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Jia L, Deng Y, Xu Y, Wu X, Liu D, Li M, Huang S, Zhang Y, Du A, Liu H, Tian Y. Development and validation of a nomogram for oral mucosal membrane pressure injuries in ICU patients: A prospective cohort study. J Clin Nurs 2024. [PMID: 38797947 DOI: 10.1111/jocn.17296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/12/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
AIMS Establishing a nomogram to estimate the probability of oral mucosal membrane pressure injury of endotracheal tube-intubated hospitalized patients in intensive care unit. DESIGN Multicentre prospective cohort study. METHODS Using Lasso regression and COX regression, variable selection was performed on demographic, clinical and laboratory data of 1037 ICU endotracheal tube-intubated hospitalized patients from West China Hospital, to construct a nomogram. External validation was conducted on 484 ICU endotracheal tube-intubated patients from People's Hospital of Zhongjiang County. RESULTS Among 38 potential predictors, five variables emerged as independent predictors, integrated into the nomogram: administration of antibiotics, nutritional therapy duration, agitation, hypotension and albumin levels. CONCLUSIONS We established a nomogram based on the hospital characteristics of ICU endotracheal tube-intubated patients, aiding in the prediction of the occurrence of oral mucosal membrane pressure injury. REPORTING METHOD The study followed TRIPOD guidelines. RELEVANCE TO CLINICAL PRACTICE The nomogram we developed can assist clinical worker in better identifying at-risk patients and risk factors. It enables the implementation of evidence-based nursing interventions in care to prevent the development of oral mucosal membrane pressure injury. TRIAL REGISTRATION The study has been registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) under registration number ChiCTR2200056615.
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Affiliation(s)
- Lingli Jia
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuchun Deng
- Department of Critical Care Medicine, People's Hospital of Zhongjiang County, Zhongjiang, Sichuan Province, China
| | - Yu Xu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoli Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Critical Care Medicine, People's Hospital of Zhongjiang County, Zhongjiang, Sichuan Province, China
| | - Muying Li
- Department of Critical Care Medicine, People's Hospital of Zhongjiang County, Zhongjiang, Sichuan Province, China
| | - Shijun Huang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yaodan Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Aiping Du
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Huan Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongming Tian
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Dirgar E, Gider NY, Tosun B. Determination of Incidence and Risk Factors of Medical Device-Related Pressure Injury in the ICU: A Descriptive Study. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38393711 DOI: 10.1097/asw.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To determine the incidence and risk factors of medical device-related pressure injury (MDRPI) in the ICU. METHODS In this descriptive study, the researchers collected data through systematic observation of patients (n = 58) in the ICU. The patients were evaluated within 24 hours of ICU admission and then followed up until they were discharged. A total of 482 patient-days were followed. The researchers used the MDRPI follow-up form, the patient descriptive form, the MDRPI follow-up form, and the Braden Scale for Predicting Pressure Sore Risk for data collection. RESULTS Overall, 39.7% of the 58 patients hospitalized in the ICU developed an MDRPI, and 5.2% of the MDRPIs were evaluated as stage 2. These injuries occurred in an average of 5 days after the patient was admitted to the ICU. Among the MDRPIs that developed, 31.9% were located in the nose, 21.3% in the mouth, and 14.9% on the cheeks. Intubation tubes were used in 7.3% of the patients, nasogastric tubes in 22.4% of the patients, and radial artery catheters in 10.5% of the patients. CONCLUSIONS The development of MDRPI is correlated with the type of medical device used. Providers should establish a planned care protocol based on the anatomic placement of the medical device and take necessary precautions to prevent MDRPI.
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Affiliation(s)
- Ezgi Dirgar
- Ezgi Dirgar, PhD, RN, is Assistant Professor, Department of Midwifery, Faculty of Health Sciences, Gaziantep University, Turkey. Neslihan Yağmur Gider, MSc, RN, is Nurse, Ceyhan State Hospital, Adana, Turkey. Betül Tosun, PhD, RN, is Associate Professor, Department of Nursing, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey. The authors have disclosed no financial relationships related to this article. Submitted April 4, 2023; accepted in revised form July 24, 2023
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Zinzoni V, Planche L, Le Potier S, Robin L, Le Parco C, Terrat P, Leroyer MH, Atger R, Dauvergne JE, Muller L, Fontaine L, Morand C, Dennemont P, Paillard O, Vastral S, Dardaine B, Le Guillou S, Maquigneau N, Martin S, Lachérade JC. Impact of two endotracheal tube fixation on the incidence of peri-oral lesions: Elastic adhesive strips versus cord in a protective sheath. Study protocol for a cluster cross-over randomized trial. PLoS One 2024; 19:e0297349. [PMID: 38330026 PMCID: PMC10852271 DOI: 10.1371/journal.pone.0297349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Endotracheal tube fixation in ventilated patients must be appropriate to ensure security during mechanical ventilation and prevent skin lesions. The incidence of endotracheal tube-caused pressure ulcers ranges from 7% to 45%. Various endotracheal tube fixations are used in intensive care units (ICUs) worldwide. By pressure exercised on the skin, these systems could lead to mucosal and skin peri-oral lesions. The main objective of this study is to evaluate the impact of the two fixation systems most commonly used in French ICUs (adhesive elastic band versus fixation cord with PolyVinyl Chloride (PVC) sheath) on the incidence of these peri-oral skin lesions. METHODS This studyis a multicenter, open-label, controlled, superiority, cluster cross-over randomized trial. 768 patients will be recruited in the 16 ICUs involved. The inclusion of patients will be carried out over two 12-month periods. Each site begins with one of the evaluated fixation systems: elastic adhesive tape or cord associated with a protective sheath. After a 4-month break, each site switches to the other fixation system. The primary outcome is the development of at least one peri-oral lesion during the first ten days of maintaining an orally inserted endotracheal tube. The presence of lesions is assessed by a blinded adjudication committee using photographs taken daily. DISCUSSION This study is the first multicenter, randomized trial designed to evaluate the impact of elastic adhesive tape versus fixation cord with PVC sheath on the incidence of peri-oral lesions. The results will provide data which could change and standardize care practices. TRIAL REGISTRATION https://www.clinicaltrials.gov. Reference number: NCT04819425.
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Affiliation(s)
- Vanessa Zinzoni
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Lucie Planche
- Unité de Recherche Clinique, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Sophie Le Potier
- Service de Réanimation Polyvalente, Centre Hospitalier Bretagne Sud, Lorient, France
| | - Laurence Robin
- Service de Réanimation Polyvalente, Centre Hospitalier d’Angoulême, Angoulême, France
| | - Cécile Le Parco
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Philippe Terrat
- Service de Réanimation, Centre Hospitalier de La Rochelle, La Rochelle, France
| | - Marie-Hélène Leroyer
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier du Mans, Le Mans, France
| | - Romain Atger
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jérôme E. Dauvergne
- Service d’anesthésie-réanimation, INSERM, CIC 1413, Hôpital Laënnec, Nantes Université, CHU Nantes, Nantes, France
- Institut du Thorax, CNRS, INSERM, Nantes Université, CHU Nantes, Nantes, France
| | - Lucie Muller
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Laetitia Fontaine
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Intercommunal de Poissy/Saint Germain-en-Laye, Poissy, France
| | - Célina Morand
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pascaline Dennemont
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre, La Réunion, France
| | - Ophélie Paillard
- Service de Neuro-réanimation, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre, La Réunion, France
| | - Servane Vastral
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint-Nazaire, Saint-Nazaire, France
| | - Baptiste Dardaine
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Sylvie Le Guillou
- Service Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Natacha Maquigneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Stéphanie Martin
- Unité de Recherche Clinique, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Jean-Claude Lachérade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
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McEvoy NL, Friel O, Clarke J, Browne E, Geoghegan P, Budri A, Avsar P, Connolly S, Patton D, Curley GF, Moore Z. Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study. Nurs Crit Care 2023; 28:1115-1123. [PMID: 36221908 PMCID: PMC9875092 DOI: 10.1111/nicc.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prone positioning has been widely used to improve oxygenation and reduce ventilator-induced lung injury in patients with severe COVID-19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). AIM This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID-19 ARDS undergoing prone positioning in the intensive care unit. STUDY DESIGN This was a single-centre pre and post-test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. RESULTS In the pre-intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post-intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post-intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre-intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post-intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post-intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre-intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). CONCLUSION The use of a new evidence-based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. RELEVANCE TO CLINICAL PRACTICE The use of a new, evidence-based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.
