rehabilitation Science and Technology and Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Michael Clark
- Welsh Wound Innovation Centre, Ynysmaerdy Wales, UK.,School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Joyce Black
- Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Shimura T, Nakagami G, Ogawa R, Ono S, Takahashi T, Nagata M, Kashiwabara K, Sugama J, Sanada H, Oe M. Incidence of and Risk Factors for Self-load-related and Medical Device-related Pressure Injuries in Critically Ill Patients: A Prospective Observational Cohort Study. Wound Repair Regen 2022; 30:453-467. [PMID: 35567569 DOI: 10.1111/wrr.13022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
There are two types of pressure injuries: self-load-related pressure injuries (PIs) and medical device-related pressure injuries (MDRPIs), but the differences in risk factors between PIs and MDRPIs have not yet been clarified. If risk factors for PIs and MDRPIs differ, preventive interventions should take this into account. This is a prospective cohort study aimed to determine the cumulative incidence of PIs and MDRPIs in critically ill patients and to identify corresponding risk factors. The study included 1418 patients who were admitted to the critical care medical center of a single university hospital in Tokyo, Japan, between December 1, 2019, and August 31, 2020. The Kaplan-Meier method was used to calculate the cumulative incidence of PIs and MDRPIs. Furthermore, the Cox proportional hazards model was used to analyze the predictors in both the PI and MDRPI incidence and non-incidence groups. Predictors were based on data from the 0th disease day. The cumulative incidence of PIs and MDRPIs was 4.6/1000 person-days and 3.6/1000 person-days, respectively. Multivariate analysis using the Cox proportional hazards model showed that common risk factors for the occurrence of PIs and MDRPIs were possession of PI on admission, higher blood lactate, blood purification therapy, and positional restriction. The risk factors for PIs only were diabetes mellitus, septic shock, and a lower serum albumin level, while the risk factors for MDRPIs only were the D-dimer level and extracorporeal membranous oxygenation treatment. Therefore, prophylactic interventions need to consider these different risk factors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tomoko Shimura
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Rei Ogawa
- Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School
| | - Shimpei Ono
- Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School
| | - Toshiaki Takahashi
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
| | - Misako Nagata
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo
| | | | - Junko Sugama
- Research Center for Implementation Nursing Science Initiative, Fujita Health University
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Makoto Oe
- School of Health Science, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
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19
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Lovegrove J, Fulbrook P, Miles S, Steele M. Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care 2022; 35:186-203. [PMID: 34144865 DOI: 10.1016/j.aucc.2021.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of the study was to investigate the effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings. REVIEW METHOD USED This is a systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Five databases (CINAHL, MEDLINE, Scopus, Web of Science, and Embase) were searched in mid-2019. Searches were updated (in April 2020) to year end 2019. REVIEW METHODS From an overarching systematic review and meta-analysis examining the effectiveness of pressure injury preventative interventions in adults admitted to acute hospital settings, trials conducted in intensive care were separated for an intensive care-specific synthesis. Two reviewers, with a third as an arbitrator, undertook study selection, data extraction, and risk-of-bias assessment. Included trials were grouped by intervention type for narrative synthesis and for random-effects meta-analysis using intention-to-treat data where appropriate. RESULTS Overall, 26 trials were included. Ten intervention types were found (support surfaces, prophylactic dressings, positioning, topical preparations, continence management, endotracheal tube securement, heel protection devices, medication, noninvasive ventilation masks, and bundled interventions). All trials, except one, were at high or unclear risk of bias. Four intervention types (endotracheal tube securement, heel protection devices, medication, and noninvasive ventilation masks) comprised single trials. Support surface trials were limited to type (active, reactive, seating, other). Meta-analysis was undertaken for reactive surfaces, but the intervention effect was not significant (risk ratio = 0.24, p = 0.12, I2 = 51%). Meta-analyses demonstrated the effectiveness of sacral (risk ratio = 0.22, p < 0.001, I2 = 0%) and heel (risk ratio = 0.31, p = 0.02; I2 = 0%) prophylactic dressings for pressure injury prevention. CONCLUSIONS Only prophylactic sacral and heel dressings demonstrated effectiveness in preventing pressure injury in adults admitted to intensive care settings. Further intensive care-specific trials are required across all intervention types. To minimise bias, we recommend that all future trials are conducted and reported as per relevant guidelines and recommendations.
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032; Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg, 2000, South Africa.
| | - Sandra Miles
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032.
| | - Michael Steele
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032; School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, 1100 Nudgee Road, Banyo, Queensland, Australia 4014.
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20
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Forni C, Gazineo D, Allegrini E, Bolgeo T, Brugnolli A, Canzan F, Chiari P, Evangelista A, Grugnetti AM, Grugnetti G, Guberti M, Matarese M, Mezzalira E, Pierboni L, Prosperi L, Sofritti B, Tovazzi C, Vincenzi S, Zambiasi P, Zoffoli C, Ambrosi E, Bandi F, Batani M, Bertin G, Bianchi L, Carmagnini M, Cedioli S, Colognese S, Consuelo M, D'Alessandro F, Fontana M, Galassi L, Gridelli M, Magnani P, Morri M, Ortolani B, Scialla M, Stanga P, Toselli P, Zanelli S. Effectiveness of a multi-layer silicone-adhesive polyurethane foam dressing as prevention for sacral pressure ulcers in at-risk in-patients: randomized controlled trial. Int J Nurs Stud 2022; 127:104172. [DOI: 10.1016/j.ijnurstu.2022.104172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
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21
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Gong X, Xu R. Prophylactic sacral protective dressings' effect on preventing pressure injury: A meta-analysis. Int Wound J 2021; 19:1463-1470. [PMID: 34962078 PMCID: PMC9493227 DOI: 10.1111/iwj.13743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/27/2022] Open
Abstract
We performed a meta-analysis to evaluate the effect of prophylactic sacral protective dressings on preventing pressure injury. A systematic literature search up to July 2021 was performed, and 11 studies included 5150 community or hospital-based adult subjects requiring care at the start of the study; 2832 of them were using sacral protective dressings and 2318 were given standard care with no sacral protective dressings. They were reporting relationships between the effects of prophylactic sacral protective dressings on preventing pressure injury. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of prophylactic sacral protective dressings on preventing pressure injury using the dichotomous method with a random or fixed-effect model. Sacral protective dressings had a significantly lower incidence of pressure injuries (OR, 0.39; 95% CI, 0.28-0.53, P < .001) compared with standard care with no sacral protective dressings in community- or hospital-based adult subjects requiring care. Sacral protective dressings had a significantly lower incidence of pressure injuries compared with standard care with no sacral protective dressings in community- or hospital-based adult subjects requiring care. Further studies are needed to confirm these findings.
