Determination of the effect of prophylactic dressing on the prevention of skin injuries associated with personal protective equipments in health care workers during COVID-19 pandemic

AimThe present study was carried out as a comparative observational study in order to determine the effect of prophylactic dressing on the prevention of skin injuries due to the use of personal protective equipment (PPE) in health care workers (HCWs) working with COVID-19 patients. In addition, the effect of nasal strip on the prevention of discomfort in breathing with mask was also investigated.Materials and methodsThe present study was carried out with 48 HCWs (Control Group-CG, n = 20; Experimental Group 1-EG1, n = 20; Experimental Group 2-EG2, n = 8) who use PPE on the face region and work with COVID-19 patients. Data was collected with Data Collection Form developed by researchers. In participants in CG, normal procedures of the institution in using PPE were followed. In EG1, prophylactic dressing was used on risky areas on the face. In EG2, nasal strip sticky on one side was used in addition to prophylactic dressing. The evaluation of the facial skin was made once a day by a researcher with expertise in wound management.ResultsGroups were similar in terms of demographic characteristics of participants. Overall rate of skin injuries associated with PPE use was 47.9%. Skin injuries developed in all participants in CG (n = 20), and in two and one participants in EG1 and EG2 respectively, with significant difference between groups. The most common skin injuries were Stage 1 pressure injury (29.2%), blanchable erythema of intact skin (27.1%) and itching (18.8%). No participant in EG2 reported discomfort in breathing (n = 8). Significant difference was found between groups in favor of EG2 in terms of experiencing discomfort in breathing (p < 0.001).ConclusionsIn the present study, it was established that using prophylactic dressing under PPE prevents skin injuries on the facial skin and using nasal strip prevents discomfort in breathing with mask. In view of these results, it was recommended that prophylactic dressing should be used under PPE.     

Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room

AimWe aimed to investigate the incidence rate and risk factors of medical device-related pressure injuries (MDRPIs) among patients undergoing prone position spine surgery.Materials and methodsThis was a prospective observational study of 147 patients who underwent spine surgery in an orthopaedic hospital in Korea. The incidence of MDRPI according to intrinsic and extrinsic factors was assessed using the independent t-, χ² -, or Fisher's exact tests. A logistic regression analysis was performed exclusively for MDRPI areas with an incidence rate >5%.ResultsThe mean incidence rate of overall MDRPI was 27.4%, while that of MDRPI by Wilson frame, bi-spectral index, and endotracheal tube (ETT) was 56.5%, 52.4%, and 9.5%, respectively. The risk factors under Wilson frame were operation time and body mass index classification. Compared to their normal weight counterparts, those who were underweight, overweight, and obese had a 46.57(95% CI: 6.37–340.26), 3.96 (95% CI: 1.13–13.86), and 5.60 times (95% CI: 1.62–19.28) higher risk of developing MDRPI, respectively. The risk factors by bi-spectral index were sex, operation time, and the American Society of Anaesthesiologists classification. Compared to ETT intubation of <2 h, the risk of MDRPI increased by 7.16 times (95% CI: 1.35–38.00) and 7.93 times (95% CI: 1.45–43.27) for<3 and ≥3 h’ duration, respectively.ConclusionThe difficulty of device repositioning can increase the incidence of MDRPI, and prolonged surgery was a significant risk factor. Thus, appropriate planning and correct equipment utilization is needed during prone position spine surgeries.     

