Protective Dressings Research Articles

Redefining Wound Healing Using Near-Infrared Spectroscopy.

No standard definition for a completely healed wound currently exists; it is recommended that providers use a reliable wound assessment tool to determine healing. The objective of this feasibility study was to determine if a point-of-care, noncontact, near-infrared (NIR) imaging device could provide an objective measure of wound resolution and guide clinical decision-making for the optimal time to transition from protective wound dressings and gradual return to full activity. In this single-center feasibility study, adult patients 18 years and older with a lower extremity wound of any size and etiology were seen weekly for wound assessment and standard-of-care treatment. The researchers performed serial imaging with a point-of-care, noncontact, NIR imaging device (Snapshot NIR ; Kent Imaging Inc) to assess the wound and surrounding skin and evaluated the difference in time to 100% reepithelialization on visual inspection and homogeneous tissue oxygen saturation levels at the wound site and surrounding closed skin envelope. An average time difference of 13.5 ± 10 days (median, 12 days; range, 0-35 days) was observed between 100% reepithelialization on visual wound inspection and imaging assessment. Further, NIR imaging could determine when a patient was at risk for recurrent wound breakdown. The addition of point-of-care, noncontact, NIR imaging may help guide clinical decision-making for the optimal time to transition from protective wound dressings with gradual return to full activity and minimize wound recurrence.

Thermal‐Cascade Multifunctional Therapeutic Systems for Remotely Controlled Synergistic Treatment of Drug‐Resistant Bacterial Infections

AbstractAntimicrobial therapy remains one of the major global challenges, particularly in the absence of effective treatment strategies for drug‐resistant bacteria. In this study, a comprehensive treatment approach is proposed for drug‐resistant bacterial wound infections based on the development of thermal‐cascade multifunctional therapeutic systems (MTSs), spanning from the design of functional nanoscale materials to macroscopic smart hydrogel. Within the MTSs, functional antibiotic‐loaded hybrid nanoclusters enable targeted therapeutic delivery and synergistic mild hyperthermia‐antibiotic treatment, strongly suppressing drug‐resistant bacteria while demonstrating excellent biocompatibility with normal cells and tissues. Furthermore, near‐infrared irradiation can trigger the photothermal effects of hybrid nanoclusters to induce gelation of thermal‐sensitive hydrogel, forming MTSs to serve as highly adaptable, drug‐enriched protective dressings for infected wounds. Both in vitro and in vivo results substantiate that MTSs enhance the bioavailability of therapeutic agents (including bacterial internalization and tissue penetration), exert synergistic effects to completely eradicate drug‐resistant bacteria, promoted wound healing and revascularization, and demonstrate excellent biocompatibility. This work offers an innovative demonstration to address drug‐resistant bacterial infections through the advancement of sophisticated material systems.

Topical Drug Delivery in the Treatment of Skin Wounds and Ocular Trauma Using the Platform Wound Device.

Topical treatment of injuries such as skin wounds and ocular trauma is the favored route of administration. Local drug delivery systems can be applied directly to the injured area, and their properties for releasing therapeutics can be tailored. Topical treatment also reduces the risk of adverse systemic effects while providing very high therapeutic concentrations at the target site. This review article highlights the Platform Wound Device (PWD) (Applied Tissue Technologies LLC, Hingham, MA, USA) for topical drug delivery in the treatment of skin wounds and eye injuries. The PWD is a unique, single-component, impermeable, polyurethane dressing that can be applied immediately after injury to provide a protective dressing and a tool for precise topical delivery of drugs such as analgesics and antibiotics. The use of the PWD as a topical drug delivery platform has been extensively validated in the treatment of skin and eye injuries. The purpose of this article is to summarize the findings from these preclinical and clinical studies.