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Affiliation(s)
- Xinyan Gong
- Department of Cardiology, Yiwu Central Hospital, Yiwu, China
| | - Ruimin Xu
- Emergency Department, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
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22
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Dalgleish L, Campbell J, Finlayson K, Barakat-Johnson M, Beath A, Ingleman J, Parker C, Coyer F. Understanding Skin Failure: A Scoping Review. Adv Skin Wound Care 2021; 34:542-550. [PMID: 34175867 DOI: 10.1097/01.asw.0000755844.87283.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To map the use of the term "skin failure" in the literature over time and enhance understanding of this term as it is used in clinical practice. DATA SOURCES The databases searched for published literature included PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature, and Google Scholar. The search for unpublished literature encompassed two databases, Open Gray and ProQuest Dissertation and Theses. STUDY SELECTION Search terms included "skin failure," "acute skin failure," "chronic skin failure," and "end stage skin." All qualitative and quantitative research designs, editorial, opinion pieces, and case studies were included, as well as relevant gray literature. DATA EXTRACTION Data collected included author, title, year of publication, journal name, whether the term "skin failure" was mentioned in the publication and/or in conjunction with other skin injury, study design, study setting, study population, sample size, main focus of the publication, what causes skin failure, skin failure definition, primary study aim, and primary outcome. DATA SYNTHESIS Two main themes of skin failure were identified through this scoping review: the etiology of skin failure and the interchangeable use of definitions. CONCLUSIONS Use of the term "skin failure" has increased significantly over the past 30 years. However, there remains a significant lack of empirical evidence related to skin failure across all healthcare settings. The lack of quality research has resulted in multiple lines of thinking on the cause of skin failure, as well as divergent definitions of the concept. These results illustrate substantial gaps in the current literature and an urgent need to develop a globally agreed-upon definition of skin failure, as well as a better understanding of skin failure etiology.
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Affiliation(s)
- Lizanne Dalgleish
- At the School of Nursing, Queensland University of Technology, Brisbane, Australia, Lizanne Dalgleish, PhD, RN, is PhD Candidate; Jill Campbell, PhD, RN, is Senior Research Fellow; Kathleen Finlayson, PhD, RN, is Lecturer; Jessica Ingleman, MSN, RN, is Lecturer; Christina Parker, PhD, RN, is Senior Lecturer; and Fiona Coyer, PhD, RN, is Professor. Michelle Barakat-Johnson, PhD, RN, is Senior Lecturer, University of Sydney, Camperdown. Amy Beath, BSN, RN, is Transitional Nurse Practitioner-Wounds, Murrumbidgee Local Health District, New South Wales. The authors have disclosed no financial relationships related to this article. Submitted June 21, 2020; accepted in revised form December 1, 2020; published online ahead of print June 23, 2021
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23
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Faucher N, Barateau M, Hentz F, Michel P, Meaume S, Rousseaux C, Marty M, Le Fort M, Nicolas B. Use of multilayer silicone foam dressings as adjuvant therapy to prevent pressure injuries. J Wound Care 2021; 30:712-721. [PMID: 34554838 DOI: 10.12968/jowc.2021.30.9.712] [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
Despite progress in the prevention of pressure injuries (PIs), they remain a challenging public health problem because of their frequency and morbidity. Protection of the skin by multilayer silicone foam dressings may be an adjuvant measure to prevent PIs in high-risk patients. Despite the available clinical data and published recommendations on this measure, caregivers face difficulties in identifying patients who would benefit from this adjuvant measure. The objective of this work was to define the profiles of high-risk patients who would benefit optimally from this measure in combination with basic preventive procedures. This consensual expert opinion was drawn up using two methods: the Nominal Group Technique with eight medical and paramedical experts, and the Delphi process with 16 experts. The bases for this expert consensual opinion were a formal search and analysis of the published literature regarding evidence on the prevention of PIs using multilayer silicone foam dressings. The consensual expert opinion reported here addresses five proposals mostly intended to define patients who would benefit from the use of a multilayer silicone foam dressing (≥4 layers) to prevent PIs (sacrum and heels).
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Affiliation(s)
- Nathalie Faucher
- Service de Gériatrie Hôpital Bichat Claude Bernard, Paris, France.,Société Française et Francophone des Plaies et Cicatrisations
| | - Martine Barateau
- Consultation Plaies, Service de Gériatrie, CHU, Bordeaux, France.,Société Française de l'Escarre
| | - Franck Hentz
- Direction des soins CHU, Clermont Ferrand, France
| | - Philippe Michel
- Réanimation Médico Chirurgicale, Centre Hospitalier René Dubos, Pontoise, France.,Société Française de l'Escarre
| | - Sylvie Meaume
- Service Plaie et Cicatrisation, Hôpital Rothschild, Paris, France.,Société Française et Francophone des Plaies et Cicatrisations
| | | | - Marc Marty
- Nukléus, Research department, Paris, France
| | - Marc Le Fort
- Service de MPR neurologique, Hôpital Saint Jacques, CHU Nantes, France
| | - Benoit Nicolas
- Pôle MPR St Hélier, Rennes, France.,Société Française de l'Escarre
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Comparing Pressure Injury Incidence Based on Repositioning Intervals and Support Surfaces in Acute Care Settings: A Quasi-Experimental Pragmatic Study. Adv Skin Wound Care 2021; 34:1-6. [PMID: 34260424 DOI: 10.1097/01.asw.0000755912.27170.9a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare pressure injury (PI) incidence based on repositioning intervals and support surfaces in acute care settings. METHODS This pragmatic, quasi-experimental trial recruited a total of 251 critically ill patients who were at low or moderate risk for PI development. Participants were assigned to three interventions: a 2-hour repositioning interval using an air mattress, a 2-hour repositioning interval using a foam mattress, or a 3-hour repositioning interval using a foam mattress. Data were collected by nurses every shift over the course of 14 days. Pressure injury incidence was analyzed using a χ2 test. RESULTS There were no statistically significant differences in PI incidence between the groups with a 2-hour repositioning interval. However, the PI incidence in the group using a foam mattress with a 3-hour repositioning interval was significantly lower than in the group using an air mattress with a 2-hour repositioning interval (odds ratio, 0.481; 95% confidence interval, 0.410-0.565). CONCLUSIONS The findings showed that PIs decreased when the repositioning interval was extended from every 2 hours to every 3 hours while using foam mattresses. This study suggests that a 3-hour repositioning interval using a foam mattress could be applied to reduce the risk of PI development for patients at low or moderate risk.