Translation and validation of the ELPO for Turkish population: Risk assessment scale for the development of pressure injuries due to surgical positioning

Aim of the studyThis study was conducted to translate the ELPO risk assessment scale for the development of pressure injuries due to surgical positioning to Turkish and to test its validity and reliability in the Turkish Population.Materials and methodsThe data were collected using the patient identification form, the risk assessment scale for the prevention of injuries due to surgical positioning, and the Braden Scale. This scale consisted of a total of seven items, each of which contained five sub-items. It is rated between 1 and 5 in the Likert type. The total score of the scale ranges between 7 and 35. The risk of developing pressure injuries increases in patients as the score increases.ResultsA total of 184 patients were included in the study sample. The mean age of the group was 55.96 ± 17.90, and the content validity index was 0.944. The sensitivity of the test was 60%, the specificity was 66%, and the accuracy was 66%. There was a negative, weak, statistically significant correlation between the total scores of the risk assessment scale for the prevention of injuries due to surgical positioning and the Braden scale. The mean total score of the scale was 18.45 ± 2.96 (12–26) and 35.9% (n = 66) of the group were at high risk.ConclusionsThe ELPO, which includes the risks specific to patients during surgery, can be used as an assessment scale for the development of pressure injury due to surgical positioning for Turkish population.     

Pressure injury prevention: Knowledge and attitude and their predictors in Indonesian nurses working in hospital settings

AimNurses' knowledge and attitude are critical for pressure injury (PI) prevention. However, to date, there has been little research carried out on the knowledge and attitude of Indonesian nurses regarding PI prevention in hospital settings, and no study has investigated the predictors of knowledge and attitude of Indonesian nurses regarding PI prevention. This study therefore aims to investigate knowledge and attitude, and to identify the predictors of knowledge and attitude regarding PI prevention among Indonesian nurses in hospital settings.MethodsA cross-sectional study was conducted between 1st November 2021 and 5th March 2022. A total of 563 nurses from three general hospitals in Central Java Province participated. The Pressure Ulcer Knowledge Assessment Tool 2.0 and the Attitude Pressure Ulcer Prevention questionnaires were used. A multiple linear regression analysis was used to determine the predictors of nurses' knowledge and attitude regarding PI prevention.ResultsThe percentage of correct answers was 35.02%, indicating poor knowledge, while the percentage of nurses' attitudes was 75.46%, indicating a satisfactory attitude. The predictors of knowledge of PI prevention were found to be age (β = -0.127, p = 0.025), level of education (β = 0.153, p = 0.001) and income (β = 0.107, p = 0.021), while the predictors of attitude toward PI prevention were level of education (β = 0.101, p = 0.020) and professional position (β = 0.093, p = 0.033).ConclusionThis is the first study to identify the predictors of attitude and knowledge regarding PI prevention in Indonesian nurses in a hospital setting. The results indicate a need for appropriate educational training based on the predictors to be given to Indonesian nurses working in hospital settings to increase their knowledge of PI prevention.     

Root cause analysis to identify contributing factors for the development of hospital acquired pressure injuries

IntroductionMany hospital settings are adopting a zero-tolerance policy towards pressure injury (PI) development; this requires good planning and the implementation of care, as the incidence of PIs reflects the quality of care given in a hospital or facility.AimTo identify common contributing factors towards the development of PIs in a geriatric rehabilitation hospital and improve patient safety through the reduction of hospital-acquired PIs.MethodThis was done using root cause analysis (RCA). All patients who developed a Stage 3 or 4 deep tissue injuries or unstageable hospital-acquired PI between December 2017 and April 2018 PIs were investigated using RCA. The RCA was facilitated through the use of a contributing framework developed by the National Pressure Ulcer Advisory Panel which guides investigations of different areas of care. Qualitative and quantitative data was collected from several sources and placed in a timeline to reconstruct the series of events. The investigator then identified if the PI was avoidable or not by comparing the evidence with pre-set criteria. Content analysis was further used to analyse the themes retrieved.ResultsA variety of root causes were common amongst all the cases. These included both flaws in the system, such as poor equipment and inadequate educational programmes, as well as human factors such as a lack of basic routine care. No skin assessment was being performed (n = 0) apart from the assessment done on admission. Documentation of action planning when it comes to PI prevention was also missing (n = 0). It was identified that 7 patients were mobilized on admission while the others (n = 3) had a delay in mobilisation, due to some fragmentation in care. There was no documentation of patient and relative education on the prevention of PIs (n = 0). All the patients were provided with the right pressure redistributing mattress however, some mattresses were bottoming out. Some causes overlapped, with system defects like lack of protocols, equipment and tools pushing human errors to occur. This created a series of events leading to the adverse event. The identification of these factors helped to provide an understanding of the changes that are needed to reduce future harm and improve patient safety.ConclusionRecommendations were proposed to reduce contributing factors to the development of hospital-acquired PIs. These include audits to reinforce adherence to hospital guidelines, streamlining of the documentation system, investment in new equipment and improvements to educational programmes. The recommendations implemented resulted in a decreased incidence rate of HAPIs.     