The prevalence of medical adhesive-related skin injury caused by protective dressings among medical staff members during the 2019 coronavirus pandemic in China

AimTo explore the prevalence and risk factors for medical adhesive-related skin injury (MARSI) caused by protective dressings among medical staff members during the 2019 coronavirus disease pandemic (COVID-19) in China. Materials and methodsA cross-sectional survey was conducted using a questionnaire. The questionnaire was released through the Questionnaire Star website and was completed online. The prevalence of MARSI was calculated and risk factors were analyzed using a multiple regression model. ResultsA total of 414 front-line medical staff members treating COVID-19 patients were enrolled from 46 hospitals across four provinces and two municipalities. Overall, 83.1% used protective medical adhesive dressings applied to the head and face to prevent skin damage from personal protective equipment. The prevalence of MARSI caused by adhesive dressings was 41.9%. By multiple regression analysis, the type of dressing, duration of dressing usage, and pain score were risk factors for MARSI development. ConclusionsThe high prevalence indicates MARSI is common among front-line medical staff members, especially those using hydrocolloid dressings and longer durations of dressing usage. Pain upon dressing removal can be severe and increased the risk of MARSI. We call for paying more attention to MARSI and recommend multisite studies with larger sample sizes to enhance the generalizability of these findings.

Preventing Medical Device-Related Pressure Injuries Due to Noninvasive Ventilation Masks and Nasal Cannulas.

Medical device-related pressure injuries attributed to oxygen delivery devices are common yet preventable. Pressure injuries increase hospital costs, patients' length of stay, and mortality rates. To decrease medical device-related pressure injuries by transitioning patients from an over-the-nose noninvasive ventilation mask to a single-headset, interchangeable under-the-nose and over-the-nose noninvasive ventilation mask; replacing polyvinyl chloride nasal cannulas with a softer nasal cannula; and providing staff education on preventing pressure injuries related to oxygen delivery devices. The project was implemented on 4 adult inpatient units with a total of 75 inpatient beds at an academic medical center. Interventions included implementing the trial noninvasive ventilation masks and nasal cannulas, alternating masks every 4 hours, relocating protective dressings, promoting the use of protective dressings for over-the-nose oral-nasal masks, and educating health care staff. In the 2 months before implementation (September and October 2020), 1 medical device-related pressure injury was caused by a noninvasive ventilation mask and 4 injuries were caused by nasal cannulas. During the 2 months of trial implementation (November and December 2020), no pressure injuries developed in patients using the trial devices. The interventions implemented had clinically relevant results. A larger sample size would be necessary to determine statistical significance. Postintervention data indicated a need for further education on evidence-based practice guidelines on mask alternation and use of preventive dressings to bolster compliance. Following institutional approval, all noninvasive ventilation masks and nasal cannulas were transitioned to the trial devices at the study institution.

Feasibility of nasal bridge pressure injury prevention using a protective dressing and the Halyard Fluidshield® N95 mask in a COVID-positive environment.

The purpose of this study was to prevent nasal bridge pressure injury among fit‐tested employees, secondary to long‐term wear of the N95 mask during working hours. A prospective, single‐blinded, experimental cohort design. Participants were enrolled using the convenience sampling methods and randomisation was utilised for group assignment. Eligibility was determined by a COVID Anxiety Scale score and non‐COVID clinical assignment. Participants with a history of previous skin injury or related condition were excluded. The experimental group was assigned Mepilex Lite® and the control group used Band‐ Aid®. Formal skin evaluations were done by Nurse Specialists who are certified in wound and ostomy care by the Wound, Ostomy, Continence, Nursing Certification Board (WOCNCB®). Fit test logs were provided to participants to measure subjective user feedback regarding mask fit and level of comfort. The results of this feasibility trial are promising in supporting the use of a thin polyurethane foam dressing as a safe and effective dressing to apply beneath the N95 mask. Additional research is needed to validate results due to limited data on efficacy and safety of the various barrier dressings as a potential intervention to prevent skin breakdown to the nasal bridge.

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

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

Alternatives and preferences for materials in use for pressure ulcer prevention: An experiment-reinforced literature review.

