Pressure-related Injury Research Articles

A Prospective, Descriptive Study on Awake Self-prone in Hospitalized COVID-19 Patients

Purpose/AimsHealthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting.DesignThis is a prospective, descriptive study.MethodPatients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected.ResultsOf 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died.ConclusionsAwake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.

P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects.

BackgroundMillions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear.MethodsSearches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan.ResultsTwenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks.ConclusionThe existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.

Medical device related pressure injuries in COVID-19 patients followed up in an intensive care unit

Aim: The aim of this study is to determine the prevalence of medical device-related pressure injuries in COVID-19 patients.
 Material and Method: This study was conducted with a cross-sectional and retrospective design. The data of 436 patients who were followed up and treated in the Anesthesia and Reanimation Intensive Care Unit with the diagnosis of COVID-19 disease between 11.03.2020- 31.02.2021 in a Training and Research Hospital in İstanbul were included in the study. The sample of the study consisted of 32 patients out of 436 patients who met the sampling criteria. The data obtained by retrospective reviewing of the patient records were analyzed through the "Patient Information Form" and "Pressure Injury Stage" forms.
 Results: Medical device-related pressure injury developed in 32 (7.3%) of 436 patients examined in the study on the specified dates. 90.6% of these patients were male, and the average age was 67.5. 43.7% had comorbid diseases. According to the Braden Risk Assessment Scale, 25% of these patients had medium and 71.8% high risk. Medical devices that cause pressure injury were continuous positive airway pressure mask (n=13), intubation tube (n=7), nasogastric tube (n=5), nasal cannula (n=3), gel pads (n=3), and oxygen mask (n=1).
 Conclusion: In this study, the potential factors in the study that may have led to the incidence of medical device-related pressure injury specific to COVID-19 disease include the rapid increase in the need for respiratory support, ischemia caused by this infection, and the use of prone position.

Utilizing a Comprehensive Wound Care Team to Lower Hospital-Acquired Pressure Injuries in an Academic Public Hospital: A Retrospective Cohort Study.

Hospital-acquired pressure injuries (HAPIs) have significant impacts on patient morbidity and mortality, with approximately 2.5 million patients treated for pressure-related injuries annually.1 This study aimed to describe the influence of a comprehensive wound care team on HAPIs over an 8-year period. Retrospective cohort study. All inpatients at an academic public hospital system with HAPIs during the study period from May 2012 to February 2020. Data on wound stage, location, infection, medical device location if applicable, and risk factors were recorded from medical records. A 1-way analysis of variance was performed to assess for significance of mean number of cases, National Pressure Injury Advisory Panel (NPIAP) stage on initial presentation, and mean number of medical device-related wounds by year. A total of 957 cases were included. The median stage of pressure injury on assessment was 2, with the mean NPIAP stage declining from 2012 to 2020 (P = .003). Thirty-three percent of pressure injuries were attributed to medical devices, most commonly endotracheal tubing. The most common site of pressure injury was the sacrum (33.6%). Creation of a comprehensive wound care team within our academic public hospital system demonstrated a significant decline in device-related and pressure injury cases over the past 8 years. The wound care team focused on frequent assessment, education, and evidence-based treatment to lower these HAPI events.

Palliative Wound Care: Case Studies.

Patients with advanced illness may present to palliative care or hospice with unmanaged symptoms that may be exacerbated by the presence of a wound. The wound can be a constant reminder to the patient and caregiver of the underlying illness. Distressing symptoms such as wound pain, odor, bleeding, and/or excessive exudate may impede the patients' ability to spend quality time with loved ones when they need them the most. Although patients may present with wounds of varying etiologies, the most common wounds seen in this patient population are pressure-related injuries. However, there is a shortage of both wound and palliative specialized clinicians. Telehealth and the use of other technology can be a way to address this shortage. This will grant access to a broader number of patients to ensure appropriate wound care plans are in place to meet the goals of care. Although wound healing may not always be possible in this patient population, having access to specialized wound and palliative experts can improve the quality of life for patients and their caregivers.