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Affiliation(s)
- Natalie L. McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Oisin Friel
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Emmet Browne
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pierce Geoghegan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Aglecia Budri
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pinar Avsar
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | | | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
| | - Gerard F. Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Beaumont HospitalDublinIreland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Health Sciences, Faculty of Life and Health SciencesUlster UniversityNorthern IrelandUK
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Lida InstituteShanghaiChina
- Cardiff UniversityCardiffWalesUK
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Lewis CP, Schenkenfelder R, Davies CC, Monroe M, Acton D, Phillips T. Developing the Baptist Health Injury Risk Assessment Phase 1: Exploring Risk Factors. J Nurs Adm 2023; 53:438-444. [PMID: 37585494 DOI: 10.1097/nna.0000000000001313] [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: 08/18/2023]
Abstract
OBJECTIVES The aim of this study was to explore risk factors for developing hospital-acquired pressure injuries (HAPIs) among critically ill adult inpatients. BACKGROUND Hospital-acquired pressure injuries remain a priority quality focus for Magnet ® organizations. Recent studies cite medical devices as a primary cause, yet published risk assessments lack inclusion of those threats. METHODS Nurses at a 434-bed, 4-time Magnet ® -designated hospital led a retrospective study acros 9 American Nurses Credentialing Center-designated facilities. Using a chart review tool, data were collected within 48 hours of a confirmed HAPI. RESULTS Of 207 HAPIs reported, 54% (n = 113) involved deep tissue pressure injuries and 50.2% (n = 104) involved 19 medical devices. Individuals with a HAPI also used 1 or more of 7 distinct types of mobility-limiting medical equipment. CONCLUSIONS Study findings support the development of a critical care risk assessment with inclusion of a medical device and mobility-limiting medical equipment as risk factors. A secondary study is underway for specificity and sensitivity testing of this assessment.
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Affiliation(s)
- C Preston Lewis
- Author Affiliations: Executive Director of Orthopedics/Urology Services & Magnet Recognition Program (Dr Lewis), WOC Clinical Nurse (Schenkenfelder), and Research Consultant (Drs Davies and Monroe), Baptist Health Lexington; WOC Clinical Nurse (Acton), Baptist Health Louisville; and Research Nurse (Dr Phillips), Baptist Health Paducah, Paducah, Kentucky
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Digesa LE, Baru A, Shanko A, Kassa M, Aschalew Z, Moga F, Beyene B, Mulatu T. Incidence and Predictors of Pressure Ulcers among Adult Patients in Intensive Care Units at Arba Minch and Jinka Hospitals, Southern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9361075. [PMID: 37096223 PMCID: PMC10122574 DOI: 10.1155/2023/9361075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/26/2023]
Abstract
Introduction The incidence of a pressure ulcer in intensive care units (ICU) is significantly higher than in noncritical care settings. The patients in the ICU are the most vulnerable group to disruption of the skin's integrity. Prior studies in Ethiopia failed to evaluate pressure ulcers in intensive care units and were limited to general wards. The purpose of this study was to identify the incidence and predictors of pressure ulcers in adult patients admitted to intensive care units in Southern Ethiopia. Methods A single-arm prospective open cohort of 216 patients was used to determine the presence of a pressure ulcer in the intensive care units from June 2021 to April 2022. A consecutive sampling was used until the sample size was reached. The data were collected using a structured questionnaire and analyzed using Stata 14. A cumulative incidence of a pressure ulcer was computed. The life table was used to estimate the cumulative survival. A multivariable Cox proportional hazard regression was used to identify independent predictors of a pressure ulcer. An adjusted hazard ratio with a 95% CI was used to measure the degree of association; a P value ≤ 0.05 was considered significant. Results Twenty-five patients developed a pressure ulcer (PU), making a cumulative incidence of 11.57%. Out of 25 incident cases of pressure ulcers, four-fifths (80%) of the study patients developed PU within 6 days of their admission to the ICUs. The incidence rate was 32.98 PU per 1000 person-days of ICU stay. Pressure ulcers were most commonly found on the sacrum, followed by the shoulder. Among the incident cases, 52% were stage 2 ulcers. The presence of friction or shearing forces, as well as being 40 years of age or older, was independently associated with pressure ulcers. Conclusion The overall cumulative incidence of the pressure ulcer was lower than that in other studies but occurred at a faster rate. Age (40 years of age or older) and the presence of friction or shearing forces were the main predictors of pressure ulcers in the intensive care units. Therefore, nurses working in ICUs should continually anticipate the risk of a pressure ulcer. Moreover, special attention should be given to patients of advanced ages. Furthermore, monitoring the installation of a mattress, keeping bed linens unwrinkled, and keeping patients in a proper position on a bed to prevent or reduce friction or shearing forces are very crucial in the prevention of pressure ulcers.
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Affiliation(s)
- Lankamo Ena Digesa
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Ararso Baru
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Alemayehu Shanko
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Mekidim Kassa
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Fikre Moga
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Bereket Beyene
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Tegegn Mulatu
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
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Walley KC, Farrar N, Shams K, Anastasio AT, Gong D, Mell K, Holmes JR, Walton DM, Talusan PG. Surface Pressures in Lower Extremity Splints: A Biomechanical Study. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231160115. [PMID: 36937805 PMCID: PMC10014985 DOI: 10.1177/24730114231160115] [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: 03/16/2023] Open
Abstract
Background Though ubiquitously used in orthopaedic trauma, lower extremity splints may have associated iatrogenic risk of morbidity. Although clinicians pad bony prominences to minimize skin pressure, the effect of joint position on skin pressure and, more specifically, changing joint position, is understudied. The purpose of this biomechanical study is to determine the effect of various short-leg splint application techniques on anterior ankle surface pressure in the development of iatrogenic skin pressure ulcers. Methods Various constructs of lower extremity, short-leg splints were applied to 3 healthy subjects (6 limbs total) with an underlying pressure transducer (Tekscan I-Scan system) on the skin surface centered on the tibialis anterior tendon at the level of the ankle. All subjects underwent anterior ankle surface pressure assessment when padding was applied in maximum plantar flexion and neutral position for conventional short-leg splints application in clinically relevant patient scenarios. Percentage change from initial contact pressure centered on the tibialis anterior with cast padding were calculated. Results The percentage change in anterior ankle contact pressure when padding was applied in maximum plantar flexion (PF) and then definitively placed in neutral was increased at least 2-fold without the addition of plaster in lower extremity short-leg splints. Removing anterior ankle padding following final splint application in neutral reduced contact forces at the anterior ankle 46% and 59% in splints applied in maximum PF and neutral ankle position, respectively. Conclusion The present study is the first of its kind to underscore and quantify clinically relevant technical pearls that can be useful in reducing risk of iatrogenic risk of skin breakdown at the anterior ankle when placing short-leg splints, mainly, that it is imperative to apply padding in the intended final splint position and to remove anterior ankle padding following splint application when able. Level of Evidence Level IV, biomechanical study with clear hypothesis.
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Affiliation(s)
- Kempland C. Walley
- Department of Orthopaedic Surgery,
University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Nicholas Farrar
- Department of Orthopaedic Surgery,
University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Kameron Shams
- Department of Orthopaedic Surgery,
University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Davin Gong
- Department of Orthopaedic Surgery,
University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Kristopher Mell
- Department of Orthopaedic Surgery,
University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - James R. Holmes
- Department of Orthopaedic Surgery,
University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - David M. Walton
- Department of Orthopaedic Surgery,
University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Paul G. Talusan
- Department of Orthopaedic Surgery,
University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
- Paul G. Talusan, MD, Associate Professor of
Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Michigan,
Michigan Medicine, 2098 S Main St, Ann Arbor, MI 48103, USA. Emails:
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Lee SY, Oh DK, Hong SB, Lim CM, Huh JW. Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit. Korean J Intern Med 2022; 37:1186-1194. [PMID: 36127798 PMCID: PMC9666256 DOI: 10.3904/kjim.2021.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/AIMS Patients in the intensive care unit (ICU) are at high risk for developing pressure injuries, which can cause severe complications and even increase the mortality risk. Therefore, prevention of pressure injuries is most important. In this study, we investigated the risk factors of pressure injury development in patients admitted to the ICU. METHODS We retrospectively analyzed patients ages > 18 years admitted to the medical ICU in a tertiary hospital between January and December 2019. We collected patient baseline characteristics, medications received, mechanical ventilation or hemodialysis use, laboratory findings, and date of pressure injury onset and characteristics. RESULTS We analyzed 666 patients who did not have pressure injuries at ICU admission. Pressure injuries developed in 102 patients (15%). The risk of pressure injury development increased as the administration days for neuromuscular blocking agents (NMBAs; odds ratio [OR], 1.138; p = 0.019) and opioids (OR, 1.084; p = 0.028) increased, and if the patient had problem with friction and shear (OR, 2.203; p = 0.011). CONCLUSION The prolonged use of NMBAs and opioids can increase the risk of pressure injury development. Because these medications are associated with immobilization, using both should be minimized and patient early mobilization should be promoted. Among the Braden subscales, "friction and shear" was associated with the development of pressure injuries in ICU patients.