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The Use of Prophylactic Foam Dressings for Prevention of Hospital-Acquired Pressure Injuries: A Systematic Review. J Wound Ostomy Continence Nurs 2021; 48:211-218. [PMID: 33951710 DOI: 10.1097/won.0000000000000762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this systematic review was to identify and evaluate the use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries (HAPIs). METHODS A systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis Statement (PRISMA). SEARCH STRATEGY Four researchers independently conducted searches in Health Source, Cochrane of Systematic Reviews, CINAHL, and PubMed. Search terms included: "pressure* OR skin breakdown AND sacrum*"; "ICU patient* OR critical care patient*"; and "foam dressing OR prophylactic* or prevent*." FINDINGS The search identified 380 articles; 14 met eligibility criteria. The methodological quality of the included studies was variable. Findings from all studies included in our review support a decrease in HAPI incidence with use of sacral foam dressings. IMPLICATIONS Findings from this review suggest that prophylactic foam dressings decrease sacral HAPI occurrences in critical care patients. While additional research is needed, current best evidence supports use of prophylactic foam sacral dressings for patients at risk for HAPI.
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Lin FF, Liu Y, Wu Z, Li J, Ding Y, Li C, Jiang Z, Yang J, Wang K, Gao J, Li X, Xia X, Liu H, Li X, Chen X, Yang L, Fang X, Zhao R, Chen J, Labeau S, Blot S. Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi-centre prospective point prevalence study. Int Wound J 2021; 19:493-506. [PMID: 34227228 PMCID: PMC8874044 DOI: 10.1111/iwj.13648] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022] Open
Abstract
Despite increasing preventive efforts, pressure injury still occurs in intensive care patients. This study was aimed to describe pressure injury prevalence, risk factors, and prevention practices in adult intensive care patients. This was a multi-centre, one-day, prospective point prevalence study in which a total of 198 intensive care units from 21 provinces in China participated. Overall and ICU-acquired prevalence in intensive care patients were 12.26% and 4.31%, respectively. Consistent with earlier reports, almost half of the ICU-acquired pressure injuries were at stage I, one-fourth were at stage 2, and the most common body sites for pressure injuries were sacral and heel region. Risk factors identified were consistent with prior studies. Repositioning was the most commonly used pressure injury prevention strategy, followed by alternating pressure mattresses/overlays, floating heels, and air-filled mattresses/overlays. These reflect a good level of adherence to recommended international pressure injury prevention clinical practice guidelines. The results provide a baseline reference for overall and ICU-acquired prevalence among adult intensive care patients in China. Future research on what contributed to the lower pressure injury incidence in China needs to be conducted to inform healthcare organisations on their future preventive strategies for pressure injury prevention.
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Affiliation(s)
- Frances Fengzhi Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Sunshine Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, China
| | - Zijing Wu
- School of Nursing, China Medical University, Shenyang, China
| | - Jing Li
- Peking University First Hospital, Beijing, China
| | - Yanming Ding
- Peking University First Hospital, Beijing, China
| | - Chunyan Li
- Beijing Nursing Association, Beijing, China
| | - Zhixia Jiang
- Guizhou Nursing Vocational College, Guiyang, Guizhou, China.,Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jing Yang
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Kefang Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Jie Gao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, China
| | | | - Hongmei Liu
- Tianjin Third Central Hospital, Tianjin, China
| | - Xinxia Li
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiaoyan Chen
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lei Yang
- HeNan Honliv Hospital, Xinxiang, China
| | | | | | | | - Sonia Labeau
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Burns, Trauma and Critical Care Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Coyer F, Cook JL, Doubrovsky A, Campbell J, Vann A, McNamara G, Edward KL, Hartel G, Fulbrook P. Implementation and evaluation of multilayered pressure injury prevention strategies in an Australian intensive care unit setting. Aust Crit Care 2021; 35:143-152. [PMID: 33992515 DOI: 10.1016/j.aucc.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pressure injuries are a ubiquitous, yet largely preventable, hospital acquired complication commonly seen in critically ill patients in the intensive care unit. OBJECTIVES The objectives of this study were to implement targeted evidence-based pressure injury prevention strategies and evaluate their effect through measurement of patient pressure injury observations. METHODS A prospective multiphased design was used in the intensive care unit of an Australian tertiary referral hospital using three study periods (period 1, weeks 1-18; period 2, weeks 19-28; and period 3, weeks 29-52). The interventions included staff-focused interventions and patient-focused interventions, with the latter defined in a work unit guideline. Weekly visual observations of critically ill patients' skin integrity were conducted by trained research nurses over 52 weeks from November 2015 to November 2016. The primary outcome measure was a pressure injury of any stage, identified at the weekly observation, and the effect of the intervention was evaluated through logistic regression. Reporting rigour has been demonstrated using the Standards for Quality Improvement Reporting Excellence checklist. RESULTS Over the whole study, 15.4% (95% confidence interval [CI] = 12.6, 18.2%, 97/631) of patients developed a pressure injury, with the majority of these injuries (73.2%, 95% CI = 64.4%, 82.0%, 71/97) caused by medical devices. After adjustment for covariates known to influence hospital-acquired pressure injury development, pressure injury rates for period 3 compared with period 1 were reduced (odds ratio = 0.41, 95% CI = 0.20-0.97, p = 0.0126). CONCLUSIONS We found the use of defined pressure injury prevention strategies targeted at both staff and patients reduced pressure injury prevalence.
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Affiliation(s)
- Fiona Coyer
- Joint Appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK; Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, 4029, Australia.
| | - Jane-Louise Cook
- School of Nursing, Queensland University of Technology, Australia.
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Australia.
| | - Jill Campbell
- School of Nursing, Queensland University of Technology, Australia; Skin Integrity Services, Royal Brisbane and Women's Hospital, Australia.
| | - Amanda Vann
- Intensive Care Services, Royal Brisbane and Women's Hospital, Australia.
| | - Greg McNamara
- Intensive Care Services, Royal Brisbane and Women's Hospital, Australia.
| | - Karen-Leigh Edward
- Department of Health Professions, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Australia; Human and Health Sciences, University of Huddersfield, UK.
| | - Gunter Hartel
- School of Nursing, Queensland University of Technology, Australia; QIMR Berghofer Medical Research Institute, Australia.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Brisbane, Australia; Nursing Research & Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Edwards A, Sitanggang N, Wolff K, Role J, Cardona T, Sanchez M, Radovich P. Pressure Injury Prevention in Patients with Prolonged ED Stays Prior to Admission. Am J Nurs 2021; 121:46-52. [PMID: 33497127 DOI: 10.1097/01.naj.0000734128.77659.2b] [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: 11/27/2022]
Abstract
PURPOSE The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. METHODS A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. RESULTS The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. IMPLICATIONS At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.
