Incidence, severity and characteristics of medical device-related pressure injuries in adult intensive care patients: A single-centre, cross-sectional study.

AIM: This study aimed to determine the incidence, severity and characteristics of medical device-related pressure injuries in intensive care units. METHODS: This is a cross-sectional study. Data were collected from 187 patients admitted to the Anaesthesia and Reanimation intensive care unit of a university hospital between January and May 2023. The skin of the patients enrolled in the study was assessed for the presence of medical device-related pressure injuries, and all medical devices used were recorded. Data were collected using the Patient Identification Form, the Medical Device-Related Pressure Injury Follow-up Form, and the Braden Scale for Predicting Pressure Ulcer Risk. RESULTS: It was found that 30.6% of the patients developed medical device-related pressure injuries; of these, 73.7% had stage I pressure injuries. We found that 36.8% of the patients were diagnosed with medical device-related pressure injuries within 8-11 days. The results showed that endotracheal tube (61.4%), non-invasive ventilation/oxygen mask (52.6%), Foley catheter (49.1%), and nasogastric tube (36.8%) devices were the most common causes of the development of medical device-related pressure injuries. Patients' demographic characteristics were found to have a significant effect on the development of medical device-related pressure injuries (p < .05). CONCLUSION: The study found that the incidence of medical device-related pressure injuries was relatively high and that a relationship was observed between the patients' demographic characteristics and medical device-related pressure injuries. It is crucial that ICU nurses, who are more likely to encounter medical device-related pressure injuries, consider these factors when caring for their patients and take appropriate preventive measures to reduce the incidence of these injuries.

Overlooked Pain Assessment Records in Patients with Pressure Injuries During the COVID-19 Pandemic: A Retrospective Data Analysis.

BACKGROUND: During the COVID-19 pandemic, healthcare professionals focused on identifying the cause of hemodynamic instability in patients and may have neglected to assess pressure injury (PI)-related pain. Although pain is an early indicator of PI development, there has been no systematic evaluation of PI-related pain in patients. OBJECTIVE: To review nurses' records of PI-related pain in patients who developed PIs during the COVID-19 pandemic. METHODS: This retrospective, descriptive study included data from 510 patients at one hospital. Collected data included patient demographics (age, sex, diagnosis, and comorbidities), PI classification, and assessment of PI-related pain. Assessment data regarding PI-related pain included the characteristics of the pain, the type of analgesia (pharmacologic/nonpharmacologic) administered before and after PI management (debridement, dressing change, etc), the route of administration, and the frequency of pain assessment before and after analgesia. RESULTS: The mean age of the patients (60.4% men) was 28.96 (SD, 5.82) years, and the mean length of hospital stay was 26.15 (SD, 16.1) days. Overall, 43.1% of the patients were treated in the ICU, 68.0% were conscious, and 18.6% tested positive for COVID-19. Deep-tissue injuries occurred in 57.5% of patients, with 48.6% developing stage 2 PI. The sacral region was the most common area for PI development (44.8%). The mean duration of repositioning in patients with PI was 23.03 (SD, 5.4) hours. Only 0.40% of patients (n = 2) were evaluated for pain, and only one patient was assessed for pain before and after analgesia was administered. CONCLUSIONS: The findings suggest a lack of comprehensive evaluation and records concerning PI-related pain in patients with COVID-19.

Sacral Ulcer Development Risk Among Older Adult Patients in North Texas Rehabilitation Hospitals: Role of Comorbidities, Lifestyle, and Personal Factors.

PURPOSE: Sacral ulcers are a serious mortality risk for older adults; thus, we aimed to determine sacral ulcer risk factors among older adults who were recently admitted to rehabilitation hospitals. METHOD: We conducted a retrospective cohort study using the Texas Inpatient Discharge database (2021). The study included 1,290 rehabilitation hospital patients aged ≥60 years diagnosed with sacral ulcers. The control group comprised 37,626 rehabilitation hospital patients aged ≥60 years without sacral ulcers. Binary logistic regression was used to identify risks for sacral ulcer development adjusting for patient demographics, insurance type, and lifestyle. RESULTS: Comorbidities of dementia, Parkinson's disease, type 2 diabetes, and cardiac dysrhythmias were significantly associated with increased risk of sacral ulcers. Longer length of stay, Medicare, and Medicare HMO were also associated with sacral ulcers. Demographically, older age, male sex, identifying as African American, and having malnutrition all had a 50% increased prevalence of sacral ulcers. CONCLUSION: Findings indicate a need to proactively treat chronic comorbidities in vulnerable populations to reduce their possible risk for hospital-acquired infections and excess mortality from sacral ulcers. [Journal of Gerontological Nursing, 50(2), 32-41.].