Exploring medical device-related pressure injuries in a single intensive care setting: A longitudinal point prevalence study

ObjectivesTo report longitudinal prevalence rates of device-related pressure injuries in critically ill adult patients in the intensive care unit and to explore the patient characteristics associated with the development of device related pressure injuries. Research designA prospective observational design where observations of patients’ skin integrity were conducted on one day each week for 52 weeks. SettingThe study was conducted in the 36-bed intensive care unit of a major metropolitan tertiary referral hospital in Queensland, Australia. The sample included all patients aged 18 years or older admitted to the intensive care unit before midnight on the day preceding the observation, with a medical device in situ. Main outcome measuresThe primary outcome measure was device related pressure injuries identified at the weekly observations and defined as a pressure injury found on the skin or mucous membrane with a history of medical device in use at the location of the injury. Patient demographic and clinical characteristics were recorded. ResultsOver the study period, 11.3% (71/631) of patients developed at least one hospital-acquired DRPI.The most common devices associated with injury were nasogastric/nasojejunal tubes (41%) and endotracheal tubes (27%). Significant predictors of device related pressure injuries were the total number of devices (OR 1.230, 95% CI 1.09–1.38, p < 0.001), the length of time in the ICU (OR 1.05, 95% CI 1.02–1.09, p = 0.003), male sex, (OR 2.099, 95% CI 1.18–3.7, p = 0.012), and increased severity of illness score on admission (OR 1.044, 95% CI 1.01–1.09, p = 0.013). ConclusionDevice related pressure injuries are an all-too-common iatrogenic problem for this vulnerable patient cohort.

TP7.2.4 Skin-to-gel is a safe and effective method to prevent patients sliding during minimally invasive colorectal surgery

Abstract Aims Minimally invasive colorectal surgery often requires manipulating the patient position to facilitate exposure of the surgical field, such as a steep Trendelenburg position. However, this exposes patients to risks of sliding on the operating table. Preventive interventions are available, such as bean bags; we explore our experiences of gel pads within a district general hospital. Methods A retrospective analysis was performed of all colorectal patients undergoing laparoscopic resections over the last ten years, identifying complications associated with the use of intra-operative gel pads (skin-to-gel) with no shoulder support. Results Over 500 patients have undergone laparoscopic colorectal resections during this time, all utilising pressure-relieving gel pads. Patients are placed skin-to-gel, lying on a single torso-length gel pad laid directly on the operating table mattress. Dependent upon the operative approach, the legs can be placed in stirrups or maintained supine on table extensions. There have been no DATIX recorded skin-tears, pressure or position-related injuries. The pads have also proven to prevent patient movement on the operating table, negating the use of shoulder supports when adopting the Trendelenburg position. On discussions with theatre staff, the Consultant body and interrogation of the DATIX database, there has only been one reported incidence of slipping when a patient was left on the slide sheet on top of the gel pad. They are relatively inexpensive, durable and easily maintained, proving a highly cost-effective piece of equipment. Conclusion Gel pads have proven to be highly effective in preventing both pressure-related injuries and patient movement during laparoscopic surgery.

The combined use of thermography and ultrasound to evaluate the development of pressure injury in a critically ill patient

Abstract Introduction: Pressure injury is 1 of the most common pressure related injuries in patients admitted to the intensive care unit. In individuals with darker skin tones, skin assessment protocols appear to be less effective, resulting in early damage from pressure. Bedside assessment measures using ultrasound and infrared thermography (IRT) have been studied to identify pressure injuries. Patient concerns: A 58-year-old dark-skinned male was admitted to the intensive care unit due to an ischemic stroke. Diagnosis: The visual evaluation of the skin took place on the second day after admission to the intensive care unit (before 48 hours). The patient had a whitish erythema on the left heel (LH) and a large bloody blister on the right heel. There were no signs of color change on the sacrum skin. Interventions: We performed 3 skin evaluations of the sacrum and calcaneus using ultrasound and IRT. Outcomes: Changes in the temperature of the target regions (sacrum, right heel and LH) were observed. The right heel showed higher mean temperatures than the LH in all evaluations. In the first evaluation of the sacrum region, the average temperature was lower (-1.3°C) than in the second and third evaluation (1°C). In the calcaneus, the mean temperature range (right heel - LH) showed a difference of (3.5°C) in the first evaluation, a difference of (1.4°C) in the second evaluation, and a difference of (1.7°C) in the third evaluation. Ultrasound images of the selected regions showed abnormal tissue patterns - edema - since the first evaluation. Conclusion: These findings indicate that the regions with deep tissue injury on ultrasound evaluation were compatible with the regions of abnormal temperatures in the IRT. IRT could identify regions of pathological process, which could be confirmed by abnormal ultrasound findings. Well-designed, randomized research with a larger sample could verify if the combination of these assessment techniques could be used as a potential method for early detection and evaluation of pressure injuries.