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Affiliation(s)
- Amanda Edwards
- Amanda Edwards is a nurse navigator at Loma Linda University Medical Center in Loma Linda, CA, where Novi Sitanggang is an interim patient care director, Kelly Wolff and Jewel Role are clinical nurses, Myra Sanchez is a patient care assistant, and Patricia Radovich is director of nursing research. Trisha Cardona is a clinical nurse at Community Hospital of the Monterey Peninsula in Monterey, CA. Contact author: Amanda Edwards, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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29
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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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Higgins J, Casey S, Taylor E, Wilson R, Halcomb P. Comparing the Braden and Jackson/Cubbin Pressure Injury Risk Scales in Trauma-Surgery ICU Patients. Crit Care Nurse 2020; 40:52-61. [PMID: 33257967 DOI: 10.4037/ccn2020874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The occurrence of pressure injury in the critical care environment has multiple risk factors. Prevention requires reliable assessment tools to help predict injury risk. The Braden scale, a commonly used risk assessment tool, has been shown to have poor predictive properties in critical care patients. The Jackson/Cubbin scale was developed specifically for pressure injury risk stratification in critically ill patients and has demonstrated acceptable predictive properties in the general critical care population but has not been examined in critically ill trauma-surgical patients. OBJECTIVE To compare the predictive properties of the Braden and Jackson/Cubbin scales in a trauma-surgical critical care population. METHODS A retrospective medical records review was performed to evaluate the clinical characteristics of 366 trauma-surgical critical care patients. Additionally, the negative predictive value, positive predictive value, sensitivity, specificity, and receiver operating characteristic curve with area under the curve of the Braden and Jackson/Cubbin scales were determined. RESULTS The sample consisted of primarily middle-aged (mean [SD], 56 [19] years) men (64%) admitted after trauma (71%). The participants who developed pressure injuries were older, more often required vasopressors and mechanical ventilation, and were less mobile. Predictive properties for the Braden and Jackson/Cubbin scales, respectively, were as follows: negative predictive value, 78% versus 87%; positive predictive value, 53% versus 66%; sensitivity, 17% versus 54%; specificity, 95% versus 92%; and area under the curve, 0.710 versus 0.793. CONCLUSION The Jackson/Cubbin scale demonstrated superior predictive properties and discrimination compared with the Braden scale for pressure injury risk prediction in critically ill trauma-surgical patients.
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Affiliation(s)
- Jacob Higgins
- Jacob Higgins is an assistant professor, University of Kentucky College of Nursing, and a nurse-scientist, UK HealthCare, Lexington, Kentucky
| | - Sherri Casey
- Sherri Casey is a quality assurance nurse for trauma-surgical services, UK HealthCare
| | - Erin Taylor
- Erin Taylor is the medical-surgical clinical nurse specialist at WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Riley Wilson
- Riley Wilson is a registered nurse in the trauma intensive care unit at UK HealthCare
| | - Paula Halcomb
- Paula Halcomb is a clinical nurse specialist for the trauma-surgical intensive care units, UK HealthCare
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Beeckman D, Fourie A, Raepsaet C, Van Damme N, Manderlier B, De Meyer D, Beele H, Smet S, Demarré L, Vossaert R, de Graaf A, Verhaeghe L, Vandergheynst N, Hendrickx B, Hanssens V, Keymeulen H, Vanderwee K, Van De Woestijne J, Verhaeghe S, Van Hecke A, Savoye I, Harrison J, Vrijens F, Hulstaert F. Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers: a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial. Br J Dermatol 2020; 185:52-61. [PMID: 33216969 PMCID: PMC8359283 DOI: 10.1111/bjd.19689] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
Background Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital‐acquired pressure ulcers (PUs). Objectives To determine whether silicone foam dressings in addition to standard prevention reduce the incidence of PUs of category 2 or worse compared with standard prevention alone. Methods This was a multicentre, randomized controlled medical device trial conducted in eight Belgian hospitals. At‐risk adult patients were centrally randomized (n = 1633) to study groups based on a 1 : 1 : 1 allocation: experimental groups 1 (n = 542) and 2 (n = 545) – pooled as the treatment group – and the control group (n = 546). The experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on the relevant body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU of category 2 or worse at the studied body sites. Results In the intention‐to‐treat population (n = 1605), PUs of category 2 or worse occurred in 4·0% of patients in the treatment group and 6·3% in the control group [relative risk (RR) 0·64, 95% confidence interval (CI) 0·41–0·99, P = 0·04]. Sacral PUs were observed in 2·8% and 4·8% of the patients in the treatment group and the control group, respectively (RR 0·59, 95% CI 0·35–0·98, P = 0·04). Heel PUs occurred in 1·4% and 1·9% of patients in the treatment and control groups, respectively (RR 0·76, 95% CI 0·34–1·68, P = 0·49). Conclusions Silicone foam dressings reduce the incidence of PUs of category 2 or worse in hospitalized at‐risk patients when used in addition to standard of care. The results show a decrease for the sacrum, but no statistical difference for the heel and trochanter areas. What is already known about this topic?The incidence of hospital‐acquired pressure ulcers (PUs) remains high despite the implementation of best‐practice recommendations. The concept of using silicone foam dressings as an additional prophylactic strategy in PU prevention has been investigated in previous studies but with some limitations. Most RCTs were monocentric studies, restricted to either critically ill or acute care patients and did not observe more than two anatomical at‐risk skin sites, which limited the generalizability of the findings.
What does this study add?This large pragmatic RCT suggests that it is beneficial to use silicone adhesive multilayer foam dressings on the sacrum, in addition to standard of care, to help prevent hospital‐acquired PUs. Clinical decision making for heel dressings should be based on the clinical effectiveness of the intervention weighed against the potential risk of falling.
Linked Comment: F. Coyer. Br J Dermatol 2021; 185:4–5.
