Prevention Of Hospital-acquired Pressure Injuries Research Articles

Perceived barriers and facilitators to preventing hospital-acquired pressure injury in paediatrics: A qualitative analysis.

This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI. A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023. Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach. Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence. These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings. Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs. No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.

Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital-acquired pressure injuries. A randomised controlled trial.

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.

The prevention of hospital-acquired pressure injuries among adult immobilized patients in a mental health department: a best practice implementation project.

The aim of this implementation project was to promote evidence-based practices regarding hospital-acquired pressure injuries prevention practices among immobilized adult patients in a mental health department and to measure the level of compliance with the best practice in this field. Pressure injuries can have significant restrictions on the patient's quality of life; affect the patient physically, psychologically, and socially; lead to increased costs and length of hospital stay; and are closely linked to increased mortality. Thus, the best evidence practice implementation project was conducted in the mental health ward of a large teaching hospital in Bucharest. The current evidence implementation project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice. The best practices project was carried out in a mental health department with 70 beds at Bucharest's largest mental health hospital. This analysis of nursing practice included all immobile patients who were hospitalized in the ward. Through the project to implement best practices for the prevention of pressure injuries, the activity of nurses was improved. If initially, the prevention of pressure injuries was a deficient activity in the hospital (compliance between 0 and 82%), after the implementation of the project, compliance with the recommendations of evidence-based practices was radically improved, obtaining a maximum percentage of 100% for all these activities: patient assessment, use of assessment tools, use of necessary devices, provision of high protein diet and patient education. The current project contributed to the standardization and improvement of nurses' practice of pressure injuries prevention in patients with mental illness and immobility hospitalized in a psychiatric ward. The development of future audits will help identify the sustainability of the implemented prevention measures.

A Comparison of Two Multi-Layer Sacral Foam Dressings for the Prevention of Hospital-Acquired Pressure Injuries.

Hospital-acquired pressure injuries (HAPIs) represent a significant detriment to patient health by increasing mortality risk, negatively impacting quality of life, and increasing risk of complications such as infection. Prophylactic use of sacral foam dressings is known to decrease the occurrence of HAPIs in various patient populations. This retrospective study compared the effect of two multi-layer sacral foam dressings on HAPI incidence in patients admitted to a short-term, acute care hospital during the years 2015 (dressing one: Mepilex® Border Protect sacral dressing [Mölnlycke Healthcare AB, Göteborg, Sweden]) and 2017 (dressing two: Optifoam® Gentle LQ silicone faced foam < border sacral dressing [Medline Industries, LP, Northfield, Illinois]). Patient medical charts were examined for full sample (n=297) and subsample (n=284) analysis, respectively. The HAPI incidence for dressing two was found to be significantly less than dressing one (full sample: 5.12% compared to 10.79% [p=0.0001], and subsample: 4.07% compared to 9.31% [p=0.0001]). The incidence rate ratio (IRR) for dressing two was 0.39 for the full sample and 0.35 for the subsample, indicating that compared to dressing one, the HAPI count was approximately 40% lower for dressing two for the full sample and approximately 35% lower for dressing two for the subsample. These results demonstrate that dressing two performed better than dressing one in HAPI prevention. The results of this study may inform clinicians in their choice of prophylactic dressings.

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study.

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy.

Reducing Hospital-Acquired Pressure Injuries During the COVID-19 Pandemic.

Reducing Hospital-Acquired Pressure Injuries During the COVID-19 Pandemic.

Discussion Guide for the Kim Article.

Discussion Guide for the Kim Article.

Pressure Injury Surveillance and Prevention in Australia: Monash Partners Capacity Building Framework.