Comparison of four risk assessment scales in predicting the risk of intraoperative acquired pressure injury in adult surgical patients: a prospective study.

OBJECTIVE: To develop and compare four predictive models for intraoperative acquired pressure injury (IAPI) in surgical patients. METHODS: One hundred patients undergoing various surgeries (hepatobiliary, pancreas, spleen, gastrointestinal, and cardiac surgeries) at Ruijin Hospital from November 2021 to September 2022 were included in this prospective cohort study. Four pressure injury risk assessment scales were used to measure the pressure injury risk: the Braden scale, Munro Pressure Injury Risk Assessment Scale, Scott Triggers tool, and CORN Intraoperative Acquired Pressure Injury Risk Assessment Scale. The patients were divided into the IAPI group and non-IAPI group. RESULTS: In total, 37% of patients (37/100) developed class I/stage pressure injury (erythema) after surgery, which resolved within 2 hours after surgery in 86.49% of cases and further progressed to class II/stage or higher pressure injury within 6 days in 15.63% of cases. The application effects of the four commonly used risk assessment tools were compared with the sensitivity, specificity, and area under the receiver operating characteristic curve. The Munro Scale showed the best sensitivity and area under the receiver operating characteristic curve among the four tools for postoperative assessment, but its specificity was only 20.63. CONCLUSIONS: More appropriate assessment tools are required for IAPI risk evaluation.

Using a Decision Tree Approach to Analyze Key Factors Influencing Intraoperative-Acquired Pressure Injury.

OBJECTIVE: To determine the key factors influencing intraoperative-acquired pressure injury (IAPI). METHODS: Researchers assessed 413 surgical patients in a Shanghai tertiary hospital using an information collection form and an IAPI occurrence record form. Analysis took place using the classification and regression tree algorithm and multiple logistic regression. RESULTS: A total of 43 surgical patients (10.4%) had IAPI, including 32 stage 1 cases (74.4%), and 11 stage 2 cases (25.6%). The multiple logistic regression analysis indicated that operation duration, surgical position, preoperative hypertension, and preoperative Braden Scale risk score were independently associated with IAPI development. The decision tree showed that preoperative Braden Scale score, surgical position, operation grade, operation duration, age, prealbumin level, and body mass index were important factors and that preoperative Braden Scale score was the most critical decision variable. The cross-validation method was used to indicate a model accuracy of 91.8%. CONCLUSIONS: The decision tree effectively identified key factors for IAPI, complementing the logistic regression analysis and providing a scientific basis for the further development of structural risk assessment, prevention, and treatment strategies for IAPI.

The Shieh Score as a Risk Assessment Instrument for Reducing Hospital-Acquired Pressure Injuries: A Prospective Cohort Study.

PURPOSE: The purpose of this study was to evaluate the Shieh Score's effectiveness in decreasing the rate of hospital-acquired pressure injuries when combined with an early warning notification system and standard order set of preventative measures. DESIGN: This was a prospective cohort study. SUBJECTS AND SETTING: This target population was nonpregnant, adult, hospitalized patients on inpatient and observation status at a tertiary hospital (Kaiser Permanente, Baldwin Park, California) during the 2020 year of the COVID-19 pandemic. METHODS: A new, risk assessment instrument, the Shieh Score, was developed in 2019 to predict hospitalized patients at high risk for pressure injuries. Data collection occurred between January 21, 2020, and December 31, 2020. When a hospital patient met the high-risk criteria for the Shieh Score, a provider-ordered pink-colored sheet of paper titled "Skin at Risk" was hung at the head of the bed and a standard order set of pressure injury preventative measures was implemented by nursing staff. RESULTS: Implementation of the program (Shieh Score, early warning system, and standard order set for preventive interventions) resulted in a 38% reduction in the annual hospital-acquired pressure injury rate from a mean incidence rate of 1.03 to 0.64 hospital-acquired pressure injuries per 1000 patient-days measured for the year 2020. CONCLUSION: The Shieh Score is a pressure injury risk assessment instrument, which effectively identifies patients at high risk for hospital-acquired pressure injuries and decreases the hospital-acquired pressure injury rate when combined with an early warning notification system and standard order set.

