RESUMEN
BACKGROUND: As COVID-19 has emerged as a pandemic virus, multiple reports have surfaced to describe skin lesions that occur either associated with the virus or due to treatment. OBJECTIVE: To compare patient demographics, treatments, and outcomes in COVID-19 symptomatic patients who developed skin lesions (COVID-19 or hospital-acquired pressure ulcer/injury [HAPU/I]) during the first year of the pandemic. METHODS: A retrospective chart review was conducted on COVID-positive symptomatic patients admitted from March 1, 2020, through March 1, 2021. The authors analyzed the difference in patient demographics, patient skin tones, treatments, hospital length of stay (LOS), intensive care unit (ICU) LOS, death, and discharge disposition for those with COVID-19 lesions compared to those who developed HAPU/Is. RESULTS: Of those who developed lesions, 2.3% developed COVID-19 lesions and 7.2% developed HAPU/Is. Patients with COVID-19 lesions were more likely to be male (64%), younger (median age 60), and had a higher BMI (30) than patients with no wounds and patients with HAPU/I. CONCLUSION: This study advances the knowledge of the patient demographics and treatments that may contribute to identifying the new phenomenon of COVID lesions and how they differ from HAPU/Is.
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COVID-19 , Úlcera por Presión , Humanos , Masculino , Persona de Mediana Edad , Femenino , Úlcera por Presión/epidemiología , Úlcera por Presión/terapia , Estudios Retrospectivos , COVID-19/epidemiología , Demografía , HospitalesRESUMEN
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Envejecimiento de la Piel , Anciano , Cuidadores , Familia , Grupos Focales , HumanosRESUMEN
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Cuidadores , Familia , Grupos Focales , Humanos , Cicatrización de HeridasRESUMEN
BACKGROUND: Pressure ulcers/injuries are not only prevalent in the long-term care facilities but also in the acute care setting. Pressure ulcer development has many contributing factors, including prolonged high surface interface pressure between the skin and mattress surface. PURPOSE: The purpose of this quality improvement project was to measure the pressure redistribution properties of 4 hospital surfaces. METHODS: Pressure measurements were performed on 8 participants lying on 1) standard mattress; 2) standard mattress with a static, air-filled bed overlay placed on top of it; 3) mattress with pulsing technology; and 4) mattress with immersing technology. Participants were volunteers measured while lying in the supine position and, in one instance, in the prone position. Pressures were measured with a full-body interface pressure mapping system. RESULTS: Of the 4 surfaces evaluated, the surface that provided the most effective pressure redistribution properties was the combination of the standard viscoelastic mattress with the static, air-filled overlay. CONCLUSION: These results can help guide surface choice for providing the best pressure redistribution properties in order to help prevent pressure ulcers/injuries.
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Úlcera por Presión , Lechos , Hospitales , Humanos , Úlcera por Presión/prevención & control , Mejoramiento de la Calidad , PielRESUMEN
INTRODUCTION: Hospital-acquired pressure ulcer/injury (HAPU/I) often occurs postoperatively despite preventative interventions. The authors recently found an increasing incidence of HAPU/I in patients having prolonged operating room (OR) procedures in both the bent knee and lithotomy positions. OBJECTIVE: The aim of this study was to measure and compare 2 different OR surfaces in both the supine with bent knees position and the supine in lithotomy position. The authors sought to identify the most effective pressure redistribution surface in different positions to prevent HAPU/I in surgical patients. MATERIALS AND METHODS: Using a pressure mapping device, the authors measured and compared 5 volunteers on the standard OR surface and on the standard surface with the static, air-filled cushion on top. RESULTS: Use of the static, air-filled seat cushion placed on top of the standard OR surface resulted in lower peak pressures and higher skin contact surface area than the standard OR surface alone. CONCLUSIONS: This study showed that use of the static, air-filled seat cushion on top of the standard OR surface resulted in superior pressure redistribution properties in both the supine with bent knees position and supine in lithotomy position compared with the standard OR surface alone.
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Quirófanos , Úlcera por Presión , Humanos , Úlcera por Presión/prevención & control , Posición SupinaRESUMEN
BACKGROUND: Pressure ulcers/injuries (PU/Is) negatively affect patients by causing pain and increasing morbidity and mortality risks. Care teams have a heightened sense of awareness of the condition and may feel confident in their ability to appropriately identify and manage PU/Is, but the potential for, and consequences of, a misdiagnosis always should be considered. PURPOSE: The purpose of this compendium is to describe and illustrate conditions that may mimic PU/Is. METHODS: Advanced practice wound care nurses were asked to identify and describe conditions that may mimic PU/Is. Permission was obtained from all patients to use their cases and photos in this article. RESULTS: Sixteen (16) different skin and wound presentations resulting from vascular diseases, systemic infections, trauma, cancer, autoimmune disorders, coagulopathies, and multisystem organ dysfunction were identified and described. CONCLUSION: A complete patient history and assessment will help prevent misidentification of the etiology of a skin lesion or wound and misdiagnosis of these lesions as PU/Is.