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Affiliation(s)
- D Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Health Sciences, Örebro University, Örebro, Sweden
| | - A Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - C Raepsaet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - N Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - B Manderlier
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - D De Meyer
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - H Beele
- Wound Care Centre, Ghent University, Ghent, Belgium
| | - S Smet
- Wound Care Centre, Ghent University, Ghent, Belgium
| | - L Demarré
- AZ Sint-Elisabeth, Zottegem, Oost-Vlaanderan, Belgium
| | - R Vossaert
- AZ Sint-Elisabeth, Zottegem, Oost-Vlaanderan, Belgium
| | - A de Graaf
- Wound Care Support Team, Nursing Centre of Excellence, University Hospitals of Leuven, Leuven, Belgium
| | | | | | - B Hendrickx
- University Hospital of Brussels (UZB), Department of Plastic Surgery, Brussels, Belgium
| | - V Hanssens
- University Hospital of Brussels (UZB), Department of Plastic Surgery, Brussels, Belgium
| | - H Keymeulen
- OLV Ziekenhuis Aalst, Aalst, Oost-Vlaanderan, Belgium
| | - K Vanderwee
- OLV van Lourdes Ziekenhuis Waregem, Waregem, West-Vlaanderan, Belgium
| | | | - S Verhaeghe
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - A Van Hecke
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - I Savoye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - J Harrison
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - F Vrijens
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - F Hulstaert
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
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Effectiveness of Multilayered Polyurethane Foam Dressings to Prevent Hospital-Acquired Sacral Pressure Injuries in Patients With Hip Fracture: A Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2020; 47:582-587. [PMID: 33201144 DOI: 10.1097/won.0000000000000715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the effectiveness of a multilayered polyurethane foam dressing applied within 24 hours of hospital admission compared with standard preventive pressure injury (PI) care in reducing sacral PI occurrence in older patients with hip fractures. DESIGN Open-label, parallel-group, 2-arm, superiority trial. SUBJECTS AND SETTING The sample comprised older patients aged 69 to 97 years admitted to a 1500-bed university hospital in Bologna, Italy, for hip fracture surgery. METHODS Patients were randomly allocated to an intervention or control group. Both groups received standard evidence-based PI preventive care in accordance with National Pressure Ulcer Advisory Panel guidelines. In addition, patients in the intervention group received a single 12.9 × 12.9-cm multilayered polyurethane foam dressing shaped for the sacrum area applied within 24 hours of hospital admission. Bivariate analysis on primary and secondary outcomes and baseline characteristics was performed to compare group differences, and a survival analysis was used to determine the difference in PI incidence rates per group. RESULTS Sixty-eight patients completed the trial; 34 patients were allocated to the intervention group and 34 patients to the control group. A trend toward significance was observed for sacral PI occurrence in the intervention group (intervention: 20.6%; control: 2.9%; P = .054). The foam dressing allowed significantly longer time (days) to PI occurrence (intervention: 5.9 ± 1.60; control: 2.7 ± 0.96; P = .003). CONCLUSIONS These findings suggest that multilayered polyurethane foam dressings are not superior to the standard preventive PI care alone and should be used with caution, especially when multiple dressing changes may occur. Further exploration of the role of multilayered polyurethane foam dressings in preventing PI development is warranted.
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Laupland KB, Coyer F. Physician and Nurse Research in Multidisciplinary Intensive Care Units. Am J Crit Care 2020; 29:450-457. [PMID: 33130861 DOI: 10.4037/ajcc2020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although clinical care is multidisciplinary, intensive care unit research commonly focuses on single-discipline themes. We sought to characterize intensive care unit research conducted by physicians and nurses. METHODS One hundred randomly selected reports of clinical studies published in critical care medical and nursing journals were reviewed. RESULTS Of the 100 articles reviewed, 50 were published in medical journals and 50 were published in nursing journals. Only 1 medical study (2%) used qualitative methods, compared with 9 nursing studies (18%) (P = .02). The distribution of quantitative study designs differed between medical and nursing journals (P < .001), with medical journals having a predominance of cohort studies (29 articles [58%]). Compared with medical journal articles, nursing journal articles had significantly fewer authors (median [interquartile range], 5 [3-6] vs 8 [6-10]; P < .001) and study participants (94 [51-237] vs 375 [86-4183]; P < .001) and a significantly lower proportion of male study participants (55% [26%-65%] vs 60% [51%-65%]; P = .02). Studies published in medical journals were much more likely than those published in nursing journals to exclusively involve patients as participants (47 [94%] vs 25 [50%]; P < .001). Coauthorship between physicians and nurses was evident in 14 articles (14%), with infrequent inclusion of authors from other health care disciplines. CONCLUSIONS Physician research and nurse research differ in several important aspects and tend to occur within silos. Increased interprofessional collaboration is possible and worthwhile.
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Affiliation(s)
- Kevin B. Laupland
- Kevin B. Laupland is an intensivist, Intensive Care Services, at Royal Brisbane and Women’s Hospital, and a professor at the School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Fiona Coyer
- Fiona Coyer is a professor of nursing with a joint appointment in Intensive Care Services at Royal Brisbane and Women’s Hospital and the School of Nursing, Queensland University of Technology (QUT)
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A Quality Improvement Project Comparing Two Treatments for Deep-Tissue Pressure Injuries to Feet and Lower Legs of Long-term Care Residents. Adv Skin Wound Care 2020; 33:594-598. [PMID: 33065681 DOI: 10.1097/01.asw.0000695780.20213.fa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To retrospectively examine clinical outcomes from a feasibility study that compared two treatment options for deep-tissue pressure injuries (DTPIs), including the clinical indicators increasing the risk of deteriorating DTPIs among long-term care residents. METHODS A retrospective chart audit of 40 DTPIs from 33 long-term care residents in two long-term care facilities was conducted to compare (1) polymeric membrane dressings (PMDs) with offloading and (2) a skin barrier film with offloading. RESULTS Of the 13 DTPIs treated with PMDs, only 23% deteriorated to a stage 3 or 4 pressure injury (PI), whereas of the 27 DTPIs treated with skin barrier film, 41% deteriorated to a stage 3 or 4 PI. The clinical factors found to increase the risk of developing and deteriorating DTPIs included weight loss, hypoalbuminemia, debility, dementia, coronary artery disease, and cerebrovascular disease. CONCLUSIONS The PMD group's DTPIs evolved into fewer open PIs despite having higher percentages of clinical indicators for DTPIs. The project findings support the use of PMD dressings for DTPIs; however, more robust research is warranted.