Risk factors of medical device-related pressure injury in intensive care units.

Intensive care unit (ICU) patients are at high risk of medical device related pressure injury (MDRPI). This study aims to ascertain the MDRPI prevalence in ICU patients and analyse the risk factors of MDRPI. The occurrence of MDRPI not only increases hospitalisation time with pain and economic burden, but also causes medical disputes. A better understanding of this condition will increase knowledge and facilitate the ability to recognise and prevent MDRPI for clinical nursing staff. However, there are few multicentre studies of MDRPI prevalence in ICU patients in China. A cross-sectional study design was employed. Data from 694 patients in 66 adult ICU at 30hospitals in China were included between October 2018 and March 2019. The stage of each MDRPI was determined according to the definitions of National Pressure Ulcer Advisory Panel. The study methods were followed by the STORBE guidelines. The overall prevalence rate of MDRPI was 13.1% (91/694), with 98 anatomic locations in total. The most common stages of MDRPI were stage 1 (54.1%, 53/98), stage 2 (15.3%, 15/98) and mucosal membrane pressure injury (15.3%, 15/98). MDRPI mainly occurred in the finger (32.7%, 32/98), followed by nose (18.4%, 18/98). The prevalence rate of MDRPI caused by CPAP or BiPAP masks (25%) was highest. Lower Braden scores and having skin oedema were risk factors for MDRPI in adult ICU patients. The prevalence of MDRPI in this study was still high. Nurses should take these related factors into consideration when taking care of ICU patients, and appropriate prevention measures should be adopted to decrease the prevalence of MDRPI. The study can help to improve the PI prevention efforts in ICU patients specific to medical device related PI.

Neonatal Nasal Tip Necrosis Secondary to Suspected In Utero Pressure/Positioning

Head and neck injury as a consequence of in utero pressure and birth trauma is a rare event. We report a case of a patient who was born full-term via vaginal delivery and presented soon after birth with skin changes over the nasal tip consistent with a pressure-related injury that progressed to a stable eschar. Conservative management with close clinical monitoring resulted in a well-healed wound over the nasal tip. A detailed discussion regarding the diagnosis and management of head and neck lesions after birth is provided.

Risk Analysis of Risk Factors for Pressure Injury Related to Tracheal Intubation in ICU Patients

Objective: This article mainly analyzes the risk factors of pressure injury related to tracheal intubation in ICU patients. Methods: This time, the investigation and research were mainly conducted on 110 patients with tracheal intubation received in the ICU of our hospital from June 2020 to June 2021, and the risk factors for related pressure injuries were analyzed. Results: According to statistics, the incidence rate of patients with tracheal intubation-related pressure injury was 23.63%, of which the lip had the highest incidence; the indwelling time of the tracheal tube, the wetness score, the movement force score, and the frictional shear score in the Braden score of the tracheal intubation These are all risk factors for pressure injury related to tracheal intubation (P&lt;0.05). Conclusion: ICU patients have a higher incidence of related pressure injuries during tracheal intubation, so it is necessary to strengthen the care of risk factors and take reasonable and effective measures to prevent them.

Knowledge, attitude, and practice of nurses in intensive care unit on preventing medical device-related pressure injury: A cross-sectional study in western China.

The knowledge, attitude, and practice of nurses in intensive care units (ICUs) are determinants for the efficacy of preventing the medical device–related pressure injury (MDRPI). The aim of this study was to determine the level and factors of knowledge, attitude, and practice of nurses' ICUs on preventing medical MDRPI in western China. An annual cross‐sectional study was conducted in hospitals of western China from May 2020 to September 2020. Nurses' knowledge and attitudes were assessed using Clinical Nurses Prevention MDRPI of Critically Ill Patients for the Knowledge, Attitude, Practice Assessment Scale. SPSS software version 25.0 and independent t‐test, Chi‐square, Fisher exact, one‐way analysis of variance, and multiple linear regression tests were used for data analysis. A total of 1002 nurses in ICUs from 37 hospitals in Gansu Province, China, participated in this study. The scores of overall KAP, knowledge, attitudes, and practice were 149.17 ± 24.62, 53.83 ± 12.23, 37.24 ± 6.35 and 58.10 ± 9.83, respectively. There was a positive and significant relationship between three variables. Findings revealed that nurses' knowledge score in the Tertiary hospital was higher than scores of other hospitals as 3.840 units. Moreover, the knowledge score and practice score of nurses with bachelor's degree or above were higher than other nurses and are 0.978 and 1.106 units, respectively. Based on the findings, practice of nurses increased by 0.992 units, with a 1‐year increase in work experience of nurses in the ICU. The levels of knowledge, attitude, and practice of nurse in ICUs on preventing MDRPI were acceptable. The findings of the study highlight that a comprehensive approach should be conducted for raising the level of knowledge, attitude, and practice of nurses' ICUs on preventing medical MDRPI, as well as improving the quality of care for critically ill patients.

