Perioperative Pressure Injury Research Articles

Triggering change in perioperative pressure injury risk assessment: A project report

Triggering change in perioperative pressure injury risk assessment: A project report

Incidence and risk factors of operating room-acquired pressure injury: a cross-sectional study.

Operating room-acquired pressure injury (PI) is defined as PI that develops within the first 48 to 72 hours after surgery. To determine the incidence and risk factors of operating room-acquired PI. This descriptive cross-sectional study was conducted at a university hospital in Turkey between May 20, 2021, and December 20, 2021, and included 309 patients who met the inclusion criteria. The study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. Operating room-acquired PI developed in 5.8% of the patients in this study. Moreover, 54.4% of the patients had medical devices, and medical device-acquired PI occurred in 4.2% of these patients (7/168). Patient age, hemodynamic parameters, and albumin level, as well as duration of surgery, were found to affect the development of operating room-acquired PI. Surgical nurses are responsible for both recognizing situations that may result in perioperative PI and taking necessary precautions. It is recommended that nurses identify existing and potential preoperative, intraoperative, and postoperative risks that impair skin integrity and affect tissue oxygenation to reduce the risk of operating room-acquired PI.

Investigation on the alleviating effect of standardized three-step nursing on perioperative pressure injury in patients with spinal fracture accompanied by spinal cord injury

Objective To explore the alleviating effect of standardized three-step nursing on perioperative pressure injury in patients with spinal fractures accompanied by spinal cord injury. Methods A retrospective analysis was conducted on the clinical data of 153 patients who underwent surgical treatment for spinal fracture accompanied by spinal cord injury in our hospital from January 2021 to January 2024. All patients met the criteria for inclusion and exclusion. According to the nursing interventions received during the perioperative period, the patients were divided into a control group (n = 76) and an observation group (n = 77). The control group received routine nursing interventions during the perioperative period, while the observation group received standardized three-step nursing interventions. The occurrence, severity, area, and pain [Visual Analog Scale (VAS)], coagulation indicators [prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D)], activities of daily living [Barthel Index], and quality of life [General Quality of Life Inventory (GQOLI-74)] were compared between the two groups. Results (1) Occurrence and severity of perioperative pressure injury: in the control group, 18 cases of pressure injury occurred, including 5 cases of stage I, 11 cases of stage II, and 2 cases of stage III; in the observation group, 7 cases of pressure injury occurred, including 4 cases of stage I and 3 cases of stage II. The occurrence rate and severity of pressure injury in the observation group were lower than those in the control group (p < 0.05). (2) Area of injury and pain: The area of injury on the day of surgery and 5 days after surgery in the observation group was lower than that in the control group (p < 0.05); the VAS score 5 days after surgery in the observation group was lower than that in the control group (p < 0.05). (3) Coagulation indicators: 5 days after surgery, the levels of D-D and FIB in the observation group were lower than those in the control group, while PT was higher than that in the control group (p < 0.05). (4) Activities of daily living and quality of life: 3 months after surgery, the Barthel score and GQOLI-74 score in the observation group were higher than those in the control group (p < 0.05). Conclusion Standardized three-step nursing can significantly reduce the occurrence rate, severity, and area of perioperative pressure injury in patients with spinal fracture accompanied by spinal cord injury, alleviate patient pain, improve coagulation function, and enhance levels of activities of daily living and quality of life.

Prevention of Postoperative Skin Disorders and Pressure Injuries in the Neurosurgical Park Bench Position Surgery: A Prospective Cohort Study.

Background In neurosurgical procedures where the park bench position is employed, the risk of perioperative pressure injuries is elevated due to the limited contact surface area, with the head and part of the upper torso extending beyond the surgical table. This study aimed to examine the effects of preventative measures against such injuries, proposing a potential standard for postural fixation in these surgeries. Methods Conducted at a medical center, from January 2017 to March 2023, this prospective cohort study involved participants aged 20 and above who underwent neurosurgical procedures in the park bench position under general anesthesia. The focus was on comparing the incidence of pressure injuries between intervention and control groups. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results Out of 65 patients enrolled, 28 were assigned to each of the intervention and control groups. The control group experienced 17 instances of postoperative pressure injuries and skin disorders in areas prone to pressure, such as the axillary and greater trochanter regions. Conversely, the intervention group reported no such incidents, underscoring the efficacy of meticulous surgical positioning and management of bodily pressure, temperature, humidity, and microclimate. Conclusion Implementing preventive measures in neurosurgical park bench procedures significantly reduces the incidence of postoperative pressure injuries and skin disorders. These findings advocate for the adoption of standardized postural fixation protocols in such surgeries, potentially influencing global clinical practices in neurosurgery.