A hospital-acquired pressure injury (HAPI) is a common complication across the globe. The severity of HAPI ranges from skin redness and no skin breakdown to full skin and tissue loss, exposing the tendons and bones. HAPI can significantly impact the quality of life. In addition to the human cost, this injury carries a high economic burden with the cost of treatment far outweighing the preventative measures. The HAPI rates are a key indicator of health services performance. Globally, healthcare services aim to reduce its incidence. In Australia, the federal health minister has prioritised the need for improvement in HAPI surveillance and prevention. Capacity building is vital to optimise pressure injury (PI) surveillance and prevention in acute care services. In this perspective article, we provide a framework for capacity building to optimise HAPI prevention and surveillance in a large cross-sector collaborative partnership in Australia. This framework comprises six key action areas in capacity building to optimise the HAPI outcomes, such as research, organisational development, workforce development, leadership, collaboration, and consumer involvement.

Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: a scoping review protocol

Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: a scoping review protocol

The Use of Prophylactic Foam Dressings for Prevention of Hospital-Acquired Pressure Injuries: A Systematic Review.

The purpose of this systematic review was to identify and evaluate the use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries (HAPIs). A systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis Statement (PRISMA). Four researchers independently conducted searches in Health Source, Cochrane of Systematic Reviews, CINAHL, and PubMed. Search terms included: "pressure* OR skin breakdown AND sacrum*"; "ICU patient* OR critical care patient*"; and "foam dressing OR prophylactic* or prevent*." The search identified 380 articles; 14 met eligibility criteria. The methodological quality of the included studies was variable. Findings from all studies included in our review support a decrease in HAPI incidence with use of sacral foam dressings. Findings from this review suggest that prophylactic foam dressings decrease sacral HAPI occurrences in critical care patients. While additional research is needed, current best evidence supports use of prophylactic foam sacral dressings for patients at risk for HAPI.

INSTRUCTIONS: The Use of Prophylactic Foam Dressings for Prevention of Hospital-Acquired Pressure Injuries: A Systematic Review.

INSTRUCTIONS: The Use of Prophylactic Foam Dressings for Prevention of Hospital-Acquired Pressure Injuries: A Systematic Review.

An economic analysis of a wearable patient sensor for preventing hospital-acquired pressure injuries among the acutely ill patients

More than 2.5 million people in the United States develop pressure injuries annually, which are one of the most common complications occurring in hospitals. Despite being common, hospital-acquired pressure injuries (HAPIs) are largely considered preventable by regular patient turning. Although current methodologies to prompt on-time repositioning have limited efficacy, a wearable patient sensor has been shown to optimize turning practices and improve clinical outcomes. The purpose of this study was to assess the cost-effectiveness of patient-wearable sensor in the prevention of HAPIs in acutely ill patients when compared to standard practice alone. A decision analytic model was developed to simulate the expected costs and outcomes from the payer’s perspective using data from published literature, including a recently published randomized controlled trial. Both univariate and probabilistic sensitivity analysis were conducted. The patient-wearable sensor was found to be cost saving (dominant). It resulted in better clinical outcomes (77% reduction in HAPIs) compared to standard care and an expected cost savings of $6,621 per patient over a one-year period. Applying the model to a cohort of 1,000 patients, an estimated 203 HAPIs would be avoided with annualized cost reduction of $6,222,884 through all patient treatment settings. The probabilistic analysis returned similar results. In conclusion, the patient-wearable sensor was found to be cost-effective in the prevention of HAPIs and cost-saving to payers and hospitals. These results suggest that patient-wearable sensors should be considered as a cost-effective alternative to standard care in the prevention of HAPIs.

Can an early mobilisation programme prevent hospital-acquired pressure injures in an intensive care unit?: A systematic review and meta-analysis.

A systematic review and meta‐analysis were conducted to clarify the effect of an early mobilisation programme on the prevention of hospital‐acquired pressure injuries in an intensive care unit as opposed to standard care. We searched a total of 11 databases until 1 May 2020 and included seven studies (n = 7.520) related to the effect of early mobilisation protocol in the prevention of hospital‐acquired pressure injuries (five quasi‐experimental and two random comparative). The five quasi‐experimental studies were significantly heterogeneous (P = .02 for Q test and 66% for I 2), and the odds ratio was 0.97 (95% CI: 0.49‐1.91) with a non‐significant statistical difference between both groups (P = .93). Our study shows inconclusive outcomes related to the effect of the implementation of an early mobility programme in the prevention of pressure injuries in critical patients. Future research is needed considering the small number of articles on the topic.