Does Wearing a Face Mask During the COVID-19 Pandemic Increase the Incidence of Dermatological Conditions in Health Care Workers? Narrative Literature Review.

BackgroundCOVID-19 is a health emergency. SARS-CoV-2 was discovered in Wuhan (Hubei Province, China) and has rapidly spread worldwide, leaving no country untouched. COVID-19 is a respiratory infection characterized by a pneumonia of unknown etiology. It is transmitted through respiratory droplets; for example: through breathing, talking, and coughing. Transmission of the virus is high. Health care workers play important roles in helping those affected by COVID-19; this could not be done without the use of personal protective equipment (PPE). PPE involves the use of goggles, masks, gloves, and gowns and is known to reduce COVID-19 transmission; however, multiple reports of skin disease and damage associated with occupational mask-wearing have emerged.ObjectiveThe objective of this study is to review the literature for newly emerging dermatological conditions as a result of occupational mask-wearing during the COVID-19 pandemic.MethodsA narrative review of new reports of dermatological conditions associated with occupational mask-wearing was carried out in May 2020 by referencing keywords including: “covid mask dermatology,” “covid dermatological damage,” “covid mask skin,” “covid N95 mask damage,” and “covid mask skin damage” from PubMed, supplemented by searches on both Google Scholar and ResearchGate. A total of 287 articles were found, of which 40 were successfully included in this study, and an additional 7 were selected from the reference lists of these 40 articles. The findings were tabulated and analyzed under the following headings: dermatological diagnosis, causes, and management.ResultsQualitative analysis of the reviewed data was carried out. A number of dermatological conditions were found to increasingly occur owing to prolonged and frequent use of face masks. Pressure-related injuries were often the most serious complaint; recommendations to reduce this type of injury include the use of hydrocolloid dressings, plastic handles, education, and regular moisturization. Innovation in PPE as well as services, such as virtual clinics, need to be advanced to protect the welfare of health care staff.ConclusionsIn these unprecedented times, PPE has been an effective barrier to the transmission of COVID-19 among health care workers. This has allowed health care workers to provide care to patients, with minimal risk. However, our findings suggest that despite the obvious benefits of using face masks to protect the respiratory system, there are also considerable health consequences to the skin. Future research studies are required to focus on improving face masks to ensure both the protection of the respiratory system as well as skin care, which, according to our study, has been overlooked.

Reducing the Incidence of Medical Device-Related Pressure Injuries From Use of CPAP/BiPAP Masks: A Quality Improvement Project.

The purpose of this work was to reduce the number of hospital-acquired pressure injuries on the nasal bridge resulting from the use of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapy. Patients with medical device-related pressure injuries (MDRPI) receiving continuous/intermittent CPAP/BiPAP in a 12-bed critical care unit in a Magnet-designated, 182-bed community hospital in the mid-Atlantic region of the United States. An interprofessional team collaborated to assess factors contributing to an increase in MDRPI development in critical care unit patients using CPAP/BiPAP. Patient dependency on the high-pressurized oxygen results in nurse reluctance to remove the mask and consequently, conduct a partial or incomplete skin assessment. The project consisted of conducting a literature search on MDRPI, developing a standard work process for skin assessment and documentation in the medical record, using skin protection under the mask, and evaluating whether a different model of mask would minimize pressure on the nasal bridge. Through active collaboration, the interprofessional team implemented standard work processes, completed product evaluation of masks, and monitored key process indicators related to documentation of daily and every 4-hour skin assessments, implementation of a thin foam dressing under the CPAP/BiPAP mask for any nonblanchable or blanchable erythema, and escalation to the certified wound, ostomy, and continence nurse. In 2016, the unit identified 4 CPAP/BiPAP mask-related MDRPIs. By December 2017, only 1 stage 1 injury was identified and it resolved quickly after appropriate assessment and prompt interventions. This showed a 75% reduction in actual injuries with a zero escalation to stage 2 or greater injuries. An interprofessional team approach to CPAP/BiPAP-related MDRPI improved patient outcomes in critical care unit patients.