Alleviation of localised, sustained tissue loads and microclimate management are the most critical performance criteria for materials in use for pressure ulcer prevention, such as in prophylactic dressings, padding or cushioning. These material performance criteria can be evaluated by calculating the extents of matching between the material stiffness (elastic modulus) and the thermal conductivity of the protective dressing, padding or cushioning with the corresponding properties of native skin, separately or in combination. Based on these bioengineering performance criteria, hydrocolloids, which are commonly used for prophylaxis of medical device-related pressure ulcers, exhibit poor stiffness matching with skin. In addition, there is remarkable variability in the modulus and thermal conductivity matching levels of different material types used for pressure ulcer prevention, however, it appears that among the materials tested, hydrogels provide the optimal matching with skin, followed by gels and silicone foams. The stiffness matching for hydrocolloids appears to be inferior even to that of gauze. This article provides quantitative performance criteria and metrics for these evaluations, and grades commonly used material types to biomechanically guide clinicians and industry with regards to the selection of dressings for pressure ulcer prevention, both due to bodyweight forces and as a result of applied medical devices.

Getting Ready for Wound Certification: Promoting Skin Health and Preventing Injuries.

Getting Ready for Wound Certification: Promoting Skin Health and Preventing Injuries.

Prophylactic sacral protective dressings' effect on preventing pressure injury: A meta-analysis.

We performed a meta‐analysis to evaluate the effect of prophylactic sacral protective dressings on preventing pressure injury. A systematic literature search up to July 2021 was performed, and 11 studies included 5150 community or hospital‐based adult subjects requiring care at the start of the study; 2832 of them were using sacral protective dressings and 2318 were given standard care with no sacral protective dressings. They were reporting relationships between the effects of prophylactic sacral protective dressings on preventing pressure injury. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of prophylactic sacral protective dressings on preventing pressure injury using the dichotomous method with a random or fixed‐effect model. Sacral protective dressings had a significantly lower incidence of pressure injuries (OR, 0.39; 95% CI, 0.28‐0.53, P < .001) compared with standard care with no sacral protective dressings in community‐ or hospital‐based adult subjects requiring care. Sacral protective dressings had a significantly lower incidence of pressure injuries compared with standard care with no sacral protective dressings in community‐ or hospital‐based adult subjects requiring care. Further studies are needed to confirm these findings.

The development and experimental assessment of medical devices protecting eviscerated abdominal organs using the eventration model

On an experimental model of eventration in small and large animals (94 rats and 12 pigs), the safety and effectiveness of samples of aseptic protective dressings made of nanomaterials with impregnations used to prevent the development of complications from abdominal organs and tissues in comparison with control ones gauze medical sterile ones were evaluated. After 3 hours, 3 and 7 days after surgery, the viability of the intestinal wall and the presence of complications were assessed on the basis of laboratory, experimental, instrumental and morphological techniques. The assessment of microcirculation (perfusion) of the intestine was carried out using the apparatus LAKK-02. It was found that according to the complex of clinical and laboratory, microbiological, morphological, microcirculatory data and expert assessment, the safest and most effective for the protection of abdominal organs was an aseptic bandage made of non-woven material spunbond impregnated with vinylin + silicone. The initial values of microcirculation parameters in the pig groups were: 18.4 [17.1; 19] perfusion units in the experimental group and 15.6 [6.8; 17.7] perfusion units in the control group. After applying the bandage in the experimental group, the level of microcirculation did not significantly change. In the control group, after 3-hour exposure to the bandage, a decrease in the level of microcirculation was observed to 6.5 [5.1; 8] perfusion units (p 0.05 compared to the initial and similar stage in the experimental group). Thus, an aseptic bandage made of spunbond nanomaterial impregnated with vinylin + silicone retains the necessary moisture and protects the eventrated abdominal organs, demonstrates safe adhesive properties and prevents the development of local and general complications in the early postoperative period.

Protective Dressings, Injury, and Device Failure in Preterm Infants Receiving Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial.