How the COVID-19 pandemic influences the prevalence of pressure injuries in the Czech Republic: A nationwide analysis of a health registry in 2020

BackgroundCOVID-19 significantly influences the overall patient status and, in severe symptomatology, the ability to move and the low oxygenation of the tissue for the ventilated patient in Intensive Care Units (ICU). There is a higher risk for Pressure injuries (PIs) development.ObjectivesThe nationwide analyses of the National health register aimed to compare the prevalence of PIs reported before the pandemic COVID-19 started and during the pandemic in 2020.MethodA retrospective, nationwide cross-sectional analysis of data regarding the STROBE checklist collected by the National Health Information System (NHIS), focusing on the PIs reporting based on the International Classification of Diseases (ICD-10) diagnoses L89.0-L89.9 for PIs in 2020. The data from the pandemic period of COVID-19 in 2020 were compared to the prevalence of PI cases in the period 2010–2019 in the Czech Republic in all hospitalized patients.ResultsThe total number of admissions for L89 in 2020 was 14,441, of which 1509 (10.4%) also had COVID-19. In the ICU were 4386 admissions, 12.1% of which also had COVID-19. A higher proportion of PIs is observed in patients hospitalized with COVID-19 than in patients without COVID-19 (2.62% vs 0.81%, respectively 1.05% vs 0.46% when standardized to the 2013 ESP = European Standard Population). In patients hospitalized in ICU, 3.68% with COVID-19 had PIs vs 1.42% without COVID-19 had PIs (1.97% vs 0.81% using the 2013 ESP).ConclusionThe national health registers analyses have proven that the prevalence of PIs was higher among patients hospitalized with the SARS-CoV-2 infection.     

The effect of pH-compatible cleansing cloths on skin pH and the development of pressure ulcers

AimSkin care plays an important role in the prevention of the development of pressure ulcers. The aim of this study was to determine the effect of skincare with a body pH-compatible cleansing cloth on the development time of pressure ulcers and on skin pH.MethodsThis experimental research was conducted with 156 patients hospitalized in intensive care clinics of a state hospital between September 2019 and 2020. The sample was calculated with a power of 80% and a significance level of 0.05 (α error) and as a result, 78 elderly patients formed the intervention group and another 78 elderly patients made up the control group. Data were collected using the Elderly Information Form, Braden Risk Assessment Scale, Pressure Ulcer Staging Tool and Skin pH Measurement Form. The pre- and post-care skin pH of both groups was measured with a skin pH meter. P < 0.05 was considered statistically significant.ResultsThe average development time for pressure ulcers was 14.9 days in the control group, 18.9 days in the intervention group and the difference was not statistically significant (p > 0.05). Skin pH decreased in the intervention group after the skin care routine was applied, whereas it increased in the control group.ConclusionIt can be said that care of one's skin with a body pH-compatible cleansing cloth has a positive effect on the development time of pressure ulcers and also positively changes the skin pH to acidic.     