Eustachian Tube Function in Flight Attendants.

Eustachian tube (ET) function is of utmost importance in people who are under constant barometric pressure changes in their daily lives. Proper functioning is essential in avoiding pressure related injuries. We aimed to investigate how well the ET functions in flying personnel and how it compares to the non-flying population.Prospective study. Acibadem University Atakent Hospital. 115 participants were included in the study. Each underwent a thorough otorhinolarynglogic examination then undertook a tympanogram followed by eustachian tube function (EtFT) test. A statistically significant difference in ear volume was observed in flight personnel. EtFT results showed the ability to equalize pressure after Valsalva manouvre was also significantly higher in flight personnel. Flight attendants that are subject to pressure changes throughout their careers do seem to be more capable of equalizing pressure through manoeuvres such as the Valsalva. This may be due to the fact that continuous pressure changes creates a more pliable tympanic membrane.

Development and Testing of an Algorithm to Prevent Medical Device-Related Pressure Injuries.

We developed and tested the effectiveness of an algorithm to prevent medical device–related pressure injuries in intensive care unit patients. It was developed in four stages: literature review and analysis of medical records; preliminary algorithm development; validation of the preliminary algorithm by experts in two rounds; and practical feasibility verification of the revised algorithm by 109 intensive care unit nurses. To verify the algorithm’s effectiveness, we compared the incidence of medical device–related pressure injuries between 324 patients without algorithm application (control group) and 312 patients with algorithm application (experimental group). The outcomes were skin inspection of the medical device attachment, pressure injury evaluation, and implementation of pressure injury-preventive nursing care, based on the medical device type. The incidence rates were 1.46 per 100 devices (control group) and 1.19 per 100 devices (experimental group). Since there was no homogeneity in the previous score of the Braden scale in the experimental and control groups, the results regarding the incidence of pressure damage after applying the algorithm should be interpreted with care. Applying this algorithm was a safe intervention that helped prevent medical device–related pressure injuries in this population.

Impact of Obesity on Outcomes of Patients With Hip Osteoarthritis Who Underwent Hip Arthroplasty.

BackgroundWhile obesity has been clearly established as a risk factor for osteoarthritis (OA), there is a scarcity of studies comparing outcomes between obese and non-obese patients with hip OA who underwent hip arthroplasty.MethodsThis study involved adults with hip OA who had hip replacement procedures. Data was sourced from the Nationwide Inpatient Sample (NIS) database for 2016 and 2017. The primary outcome was inpatient mortality. Secondary outcomes included the development of non-ST segment elevation myocardial infarction (NSTEMI), sepsis, post-procedure site infection, pneumonia, acute kidney failure, deep vein thrombosis (DVT), pulmonary embolism, need for transfusion of blood products, complications involving orthopedic devices as well as mean length of hospitalization and mean total hospital charges.ResultsObese patients did not have higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.65, 95% CI 0.303-1.381, p=0.260), had increased mean length of hospitalization (0.11, 95% CI 0.083-0.134, p<0.001) and higher odds of developing DVT (aOR: 1.62, 95% CI 1.187-2.222, p<0.001), acute kidney failure (aOR: 1.64, 95% CI: 1.488-1.807, p<0.001) and pressure-related injuries (aOR: 1.64, 95% CI 1.081-2.483, p=0.020), compared with non-obese patients. Obese patients were found to have a lower aOR of having NSTEMI (aOR: 0.57, 95% CI 0.332-0.986, p=0.044), and need for blood product transfusion (aOR: 0.80, 95% CI 0.726-0.875, p<0.001).ConclusionAlthough there is no difference in mortality among obese and non-obese patients who had hip arthroplasty, obese adults have increased odds of morbidity and perioperative complications. Hence, obese adults likely require better perioperative management to decrease the incidence of these complications.

Mechanism and prevention of facial pressure injuries: A novel emergent strategy supported by a multicenter controlled study in frontline healthcare professionals fighting COVID-19.