To investigate the protective effect of a hydrocolloid nasal dressing on the incidence and severity of nasal injury and continuous positive airway pressure (CPAP) failure in preterm infants receiving nasal CPAP (N-CPAP). A randomized controlled trial was conducted over 4 months in 2019 at level 3 neonatal ICUs in two hospitals affiliated with Isfahan University of Medical Sciences, Iran. Eighty eligible infants were born at 32 weeks of gestation or younger and/or with a birth weight of 1,500 g or less and had received between 4 and 72 hours of CPAP. Infants were randomly assigned to two groups; the intervention group used a protective dressing, and the control group received routine care. Data collection tools included a demographic questionnaire and nasal injury assessment score chart. The incidence and severity of nasal injury in preterm infants undergoing N-CPAP. Infants in the intervention group had a significantly lower incidence and severity of nasal injury compared with the control group: 15 of 40 (37.5%) versus 37 of 40 (92.5%; P < .001). Overall, the injuries identified in this study were mostly mild and moderate, with only three severe injuries in the intervention group and five in the control group. No significant differences were detected in CPAP failure (P > .05). The studied nasal barrier dressing is a safe and convenient solution to reduce nasal injury in preterm infants receiving N-CPAP.

Establishment of incontinence-associated dermatitis rat models and assessment of the therapeutic effects of zinc oxide, painless skin protective film and silicone dressing.

The aim of the present study was to construct incontinence-associated dermatitis (IAD) rat models and observe the therapeutic effects of zinc oxide, painless skin protective film and silicone dressing on IAD. A total of 54 rats were randomly divided into nine groups: i) Control group; ii) trypsin model group; iii) model + zinc oxide group; iv) model + painless skin protective film group; v) model + silicon dressing group; vi) synthetic urine combined with trypsin model group (joint model group); vii) joint model + zinc oxide group; viii) joint model + painless skin protective film group; and ix) joint model + silicone dressing group. A total of 4 days after applying the zinc oxide, protective film or silicon dressing intervention, IAD scores and pH values in skin tissues were examined. Skin tissues and blood samples were collected. Hematoxylin and eosin staining, immunohistochemical staining of major histocompatibility complex class II (MHC-II) and western blot analysis of MHC-II, NF-κB/p65, phosphorylated (p)-NF-κB/p65, STAT1 and p-STAT1 were carried out in skin tissue. Serum IFN-γ, IL-1β, IL-2 and TNF-α levels were determined using ELISA. The results demonstrated that IAD scores and pH values were both higher in the model groups than the control, which were significantly ameliorated by silicone dressing. The skin tissue structure of IAD rats both in trypsin model group and joint model group was severely damaged, the wounds were not covered by epidermis, and numerous inflammatory cell infiltrations were observed. After treatment, dermatitis was improved. Skin tissue from the trypsin and joint IAD models had higher MHC-II, NF-κB p65, p-NF-κB p65, STAT1 and p-STAT1 expression than controls, which was decreased by protective film and silicon dressing. Zinc oxide reduced NF-κB p65, p-NF-κB p65, STAT1 and p-STAT1 expression. However, no significant differences were observed in NF-κB/p-NF-κB ratio and STAT1/p-STAT1 ratio among groups. Furthermore, serum IFN-γ, IL-1β, IL-2 and TNF-α levels were significantly elevated in trypsin and joint IAD rats. The upregulation of these cytokines was significantly inhibited after all three treatments. Among the three treatment methods, silicone dressing had the best therapeutic effect. Thus, these findings revealed that zinc oxide, painless skin protective film and silicone dressing could ameliorate the severity of IAD rat models, and that silicone dressing possessed the best therapeutic effect.

Preventing Pressure Injury Related to Personal Protective Equipment.