Knowledge of pressure injury in medical and surgical nurses in a tertiary level hospital: A cross-sectional study

BackgroundNurses play a vital role in pressure injury prevention (PIP) but require foundational knowledge to ensure appropriate PIP strategies are enacted.AimsTo describe and compare medical and surgical nurses’ knowledge of pressure injury (PI) in a tertiary level hospital in China, and to identify predictors of PI knowledge among these groups.DesignA cross-sectional survey was conducted between June and December 2020.MethodsRegistered nurses from nine medical and fifteen surgical wards in a tertiary hospital were invited. The survey was composed of two parts; demographic and professional characteristics; and the Chinese translated version of the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0) where the total score ranged from 0 to 25; higher scores imply more knowledge. Medical and surgical nurses' knowledge test scores were compared using independent t-test. Multiple linear regression analysis was used to determine factors predictive of nurses’ knowledge.ResultsIn total, 423 nurses from 24 wards participated the study and 404 nurses (95.5%) completed the knowledge test (Surgical n = 236, 58.4%; Medical n = 168, 41.6%). The PUKAT 2.0 mean score was 11.6 ± 3.0 (Surgical 12.2 ± 3.0; Medical 10.7 ± 2.8) with 335 (82.9%) nurses scoring <60%. Multiple linear regression showed working in surgical wards, nurse-in-charge position and previous PI training were significant predictors of knowledge scores.ConclusionKnowledge is a precursor to safe practice. Nurses demonstrated poor knowledge of PIP. Pressure injury related education may help improve nurses' knowledge but the extent to which it is used in place and impacts patients’ outcome requires more investigation.     

What is the incidence of medical device-related pressure injuries in adults within the acute hospital setting? A systematic review

Medical devices provide effective therapeutic care for patients. However, medical device-related pressure injuries (MDRPI) are caused by prolonged pressure or shear from a medical device on any location on the body, including mucosal cavities. The primary outcome of this quantitative systematic review was to identify the incidence of MDRPIs in adults within the acute hospital setting. Secondary outcomes include grading, anatomical location and devices that caused such injuries. Electronic databases (CINAHL Plus with Full Text, MEDLINE, EBSCO Host, Health Business Elite Web of Science, PsychINFO, Google Scholar, and Research Gate) were searched for all potential primary studies between November 2019–January 2020. Studies were refined to the English language only, had no time limit from publication, and had to include participants over the age of 18 years with an MDRPI in the acute hospital setting and 720 potential primary studies were identified. Fourteen articles were identified that matched the predefined criteria and were included in the review. All included studies were critically appraised using the evidence-based librarianship critical appraisal tool and data analysis and narrative synthesis were completed. The incidence of MDRPIs in adults within the acute care setting was 28.1% (SD: 29.1%, min: 1.14%, max: 100%). 71.3% of studies documented anatomical locations of MDRPIs, 36.2% included grading of MDRIs, and 71.4% studies documented the offending medical devices. The mean quality appraisal percentage of all included studies was 76.67% (SD: 4.61%; min: 66.6%, max: 83.3%). Despite the heterogeneity of the studies, the review has identified that MDRPIs are prevalent among individuals cared for within the acute hospital setting. Thus, given the morbidity associated with these wounds, it is important to develop strategies to reduce the scope of this problem.     

Preventing recurrence after surgical repair of pressure injuries in patients with spinal cord injury: Effects of a presurgical and postsurgical wheelchair seating intervention by experts

ObjectivePressure injuries in people with spinal cord injury or dysfunction (SCI/D) are known to have a high recurrence rate. As a countermeasure, we perform surgery after adjusting the wheelchair and cushion with the intervention of a seating expert. The effectiveness of seating interventions in postsurgical recurrence prevention was examined.Materials and methodsIn this retrospective analysis, the participants were 19 patients with SCI/D who underwent pressure injury surgical treatment in the gluteal region from 2005 to 2018. The patients with conventional rehabilitation were assigned to Group 1 (n = 8), and those with seating intervention by experts in addition to conventional rehabilitation were assigned to Group 2 (n = 11). The main outcome measure was the presence or absence of recurrence 3 years after the surgery. The recurrence rate was compared between the two groups.ResultsThe recurrence rates were 18% with seating intervention and 75% without; there was a significant difference (p = 0.025). The recurrence odds ratio was 13.5.ConclusionThis study suggests that presurgical seating evaluation and assessment by experts, postsurgical rehabilitation based on presurgical evaluation and assessment, and routine follow-up and seating adjustment according to changes are efficacious for preventing postsurgical pressure injury recurrence in patients with SCI/D.     