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Affiliation(s)
- Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Factors Associated with Pressure Injury Among Critically Ill Patients in a Coronary Care Unit. Adv Skin Wound Care 2022; 35:1-10. [PMID: 36125458 DOI: 10.1097/01.asw.0000872172.83299.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To ascertain the incidence of pressure injuries (PIs) in patients in the coronary care unit (CCU), identify PI characteristics, and determine associated risk factors. METHODS Researchers conducted a retrospective investigational study of patients' medical records. A total of 820 patients who were admitted to the CCU between January 2018 and December 2020 met the study criteria. Of these, 200 patients who developed PIs after admission to the CCU were included in this study. This study examined the clinical features of PIs, as well as five PI risk factors: patient characteristics; length of stay; intrinsic factors; care factors, including medical devices; and vasopressor agents. RESULTS The incidence of PIs among patients in the CCU was 24.4%. At initial detection, 79.5% of these injuries were already at stage 2 or higher. The results indicated a significant correlation between PI stage and hemoglobin level. Moreover, the authors also found relationships between the use of medical devices (eg, arterial catheters, oxygen tubes, and Levin tubes) and PI onset. CONCLUSIONS Critically ill patients in the CCU use various medical devices for an extended period with severe consequences. The risk factors affecting PI are multifactorial. Therefore, the implementation of PI prevention and early detection strategies for patients in the CCU are crucial.
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Najjar YW, Saleh MY, Hassan ZM. Medical device related pressure ulcers in Jordan: Prevalence study among critically ill patients. Health Sci Rep 2022; 5:e620. [PMID: 35539444 PMCID: PMC9069546 DOI: 10.1002/hsr2.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background Medical device‐related pressure ulcers are increasingly common in critical care units. These ulcers can be complicated due to the necessity of the device for diagnosis or treatment. Purpose To determine the prevalence of and risk for medical device‐related pressure ulcers in critical care units in Jordan in addition to identifying the preventive measures for those ulcers as well as identifying the most frequently used medical devices that cause ulcers and to assess the relationships between prevention measures and developing ulcers. Methods A cross‐sectional survey was used to assess ulcers among 318 patients who were elder than 18 years old. Data collection was based on an outline published by the European Pressure Ulcer Advisory Panel, Braden Scale, and an author‐developed specific checklist. Results The prevalence rate of medical device‐related pressure ulcers was 38.1%. Most affected sites were sacrum and heel, and most affected were those with old age, being admitted to public hospitals, and with a prolonged hospital stay. About half of the patients (46.3%) had severe risk. Only 17% of the patients who were at risk got adequate preventive measures. Face masks, endotracheal tubes, pulse oximetry probes, and intravenous catheters were associated with almost half of the ulcers. Conclusion Medical device‐related pressure ulcers are threats to patient safety and quality of nursing care in hospitals, which require determining appropriate preventive measures. Key messages: Medical device‐related pressure ulcers are common among patients in critical care units, which raise the need to evaluate the prevalence of such type of ulcers in those patients. Three hundred and eighteen patients were investigated for the prevalence of medical device‐related pressure ulcers through a cross‐sectional survey. Patients in critical care units in Jordan had a high prevalence rate for medical device‐related pressure ulcers, which require the need to apply appropriate preventive measures.
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Affiliation(s)
- Yahya W. Najjar
- Zarqa University College Al‐Balqa Applied University Zarqa Jordan
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11
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Haavisto E, Kielo-Viljamaa E, Hjerppe A, Puukka P, Stolt M. Consistent Practices in Pressure Injury Prevention at Long-term Care Facilities. Adv Skin Wound Care 2022; 35:1-10. [PMID: 35188487 DOI: 10.1097/01.asw.0000818576.93870.40] [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: 11/26/2022]
Abstract
OBJECTIVE To examine the use of consistent practice in pressure injury (PI) prevention based on international guidelines at long-term care facilities in Finland. METHODS A correlational cross-sectional design was used. The authors collected data from 84 contact persons within 62 participating long-term care facilities in Finland using the Pressure Ulcer Prevention Practice instrument. RESULTS According to the respondents, the PI prevention strategies practiced most often were skin assessment and skin care; nutrition was the prevention used least often. Consistent practices relating to repositioning were most frequently agreed upon, whereas those relating to risk assessment were least frequently agreed upon. Some of the demographic factors of respondents, including knowledge level and reading of PI prevention guidelines and articles, were associated with the frequency of prevention practices. CONCLUSIONS Although respondents reported a moderate level of PI prevention based on international guidelines, there were often no consistent practices in the units. Further education about PI prevention might improve the consistent practice of evidence-based PI prevention.
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Affiliation(s)
- Elina Haavisto
- At the University of Turku, Finland, Elina Haavisto, PhD, RN, is Professor, Department of Nursing Science; Emilia Kielo-Viljamaa, PhD, RN, is Researcher, Department of Nursing Science; Anna Hjerppe, MD, is Chief Physician and Clinical Teacher, Department of Medicine; Pauli Puukka, MSocSci, is Statistician, Department of Nursing Science; and Minna Stolt, PhD, is University Lecturer, Department of Nursing Science. Acknowledgments: The authors thank all the contact persons who participated in this study by assessing the skin condition of all patients at their own long-term care facilities and completing the questionnaires. Study materials and salaries were funded by State Research Funding, Satakunta Hospital District, Finland. The authors have disclosed no other financial relationships related to this article. Submitted February 16, 2021; accepted in revised form April 7, 2021
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12
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Yu M, Park KH, Shin J, Lee JH. Predicting the cut-off point for interface pressure in pressure injury according to the standard hospital mattress and polyurethane foam mattress as support surfaces. Int Wound J 2022; 19:1509-1517. [PMID: 35107216 PMCID: PMC9493213 DOI: 10.1111/iwj.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/19/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
This study aimed to investigate the interface pressure (IP) of patients using a standard hospital mattress and polyurethane foam mattress as support surfaces and present cut‐off points for IP in patients who exhibited skin changes. A total of 189 inpatients enrolled from six general wards and three intensive care units at a Korean University Hospital. Skin changes were classified, and peak IP at the sacral and occipital regions was measured using a pressure scanner. Differences in IPs according to mattress type were analysed using independent t‐tests. The receiver operating characteristic curve was constructed to determine the cut‐off point, and the area under the curve with a 95% confidence interval was obtained using the Stata 15.1.program. The IP for a standard hospital mattress was significantly higher than that of a polyurethane foam mattress. The cut‐off points for IP at the sacral region were 52.90 and 30.15 mm Hg for a standard hospital mattress and polyurethane foam mattress, respectively. The cut‐off point for IP at the occipital region was 36.40 mm Hg for a polyurethane foam mattress. Using IP measurements to prevent pressure injuries is important and employ individualised interventions based on the cut‐off points for different support surfaces.