Assessment of Knowledge, Attitude and Practice regarding Patient’s Perioperative Pressure Injury Prevention among the Operating Room Personnel of Medical Teaching Institutions, Peshawar

Background: Pressure injuries (PIs), particularly perioperative pressure injuries (ORPIs), pose significant challenges in patient care, leading to increased morbidity, extended hospital stays, and elevated healthcare costs. Despite established guidelines, the incidence of ORPIs remains a concern, underlining the need for improved prevention strategies within the operating room setting. Objective: This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding perioperative pressure injury prevention among operating room personnel in medical teaching institutions in Peshawar, Pakistan, to identify knowledge gaps and areas for intervention. Methods: A cross-sectional descriptive study was conducted over four months, from June to October 2023, involving 264 operating room personnel from three major medical teaching institutions in Peshawar. Participants included nurses, surgeons, and surgical technicians/technologists. Data were collected using structured questionnaires and the KoboCollect mobile application, covering sociodemographic information, and KAP related to perioperative pressure injury prevention. The study employed descriptive statistics, chi-square tests, and Pearson correlation coefficients for data analysis, utilizing IBM-SPSS version 27 and Microsoft Excel 365. Results: The study revealed a mean knowledge score of 66.02% (SD = 18.99), with 44.3% of participants displaying low knowledge levels (&lt;69%). Attitudes towards pressure injury prevention were predominantly positive, with an average score of 78.17% (SD = 10.38). Practice levels were moderate, with an average score of 79.43% (SD = 10.59), and 54.9% of respondents engaging in high-level practices (≥80%). Significant associations were found between knowledge levels and education (p=&lt;0.001), and between practice levels and both age (p=0.01) and professional role (p=0.006). Conclusion: The study highlights a critical gap in knowledge regarding perioperative pressure injury prevention among operating room personnel, despite positive attitudes and moderately high practice levels. Addressing this gap through tailored educational programs and policy interventions is crucial for enhancing patient care and preventing ORPIs.

Clinical Risk Factors of Perioperative Pressure Injury in Older Adult Patients with a Hip Fracture.

To examine the clinical risk factors of perioperative pressure injury (PrI) in older adults with a hip fracture, including preoperative chronic comorbidities and postoperative complications. In this retrospective study, the authors queried the PearlDiver Patient Records database between January 2011 and January 2020. Data from 54,194 patients without preexisting PrI were included for analyses. Patients were separated into two groups: (1) one or more perioperative PrI and (2) no PrI. Clinical factors as outcome variables include 21 comorbidities and 10 complications. Univariate analyses were computed to compare the variables between groups, and two logistic regression models were developed to find comorbidity predictors and complication predictors. Of all patients, 1,362 (2.5%) developed one or more perioperative PrI. Patients with perioperative PrIs were more likely to be older men. One-year mortality for patients with perioperative PrI was 2.5 times that of patients without PrI. The regression models showed that predictors of perioperative PrI are malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infection, perioperative red blood cell transfusion, and atrial fibrillation. Screening for these comorbidities and complications may assist in determining the risk of PrI in older adults undergoing hip fracture surgery. Determining PrI risk enables the appropriate prevention strategies to be applied perioperatively.

Perioperative Pressure Injury Prevention Program ina Military Medical Treatment Facility: A Quality Improvement Project.

The incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning. We used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding. There was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented. This project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.

Evaluation of perioperative pressure injury in adults 65 years and older: A prospective cohort study

IntroductionOld age is an important risk factor for the formation of pressure injury (PI). The aim of this study was to investigate the incidence, risk factors, characteristics of PI and suitability of risk assessment tools for patients aged 65 years and older. MethodThis prospective monocentric cohort study was conducted in Turkey between September 2022 and March 2023. Data were collected from a total of 240 surgical patients aged 65 years and older using a skin assessment form and the Braden and Munro scales for PI risk assessment. ResultsThe patients had a mean age of 72.90 ± 5.53 years, 123 (51 %) were male, 203 (85 %) had chronic diseases, and the mean operative time was 194.83 ± 99.45 min. PI occurred in 45 patients (18.8 %). PIs were most commonly stage I and located in the coccyx region. Postoperative Munro score, postoperative Braden score, and operative time were significant in univariate analyses (p < 0.001). According to the multiple logistic regression model, a postoperative Munro score ≥26 and postoperative Braden score ≤20 were independent factors associated with increased risk of PI. ConclusionMeasures to prevent PI in surgical patients should begin in the preoperative period. Age alone may not be a risk factor in geriatric surgical patients. The Munro and Braden PI risk assessment scales can be used in geriatric surgical patients, but changes in cut-off score calculations may be required and additional age-related risk factors should be evaluated.

Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients.