Risk factors for the development and evolution of deep tissue injuries: A systematic review

AimsThe aim of this systematic review is to identify the current epidemiological evidence indicating the unique risk factors for deep tissue injury (DTI) compared to grade I-IV pressure injury (PI), the proportion of DTI which evolve rather than resolve and the anatomical distribution of DTI.MethodsA systematic literature search was undertaken using the MEDLINE and CINAHL Plus databases using the search terms ‘Deep tissue injury OR DTI [Title/abstract]’. A google scholar search was also conducted in addition to hand searches of relevant journals, websites and books which were identified from reference lists in retrieved articles. Only peer-reviewed English language articles published 2009–2021 were included, with full text available online.ResultsThe final qualitative analysis included nine articles. These included n = 4 retrospective studies, n = 4 prospective studies and n = 1 animal study.ConclusionThe literature indicates that the majority of DTI occur at the heel and sacrum although in paediatric patients they are mainly associated with medical devices. Most DTI are reported to resolve, with between 9.3 and 27% deteriorating to full thickness tissue loss.Risk factors unique to DTI appear to include anaemia, vasopressor use, haemodialysis and nicotine use although it is unclear if these factors are unique to DTI or are shared with grade I-IV PI. Factors associated with deterioration include cooler skin measured using infrared thermography and negative capillary refill. With 100% of DTI showing positive capillary refill in one study resolving without tissue loss (p = 0.02) suggesting this may be an effective prognostic indicator.More prospective studies are required focusing on establishing causal links between risk factors identified in earlier retrospective studies. Ideally these should use statistically powered samples and sufficient follow up periods allowing DTI outcomes to be reached. Further work is also needed to establish reliable diagnostic criteria for DTI in addition to more studies in the paediatric population.     

A randomized controlled trial to compare the interface pressures of alternating pressure overlay with gel pad versus gel pad alone during prolonged surgery

IntroductionProlonged surgery is a known risk of pressure ulcer formation. Pressure ulcers affect the quality of life, are a significant cause of morbidity and mortality, and pose a burden on the healthcare system. This study aimed to compare the effectiveness of an alternating pressure (AP) overlay with Gel pad against the Gel pad in reducing interface pressure (IP) during prolonged surgery.MethodsA total of 180 participants from a tertiary hospital were randomized to AP overlay with Gel pad group (n = 90) and Gel pad group (n = 90). Patients were placed supine on the pressure redistributing surfaces, and IP data under the sacrum and ischial tuberosities were collected at an interval of 30 min from 0 min up to a maximum of 570 min.ResultsBased on data from 133 participants, the average IPs during all the deflation cycles of the AP overlay (with Gel pad) were significantly lower than the average continuous IP recorded for Gel pad throughout the measuring period (p < 0.001). Only three patients (2.26% of study participants) – Gel pad group (n = 2; 2.99%) and AP overlay with Gel pad group (n = 1; 1.52%) developed post-operative pressure ulcer (p = 0.5687).ConclusionsThe lower IP during deflation cycles of the AP overlay (with Gel pad) suggests its potential effectiveness in preventing pressure ulcer formation in patients undergoing prolonged surgery. The prevention and reduction of pressure ulcers will have a considerable impact on the improved quality of life and cost savings for the patient. The study findings may facilitate the formulation of policies for preventing pressure ulcer development in the perioperative setting.