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Affiliation(s)
- Mi Yu
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Kyung Hee Park
- Department of Nursing Science, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Jiseon Shin
- Department of Nursing, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji Hyun Lee
- Department of Nursing, Gyeongsang National University Hospital, Jinju, Republic of Korea
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13
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Haavisto E, Stolt M, Puukka P, Korhonen T, Kielo-Viljamaa E. Consistent practices in pressure ulcer prevention based on international care guidelines: A cross-sectional study. Int Wound J 2021; 19:1141-1157. [PMID: 34761513 PMCID: PMC9284652 DOI: 10.1111/iwj.13710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023] Open
Abstract
The use of consistent and evidence‐based practices is essential in terms of patient safety and quality of care. The purpose of this study was to describe the use of consistent practices in PU prevention based on international care guidelines and to assess the validity and reliability of the pressure ulcer prevention practice (PUPreP) instrument. The data (n = 554) were collected between 2018 and 2019 from nursing professionals working at two hospital districts in Finland using the PUPreP instrument. The instrument consisted of 42 items assessing participants' perceptions of the frequencies of pressure ulcer prevention practices with the following scale: never, sometimes, often, always. The data were analysed using statistical analysis. According to the results, the use of pressure ulcer prevention practices was more frequently described as often. The most frequently used prevention practice was repositioning, and the least frequently used practice was nutrition. Factors related to nursing professionals' pressure ulcer prevention practices were the working sector, education and working frequency in pressure ulcer prevention, and early identification of pressure ulcers. The study results suggest that the evidence‐based pressure ulcer prevention practices were followed at a moderate level by nurses. The PuPreP instrument demonstrated validity and reliability, but further development is needed.
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Affiliation(s)
- Elina Haavisto
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Pauli Puukka
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Emilia Kielo-Viljamaa
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
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Kara H, Arikan F, Kahyaoglu A. Student Nurse Knowledge of and Attitudes Toward Pressure Injury Prevention: How Sufficient Is Undergraduate Education? Adv Skin Wound Care 2021; 34:473-480. [PMID: 34415251 DOI: 10.1097/01.asw.0000767332.40833.28] [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: 11/27/2022]
Abstract
OBJECTIVES To assess the knowledge and attitudes of student nurses regarding evidence-based guidelines for preventing pressure injuries. METHODS This study used a descriptive research design. The participants included second-, third-, and fourth-year nursing students completing their bachelor's degrees at a faculty of nursing in Turkey. Data collection forms consisted of a student nurse information form, the Pressure Ulcer Prevention Knowledge Assessment Instrument, and the Attitude Towards Pressure Ulcer Prevention Instrument. RESULTS The overall mean score for knowledge was 49.9% (11.7/26). The highest scores for the instrument's subthemes were for nutrition (72%), and the lowest were for etiology and development (40.1%). The overall mean attitude score was 42.20 ± 2.40, although a statistically significant difference among grades was found (P < .001). The highest mean scores showed agreement among students that pressure injury prevention should be a priority (10.50 ± 1.43). A significant difference was found in the competence subscale according to the number of dressing changes observed and sense of competence in pressure injury care (P = .003). A weak but statistically significant positive relationship was found between knowledge and attitude scores (r = 0.158; 95% confidence interval, .040-.269; P < .001). CONCLUSIONS This study revealed that certain revisions are needed in the nursing curriculum to improve the knowledge and attitudes of nursing students toward the prevention and care of pressure injuries. More details should be covered in the classroom and laboratories through simulation or clinical practice for improved management of pressure injuries.
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Affiliation(s)
- Hava Kara
- At Akdeniz University in Antalya, Turkey, Hava Kara, RN, is Research Nurse, Nursing Practice and Research Center; Fatma Arikan, PhD, RN, is Director, Nursing Practice and Research Center; and Ali Kahyaoglu, BHSc is Student Nurse, Faculty of Nursing. Acknowledgments: The authors thank the nursing students who participated in this study. The authors have disclosed no financial relationships related to this article. Submitted August 30, 2020; accepted in revised form October 30, 2020
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15
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Smith RE, Shifrin MM. Critical Care Considerations in Adult Patients With Influenza-Induced ARDS. Crit Care Nurse 2021; 40:15-24. [PMID: 33000130 DOI: 10.4037/ccn2020746] [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
TOPIC Acute respiratory distress syndrome is a complex respiratory disease that can be induced by influenza virus infection. Critical care providers are uniquely positioned to manage this pathological progression in adult patients through evidence-based practice. CLINICAL RELEVANCE Influenza and subsequent acute respiratory distress syndrome are associated with extremely high morbidity and mortality in adult patients in the United States. Although evidence-based medical management strategies can alter the clinical trajectory of acute respiratory distress syndrome and improve outcomes, critical care providers do not always implement these measures. PURPOSE To provide critical care providers with an overview of the pathological progression of influenza-induced acute respiratory distress syndrome and the current evidence-based strategies for management. CONTENT COVERED This article reviews the epidemiology and pathophysiology associated with influenza-induced acute respiratory distress syndrome, the criteria for diagnosis, and the evidence-based medical management.
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Affiliation(s)
- Rachel E Smith
- Rachel E. Smith is an acute care nurse practitioner in the medical intensive care unit at Saint Thomas West Hospital, Nashville, Tennessee
| | - Megan M Shifrin
- Megan M. Shifrin is an assistant professor and the coordinator of the Adult-Gerontology Acute Care Nurse Practitioner Intensivist Focus at Vanderbilt University School of Nursing, Nashville, Tennessee
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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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Okamoto S, Ogai K, Mukai K, Sugama J. Association of Skin Microbiome with the Onset and Recurrence of Pressure Injury in Bedridden Elderly People. Microorganisms 2021; 9:microorganisms9081603. [PMID: 34442680 PMCID: PMC8400065 DOI: 10.3390/microorganisms9081603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 01/01/2023] Open
Abstract
Pressure injuries have been identified as one of the main health hazards among bedridden elderly people. Bedridden elderly people often stay in the same position for a long time, because they cannot switch positions; thus, the blood flow in the part of the body that is being compressed between the bed and their own weight is continuously blocked. As a result, redness and ulcers occur due to lacking oxygen and nutrients in the skin tissues, and these sites are often infected with microorganisms and, thus, become suppurative wounds, a condition commonly determined as pressure injuries. If left untreated, the pressure injury will recur with microbial infections, often resulting in cellulitis, osteomyelitis, and sepsis. The skin microbiome, in which many types of bacteria coexist, is formed on the skin surface. However, it remains unclear what characteristic of the skin microbiome among the bedridden elderly constitutes the development and severity of pressure injuries and the development of post-pressure injury infections. Thus, in this review article, we outlined the changes in the skin microbiome among the bedridden elderly people and their potential involvement in the onset and recurrence of pressure injuries.
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Affiliation(s)
- Shigefumi Okamoto
- Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa 920-0942, Japan;
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa 920-0942, Japan
- Correspondence:
| | - Kazuhiro Ogai
- AI Hospital/Macro Signal Dynamics Research and Development Center, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa 920-0942, Japan;
| | - Kanae Mukai
- Department of Clinical Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa 920-0942, Japan;
| | - Junko Sugama
- Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa 920-0942, Japan;
- Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake 470-1192, Japan
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Lovicu E, Faraone A, Fortini A. Admission Braden Scale Score as an Early Independent Predictor of In-Hospital Mortality Among Inpatients With COVID-19: A Retrospective Cohort Study. Worldviews Evid Based Nurs 2021; 18:247-253. [PMID: 34275200 PMCID: PMC8447426 DOI: 10.1111/wvn.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 01/08/2023]
Abstract
Background The COVID‐19 pandemic has put a strain on health systems. Predictors of adverse outcomes need to be investigated to properly manage COVID‐19 patients. The Braden Scale (BS), commonly used for the assessment of pressure ulcer risk, has recently been proposed to identify frailty. Objective To investigate the predictive utility of the BS for prediction of in‐hospital mortality in a cohort of COVID‐19 patients admitted to non‐ICU wards. Methods We conducted a retrospective single‐center cohort study evaluating all patients with SARS‐CoV‐2 infection consecutively admitted over a 2‐month period (from March 6 to May 7, 2020) to the COVID‐19 general wards of our institution. Demographic, clinical, and nursing assessment data, including admission BS, were extracted from electronic medical records. Univariable and multivariable logistic regression models were used to explore the association between the BS score and in‐hospital death. Results Braden Scale was assessed in 146 patients (mean age 74.7 years; 52% males). On admission, 46 had a BS ≤ 15, and 100 patients had a BS > 15. Mortality among patients with BS ≤ 15 was significantly higher than in patients with BS > 15 (45.7% vs. 16%; p < .001). On multivariable regression analysis, adjusting for potentials confounders (age, Barthel scale, chronic kidney disease, atrial fibrillation, and hypertension), the admission BS remained inversely associated with the risk of in‐hospital mortality (OR = 0.76; 95% CI [0.60, 0.96]; p = .020). Linking Evidence to Action Admission BS could be used as a simple bedside predictive tool able to early identify non‐ICU COVID‐19 patients with poor prognosis who might benefit from specific and timely interventions.