Numerous healthcare professionals fighting COVID-19 worldwide are suffering from the protective respirators related facial pressure injuries. This study explored the mechanism and prevention of such injuries and devised a novel emergent strategy, which was supported by a multicenter self-controlled study in 1161 frontline healthcare professionals. In this study, according to the anatomy of the face and the characteristics of facial pressure injuries, a respirator liner was designed using a polyurethane foam to redistribute the pressure across the face. A preclinical crossover trial was performed on eight participants to evaluate its efficacy. The strategy was then widely applied among 11 100 healthcare workers in seven frontline hospitals, and 1161 of them were sampled for a questionnaire investigation. The preclinical crossover trial showed that the novel strategy was very effective in preventing facial pressure injuries. The questionnaire investigation showed that pain score, wearing disturbance, and the incidence of pressure injury in the healthcare professionals were significantly correlated with wearing time (all ρ = 0.986). The new strategy significantly reduced the incidence of pressure injury from 84.7% to 11.1%, pain score IQR from 5 (2) to 1 (2), and wearing disturbance rate from 91.6% to 6.3%, and the results analyzed according to individual hospitals or different wearing time showed similar trends (all P < .0005). The protective respirators related facial pressure injuries can be effectively mitigated with this emergent strategy, which has also been applied in some European hospitals and can be popularized to help more healthcare professionals who are combating COVID-19 on the frontlines.

Medical Device-Related Pressure Injuries in Infants and Children.

The purpose of this study was to describe medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients. A prospective, descriptive study. The sample comprised 625 patients cared for in 8 US pediatric hospitals. Participants were aged preterm to 21 years, on bed rest for at least 24 hours, and had a medical device in place. Two nursing teams, blinded to the other's assessments, worked in tandem to assess pressure injury risk, type of medical devices in use, and preventive interventions for each medical device. They also identified the presence, location, and stage of MDRPI. Subjects were observed up to 8 times over 4 weeks, or until discharge, whichever occurred first. Of 625 enrolled patients, 42 (7%) developed 1 or more MDRPIs. Two-thirds of patients with MDRPIs were younger than 8 years. Patients experiencing MDRPIs had higher acuity scores on hospital admission, were more frequently cognitively and/or functionally impaired, or were extreme in body mass index. Respiratory devices caused the most injuries (6.19/1000 device-days), followed by immobilizers (2.40/1000 device-days), gastric tubes (2.24/1000 device-days), and external monitoring devices (1.77/1000 device-days). Of the 6336 devices in place, 36% did not have an MDRPI preventive intervention in place. Clinical variables contributing to MDRPI development included intensive care unit care (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-43.6), use of neuromuscular blockade (OR 3.7, 95% CI 1.7-7.8), and inotropic/vasopressor medications (OR 2.7, 95% CI 1.7-4.3). Multivariable analysis indicated that Braden QD scores alone predicted MDRPI development. Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.

Prevention of pressure injuries in critically ill children: A preliminary evaluation

AimsTo evaluate a prevention strategy implemented to reduce incidence and severity of positioning related pressure injuries affecting pediatric patients in a pediatric critical care unit. Secondary objective was to evaluate compliance with preventive recommendations. BackgroundThe skin in infants or children has important physiological and anatomical differences compared with adults. Further, factors such as the immaturity of the skin and limited activity and mobility in pediatric critical care unit, along with the pressure exerted by medical devices, increases the risk of pressure ulcers in infants and children. The most effective preventive measures specific to this intensive care population need to be evaluated. Material and methodsQuasi-experimental before-after study with consecutive sampling. The effectiveness of the care bundle implementation was evaluated based on the latest evidence (intervention group) versus the application of non-standardized care (control group). Pediatric patients up to 14 years old at risk of suffering from pressure injuries and who were admitted more than 48 h in a pediatric intensive care unit (level III) participated. For the collection of data, two computer programs and the hospital clinical records of each participant were consulted. The data collection period was 6 months per group (pre and post intervention). ResultsA sample of 110 patients was obtained (50 control group and 60 intervention group). The cumulative incidence in pediatric patients exposed to the risk of pressure injuries was reduced from 16% to 13.3%; and in the subgroup of patients with prolonged stay (≥28 days), the incidence was reduced from 55.55% to 20%. In the intervention group, category III and IV pressure ulcers were completely reduced. In addition, the total number of pressure injuries decreased by 21.43%. The care bandle recommendations with the highest level of adhesion recorded were: skin inspection, application of hyperoxygenated fatty acids and use of a special support surface. The main risk factor found during the study was the prone position (p < 0.05). ConclusionsThe application of a care bundle for prevention can be an effective solution to reduce the number and severity of LPPs in an intensive care unit. The most vulnerable subgroup of patients may benefit from the application of these resources.