The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P<.001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.

Guidelines in Practice: Prevention of Perioperative Pressure Injury.

Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand-over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient-specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population.

Prevention of Perioperative Pressure Injury.

AORN JournalVolume 117, Issue 5 p. 317-323 Back to Basics 2.0 Prevention of Perioperative Pressure Injury Lisa Spruce DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, Corresponding Author Lisa Spruce DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN [email protected] Search for more papers by this author Lisa Spruce DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, Corresponding Author Lisa Spruce DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN [email protected] Search for more papers by this author First published: 27 April 2023 https://doi.org/10.1002/aorn.13918 1.5: https://aorn.us/May23-b2b Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume117, Issue5Special Focus Issue: Infection PreventionMay 2023Pages 317-323 RelatedInformation

Extrinsic factors of pressure injuries in patients during surgery: A frequency matched retrospective study.

This study was to clarify the connection between extrinsic factors and the risk of perioperative pressure injuries (PIs) through the case-control approach, which involved making the intrinsic factors of the patients in the control group with no PIs consistent with those of the case group with PIs. We collected samples from a teaching hospital in Taiwan. We found a total of 132 patients deemed to have developed perioperative PIs. Using 1:2 frequency matching, we matched these cases with patients who had not developed PIs by gender, age, and BMI. Binary logistic regression analysis of the odds ratios of the extrinsic factors and PI risk revealed that the independent variables with statistical significance included duration of anaesthesia 3h, amount of blood loss, use of electric blankets, diastolic blood pressure below 60 mmHg during surgery, and oxyhemoglobin saturation by pulse oximetry (SPO2 ) below 93% during surgery. Emphasis should be placed on cooperation among the medical team during surgery, less use of electric blankets, control over the duration of anaesthesia and blood loss, continuous monitoring of the patient during surgery for any emergencies, and the maintenance of patient diastolic blood pressure and blood oxygen levels to reduce the risk of PIs.

Perioperative pressure injury prevention: National Pressure Injury Advisory Panel root cause analysis toolkit 3.0

Operating room-related pressure injuries (ORPI) are particularly challenging to examine for several reasons. Time in the OR is often a distinct event within the hospitalisation, and discovery of an ORPI may occur between several hours and up to 5 days postoperatively. The National Pressure Injury Advisory Panel (NPIAP) first developed a root cause analysis (RCA) toolkit in 2017 as a systematic strategy for investigating the root causes of facility-acquired pressure injury (PI). The purpose of this 2021 RCA toolkit update was to address an expanded investigation of medical device-related PIs (MDRPIs), both inside and outside the OR, as well as the specific PI prevention issues of the perioperative area. Clinicians have been using the 2017 toolkit as a basis for ongoing quality improvement tracking, since it provides more accurate information than data extractions from patient health records. A small working group consisting of NPIAP board and panel members developed investigative questions to identify the ORPI root causes and compliance with best practices for the entire perioperative experience. Action items are linked to evidence-based recommendations from the NPIAP/European Pressure Ulcer Advisory Panel/Pan Pacific Pressure Injury Alliance 2019 International Guideline and the Association of PeriOperative Registered Nurses (AORN) Guidelines for Perioperative Practice. A multidisciplinary clinician guide was also developed to identify practice gaps and to compile the information into an action plan for staff education and/or process improvement. The updated NPIAP RCA toolkit provides mechanisms for investigating, compiling and trending data as a basis for data-driven quality improvement. Using the enhanced investigative tools, the root causes of both MDRPIs and ORPIs can be better understood to target efforts to reduce their occurrence.

AORN Position Statement on Prevention of Perioperative Pressure Injury.

AORN JournalVolume 115, Issue 5 p. 458-461 From AORN AORN Position Statement on Prevention of Perioperative Pressure Injury First published: 27 April 2022 https://doi.org/10.1002/aorn.13672Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume115, Issue5May 2022Pages 458-461 RelatedInformation

Guideline for Prevention of Perioperative Pressure Injury.

AORN JournalVolume 115, Issue 5 p. P8-P10 Guideline First Look Guideline for Prevention of Perioperative Pressure Injury Carina Stanton, Carina Stanton Contributing WriterSearch for more papers by this author Carina Stanton, Carina Stanton Contributing WriterSearch for more papers by this author First published: 27 April 2022 https://doi.org/10.1002/aorn.13681Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume115, Issue5May 2022Pages P8-P10 RelatedInformation

Relationship between predisposing and facilitating factors: Does it influence the risk of developing peri-operative pressure injuries?