[Health policy approach to the treatment and prevention of pressure ulcers]. / A felfekvés (decubitus) ellátásának és megelozésének szakmapolitikai megközelítése.

INTRODUCTION: A pressure sore (decubitus) is a wound that develops on the skin and subcutaneous tissue in places exposed to pressure. Primarily occurs in elderly, non-mobile individuals, the prevention and control of which requires not only medical and nursing participation, but it also financial expenditure. OBJECTIVE: In our study, after a systematic document analysis, we present the relevant results of the decubitus survey conducted among state hospitals during Q2 of 2022, focusing on the organizational and management factors of decubitus prevention and care. METHOD: The national survey was comprehensive in terms of the range of institutions relevant to decubitus care. After defining the selection criteria, we got a picture of 86 institutional practices for the base year of 2019. RESULTS: During the review and systematization of domestic and European Union professional policy documents, regulators and strategy documents, it can be established that pressure ulcer prevention and care can be adapted to several development policy objectives, and its incidence appears as a quality indicator of the health sector. DISCUSSION: Based on the results of our national decubitus survey, it can be said that domestic good practices operate in isolation, our reporting system is inhomogeneous, and the documentation is not uniform in our institutional system. 17 of the 86 institutions have new (2021-2022) documents regulating decubitus care at the institutional level, which in 17% of the institutions are dated 2010 or earlier. The scope of revision of the regulatory documents is set at 10% of the institutions. 61 of the examined institutions (71%) operate decubitus teams, 55 institutions (64%) use prophylactic bandages. There is a lack of professional monitoring measures and quality indicators, institutional-level expenditure analyses, controlling-type feedback, which would form the basis of costing and cost-effectiveness analyses. CONCLUSION: In addition to our proposals for several organizational and managerial measures, we advocate the renewal of the relevant professional directive and the introduction of a uniform institutional reporting system as well. Orv Hetil. 2023; 164(21): 821-830.

Assessment of the risk factors for intraoperative pressure injuries in patients.

AIM: This study was conducted to assess the risk factors for pressure injuries in patients during surgery. METHODS: In this descriptive cross-sectional study, the risk of pressure injuries during surgery was evaluated in 250 patients in a university hospital. Data were collected through a Patient Descriptive Information Form (PDIF) and the 3S Intraoperative Pressure Injury Risk Assessment Scale (IPIRAS). RESULTS: The mean age of the patients was 44.15 ± 17.00, and 52.4% were female. In addition, it was determined that the mean 3S IPIRAS score was higher in patients who were male, were aged ≥60 years, were obese, had a chronic disease, and had low serum albumin and hemoglobin levels (p < .05). During the surgery of the patients included in the study, support surfaces were used in 67.6%, positioning aids were used in 82.4%, and 55.6% had normal skin. Patients who underwent CVS procedures for more than 6 h, did not use support surfaces during surgery, had moist skin, or used vasopressors had higher and significantly different mean 3S IPIRAS scores (p < .05). CONCLUSIONS: According to the results, all surgical patients were at risk for pressure injury in the intraoperative period. In addition, it was found that male gender was associated with risk factors and that being aged ≥60 years, obesity, chronic disease, low serum hemoglobin and albumin levels, CVS, operations lasting more than 6 h, moist skin, vasopressor drugs, and not using support surfaces during surgery increased the risk of pressure injuries significantly.

Development and psychometric property testing of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool.

AIMS: We aimed to develop and test the psychometric properties of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool. BACKGROUND: Assessment of nurses' knowledge and practices is critical in the prevention of Medical Device-related Pressure Injuries. DESIGN: This was an instrument development and testing study. METHODS: The sample of the study consisted of nurses (n = 189). The study was conducted in three phases between January and February 2021. In the first phase, multiple-choice items contained within Aetiology/Risk Factors, Prevention Interventions, and Staging domains were created. In the second phase, content validity and criterion validity were evaluated, and the tool was pre-tested. The third phase examined item difficulty, discrimination index and distractor quality. The test-retest method was used for reliability. RESULTS: The Content Validity Index was found to be 0.75, 0.86 and 0.96 for the domains of Aetiology/Risk Factors, Prevention and Staging, respectively. The item difficulty values of the items were between 0.18 and 0.96. A positive, strong and significant relationship was found between the results and a positive, moderate and significant relationship between the tools administered for the proof of scale validity. The Cronbach's alpha reliability coefficient was found to be 0.54. CONCLUSIONS: The tool is a suitable measurement instrument for use in nursing education, research and clinical settings.

EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: the EEPOC trial.

BACKGROUND: Prophylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients. METHODS: This is a multicentre, pragmatic, parallel group, randomised controlled trial. A sample size of 1320 was calculated to have >90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses. DISCUSSION: This trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19. TRIAL REGISTRATION: ANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019.

Risk assessment scale for pressure ulcers in pediatric patients: French translation, internal consistency, convergent validity, feasibility, and clinical utility of the Braden QD Scale / Échelle d'évaluation des risques d'escarres en pédiatrie : traduction en langue française, cohérence interne, validité convergente, faisabilité et utilité clinique de l'échelle Braden QD

Introduction: Pediatric patients are particularly vulnerable to pressure ulcers. Structured evaluation with a risk assessment tool is recommended in order to identify patients at risk. The Braden QD Scale integrates the risks of both immobility-related and medical device-related pressure ulcers in pediatric patients. Objectives: To translate and pretest the Braden QD Scale into French (Swiss-French version), and to evaluate its consistency, convergent validity, feasibility, and clinical utility. Method: Over five prevalence surveys, the Braden QD Scale was used on all hospitalized pediatric patients. Convergent validity and internal consistency were tested. A self-administered questionnaire on feasibility and clinical utility was completed by nurses. Results: The translated version of the Braden QD Scale was pretested on 352 children. The prevalence surveys showed that 5.1% were at risk of developing pressure ulcers. Medical devices were present in 85.8% of cases. A Cronbach's alpha of 0.710 and a high convergent validity were measured. High scores of feasibility and clinical utility were found. Discussion and conclusion: This study suggests that the Swiss-French version of the Braden QD Scale is reliable, valid, feasible, and has clinical utility.

Introduction: La population pédiatrique est particulièrement vulnérable aux escarres. Afin d'identifier les patients à risques, une évaluation structurée est recommandée. L'utilisation de l'échelle Braden QD permet d'intégrer les risques liés à l'immobilité et à la présence de dispositifs médicaux. Objectifs: Réaliser une traduction en langue française (suisse francophone), un test de l'échelle Braden QD, évaluer sa cohérence interne, sa validité convergente, sa faisabilité et son utilité clinique. Méthode : lors de cinq enquêtes de prévalence, l'échelle Braden QD a été utilisée auprès de tous les enfants hospitalisés. Des tests psychométriques ont été mesurés. Un questionnaire de faisabilité et d'utilité clinique a été distribué aux enquêtrices. Résultats: L'échelle traduite a pu être testée auprès de 352 enfants. Les enquêtes ont montré que 5,1 % étaient à risques de développer une escarre et 85,8 % étaient porteurs de dispositifs médicaux. Un alpha de Cronbach à 0,710, avec une validité convergente élevée, de hauts scores de faisabilité et d'utilité clinique ont été retrouvés auprès des infirmières. Discussion et conclusion: Cette étude suggère que la version suisse francophone de la Braden QD est faisable, fiable et valide. Les infirmières ont estimé qu'elle était facile à utiliser et utile pour leur pratique.

Barriers and facilitators to reporting medical device-related pressure ulcers: A qualitative exploration of international practice.

BACKGROUND: Pressure ulcers are a complex healthcare issue. Hospital-acquired pressure ulcers are used as proxy measurements for the quality and safety of nursing care. Medical device-related pressure ulcers are mostly facility acquired, but their reporting has only recently been widely adopted. Consequently, we do not yet know what factors impact their reporting by registered nurses. OBJECTIVES: To identify and systematically report determinants of the practice of medical device-related pressure ulcers reporting using the Tailored Implementation for Chronic Diseases checklist. DESIGN: Descriptive, explorative design using semi-structured interviews to explore barriers and facilitators to reporting medical device-related pressure ulcers. SETTING: We undertook online, telephone, and face-to-face interviews with participants from 11 different countries. PARTICIPANTS: We interviewed 17 participants who represented acute care (Adult, Paediatrics), academia, and industry. Eleven participants were healthcare professionals with more than 10 years' experience in wound care. METHODS: The interview recordings were transcribed and coded by the lead researcher. Data were analysed thematically using the codebook approach, and themes were developed inductively and deductively. RESULTS: Participants identified determinants of practice which clustered around four domains of the Tailored Implementation for Chronic Diseases checklist i) individual health professional factors, ii) professional interactions, iii) incentives and resources, and iv) capacity for organisational change. Knowledge, attitudes, workload, time, staffing, and perception of consequences, including financial, were identified as the main barriers to reporting. Factors supporting the practice were education, openness, and teamwork. Device procurement could take on characteristics of a barrier or facilitator depending on the organisation. CONCLUSIONS: Reporting medical device-related pressure ulcers has been adopted in healthcare institutions worldwide. Understanding what drives the reporting practice enables improvements in incident reporting, which consequently can lead to improvements in the quality of nursing care and patient safety.

Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit.

BACKGROUND: Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury. METHODS: Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury. RESULTS: A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination. CONCLUSIONS: Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.

The effect of a pressure ulcer prevention care bundle on nursing workload costs.

AIM: This study investigated the effect of care under the guidance of a pressure ulcer prevention care bundle on pressure ulcer incidence rates and on nursing workload costs. DESIGN, SETTING, AND PARTICIPANTS: This prospective pre-post interventional study was conducted in an anesthesia and reanimation intensive care unit. The sample consisted of 16 nurses and 84 patients. METHODS: The study was conducted in two periods: (1) nursing workload of pre-care bundle period and (2) nursing workload of post-care bundle period. In the collection of data, 6 forms (the demographic data forms, the Braden scale, nurse information form, the care bundle follow-up form and nursing workload follow-up form) were administered. The main outcomes of the study; Pressure ulcer incidence rate was evaluated with Form V, and nursing workload costs were evaluated with Form VI. These forms were evaluated daily by the nurses. In the first period (15.09.2018-30.11.2018), pressure ulcer incidence rates and nursing workload costs were evaluated before training. Then, the researcher trained nurses on how to prevent pressure ulcers and use the care bundle. The care bundles components were risk assessment, skincare, activity, in-service training, nutrition, wetness/incontinence and support surface management, and keeping records. In the second period (01.12.2018-15.02.2019), pressure ulcer incidence rates and nursing workload costs were evaluated after the training. The outcomes of the two periods regarding the incidence of pressure ulcers and nursing workload costs were compared. RESULTS: The pressure ulcer incidence rates before and after the care bundle were 22.1 and 13.0 per 100 patient-day, respectively. There was a decrease in pressure ulcer incidence rates after the care bundle, but it wasn't significant (p = 0.138). The total workload cost of pressure ulcer prevention was significantly lower after the care bundle than before (p = 0.001). CONCLUSION: The pressure ulcer incidence rates were lower after the care bundle than before, albeit insignificantly. The total pressure ulcer prevention workload costs were significantly lower after the care bundle than before. The reduction in pressure ulcer incidence and workload cost indicates that the use of care bundle is effective. Healthcare professionals in intensive care units should use a pressure ulcer prevention care bundle more often.

Munro Pressure Ulcer Risk Assessment Scale in Adult Patients Undergoing General Anesthesia in the Operating Room.

Pressure ulcers are a common complication of immobility and frequently occur in surgical patients. The occurrence of pressure ulcers is affected by many factors, such as operation time and position, anesthesia method, and postoperative nursing. The aim of this study was to investigate the Munro Pressure Ulcer Risk Assessment Scale's value in predicting acute pressure ulcers in general anesthesia patients. This case-control study included patients who underwent more than 2 hours of general anesthesia in our hospital from January 2018 to December 2020. The case group comprised 42 patients who had pressure sores in surgical compression sites within 3 days after surgery. The control group consisted of 84 patients without acute pressure sores after surgery. Baseline patient data were compared between the two groups, and a logistic multivariate model was used to analyze potential risk factors for acute pressure ulcers. The Munro Pressure Ulcer Risk Assessment Scale scores and Braden scale scores were compared between the two groups during and after surgery. A receiver operating characteristic curve was used to evaluate the clinical value of the two scales (administered at the two time points) in predicting the occurrence of acute pressure ulcers after surgery. The operation and anesthesia times of patients in the case group were longer than those in the control group (P < 0.05). The proportion of comatose patients and patients with diabetes were significantly higher in the case group. While the case group had higher Munro scores during and after surgery compared to the control group (P < 0.05), Braden scores at the corresponding time points were lower (P < 0.05). The following variables were identified as independent risk factors of acute pressure ulcers: prolonged operation time and anesthesia time, increase in Munro scores during and after operation, decrease in Braden scores during and after operation, and comatose status (P < 0.05). The area under the receiver operating characteristic curve (AUC) of the postoperative Munro score for predicting postoperative pressure ulcer risk was 0.774; the sensitivity and specificity were 67.73% and 80.58%, respectively. The AUC of the intraoperative Braden score for predicting postoperative pressure ulcer risk was 0.836, with a sensitivity of 78.95% and specificity of 78.00%. The AUC of the postoperative Braden score for predicting postoperative pressure ulcer risk was 0.809, with a sensitivity of 73.58% and specificity of 64.26% (P < 0.05). Our results indicate that the intraoperative Munro Pressure Ulcer Risk Assessment Scale is highly effective for predicting the risk of postoperative pressure ulcers in surgical patients who require general anesthesia.