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Affiliation(s)
- Elena Lovicu
- Internal Medicine Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Antonio Faraone
- Internal Medicine Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Alberto Fortini
- Internal Medicine Unit, San Giovanni di Dio Hospital, Florence, Italy
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19
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Floyd NA, Dominguez-Cancino KA, Butler LG, Rivera-Lozada O, Leyva-Moral JM, Palmieri PA. The Effectiveness of Care Bundles Including the Braden Scale for Preventing Hospital Acquired Pressure Ulcers in Older Adults Hospitalized in ICUs: A Systematic Review. Open Nurs J 2021. [DOI: 10.2174/1874434602115010074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background:
Despite technological and scientific advances, Hospital Acquired Pressure Ulcers (HAPUs) remain a common, expensive, but preventable adverse event. The global prevalence ranges from 9% to 53% while three million people develop HAPUs in the United States and 60,000 people die from associated complications. HAPU prevalence is reported as high as 42% in ICUs (ICU) costing on average $48,000 to clinically manage.
Objective:
The purpose of this systematic review was to evaluate the effectiveness of multi-component interventions (care bundles), incorporating the Braden scale for assessment, in reducing the prevalence of HAPUs in older adults hospitalized in ICUs.
Methods:
This was a systematic review of the literature using the Cochrane method. A systematic search was performed in six databases (CINAHL, Cochrane Library, Google Scholar, JBI Evidence-Based Practice Database, PubMed, and ProQuest) from January 2012 until December 2018. Bias was assessed with the Critical Appraisal Skills Programme Checklist, and the quality of evidence was evaluated with the American Association of Critical-Care Nurses Levels of Evidence.
Results:
The search identified 453 studies for evaluation; 9 studies were reviewed. From the analysis, pressure ulcer prevention programs incorporated three strategies: 1) Evidence-based care bundles with risk assessments upon admission to the ICU; 2) Unit-based skincare expertise; and 3) Staff education with auditing feedback. Common clinical management processes included in the care bundles were frequent risk reassessments, daily skin inspections, moisture removal treatments, nutritional and hydration support, offloading pressure techniques, and protective surface protocols. The Braden scale was an effective risk assessment for the ICU. Through early risk identification and preventative strategies, HAPU programs resulted in prevalence reduction, less severe ulcers, and reduced care costs.
Conclusion:
Older adults hospitalized in the ICU are most vulnerable to developing HAPUs. Early and accurate identification of risk factors for pressure is essential for prevention. Care bundles with three to five evidence-based interventions, and risk assessment with the Braden scale, were effective in preventing HAPUs in older adults hospitalized in intensive care settings. Higher quality evidence is essential to better understanding the impact of HAPU prevention programs using care bundles with risk assessments on patient outcomes and financial results.
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Aghazadeh A, Lotfi M, Asgarpour H, Khajehgoodari M, Nobakht A. Frequency and risk factors of pressure injuries in clinical settings of affiliated to Tabriz University of Medical Sciences. Nurs Open 2021; 8:808-814. [PMID: 33570276 PMCID: PMC7877138 DOI: 10.1002/nop2.685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022] Open
Abstract
AIM Pressure injuries are considered a common and costly problem in the care of patients. Prevention and identification of risk factors for pressure injuries are very important due to the high cost of treatment and the adverse consequences of pressure injuries. This study aimed to assess the prevalence of pressure injuries and its risk factors in clinical settings of affiliated to Tabriz University of Medical Sciences. DESIGN A descriptive-analytical study. METHODS This study was performed on 200 patients who were selected by random sampling. The data collection tool was a 3-part questionnaire. Data were analysed using a t test, chi-square, Fisher's exact test and logistic regression in SPSS v. 24. RESULTS The mean age of the participants was 51.93 (SD 14.99) years. The rate of pressure injuries in this study was 19.5%. The most susceptible area for pressure injuries were sacral (35.89%) and gluteal (20.51%), respectively. The pressure injuries was significantly associated with Braden's criteria, age, disease diagnosis and length of hospital stay (p < .05). But there was no statistically significant difference between sex and incidence of pressure injuries (p > .05).
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Affiliation(s)
- AhmadMirza Aghazadeh
- Department of Basic SciencesParamedical FacultyTabriz University of Medical SciencesTabrizIran
| | - Mojgan Lotfi
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
| | - Hossein Asgarpour
- Department of Surgical NursingFaculty of Health SciencesÇanakkale Onsekiz Mart UniversityCanakkaleTurkey
| | - Mohammad Khajehgoodari
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Afsaneh Nobakht
- Faculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
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21
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Delawder JM, Leontie SL, Maduro RS, Morgan MK, Zimbro KS. Predictive Validity of the Cubbin-Jackson and Braden Skin Risk Tools in Critical Care Patients: A Multisite Project. Am J Crit Care 2021; 30:140-144. [PMID: 33644804 DOI: 10.4037/ajcc2021669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients in intensive care units are 5 times more likely to have skin integrity issues develop than patients in other units. Identifying the most appropriate assessment tool may be critical to preventing pressure injuries in intensive care patients. OBJECTIVES To validate the Cubbin-Jackson skin risk assessment in the critical care setting and to compare the predictive accuracy of the Cubbin-Jackson and Braden scales for the same patients. METHODS In 5 intensive care units, the Cubbin-Jackson and Braden assessments were completed by different clinicians within 61 minutes of each other for 4137 patients between October 2017 and March 2018. Bivariate correlations and the Fisher exact test were used to check for associations between the scores. RESULTS The Cubbin-Jackson and Braden scores were significantly and positively correlated (r = 0.80, P < .001). Both tools were significant predictors of skin changes and identified as "at risk" 100% of the patients who had a change in skin integrity occur. The specificity was 18.4% for the Cubbin-Jackson scale and 27.9% for the Braden scale, and the area under the curve was 0.75 (P < .001) for the Cubbin-Jackson scale and 0.76 (P < .001) for the Braden scale. These findings show acceptable construct validity for both scales. CONCLUSIONS The predictive validities of the Cubbin-Jackson and Braden scales are similar, but both are sub-optimal because of poor specificity and positive predictive value. Change in practice may not be warranted, because there are no differences between the 2 scales of practical benefit to bedside nurses.
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Affiliation(s)
- Jill M. Delawder
- Jill M. Delawder is a clinical nurse specialist for Critical Care and manager of nursing professional development, Sentara RMH Medical Center, Harrisonburg, Virginia
| | - Samantha L. Leontie
- Samantha L. Leontie is a professional development generalist, Critical Care, Sentara RMH Medical Center
| | - Ralitsa S. Maduro
- Ralitsa S. Maduro is a biostatistician, Quality Research Institute, Department of Enterprise Analytics, Sentara Healthcare, Virginia Beach, Virginia
| | - Merri K. Morgan
- Merri K. Morgan is manager of analytical services, Quality Research Institute, Department of Enterprise Analytics, Sentara Healthcare, Virginia Beach, Virginia
| | - Kathie S. Zimbro
- Kathie S. Zimbro is director, Quality Research Institute, Department of Enterprise Analytics, Sentara Healthcare; nurse executive for research, Sentara Healthcare; and adjunct professor, College of Health Sciences, Old Dominion University, Norfolk, Virginia
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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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A Multicenter, Comparative Study of Two Pressure-Redistribution Mattresses with Repositioning Intervals for Critical Care Patients. Adv Skin Wound Care 2020; 33:1-9. [PMID: 32058444 DOI: 10.1097/01.asw.0000653160.13611.5d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effectiveness of two protocols for preventing pressure injuries (PIs) in Chinese hospitals. DESIGN AND SETTING A multicenter, open-label, comparative study conducted in seven Chinese acute care hospitals. PATIENTS AND INTERVENTION In total, 1,654 eligible patients were identified, and 1,204 were enrolled in the study. Enrolled patients were randomly assigned into the trial group (4-hour repositioning combined with a viscoelastic foam mattress; n = 602) or the control group (2-hour repositioning combined with a powered air pressure redistribution mattress; n = 602). Participants received their respective protocols until they were discharged, died, or for at least 7 days. MAIN OUTCOME MEASURES The incidence of PIs, Braden Scale scores, and the time to development of PIs. MAIN RESULTS Ultimately, 596 trial group patients and 598 control group patients were analyzed. Thirteen patients had single new stage 2 or worse PIs. The total incidence of PIs was 1.1%. The difference between the two groups was significant (0.3% vs 1.8%). However, the difference between the groups' Braden Scale score median during the intervention was not significant (13 vs 13.5). CONCLUSIONS The 4-hour repositioning interval combined with a viscoelastic foam mattress did not increase PI incidence or risk. These findings could help providers select the right pressure redistribution mattresses and repositioning intervals for critical care patients.