This study examined the relationship between the personal predisposing factors of patients and the severity of pressure injuries (PIs) developed during surgery. This retrospective cohort study collected 439 cases of peri-operative PIs. Using binary logistic regression to identify the variables associated with PI severity, the effects of interactions between associated variables were then tested. The results of this study revealed that among the personal predisposing factors, only higher patient age (P=.001) and higher body mass index (P < .001) posed a greater risk of stage 2 PIs or higher. Among the surgery-related facilitating factors, only patients who were placed in the prone position during surgery and patients who lost ≥1000 mL of blood during surgery were at greater risk of stage 2 PIs or higher, compared, respectively, to those placed in the supine position and those who lost ≤100 mL of blood. Furthermore, the amount of blood lost during surgery moderated the influence of age on PI severity. For elderly patients who are expected to lose a large blood volume during surgery or lose an immeasurable amount of blood due to the use of cardiopulmonary bypass, taking more precautionary measures to prevent PIs is recommended.

Using Evidence to Prevent Risk Associated With Perioperative Pressure Injuries

Pressure injuries (PI) are a significant concern for surgical patients due to prolonged immobility and potential exposure to other risk factors associated with procedures. PI prevention strategies should begin early in the patient's surgical encounter starting with preoperative assessment. Much literature has been published to discuss PI risk factors, assessment tools, and evidence-based prevention measures. The purpose of this article is to critically review current best evidence to holistically assess patient risk for Hospital Acquired Pressure Injuries (HAPI) and review current tools used for risk assessment, interventions to combat skin injuries, and discuss implications for practice in perioperative nursing.

Improving Skin Assessment Documentation in the Electronic Health Record to Prevent Perioperative Pressure Injuries.

Perioperative leaders at a pediatric trauma hospital initiated an examination of the existing processes for pressure injury prevention. They assembled a workgroup comprising a wound and skin clinical nurse specialist, a nursing informatics specialist, and a perioperative nurse specialist who applied a proven change management framework to guide their efforts. The workgroup identified a critical gap in the documentation features in the electronic health record: nurses were unable to communicate skin assessment and pressure injury information easily and consistently across services (eg, inpatient, emergency department, surgical services). Using evidence from nursing and pressure injury associations on skin assessments, interventions, and documentation, the workgroup developed, trialed, and implemented updated documentation fields, making them consistent throughout the electronic health record. Based on postimplementation survey responses, nurses at the hospital are highly satisfied with the changes. The surgically acquired pressure injury rate at the hospital continues to remain low.

Comparison of Interface Pressures and Subjective Comfort of Pressure-Relieving Overlays on the Operating Table for Healthy Volunteers.

(1) Background: Pressure ulcers in the hospital setting occurring within 72 h after surgery are called perioperative pressure injuries. The aim of this study was to provide data for the prevention of perioperative pressure injuries following the use of pressure-relieving overlays by measuring the interface pressures and subjective comfort. (2) Methods: This study is based on a repeated measures design. The subjects included 30 healthy volunteers aged 18 to 57 years. Interface pressures of the sacrum and both heels were measured in the supine position, and the subjective comfort was evaluated with visual analog scale after applying polyurethane foam, gel pad, and egg crate foam for relief. (3) Results: The pressures in the sacrum and both heels were the lowest with polyurethane foam, and the subjective comfort was the highest. (4) Conclusions: Inexpensive polyurethane foam with satisfactory pressure relief is recommended as an overlay for surgical patients.

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

BackgroundPerioperative patients are potentially at risk for pressure injuries due to anesthetic agents and surgical positioning. Pressure injury increases discomfort and pain in patients and causes complications, which lead to an increase in mortality and hospitalization duration. Most previous studies did not focus on specific types of surgery or surgical positioning. We tried to identify the incidence of perioperative pressure injury during spinal surgery and perioperative risk factors that contribute to pressure injury.MethodsWe retrospectively analyzed electronic medical records of 663 patients who underwent spinal surgery between March 2016 and May 2018. The primary outcome was occurrence of pressure injury. Potential risk factors of pressure injury were selected based on previous studies and expert opinion, and divided into two sub-categories: preoperative and intraoperative risk factors. We compared the clinical characteristics of patients in the pressure injury and non-injury groups. Perioperative risk factors for pressure injury were analyzed by logistic regression.ResultsAmong 663 patients, the incidence of all stages of pressure injury was 5.9%. The face and inguinal regions were the most injured sites (both 28.6%). The pressure injury group showed a 13% longer hospitalization period. Preoperative plasma concentration of protein was associated with 0.5-fold lower pressure injury (OR: 0.50; 95% CI: 0.27 to 0.95; P = 0.034).ConclusionsThe incidence of pressure injury was similar to that previously reported and occurred in the direct weight-bearing areas, which led to longer hospitalization. We found that a lower preoperative serum protein level is significantly associated with intraoperative pressure injury occurrence during spinal surgery.