One side effect of the COVID-19 pandemic was the increased need for personal protective equipment (PPE). At first, the biggest problem facing nurses was just having PPE available to care for these highly infectious patients. But the length of time wearing PPE has created its own new issue: PPE-related pressure injury. Bambi et al, in their small Italian study titled “Pressure Injuries Due to Personal Protective Equipment in COVID-19 Critical Care Units,” found that 77% of nurses had a device-related pressure injury (DRPI) develop, primarily on the nose, ears, or forehead, after an average of just 5 hours of wearing PPE.Another significant concern for nurses is the need to prevent infection while preventing PPE-related pressure injury using protective dressings or moisture barriers. The National Pressure Injury Advisory Panel (NPIAP) recommends 3 measures to minimize the risk of infection if you are using a dressing or moisture barrier to prevent pressure injury. The first is to do another fit test if possible. The second is to do a “seal check” after the application of a dressing or barrier. And finally, when removing the dressing, NPIAP recommends assuming that the dressings are contaminated and removing them with your eyes closed while holding your breath.

Pressure Injury Prevention in COVID-19 Patients With Acute Respiratory Distress Syndrome.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019 and became a pandemic in a short period of time. While most infected people might have mild symptoms, older people and people with chronic illnesses may develop acute respiratory distress syndrome (ARDS). Patients with ARDS with worsening hypoxemia require prone positioning to improve the respiratory mechanics and oxygenation. Intubated patients may stay in a prone position up to 12–16 h, increasing the risk of pressure injury (PI). Frequent skin inspections and PI risk assessment in COVID-19 patients will be challenging due to hospital infection control measures aimed to reduce the risk for health professionals. In this perspective article, we summarize the best practice recommendations for prevention of PI in SARS-CoV-2-infected ARDS patients in prone positioning. Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. Once a patient is in prone position, it is recommended to (1) use the swimmer's position, (2) reposition the patient every 2 h, and (3) keep the skin clean. When the patient is repositioned to supine position, healthcare professionals are advised to (1) assess the pressure points and (2) promote early mobilization.

Investigation of the Clinical Effectiveness of Polyhexanid/Polyhexamethylene Biguanide Wound Dressing in Chronic Cases

Polyhexanid/polyhexamethylene biguanide is one of the most used wound antiseptics, with a high tissue compatibility and low cytotoxicity. In the present study, it was aimed to investigate the effectiveness of antimicrobial gel and spray that containing 0.1% PHMB, on wound healing in the treatment of patients who come to our clinic with chronic infected wound formation due to different reasons. The materials of the study consisted of 12 cats and 8 dogs with chronic, infected, ulcerative and suppurative wounds in various parts of the body, which were treated at the Surgery Clinic of SU Faculty of Veterinary Medicine. In the evaluation of the wound bed, the color, depth, shape, size of the wound, type and amount of the exudate, localization of the wound, and wound care conditions were taken into consideration. Surgical or mechanical superficial debridements of the wound were performed initially. Following this procedure, irrigation of the wound area was achieved with 0.9% saline. Protective dressing was applied to the wound area of all patients by applying antimicrobial (Actolind® w Gel, ACTO, Germany) spray containing 0.1% PHMB twice a day, and gel of the same product after 5 minutes. When the wound bed of the cases were evaluated on the 15th day, (100%) granulation and epithelization occurred in all the wounds of 19 patients, and only in one patient epithelization was observed. At the end of the 30th day, it was noted that granulation was completed in all cases except one case and passed to the epithelization stage. In all clinical cases, no complications were encountered during the treatment process. Clinical studies of polyhexanide/polyhexamethylene biguanide are promising. In this study, positive response was obtained in a short time. However, more experimentally controlled clinical and laboratory studies are required in order to improve 0.1% PHMB applications in chronic wound treatments.

Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project.

PURPOSE:Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19.PARTICIPANTS AND SETTING:This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory.APPROACH:We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period.OUTCOMES:We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings).CONCLUSION:Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.