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Úlcera por Presión , Humanos , Úlcera por Presión/diagnósticoRESUMEN
A pressure ulcer/injury (PU/I) is caused by multiple factors with sustained pressure being the major contributor to its development. This pressure may be measured by a health care provider using a pressure mapping device in order to assess pressure distribution properties of surfaces used. This educational article describes a general overview, the value, how to perform, and how to incorporate pressure mapping into clinical practice. Also included is an exemplar of a nurse and a physical therapist using pressure mapping to identify the best surface and position for a wheelchair-bound patient in order to minimize PU/I risk.
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Úlcera por Presión/prevención & control , Presión , Cuidados de la Piel/métodos , Lechos , Diseño de Equipo , Humanos , Guías de Práctica Clínica como Asunto , Reproducibilidad de los ResultadosRESUMEN
Research about community-acquired pressure ulcer/injuries (CAPU/I) remains limited. PURPOSE: The aim of this descriptive, retrospective study was to quantify the number of patients with pressure ulcers/injuries (PU/Is) present on admission (POA), with particular attention to patient residence (home or skilled/long-term care facility [SNF]). METHODS: Data from the electronic medical records (EMR) and the incident reporting system of a 620-bed integrated health system in northern California from January 1, 2017, to December 31, 2017, were examined and used to create a registry that included patient demographics, length of stay (LOS), source of admission (home versus SNF), co-existing conditions, and documentation on end of life and death. A manual chart review was conducted to confirm the accuracy of data entered into the registry. All patients at least 18 years old and with a nurse-reported incident and EMR-documented PU/I that was listed as POA were included; pediatric, pregnant, or incarcerated patients were excluded. Extracted variables included demographic data, stage of PU/I on admission, and major diagnosis (or co-existing condition) by groups (spinal cord injuries [tetraplegia, paraplegia], neurological conditions, end-stage renal disease, cardiac and vascular disease, end of life [EOL], and death while in hospital during the year 2017). Descriptive analysis was used to examine the data. RESULTS: Of the 2340 records of patients with an PU/I POA, 477 were complete and analyzed. The majority (336, 70.4%) originated from home. Patients admitted from home were younger than those admitted from SNF (average age 62.9 and 71.5 years, respectively) and had a higher proportion of co-existing paraplegia/tetraplegia (24.4% vs 12.8%). More than 60% of all patients had a stage 3, stage 4, or unstageable PU/I. CONCLUSION: The majority of patients with a PU/I POA were admitted from home. Additional research and improved efforts to help high-risk individuals living at home prevent and manage PU/Is are needed.
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Transferencia de Pacientes/normas , Úlcera por Presión/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Servicios de Salud Comunitaria , Comorbilidad , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Servicios de Atención de Salud a Domicilio/normas , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Casas de Salud/normas , Casas de Salud/estadística & datos numéricos , Transferencia de Pacientes/clasificación , Transferencia de Pacientes/estadística & datos numéricos , Úlcera por Presión/epidemiología , Úlcera por Presión/fisiopatología , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Hospital-acquired pressure ulcers/injuries (HAPU/I) have been a major focus of research, but information about community-acquired pressure ulcer/injuries (CAPU/I) is limited. PURPOSE: The aim of this study was to compare HAPU/I and CAPU/I in a 620-bed academic medical center in the western United States. METHODS: This descriptive study involved prospective/retrospective data collected from the National Data for Nursing Quality Indicators, including pressure ulcer stage (January 1, 2015, through December 31, 2017); the hospital's incident reporting system (January 1, 2017, through December 31, 2017); electronic medical records (EMR) as needed for verification; and the hospital's pressure ulcer registry (January 1, 2012, through December 31, 2017), developed by both EMR and manual extraction. Data regarding point prevalence, length of stay (LOS), source of admission, ulcer stage, and frequency of hospital encounters from patients at least 18 years of age with a pressure ulcer/injury documented in their records were abstracted. Data from pregnant or incarcerated persons and persons with missing or incomplete information on staging or origin of admission were excluded. Variables were analyzed using descriptive statistics. RESULTS: The number of patients with data reviewed for point prevalence was 1787 for 2015, 1989 for 2016, and 1917 for 2017. For 2015, the average CAPU/I and HAPU/I point prevalence was 6.6% and 0.8%, respectively; for 2016, 6.0% and 1.5%, respectively; and for 2017, 6.9% and 0.9%, respectively. The average LOS for patients analyzed for 2017 admitted with a CAPU/I or HAPU/I was 10.5 days and 38.9 days, respectively. Hospital encounters were more frequent in the CAPU/I than in the HAPU/I group, with 821 CAPU/encounters compared to 45 HAPU/I encounters. The majority of patients with a HAPU/I (80%) or CAPU/I (65.4%) were admitted from home. CONCLUSION: In this study, CAPU/I were more prevalent than HAPU/I and most patient encounters originated from home. More descriptive research that includes staging and source of admission is needed to document the rate of CAPU/I and characteristics of HAPU/I compared to CAPU/I in order to optimize pressure ulcer/injury practices across the continuum of care.