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Wåhlin I, Ek AC, Lindgren M, Geijer S, Årestedt K. Development and validation of an ICU-specific pressure injury risk assessment scale. Scand J Caring Sci 2020; 35:769-778. [PMID: 32666602 DOI: 10.1111/scs.12891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Critically ill patients are at high risk for pressure injury (PI) due to critical illness combined with multiple interventions and therapies. It is hence important to gain more knowledge about the risk factors associated with pressure injury development and methods for decreasing its prevalence. AIMS To develop and validate a clinical useful ICU-specific PI risk assessment scale based on the RAPS. METHOD The study was designed as a prospective instrument development and validation study. The Risk Assessment Pressure Ulcer Scale (RAPS), which in Sweden is a commonly used PI risk assessment scale, was used as a starting point. Development was then performed in different steps; adaption of items and response options to ICU care, discussion with ICU staff members to enhance clinical relevance and usability, test of interrater reliability, revision of instrument, a new test with 300 patients followed by statistical evaluation. RESULTS The final version of the RAPS-ICU consists of six items: failure of vital organs, mobility, moisture, sensory perception, level of consciousness and special treatment in the form of mechanical ventilation, continuous dialysis and/or inotropic drugs. A total score was reached by summing all responses. Each of the items was found to be significant associated with PI development as well as the total score (p < 0.001). The total score also showed a high interrater reliability (ICC = 0.96), good sensitivity and acceptable specificity with AUC = 0.71 and ICU staff perceived the RAPS-ICU as relevant and easy to use in clinical practice. CONCLUSION The RAPS-ICU is a valid and clinically useful tool to identify patients at risk to develop pressure injury at ICU.
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Affiliation(s)
- Ingrid Wåhlin
- Research Section, Region Kalmar County, Kalmar, Sweden.,School of Health and Caring Sciences, Linnaeus University, Växjö, Kalmar, Sweden
| | - Anna-Christina Ek
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Margareta Lindgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sebastian Geijer
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Critical Care, University Hospital of Linköping, Linköping, Sweden
| | - Kristofer Årestedt
- Research Section, Region Kalmar County, Kalmar, Sweden.,School of Health and Caring Sciences, Linnaeus University, Växjö, Kalmar, Sweden
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Incidence of Pressure Ulcers In The Patients On Mechanical Ventilation: A Prospective Study. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.628095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bubun J, Yusuf S, Darwis M. Relationship between skin moisture and medical device related pressure injury (MDRPI) in intensive care units: Prospective study. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wei M, Wu L, Chen Y, Fu Q, Chen W, Yang D. Predictive Validity of the Braden Scale for Pressure Ulcer Risk in Critical Care: A Meta‐Analysis. Nurs Crit Care 2020; 25:165-170. [PMID: 31985893 DOI: 10.1111/nicc.12500] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/04/2019] [Accepted: 01/06/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Min Wei
- Department of Orthopedics, Nanjing Drum Tower Hospitalthe Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Ling Wu
- Wound Care Center, Nanjing Drum Tower Hospitalthe Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Yan Chen
- Nursing Department Office, Nanjing Drum Tower Hospitalthe Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Qiaomei Fu
- Surgery Branch, Nanjing Drum Tower Hospitalthe Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Wenyue Chen
- Department of Orthopedics, Nanjing Drum Tower Hospitalthe Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu China
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Defining Best Practices for Patient Safety in Positioning and Transferring Patients With the Surgical Spine Table. Orthop Nurs 2020; 39:7-20. [PMID: 31977736 DOI: 10.1097/nor.0000000000000622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This quality improvement project's purpose was to define and provide best practices in surgical patient positioning and transfer processes with the surgical spine table to increase patient safety. Using the Define, Measure, Analyze, Improve, and Control quality improvement framework, a multidisciplinary team analyzed surveys, qualitative interviews, ergonomics, near-miss sentinel events and skin integrity data to standardize this process. Results reinforced the need to develop and standardize the process of patient positioning and transfer from cart to table. Findings resulted in practice changes, including a standardized best practice for transfer of patients, educational tools, and checklists for continued monitoring of patient safety issues. Metrics for intervention effectiveness include reduced patient skin integrity, increased staff satisfaction, and improved comfort level with use of spine table accessories and equipment. This practice improvement has a patient safety focus in the perioperative nursing practice.
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Babamohamadi H, Ansari Z, Nobahar M, Mirmohammadkhani M. The effects of peppermint gel on prevention of pressure injury in hospitalized patients with head trauma in neurosurgical ICU: A double-blind randomized controlled trial. Complement Ther Med 2019; 47:102223. [PMID: 31780037 DOI: 10.1016/j.ctim.2019.102223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of peppermint gel on the prevention of pressure injuries in patients with head trauma admitted to neurosurgical intensive care units. DESIGN This double blind, randomized, controlled clinical trial study was conducted on 150 patients with head trauma admitted to the ICU. Using sealed envelopes, patients were assigned randomly into two intervention (n = 75) and control (n = 75) groups. SETTING The study was conducted in the ICUs of a university hospital and a general hospital in Shiraz, Iran. INTERVENTION The intervention group received peppermint gel three times a day up to 14 days during the skin care as a layer on the skin areas exposed to the risk of pressure injuries. The control group used a placebo gel. PRIMARY OUTCOMES The expected outcome in this study was the incidence of pressure injuries stage I, which once daily was evaluated by pairs of observers with the National Pressure Ulcer Advisory Panel. RESULTS The incidence rate of pressure injuries was 22.8% and 77% in the intervention and the control groups, respectively. The chi-square test result showed a significant deference between two groups (P < 0.001). Sacrum was the most common site for incidence of the pressure injuries. CONCLUSION The findings showed that the peppermint gel has a positive effect in the prevention of pressure injuries in the patients with head trauma admitted to ICUs. So, the use of this gel is suggested as an easy and low-cost method for prevention of pressure injuries in the patients admitted to ICUs.
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Affiliation(s)
- Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
| | - Zahra Ansari
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran, Iran.
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran; Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Epidemiology and Statistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
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Amrani G, Gefen A. Which endotracheal tube location minimises the device-related pressure ulcer risk: The centre or a corner of the mouth? Int Wound J 2019; 17:268-276. [PMID: 31724822 DOI: 10.1111/iwj.13267] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
The use of an endotracheal tube (ETT), which is required for any mechanical ventilation procedure, involves an inherent risk for facial skin, lip, and mucosal pressure ulcers. The ETT is one of the most common devices associated with medical device-related pressure ulcers (MDRPUs) among surgical and intensive care unit patients. In the present work, we investigated, for the first time in the literature, the biomechanical effects of the presence and positioning of an ETT in the mouth on lip, mucosal and surrounding facial skin loads. Using two anatomically realistic finite element model variants, two ETT locations were simulated and compared, at the centre versus the corner of the mouth. Our study shows that a central location of the ETT inflicted greater lip and mucosal stress values, but a corner location caused a more widespread and diffused lip, mucosal and facial skin stress exposure. Accordingly, we cannot recommend a "safer" location for ETTs in the mouth; additional preventative measures such as dedicated dressing materials or special cushioning pads applied prophylactically, should be developed to protect from MDRPUs associated with ETT usage. The present modelling framework can be used to study the biomechanical efficacy of such protective technologies, and can therefore aid in the prevention of ETT-caused MDRPUs.