Development of bioactive films based on chitosan and Cynara cardunculus leaves extracts for wound dressings

The development of natural based, effective and protective wound dressings associated to local treatment applied on chronic wounds, represents a major challenge nowadays. In this work chitosan-based films were prepared with different concentrations of ethanolic ultrasound assisted extracts from Cynara cardunculus leaves (EtPUAE). The physico-chemical film properties revealed that extract incorporation influences the volumetric swelling capacity and mechanical properties of the films, leading to materials with a lower fluid absorption capacity and more fragile. However, no impact was detected on the thermal properties of the films, as well as on their dense structure characterized by Scanning Electronic Microscopy (SEM) analysis. Biological screening of chitosan-based films show that chitosan with a 1% (w/w) and a 5% (w/w) EtPUAE loading did not induce cytotoxicity on normal human skin fibroblasts (Bj5-ta cell line), mainly attributed to cynaropicrin (extract key active compound) present in the film below its IC50 value. Nevertheless, chitosan-based films with 5% (w/w) EtPUAE presented an interesting anti-inflammatory activity. Bj5-ta cells stimulated with liposaccharides (LPS), presented a reduction of 86% on IL-6 cytokine levels, after exposure to chitosan with 5% EtPUAE film extract.The results obtained in this study open up the possibility of successfully using chitosan films doped with EtPUAE for development of chronic wound dressings, with the advantage of using naturally-sourced materials with anti-inflammatory activity.

Pressure Injuries of the Nose and Columella in Preterm Neonates Receiving Noninvasive Ventilation via a Specialized Nasal Cannula: A Retrospective Comparison Cohort Study.

The aims of this study were to measure the incidence and severity of nasal septum injury in premature infants receiving continuous positive airway pressure (CPAP) via a noninvasive thin-walled cannula, and to evaluate the effect of a polyvinyl chloride foam barrier dressing in reducing these injuries. Retrospective chart review, comparison cohort study. The sample comprised 235 neonates with a gestational age of 28 weeks or younger. Their mean gestational age was 26 weeks (range 22-28 weeks) and mean birth weight was 840 g (range 430-1320 g). The study setting was a level 4, regional neonatal intensive care unit housed in a 200-bed freestanding children's hospital located in the Northeastern United States. Data were collected during 3 periods. During all 3 data collection periods, we used a soft, thin-walled nasal cannula, with a relatively short, binasal prong interphase and small diameter tubing connected to a ventilator circuit capable of transmitting positive airway pressure in neonates. During data collection periods 1 and 3, we used a polyvinyl foam barrier dressing as a preventive intervention against nasal skin damage; specifically, we placed a precut barrier on the prongs to protect the nasal skin. One side of the barrier foam has an adhesive surface, which was placed against the prongs. Study period 2 differed; during this period neonates were treated with the nasal cannula without the foam barrier based on manufacturer experience suggesting the foam barrier is not needed for prevention of skin damage. Pressure injuries (PIs) that occurred during each study period were staged according to National Pressure Ulcer Advisory Panel definitions. Eighty neonates were evaluated during study period 1 (thin-walled nasal cannula plus foam barrier). We evaluated 27 neonates during period 2 (thin-walled nasal cannula and no foam barrier) and 128 were evaluated during study period 3 (thin-walled nasal cannula plus foam barrier). Six neonates (7%) developed PIs during period 1, and 2 (1.5%) developed during study period 3. All were stage 1 and 2 PIs, no full-thickness injuries, also referred to as columella necrosis developed during use of the thin-walled nasal cannula in combination with the foam barrier dressings. In contrast, 13 PIs (48%) of neonates managed during data collection period 2 (thin-walled nasal cannula with no foam barrier) developed PI, and 40% experienced stage 3 PI or columella necrosis. This difference reflects a 6-fold increase in nasal injury occurred when nasal continuous positive airway pressure (NCPAP) was administered without use of the protective barrier dressing. We found clinically relevant difference in the occurrences of nasal PI in neonates managed with NCPAP; occurrences of stage 3 PI were 6-fold higher when a thin-walled cannula was used without a protective foam barrier dressing.

Prevention and Treatment of Device-Related Hospital-Acquired Pressure Injuries.

Prevention and Treatment of Device-Related Hospital-Acquired Pressure Injuries.