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 STUDY: This 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 METHODS: The 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. RESULTS: A 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. CONCLUSIONS: The 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.

Electrical stimulation to prevent recurring pressure ulcers in individuals with a spinal cord injury compared to usual care: the Spinal Cord Injury PREssure VOLTage (SCI PREVOLT) study protocol.

BACKGROUND: Pressure ulcers (PUs) on the buttocks are among the most common secondary complications in individuals with chronic spinal cord injury (SCI). PUs can result from sitting for extended periods, disuse atrophy, increased sitting pressure and reduced circulation. Compared with usual care, activation of paralysed muscles using electrical stimulation (ES) has been shown to markedly increase paralysed muscle mass, improve circulation of skin and muscle and improve sitting pressure distribution. ES might therefore be a useful method to reduce PU incidence. METHODS: A multicentre randomized controlled trial (SCI PREVOLT) will be conducted with an economic and process evaluation alongside. One hundred participants with a SCI in the chronic phase and a minimal incidence of 1 PU in the last 5 years will be recruited from rehabilitation centres across the Netherlands. Participants will be stratified by centre and age and randomized to the intervention or control group. The intervention group will use ES at least 1 h/day during at least 4 times a week for 1 year next to usual care. The control group will only receive usual care. The primary outcome is the incidence of PUs, measured by a blinded person assessing the presence or absence of a PU on the buttocks on a photo made by the participant or his/her caregiver. The incidence of a PU will be evaluated every 2 weeks. Secondary outcomes include interface pressure distribution, blood flow in the profunda femoris artery, muscle thickness of the hamstrings and gluteal muscles and questionnaires about different dimensions of life, e.g. participation and quality of life. Secondary outcomes will be measured at baseline and 3, 6, 9 and 12 months after randomization. DISCUSSION: This study will assess if electrical stimulation is a (cost-)effective method to prevent PUs and reduce the risk factors of getting PUs. If ES is effective and cost-effective compared with usual care, ES could be implemented in daily treatment of individuals with a SCI. TRIAL REGISTRATION: Netherlands Trials Register NTR NL9469 . Registered on 26 May 2021.

Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study.

AIM: To examine the incidence and risk factors associated with hospital-acquired pressure ulcers (HAPUs) following total hip arthroplasty (THA) using a large-scale national database. MATERIAL AND METHODS: A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005 to 2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), total charges during hospitalization, in-hospital mortality, preoperative comorbidities, and perioperative complications were assessed. RESULTS: The general incidence of HAPUs after THA was 0.05%, with a fluctuating trend annually. Patients suffered from HAPUs were older, less likely through elective admission, more likely in large hospital, more usage of Medicare, and less possibly paying via Private insurance. Additionally, the occurrence of HAPUs was associated with more preoperative comorbidities, longer LOS, extra total charges, and higher in-hospital mortality. Risk factors associated with HAPUs included advanced age (≥75 years), large hospital, multiple comorbidities (n ≥ 3), diabetes with chronic complications, drug abuse, liver disease, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disorders, psychoses, chronic renal failure, peptic ulcer disease, and weight loss. Besides, HAPUs were associated with inflammatory arthritis and femoral neck fracture (compared with primary/secondary osteoarthritis), frailty/senility, osteoporosis, acute renal failure, pneumonia, postoperative delirium, urinary tract infection, deep vein thrombosis, sepsis/septicemia, wound dehiscence/non-healing surgical wound, periprosthetic joint infection, and mechanical prosthesis-related complications. CONCLUSION: It is beneficial to study the risk factors associated with HAPUs after THA to ensure the preventive management and optimize outcomes although a low incidence was identified.