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Affiliation(s)
- Golan Amrani
- 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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Park SK, Park HA, Hwang H. [Development and Evaluation of Electronic Health Record Data-Driven Predictive Models for Pressure Ulcers]. J Korean Acad Nurs 2019; 49:575-585. [PMID: 31672951 DOI: 10.4040/jkan.2019.49.5.575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/21/2019] [Accepted: 07/22/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to develop predictive models for pressure ulcer incidence using electronic health record (EHR) data and to compare their predictive validity performance indicators with that of the Braden Scale used in the study hospital. METHODS A retrospective case-control study was conducted in a tertiary teaching hospital in Korea. Data of 202 pressure ulcer patients and 14,705 non-pressure ulcer patients admitted between January 2015 and May 2016 were extracted from the EHRs. Three predictive models for pressure ulcer incidence were developed using logistic regression, Cox proportional hazards regression, and decision tree modeling. The predictive validity performance indicators of the three models were compared with those of the Braden Scale. RESULTS The logistic regression model was most efficient with a high area under the receiver operating characteristics curve (AUC) estimate of 0.97, followed by the decision tree model (AUC 0.95), Cox proportional hazards regression model (AUC 0.95), and the Braden Scale (AUC 0.82). Decreased mobility was the most significant factor in the logistic regression and Cox proportional hazards models, and the endotracheal tube was the most important factor in the decision tree model. CONCLUSION Predictive validity performance indicators of the Braden Scale were lower than those of the logistic regression, Cox proportional hazards regression, and decision tree models. The models developed in this study can be used to develop a clinical decision support system that automatically assesses risk for pressure ulcers to aid nurses.
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Affiliation(s)
- Seul Ki Park
- College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Hyeoun Ae Park
- College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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Topical Pentoxifylline for Pressure Injury Prevention: A Call for Clinical Research. Adv Skin Wound Care 2019; 32:486. [PMID: 31625963 DOI: 10.1097/01.asw.0000604056.12313.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jentzer JC, Anavekar NS, Brenes-Salazar JA, Wiley B, Murphree DH, Bennett C, Murphy JG, Keegan MT, Barsness GW. Admission Braden Skin Score Independently Predicts Mortality in Cardiac Intensive Care Patients. Mayo Clin Proc 2019; 94:1994-2003. [PMID: 31585582 DOI: 10.1016/j.mayocp.2019.04.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities. PATIENTS AND METHODS This retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause hospital mortality, using elastic net penalized logistic regression to determine predictors of hospital mortality. The secondary outcome was all-cause post-discharge mortality, using Cox proportional hazards models to determine predictors of post-discharge mortality. RESULTS The study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%] were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased short-term mortality as a function of decreasing admission BSS. After adjustment for illness severity and comorbidities using multivariable analysis, admission BSS remained inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92; P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge mortality after adjustment for illness severity and comorbidities (adjusted hazard ratio, 0.89; 95% CI, 0.88-0. 90; P<.001). CONCLUSION The admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting frailty and overall illness acuity, was independently associated with hospital and post-discharge mortality when added to established multiparametric illness severity scores among contemporary CICU patients.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | | | | | - Brandon Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Courtney Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Abstract
Background Reducing hospital-acquired pressure ulcers (PUs) in intensive care units (ICUs) has emerged as an important quality metric for health systems internationally. Limited work has been done to characterize the profile of PUs in the ICU using observational data from the electronic health record (EHR). Consequently, there are limited EHR-based prognostic tools for determining a patient's risk of PU development, with most institutions relying on nurse-calculated risk scores such as the Braden score to identify high-risk patients. Methods and Results Using EHR data from 50,851 admissions in a tertiary ICU (MIMIC-III), we show that the prevalence of PUs at stage 2 or above is 7.8 percent. For the 1,690 admissions where a PU was recorded on day 2 or beyond, we evaluated the prognostic value of the Braden score measured within the first 24 hours. A high-risk Braden score (<=12) had precision 0.09 and recall 0.50 for the future development of a PU. We trained a range of machine learning algorithms using demographic parameters, diagnosis codes, laboratory values and vitals available from the EHR within the first 24 hours. A weighted linear regression model showed precision 0.09 and recall 0.71 for future PU development. Classifier performance was not improved by integrating Braden score elements into the model. Conclusion We demonstrate that an EHR-based model can outperform the Braden score as a screening tool for PUs. This may be a useful tool for automatic risk stratification early in an admission, helping to guide quality protocols in the ICU, including the allocation and timing of prophylactic interventions.
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Barakat-Johnson M, Lai M, Wand T, Li M, White K, Coyer F. The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review. J Wound Care 2019; 28:512-521. [DOI: 10.12968/jowc.2019.28.8.512] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: The objective of this review was to synthesise the literature and evaluate the incidence, prevalence and severity of medical device-related pressure ulcers (MDRPU) in adult intensive care patients. Method: Electronic databases and additional grey literature were searched for publications between 2000 and 2017. Outcome measures included cumulative incidence or incidence rate, point prevalence or period prevalence as a primary outcome and the severity and location of the pressure ulcer (PU) as secondary outcome measures. Included studies were assessed for risk of bias using a nine-item checklist for prevalence studies. The heterogeneity was evaluated using 12 statistic. Results: We included 13 studies in this review. Prevalence was reported more frequently than incidence. Pooled data demonstrated a high variation in the incidence and prevalence rates ranging from 0.9% to 41.2% in incidence and 1.4% to 121% in prevalence. Heterogeneity was high. Mucosal pressure injuries were the most common stage reported in the incidence studies whereas category II followed by category I were most commonly reported in the prevalence studies. In the incidence studies, the most common location was the ear and in the prevalence studies it was the nose. Conclusion: While MDRPU are common in intensive care patients, it is an understudied area. Inconsistency in the staging of MDRPU, along with variations in data collection methods, study design and reporting affect the reported incidence and prevalence rates. Standardisation of data reporting and collection method is essential for pooling of future studies.
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Affiliation(s)
- Michelle Barakat-Johnson
- Susan Wakil, School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia 2050
- Nursing and Midwifery, Sydney Local Health District
| | - Michelle Lai
- Susan Wakil, School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia 2050
| | - Timothy Wand
- Nursing and Midwifery, Sydney Local Health District
- Associate Professor, Emergency Department, Royal Prince Alfred Hospital, Sydney Local Health District
| | - Mengbo Li
- School of Mathematics and Statistics, University of Sydney, Camperdown, Australia 2050
| | - Kathryn White
- Professor of Nursing, Cancer Nursing Research Unit, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia 2050
| | - Fiona Coyer
- Professor of Nursing, School of Nursing, Queensland University of Technology and Intensive Care, Services, Royal Brisbane & Women's Hospital, Kelvin Grove, Queensland 4059
- Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
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Scientific and Clinical Abstracts From WOCNext 2019. J Wound Ostomy Continence Nurs 2019. [DOI: 10.1097/won.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barakat‐Johnson M, Lai M, Gefen A, Coyer F. Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study. Int Wound J 2019; 16:424-432. [PMID: 30560571 PMCID: PMC7949333 DOI: 10.1111/iwj.13051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022] Open
Abstract
This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post-test design with a historical control group was used in a 54-bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty-four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger-scale study.
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Affiliation(s)
- Michelle Barakat‐Johnson
- Pressure Injury Prevention and Management, Sydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Michelle Lai
- Cancer Nursing Research UnitFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Amit Gefen
- Department of Biomedical EngineeringFaculty of Engineering, Tel Aviv UniversityTel AvivIsrael
| | - Fiona Coyer
- Faculty of Health, School of NursingQueensland University of Technology and Intensive Care Services, Royal Brisbane & Women's HospitalBrisbaneQueenslandAustralia
- Critical Care and Clinical Support Services Division, Institute for Skin Integrity and Infection Prevention, University of HuddersfieldHuddersfieldUK
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Pachá HHP, Faria JIL, Oliveira KAD, Beccaria LM. Pressure Ulcer in Intensive Care Units: a case-control study. Rev Bras Enferm 2019; 71:3027-3034. [PMID: 30517408 DOI: 10.1590/0034-7167-2017-0950] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/25/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between presence/absence of Pressure Ulcer, socio-demographic factors and hospitalization. METHOD Case-control study, performed through multiple logistic regression based on information from the adverse event reporting system and the hospital information system, between September/2014 and August/2015. RESULTS Among the risk factors, after adjustment, age greater than or equal to 60 years, hospitalization due to infectious, parasitic and neoplastic diseases, periods of hospitalization longer than seven days and being hospitalized in ICU other than ICU covenant were highlighted. Most of ulcers were reported with mild damage degree and Stage II classification. CONCLUSION Age and days of hospitalization presented a dose-response effect, the longer the age or the number of days of hospitalization, the greater the chances of Pressure Ulcer. There was a significant association among higher occurrences of death in patients with ulcer.