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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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Lovegrove J, Fulbrook P, Miles S. International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study. Int Wound J 2020; 17:1112-1127. [PMID: 33591631 PMCID: PMC7948917 DOI: 10.1111/iwj.13461] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this modified Delphi study was to determine a minimum pressure injury preventative intervention set for implementation relative to critically ill patients' risk level. Preventative interventions were identified via systematic review, risk levels categorised by an intensive-care-specific risk-assessment-scale (COMHON Index), and panel members (n = 67) identified through an international critical care nursing body. Round 1: panel members were asked to rate implementation of 12 interventions according to risk level (low, moderate, high). Round 2: interventions were rated for use at the risk level which received greatest round 1 support. Round 3: interventions not yet achieving consensus were again rated, and discarded where consensus was not reached. Consensus indicated all patients should receive: risk assessment within 2-hours of admission; 8-hourly risk reassessment; and use of disposable incontinence pads. Additionally, moderate- and high-risk patients should receive: a reactive mattress support surface and a heel off-loading device. High-risk patients should also receive: nutritional supplements if eating orally; preventative dressings (sacral, heel, trochanteric); an active mattress support surface; and a pressure-redistributing cushion for sitting. Repositioning is required at least 4-hourly for low-risk, and 2-hourly for moderate- and high-risk patients. Rigorous application of the intervention set has the potential to decrease pressure injuries in intensive care.
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sandra Miles
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
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Peko L, Barakat-Johnson M, Gefen A. Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in the context of the COVID-19 pandemic. Int Wound J 2020; 17:1595-1606. [PMID: 32618418 PMCID: PMC7361768 DOI: 10.1111/iwj.13435] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023] Open
Abstract
Prone positioning is used for surgical access and recently in exponentially growing numbers of coronavirus disease 2019 patients who are ventilated prone. To reduce their facial pressure ulcer risk, prophylactic dressings can be used; however, the biomechanical efficacy of this intervention has not been studied yet. We, therefore, evaluated facial soft tissue exposures to sustained mechanical loads in a prone position, with versus without multi‐layered silicone foam dressings applied as tissue protectors at the forehead and chin. We used an anatomically realistic validated finite element model of an adult male head to determine the contribution of the dressings to the alleviation of the sustained tissue loads. The application of the dressings considerably relieved the tissue exposures to loading. Specifically, with respect to the forehead, the application of a dressing resulted in 52% and 71% reductions in soft tissue exposures to effective stresses and strain energy densities, respectively. Likewise, a chin dressing lowered the soft tissue exposures to stresses and strain energy densities by 78% and 92%, respectively. While the surgical context is clear and there is a solid, relevant need for biomechanical information regarding prophylaxis for the prone positions, the projected consequences of the coronavirus pandemic make the present work more relevant than ever before.
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Affiliation(s)
- Lea Peko
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Michelle Barakat-Johnson
- Pressure Injury Prevention and Management, Sydney Local Health District, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Sacral Pressure Injury Prevention in Trauma Patients: Silicone-Bordered Multilayered Foam Dressing. J Trauma Nurs 2020; 27:246-249. [PMID: 32658068 DOI: 10.1097/jtn.0000000000000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital-acquired pressure injuries are a chronic phenomenon in health care, and their prevention is an ongoing challenge. This study aims to investigate whether the application of a silicone-bordered multilayered foam dressing during the initial trauma resuscitation reduces sacral hospital-acquired pressure injury occurrence in trauma patients. METHODS This is a single-center quality improvement study using a nonequivalent control group posttest-only design to study the effect of silicone-bordered multilayered foam dressing on the incidence of hospital-acquired pressure injuries. The study population included admitted, highest tier trauma activations, age 18 years and older. Preimplementation 2014 data were compared with postimplementation 2018 data. RESULTS The result showed no statistically significant reduction in hospital-acquired pressure injury occurrence between the control and intervention groups. Incident rates for sacral hospital-acquired pressure injuries were 0.23% (2014) compared with 0.21% (2018). No statistically significant difference was found in the hospital and intensive care lengths of stay or injury severity. Preventive dressing costs were $7,689 annually compared with the estimated treatment costs of $70,000 per hospital-acquired pressure injury. CONCLUSION Although this study's hospital-acquired pressure injury reduction rate was not significant, the inclusion of multidisciplinary team members in the quality improvement project led to the cultural hardwiring of hospital-acquired pressure injury prevention among all team members beyond that of just nursing.
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El Genedy M, Hahnel E, Tomova-Simitchieva T, Padula WV, Hauß A, Löber N, Blume-Peytavi U, Kottner J. Cost-effectiveness of multi-layered silicone foam dressings for prevention of sacral and heel pressure ulcers in high-risk intensive care unit patients: An economic analysis of a randomised controlled trial. Int Wound J 2020; 17:1291-1299. [PMID: 32391627 PMCID: PMC7948587 DOI: 10.1111/iwj.13390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
Pressure ulcer incidence is high in intensive care units. This causes a serious financial burden to healthcare systems. We evaluated the cost‐effectiveness of multi‐layered silicone foam dressings for prevention of sacral and heel pressure ulcers in addition to standard prevention in high‐risk intensive care units patients. A randomised controlled trial to assess the efficacy of multi‐layered silicone foam dressings to prevent the development of pressure ulcers on heels and sacrum among 422 intensive care unit patients was conducted. Direct costs for preventive dressings in the intervention group and costs for treatment of incident pressure ulcers in both groups were measured using a bottom‐up approach. A cost‐effectiveness analysis by calculating the incremental cost‐effectiveness ratio using different assumptions was performed. Additional dressing and labour costs of €150.81 (€116.45 heels; €34.36 sacrum) per patient occurred in the intervention group. Treatment costs were €569.49 in the control group and €134.88 in the intervention group. The incremental cost‐effectiveness ratio was €1945.30 per PU avoided (€8144.72 on heels; €701.54 sacrum) in the intervention group. We conclude that application of preventive dressings is cost‐effective for the sacral area, but only marginal on heels for critically ill patients.
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Affiliation(s)
- Monira El Genedy
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Hahnel
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, California, USA.,The Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Armin Hauß
- Nursing Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Löber
- Department of Clinical Quality and Risk Management, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), Ghent University, University Centre for Nursing and Midwifery, Ghent, Belgium
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40
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Weller CD, Team V, Sussman G. First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Front Pharmacol 2020; 11:155. [PMID: 32180720 PMCID: PMC7059819 DOI: 10.3389/fphar.2020.00155] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/05/2020] [Indexed: 01/20/2023] Open
Abstract
Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians’ knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.