Artificial Intelligence (AI) and machine learning (ML) in risk prediction of hospital acquired pressure injuries (HAPIs) among oncology inpatients.

309 Background: Utilizing AI and ML is an emerging method to improve risk identification, characterization and stratification for clinical outcomes such as HAPIs. The Jvion Cognitive Clinical Success Machine (CCSM) utilizes the Eigen Sphere technique to factor in clinical, socioeconomic, and behavioral covariates at the individual patient level to maximize accuracy of risk prediction and provide insights on prevention of HAPIs. Methods: A retrospective analysis was performed utilizing claims and EHR data on 63,476 inpatient admissions between June 2016 and June 2018 at M D Anderson Cancer Center, a 660-bed oncology facility (Table 1) . All risk assessment indicators in the data were removed prior to analysis by the CCSM to compute unbiased risk probabilities for HAPIs. The performance of the CCSM risk prediction for all new stage 2 and above HAPIs (&gt;=Stage 2 HAPIs) was compared with the Braden scale using AUC. Results: The Jvion CCSM had an AUC of 0.84 compared to the AUC of 0.72 for the Braden scale in the prediction of &gt;=Stage 2 HAPIs. Conclusions: The AUC indicates that the Jvion CCSM has better predictive accuracy than the Braden scale. It also has better discrimination in risk identification. Thus, Jvion CCSM can be a valuable tool in risk screening for HAPIs which can lead to early preventative interventions. Characteristics of admission records used to compare accuracy of Jvion CCSM and Braden scale in predicting new &gt;=Stage 2 HAPIs (N=58,228). [Table: see text]

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

Artificial Intelligence (AI) and machine learning (ML) in risk prediction of hospital acquired pressure injuries (HAPIs) among oncology inpatients.

e18095 Background: Utilizing AI and ML is an emerging method to improve risk identification, characterization and stratification for clinical outcomes such as HAPIs. The Jvion Cognitive Clinical Success Machine (CCSM) utilizes the Eigen Sphere technique to factor in clinical, socioeconomic, and behavioral covariates at the individual patient level to maximize accuracy of risk prediction and provide insights on prevention of HAPIs. Methods: A retrospective analysis was performed utilizing claims and EHR data on 63,476 inpatient admissions between June 2016 and June 2018 at M D Anderson Cancer Center, a 660-bed oncology facility (Table). All risk assessment indicators in the data were removed prior to analysis by the CCSM to compute unbiased risk probabilities for HAPIs. The performance of the CCSM risk prediction for all new stage 2 and above HAPIs ( &gt; = Stage 2 HAPIs) was compared with the Braden scale using AUC. Results: The Jvion CCSM had an AUC of 0.84 compared to the AUC of 0.72 for the Braden scale in the prediction of &gt; = Stage 2 HAPIs. Conclusions: The AUC value indicates that the Jvion CCSM has better predictive accuracy than the Braden scale. It also has better discrimination in risk identification. Thus, Jvion CCSM can be a valuable tool in risk screening for HAPIs which can lead to early preventative interventions. [Table: see text]

Nursing Education Program for Hospital-Acquired Pressure Injury Prevention in Adult Acute Care Setting: A Quality Improvement Project.

The purpose of this Quality Improvement project was to develop a multimedia hospital-acquired pressure injury (HAPI) prevention education program. The project setting was 3 adult critical care units plus a step-down unit located in the Mid-Atlantic region of the United States. A multimedia educational intervention was developed, which comprised 4 modules designed to improve nursing knowledge and competency in HAPI prevention. A posteducation program staff survey was also administered to evaluate nurse satisfaction with the program. Nurse knowledge of HAPI prevention was measured before and following implementation of the educational intervention. One hundred twenty-nine participants completed the education program, and 117 completed the satisfaction survey. Analysis revealed a statistically significant increase in knowledge after the education course (P < .05). Findings also indicated participants were satisfied that the program met stated aims.