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Úlcera por Presión/clasificación , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Estudios de Cohortes , Registros Electrónicos de Salud/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Úlcera por Presión/epidemiología , Prevalencia , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaRESUMEN
: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Cuidadores/educación , Rol de la Enfermera , Cuidados de la Piel/métodos , Infección de Heridas/enfermería , Antibacterianos/administración & dosificación , Manejo de la Enfermedad , Familia , Femenino , Grupos Focales , Humanos , Masculino , Infección de Heridas/prevención & controlRESUMEN
: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Envejecimiento de la Piel/fisiología , Cuidados de la Piel/enfermería , Dieta , Emolientes/uso terapéutico , Humanos , Úlcera por Presión/terapia , Enfermedades de la Piel/fisiopatología , Enfermedades de la Piel/terapiaRESUMEN
Deep tissue injury (DTI) may develop in critically ill patients despite implementation of preventive interventions. A retrospective, descriptive study was conducted in a 620-bed, level 1 trauma, academic medical center with 7 adult intensive care units ([ICUs] cardiac surgery, trauma surgery, burn surgery, med-surgery, neurosurgery, medical, and transfer) among patients treated from January 1, 2010 to January 1, 2015. All patients 18 years of age or older that developed a sacral DTI that evolved into a Stage 3, Stage 4, or unstageable hospital-acquired pressure ulcers (HAPU) in the ICU were included. Control group data were obtained from a sample of ICU patients who did not develop a DTI during 1 random day during that time period. Data were extracted from electronic medical records to compare ICU patients that developed a DTI (n = 47; age 55 [range 28-93] years, 28 men) to those who did not develop a DTI (n = 72; age 58.9 [range 18-94] years, 46 men). Twenty-five (25) potential sociodemographic and clinical risk factors were identified from root cause analysis and measured for significance. Systolic and diastolic blood pressure, length of surgery, hematocrit levels, international ratio, dialysis treatments, history of shock or vasopressor use, and total Braden score were significantly (P <.05) different between the general and HAPU population. Braden scores were low for general ICU (15.0 ± 0.4) and HAPU patients (12.9 ± 0.3) (P = 0.03). Multivariate, univariate, and regression analysis showed patients with poor perfusion (low blood pressure) (OR 0.93; 95% CI 0.88-0.99), prolonged surgical procedures (time in surgery OR 1.20; 95% CI 1.07-1.33), or a history of dialysis (OR 4.0; 95% CI 0.060-0.99) and shock (OR 10.0; 95% CI 0.025-0.43) were at greatest risk for the development of DTI evolving into a Stage 3, Stage 4, or unstageable HAPU. For every mm Hg decrease in diastolic blood pressure, the odds of a DTI increased by approximately 7.5% (1/0.93 = 1.075). For every hour increase in surgery, the odds of developing a DTI increased by 20%. These data suggest when all modifiable (Braden Scale-identified) risk factors are addressed, as was the case in this population, patient-related risk factors may be more important for HAPU development in ICU patients than quality of nursing care variables. Future research should focus on the role of and methods to increase perfusion to prevent DTI development, especially during dialysis and surgical procedures.
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Úlcera por Presión/etiología , Úlcera por Presión/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Enfermedad Crítica/enfermería , Femenino , Humanos , Enfermedad Iatrogénica/prevención & control , Unidades de Cuidados Intensivos/organización & administración , Masculino , Persona de Mediana Edad , Perfusión/efectos adversos , Perfusión/normas , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Mortality and health care costs associated with hospital-acquired pressure ulcers (HAPUs) increase yearly. After four hours of surgery, the risk of developing a pressure ulcer increases by 33% for every 30 minutes of surgery. Prolonged immobility, lower blood pressures, and increased surface interface pressure may hinder the blood supply delivered to the skin, eventually leading to pressure ulcers. We measured and compared four different OR surfaces to identify the most effective pressure redistribution surface for prolonged OR procedures. The best surface attributes that provide efficient pressure redistribution should have the following properties: the lowest average interface pressure, the lowest peak interface pressure, and the highest skin contact area. Although all surfaces had similar average interface pressures, the air-inflated static seat cushion had the best pressure redistribution properties in the sacral region compared with the other surfaces tested.