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Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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41
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Bejinariu CG, Marinescu SA. The Role of Myocutaneous Flaps in the Treatment of Patients with Multiple Decubitus Ulcers. J Med Life 2020; 12:453-456. [PMID: 32025266 PMCID: PMC6993285 DOI: 10.25122/jml-2019-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current research aims to present the therapeutic approach in the case of a paraplegic patient hospitalized in the Plastic Surgery Department at the “Bagdasar-Arseni” Emergency Clinical Hospital for the treatment of decubitus ulcers located at the level of the sacral, left trochanteric and posterior thoracic regions. The particularity of the case is given by the complexity of the surgical interventions necessary for the reconstruction of the above-mentioned anatomical regions. In order to cover the sacral region, two gluteal myocutaneous flaps were used, followed by a tensor fascia lata flap for the trochanteric lesion. For the thoracic defect, the surgical team has chosen the technique of excision and direct suture. Following reconstructive surgery, the patient had a favorable local evolution, being included in an intensive medical recovery program within the same health unit.
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Affiliation(s)
- Catalin Gheorghe Bejinariu
- Department of Plastic and Reconstructive Surgery, "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania
| | - Silviu Adrian Marinescu
- Department of Plastic and Reconstructive Surgery, "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania
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42
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Forni C, Searle R. A multilayer polyurethane foam dressing for pressure ulcer prevention in older hip fracture patients: an economic evaluation. J Wound Care 2020; 29:120-127. [PMID: 32058851 DOI: 10.12968/jowc.2020.29.2.120] [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 Hospital-acquired pressure ulcers (PU) have a substantial negative impact on patients and continue to impose a cost burden on hospital providers. Since the incidence of fragility fracture is growing, driven by the increase in the older population, it is expected that the overall incidence of associated complications will also increase accordingly. The aim of this economic evaluation was to determine whether the use of a multilayer, silicone-adhesive polyurethane foam dressing (ALLEVYN LIFE, Smith & Nephew, UK) alongside standard prevention (SP) for the prevention of PUs in older patients with hip fractures is a cost-effective strategy, compared with SP alone. METHOD A decision-analytic model was constructed to determine the incremental cost and effectiveness of the foam dressing strategy from the perspectives of the Italian and US hospital systems. We also performed one-way and probabilistic sensitivity analyses. RESULTS The foam dressing intervention was found to be cost saving and more effective than SP in both Italy and the US. Switching to foam dressing and standard prevention would result in an expected cost saving of €733 per patient in Italy and $840 per patient in the US, reducing the per-patient cost of treating PUs by 37-69% and 36-68%, respectively. The one-way and probabilistic sensitivity analyses demonstrate that the strategy remains dominant over a range of values of the input variables. CONCLUSION The foam dressing intervention is likely to be a cost-effective strategy compared with standard prevention alone.
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Affiliation(s)
- Cristiana Forni
- Head of the Nursing and Allied Profession Research Unit 1, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Richard Searle
- Health Economics Director, Smith & Nephew Medical Ltd, Hull, UK
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43
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Schwartz D, Gefen A. An integrated experimental-computational study of the microclimate under dressings applied to intact weight-bearing skin. Int Wound J 2020; 17:562-577. [PMID: 31991530 DOI: 10.1111/iwj.13309] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/21/2019] [Accepted: 01/10/2020] [Indexed: 12/15/2022] Open
Abstract
Pressure ulcers (PUs) are one of the most prevalent adverse events in acute and chronic care. The root aetiological cause of PUs is sustained cell and tissue deformations, which triggers a synergistic tissue damage cascade that accelerates over relatively short time periods. Changes in skin microclimate conditions are known to indirectly contribute to PU-risk levels or to exacerbation of existing wounds. It is therefore surprising that information concerning heat accumulation under dressings is poor. Here, we aimed to investigate the effects of dressings on the microclimate of weight-bearing buttocks skin in 1-hour supine lying sessions. Using a novel and originally developed experimental-computational approach, we compared the combined influence of the mechanical and thermal properties of a polymeric membrane dressing (PolyMem, Ferris Mfg. Corp., Fort Worth, TX) on skin microclimate under and near the dressings with those of a standard placebo foam dressing. We specifically identified the thermal conductivity properties of dressings as being highly important in the context of protective dressing performances, given its association with potential heat accumulation under dressings. Accordingly, this article highlights, for the first time in the literature, the relevance of thermal properties of a dressing in effectively mitigating the risk of developing PUs or aggravating an injury, and offers a systematic, methodological bioengineering process for assessing the thermal performances of dressings.
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Affiliation(s)
- Dafna Schwartz
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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New Clinically Relevant Method to Evaluate the Life Span of Prophylactic Sacral Dressings. Adv Skin Wound Care 2020; 32:S14-S20. [PMID: 31219897 DOI: 10.1097/01.asw.0000558697.53057.8e] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It has been demonstrated that wound dressings provide a protective effect against pressure injuries. However, no method exists to measure either the life or performance of dressings used in prevention; testing dressings in a clinical setting or a research environment has typically been based on measuring its moisture absorption capacity. This article examines the changes that occur in the structural and mechanical properties of a prophylactic dressing based on conditions of use when wound exudate is not present.A clinically relevant method was developed to simulate the loading, friction-inducing shear, and moisture transpiration present in a typical hospitalization where a dressing is applied for prevention. Single-use dressings were tested using this method to evaluate their ability to protect patients from pressure injuries throughout the typical 5 to 7 days of use. Following this aging process, researchers measured the physical, structural, and mechanical changes in prophylactic dressings over time.This innovative method provides guidance for clinicians on dressing use and replacement intervals. For bioengineers, the method generates important empirical data for computer modeling of dressing performance, which can then reveal the consequences of changes in dressing structure and function on sustained tissue loads. It is the authors' hope to generate discussion about the creation of industry-wide standards for testing dressings to improve patient care.