Tree-based Approach to Predict Hospital Acquired Pressure Injury

Despite technical advances in healthcare, the rates of hospital-acquired pressure injury (HAPI) are still high although many are potentially preventable. The purpose of this study was to determine whether tree-based prediction modeling is suitable for assessing the risk of HAPI in ICU patients. Retrospective cohort study has been carried out. A decision tree model was constructed with Age, Weight, eTube, diabetes, Braden score, Isolation, and Number of comorbid conditions as decision nodes. We used RStudio for model training and testing. Correct prediction rate of the final prediction model was 92.4 and the Area Under the ROC curve (AUC) was 0.699, which means there is about 70% chance that the model is able to distinguish between HAPI and non- HAPI. The results of this study has limited generalizability as the data were from a single academic institution. Our research finding shows that the data-driven tree-based prediction modeling may potentially support ICU sensitive risk assessment for HAPI prevention.

Preventing pressure injuries in the emergency department: Current evidence and practice considerations.

The emergency department (ED) is at the front line of hospital pressure injury (PI) prevention, yet ED clinicians must balance many competing clinical priorities in the care of seriously ill patients. This paper presents the current biomechanical and clinical evidence and management considerations to assist EDs to continue to develop and implement evidence-based PI prevention protocols for the high-risk emergency/trauma patient. The prevention of hospital-acquired pressure injuries has received significant focus internationally over many years because of the additional burden that these injuries place on the patient, the additional costs and impact to the efficiency of the hospital, and the potential for litigation. The development of a PI is the result of a complex number of biomechanical, physiological, and environmental interactions. Our understanding of the interaction of these factors has improved significantly over the past 10 years. We have demonstrated that large reductions in PI incidence rates can be achieved in critical care and general hospital wards through the application of advanced evidence-based prevention protocols and believe that further improvement can be achieved through the application of these approaches in the ED.

Costs and consequences of an intervention-based program to reduce hospital-acquired pressure injuries in one health district in Australia.

Objectives The aims of this study were to determine the costs of hospital-acquired pressure injuries (HAPIs) in one local health district in Australia and compare the costs and consequences of an intervention-based program with current practice to reduce HAPI incidence and prevalence. Methods A retrospective cost-consequence analysis was conducted using HAPI incidence rate per occupied bed days, point prevalence rates, Australian Refined-Diagnosis Related Group (AR-DRG) costs and the costs of the program to reduce the HAPI rate. Data were analysed for two phases: preprogram implementation (1 June 2015-1 June 2016) and postprogram implementation (1 August 2016-31 July 2017). Results The HAPI intervention-based program resulted in a 51.4% reduction in the incidence of HAPI (from 1.46 per occupied bed day in 2014 to 0.71 per occupied bed day in 2017) and a 71.6% reduction in the prevalence of HAPI (from 6.7% in 2014 to 1.9% in 2017). The occurrence of HAPI added an average cost of A$3332 per episode, such that the overall program, including implementation, reduced costs by A$837387. The greatest cost reduction was due to the cessation of washable and disposable underpads. The largest contributor to the cost of HAPI prevention was for education and training regarding HAPI prevention initiatives. Conclusions The HAPI intervention-based program halved the incidence and substantially reduced the prevalence of HAPI, with a 23.1% cost saving compared with the previous approach to preventing HAPIs. What is known about the topic? HAPIs are costly to the individual, the organisation and health system. The prevention of HAPIs is a priority in Australia. There is limited research on the economic effect of HAPIs and the costs and consequences for hospitals of implementation strategies to reduce their incidence. What does this paper add? This paper informs health policy and decision makers about the costs and consequences for a local health district of a program to reduce and prevent HAPIs. This paper reports the economic effect of HAPIs, including hospital episode costs per HAPI and length of stay, on one local health district. What are the implications for practitioners? This cost-consequence analysis has shown that the program to reduce HAPIs resulted in a reduction in expenditure and positive patient outcomes. Such a program is potentially transferable to other healthcare settings.