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A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian 2019. [DOI: 10.1016/j.colegn.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Soetens J, Worsley P, Bader D, Oomens C. Investigating the influence of intermittent and continuous mechanical loading on skin through non-invasive sampling of IL-1α. J Tissue Viability 2019; 28:1-6. [DOI: 10.1016/j.jtv.2018.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/15/2018] [Accepted: 12/31/2018] [Indexed: 12/14/2022]
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De Meyer D, Van Hecke A, Verhaeghe S, Beeckman D. PROTECT - Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance. J Adv Nurs 2019; 75:1085-1098. [PMID: 30549321 DOI: 10.1111/jan.13932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/09/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
AIM To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses' compliance to repositioning frequencies; (b) body posture of patients after repositioning; (c) incidence of pressure ulcers and incontinence-associated dermatitis; (d) nurses' and patients' preferences, comfort and acceptability; and (e) budget impact. BACKGROUND Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking. DESIGN Multicentre, cluster, three-arm, randomized, controlled pragmatic trial. METHODS Two hundred and twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group. RESULTS Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group. CONCLUSION This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education. TRIAL REGISTRATION This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.
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Affiliation(s)
- Dorien De Meyer
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Health Sciences, Örebro University, Örebro, Sweden
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Koo M, Sim Y, Kang I. Risk Factors of Medical Device-Related Pressure Ulcer in Intensive Care Units. J Korean Acad Nurs 2019; 49:36-45. [DOI: 10.4040/jkan.2019.49.1.36] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 11/09/2022]
Affiliation(s)
- MiJee Koo
- Surgical Intensive Care Unit, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - YoungA Sim
- Surgical Intensive Care Unit, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - InSoon Kang
- College of Nursing, Pusan National University, Yangsan, Korea
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44
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Ratnani I, Tuazon D, Zainab A, Uddin F. The Role and Impact of Extracorporeal Membrane Oxygenation in Critical Care. Methodist Debakey Cardiovasc J 2018; 14:110-119. [PMID: 29977467 DOI: 10.14797/mdcj-14-2-110] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Use of extracorporeal membrane oxygenation (ECMO) has been exponentially increasing over the last decade and is now considered a mainstream lifesaving treatment modality in critical care medicine. However, the need for physician education, training, and experience remains imperative. Although ECMO has traditionally been used in end-stage lung disease and circulatory collapse, it is being adopted for use in right heart failure, as a bridge to heart and lung transplantation, and as rescue therapy for both sepsis and post-organ transplantation. The following article discusses indications, management, complications, and challenges of ECMO as well as our experience at the Houston Methodist DeBakey Heart & Vascular Center.
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Abstract
BACKGROUND Pressure injuries are the third most expensive condition after cancer and cardiovascular disease. Nurses are responsible for the direct and continuous care, treatment, and prevention of pressure injuries. To achieve optimal quality care, nursing knowledge and attitudes must be based on the best scientific evidence. This study aimed to examine the knowledge and attitudes of nurses working in intensive care units of hospitals affiliated with Zahedan Medical Sciences University regarding the prevention of pressure injuries. METHODS This was a descriptive analytic study involving 89 critical care nurses. Data analysis was conducted using a 3-part questionnaire: demographic data, knowledge, and attitudes of intensive care nurses toward the prevention of pressure injuries. Collected data were analyzed with SPSS version 19 (IBM, Armonk, New York), using descriptive and inferential statistics (such as Pearson correlation coefficient, independent t test, and analysis of variance). RESULTS The results showed that the mean ± SD score of pressure injury knowledge was 0.44 ± 0.12, and the attitude of participants toward pressure injury prevention was 2.69 ± 0.47. Scores varied widely; "nutrition" showed the highest mean score (0.71 ± 0.45), but "etiology and development" (0.42 ± 0.21) and "classification and observation" (0.42 ± 0.24) showed the lowest mean scores. Of the different aspects of attitudes toward pressure injury prevention, "the impact of pressure injuries" showed the highest mean score (2.95 ± 0.56), and "confidence in the effectiveness of prevention" showed the lowest mean score (2.56 ± 0.46). A statistically significant relationship was observed between pressure injury knowledge and attitudes toward pressure injury prevention (P < .001). CONCLUSIONS Pressure injury prevention is one of many nursing care priorities and is a key indicator of the quality of nursing care. In order to achieve optimal quality care in this area, nurse managers and other administrators should make efforts to improve nursing knowledge and attitudes based on the latest scientific evidence for pressure injury prevention.
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46
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Abed Elahad J, McCarthy MW, Goverman J, Kaafarani HMA. An Overview of Sacral Decubitus Ulcer. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0152-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Nowicki JL, Mullany D, Spooner A, Nowicki TA, Mckay PM, Corley A, Fulbrook P, Fraser JF. Are pressure injuries related to skin failure in critically ill patients? Aust Crit Care 2018; 31:257-263. [DOI: 10.1016/j.aucc.2017.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 11/15/2022] Open
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48
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Zimmermann GDS, Cremasco MF, Zanei SSV, Takahashi SM, Cohrs CR, Whitaker IY. PREDIÇÃO DE RISCO DE LESÃO POR PRESSÃO EM PACIENTES DE UNIDADE DE TERAPIA INTENSIVA: REVISÃO INTEGRATIVA. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018003250017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar os instrumentos que são utilizados para avaliar o risco de lesão por pressão em pacientes críticos adultos de unidade de terapia intensiva e analisar a capacidade preditiva dos mesmos. Método: revisão integrativa observando-se os critérios para seleção dos estudos: avaliação do risco de lesão por pressão em pacientes internados em unidade de terapia intensiva de adultos por meio de escala ou índice; mensuração da capacidade preditiva do instrumento aplicado; idiomas inglês, português ou espanhol; período entre 1962 e 2016. Os descritores utilizados foram: pressure ulcer ou pressure sores e risk assessment. As variáveis de interesse foram: sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e área sob a curva receiver operator characteristic. Resultados: : foram identificadas 1032 publicações e deste total foram selecionados 13 estudos para análise. A predição do risco para lesão por pressão foi mensurada unicamente com escalas genéricas em sete dos 13 estudos. Nos estudos comparativos de escalas específicas de unidade de terapia intensiva com escalas genéricas, o valor preditivo negativo foi elevado e todos com área da curva receiver operator characteristic com valores acima de 0,700. Entre as escalas genéricas predominou a escala de Braden. Foram identificadas seis escalas que apresentaram boa capacidade preditiva para avaliar risco de lesão por pressão em pacientes de unidade de terapia intensiva. Conclusão: : esta revisão revelou uma variedade de escalas preditivas, genéricas e específicas, que são utilizadas para avaliação de risco de lesão por pressão no paciente de unidade de terapia intensiva.
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49
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Hekmatpou D, Ahmadian F, Eghbali M, Farsaei S. Henna ( Lawsonia inermis) as an Inexpensive Method to Prevent Decubitus Ulcers in Critical Care Units: A Randomized Clinical Trial. J Evid Based Integr Med 2018; 23:2515690X18772807. [PMID: 29756474 PMCID: PMC5954567 DOI: 10.1177/2515690x18772807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background. Henna has been used to combat various diseases and pathological conditions of the skin. This study aimed to determine the cooling and protecting effects of henna on prevention of decubitus ulcers in critical care units. Method. This is a randomized clinical trial. It was conducted on 80 patients hospitalized in intensive care units. Patients were randomly allocated into 2 groups of control and intervention (n = 40) by blocking method. For the intervention group, along with the standard prevention cares for decubitus ulcers, henna was applied with 15 cm extent on the patients’ sacrum. Results. At the end of the study, 1 patient in the intervention group (2.7% male) and 6 patients in the control group (14.29% male, 2.85% female) had developed decubitus ulcers; this difference was significant (P = .001). Conclusion. For every patient at risk of developing decubitus ulcers, application of henna as a preventive measure is recommended.
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Affiliation(s)
| | | | | | - Shadi Farsaei
- 2 Isfahan University of Medical Sciences, Isfahan, Iran
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50
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Ceylan B, Yapucu Gunes U, Uyar M. Examination of sacral tissue oxygen saturation among immobile patients. J Clin Nurs 2018; 27:3641-3651. [DOI: 10.1111/jocn.14218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Burcu Ceylan
- Department of Fundamentals of Nursing; Faculty of Health Sciences; Izmir Katip Celebi University; Cigli Izmir Turkey
| | - Ulku Yapucu Gunes
- Fundamentals of Nursing Department; Faculty of Nursing; Ege University; Bornova Izmir Turkey
| | - Mehmet Uyar
- Anesthesia and Reanimation Department; Medical Faculty; Ege University; Bornova Izmir Turkey
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