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45
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Measuring Tensile Strength to Better Establish Protective Capacity of Sacral Prophylactic Dressings Over 7 Days of Laboratory Aging. Adv Skin Wound Care 2020; 32:S21-S27. [PMID: 31219898 DOI: 10.1097/01.asw.0000558694.20067.4f] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Results from large-scale randomized clinical trials support the application of prophylactic dressings to provide protection from body-weight force-induced deformations known to damage skin and underlying tissues, which often result in pressure injuries (pressure ulcers). This laboratory study using a new method for aging dressings in simulated use followed by tensile testing was conducted to further understand the protective effect of sacral prophylactic dressings (SPDs) in alleviating tissue deformations in the sacral region through the course of typical application. Specifically, four SPDs were exposed to a simulation of the clinical environment incorporating saline solution absorption, mechanical loading, and repetitive sliding-induced shear. After aging, the protective endurance of the SPDs was measured through tensile testing to determine their effectiveness against tissue-damaging forces over time.This study uses the concepts of axial stiffness, protective endurance, and elastic limit to describe more accurately the protective aspects of SPDs under dry and moist conditions and how they interact with the skin and underlying tissues over the life of the dressing. The authors propose two primary features in SPD effectiveness in preventing pressure injuries: high conformability (ie, low flexural stiffness) and protective endurance (the dressing's capacity to maintain biomechanical performance when moist).
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Stolt M, Hjerppe A, Hietanen H, Puukka P, Haavisto E. Local treatment of pressure ulcers in long-term care: a correlational cross-sectional study. J Wound Care 2019; 28:409-415. [PMID: 31166863 DOI: 10.12968/jowc.2019.28.6.409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To analyse the treatment of pressure ulcers (PU) in long-term care. METHOD In this correlational cross-sectional study, data was collected between November 2015 and January 2016 from older people with PUs in private and public long-term care facilities in Finland. Data collection was conducted by trained nurses using the Pressure Ulcer Patient Instrument (PUP-Ins). Outcomes measured were: prevalence and localisation of PU, local PU treatment, frequency (how often/week/day) and duration (minutes/week or day) of PU treatment. RESULTS In total, 112 patients with 158 PUs were identified (a prevalence rate of 5%). PUs were located most often on the heel (38%), hip (13%), buttocks (10%) and lateral malleolus (9.5%). The most frequently used PU treatment was skin protecting agents and local wound care products. The most typical treatment in category I, II and III PUs were foam dressings. In category III PUs, ribbon gauze dressings were also used. The most typical products for category IV PUs were complex dressings. Category I PUs received more treatment per day or week than other categories of PUs. CONCLUSION PU treatment is inconsistent and often conducted with varying methods and products. Holistic patient care must be the focus. Nurses in long-term care settings might benefit from in-depth in-service education focusing on the treatment of PUs. More research is needed about nurses' competence in PU treatment.
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Affiliation(s)
- Minna Stolt
- Docent, University Lecturer, Podiatrist, Department of Nursing Science, University of Turku, Finland.,Turku University Hospital, Finland
| | - Anna Hjerppe
- Chief Physician, Clinical Teacher, Clinic of Dermatology, Satakunta Hospital District, Finland.,Department of Medicine, University of Turku, Finland.,Finnish Medial Association, Finland
| | - Helvi Hietanen
- Wound Care Expert, Finnish Wound Care Association, Finland
| | - Pauli Puukka
- Senior Research Statistician, National Institute for Health and Welfare, Turku, Finland
| | - Elina Haavisto
- Docent, University Lecturer, Podiatrist, Department of Nursing Science, University of Turku, Finland.,Professor, Satakunta Hospital District, Finland
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Hahnel E, El Genedy M, Tomova‐Simitchieva T, Hauß A, Stroux A, Lechner A, Richter C, Akdeniz M, Blume‐Peytavi U, Löber N, Kottner J. The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: a randomized controlled parallel‐group trial. Br J Dermatol 2019; 183:256-264. [DOI: 10.1111/bjd.18621] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Affiliation(s)
- E. Hahnel
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - M. El Genedy
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - T. Tomova‐Simitchieva
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - A. Hauß
- Department of Clinical Quality and Risk Management Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Stroux
- Department of Biometry and Clinical Epidemiology Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Lechner
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - C. Richter
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - M. Akdeniz
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - U. Blume‐Peytavi
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - N. Löber
- Department of Clinical Quality and Risk Management Charité – Universitätsmedizin Berlin Berlin Germany
| | - J. Kottner
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
- Department of Public Health and Primary Care Skin Integrity Research Group (SKINT) University Centre for Nursing and Midwifery Ghent University Ghent Belgium
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Fulbrook P, Mbuzi V, Miles S. Effectiveness of prophylactic sacral protective dressings to prevent pressure injury: A systematic review and meta-analysis. Int J Nurs Stud 2019; 100:103400. [DOI: 10.1016/j.ijnurstu.2019.103400] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 01/27/2023]
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Padula WV, Chen YH, Santamaria N. Five-layer border dressings as part of a quality improvement bundle to prevent pressure injuries in US skilled nursing facilities and Australian nursing homes: A cost-effectiveness analysis. Int Wound J 2019; 16:1263-1272. [PMID: 31475434 PMCID: PMC6900030 DOI: 10.1111/iwj.13174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/26/2019] [Indexed: 01/16/2023] Open
Abstract
The BORDER III trial found that five-layer silicone border dressings effectively prevented pressure injuries in long-term care, but the value of this approach is unknown. Our objective was to analyse the cost-effectiveness of preventing facility-acquired pressure injuries with a quality improvement bundle, including prophylactic five-layer dressings in US and Australian long-term care. Markov models analysed the cost utility for pressure injuries acquired during long-term care from US and Australian perspectives. Models calibrated outcomes for standard care compared with a dressing-inclusive bundle over 18 monthly cycles or until death based on BORDER III outcomes. Patients who developed a pressure injury simulated advancement through stages 1 to 4. Univariate and multivariate probabilistic sensitivity analyses tested modelling uncertainty. Costs in 2017 USD and quality-adjusted life years (QALYs) were used to calculate an incremental cost-effectiveness ratio (ICER). Dressing use yielded greater QALYs at slightly higher costs from perspectives. The US ICER was $36 652/QALY, while the Australian ICER was $15 898/QALY, both of which fell below a willingness-to-pay threshold of $100 000/QALY. Probabilistic sensitivity analysis favoured dressings as cost-effective for most simulations. A quality improvement bundle, including prophylactic five-layer dressings, is a cost-effective approach for pressure injury prevention in all US and Australia long-term care residents.
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Affiliation(s)
- William V. Padula
- Department of Pharmaceutical & Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCalifornia
- The Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Yutong H. Chen
- Department of EconomicsUniversity of VirginiaCharlottesvilleVirginia
| | - Nick Santamaria
- Department of NursingUniversity of MelbourneMelbourneVictoriaAustralia
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Mervis JS, Phillips TJ. Pressure ulcers: Prevention and management. J Am Acad Dermatol 2019; 81:893-902. [DOI: 10.1016/j.jaad.2018.12.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
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