The pressure injury prevalence and practice improvements (PIPPI) study: A multiple methods evaluation of pressure injury prevention practices in an acute-care hospital.

Pressure injuries are a significant problem for immobile patients in acute care and can have a profound impact on patients' health and well-being, putting pressure on healthcare systems and strain on the healthcare economy. Nurses play a pivotal role in preventing pressure injuries. A study using multiple methods was conducted to explore pressure injury prevention practices in four inpatient units within a tertiary-level Australian Hospital. Quantitative and qualitative methods were used to gather data across a 9-month period. Observations, audits, surveys and interviews were used to collect data across five time points. Statistical analysis of the quantitative data was undertaken, and thematic analysis was used to analyse qualitative data. Data were integrated using a realist evaluation framework. Ethical approval for the study was granted. The quantitative results demonstrated significant reductions in pressure injury prevalence from 11.5% at commencement to 4.8% at completion of the study. Hospital-acquired pressure injuries also reduced from 4.6% to 1.9%. These results were achieved even though nursing knowledge and attitudes did not increase during the study period. Three qualitative themes were identified: Making Nursing Care Visible, Understanding the 'Why' and Engagement is Key. This study demonstrates that pressure injuries can be prevented with improvements in nursing care processes. Nurses' knowledge and attitudes towards pressure injury prevention did not change throughout this study and further research is required on how nurses' knowledge and attitudes contribute towards pressure injury prevention practices.

Incidence and Risk Factors for Perioperative Pressure Injuries: Prospective Descriptive Study.

PURPOSE: Pressure injuries can often occur in patients undergoing surgical, diagnostic, or other invasive procedures, so it is important to assess patients in the perioperative period. This study was conducted to determine the incidence and risk factors of perioperative pressure injury. DESIGN: A cross-sectional, prospective, and descriptive study. METHODS: This study involved 158 patients who met the study's eligibility criteria between May 2022 and July 2022. The data were collected using the Patient Information Form, Munro Scale, Braden Scale, and pressure injury staging form. The patients were monitored postoperatively or for 3 days. FINDINGS: Pressure injury developed in 13.9% of the patients. Perioperative risk factors were age, edema, mobilization time, parenteral nutrition, blood transfusion, and glucose level, while preoperative albumin level was lower in patients with pressure injury. In the postoperative period, the risk factors were duration of mobilization and transition to oral feeding, length of intensive care unit stay, and low Braden score. In multivariate analysis, the variables that showed significance with the risk of pressure injury were postoperative Munro score and edema. CONCLUSIONS: It is crucial to evaluate the risk factors for pressure injury in patients who have undergone surgical procedures.

Multidimensional-Based Prediction of Pressure Ulcers Development and Severity in Hospitalized Frail Oldest Old: A Retrospective Study.

Purpose: In recent times, growing uncertainty has emerged regarding the effectiveness of standard pressure ulcer (PU) risk assessment tools, which are suspected to be no better than clinical judgment, especially in the frail and comorbid elderly population. This study aimed to identify the primary clinical predictive variables for PU development and severity in hospitalized older adults, utilizing a multidimensional frailty assessment, and compare them with the Braden scale. Patients and methods: The population consisted of 316 patients, admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital in Sarzana (Italy) during the period 21/02/22-01/07/22. The collected information included both anamnestic and laboratory data. A comprehensive geriatric assessment was performed, including also anthropometric and physical performance measurements. Multivariate logistic analysis was used, both in a binary classification test and in the subsequent ordinal classification test of severity levels. The final performance of the model was assessed by ROC curve estimation and AUC comparison with the Braden scale. Results: Within the population, 152 subjects (48%) developed PU at different levels of severity. The results showed that age, Braden scale (subscales of mobility and friction/shear), Barthel scale, Mini Nutritional Assessment, hemoglobin, and albumin are predictors associated with the development of PU (AUC 85%). The result is an improvement over the use of the Braden scale alone (AUC 75%). Regarding the identification of predictive factors for PU severity, 4AT also emerges as potentially relevant. Conclusion: Assessing the subject's nutritional status, physical performance, and functional autonomies enables the effective integration of the Braden scale in identifying patients most susceptible to developing PU. Our findings support the integration of a comprehensive set of methodologically robust frailty determinants into traditional risk assessment tools. This integration reflects the mutual interplay between patients' frailty, skin frailty, and PU development in very old hospitalized patients.

The uptake of the international pressure ulcer/injury prevention and treatment guidelines: An updated systematic citation analysis.

The European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance collaboratively developed three editions of the International Clinical Practice Guidelines for preventing and treating pressure ulcers/injuries in 2009, 2014, and 2019. Dissemination and uptake of these guidelines are important to improve care. The aim of this work was to provide an updated and expanded citation analysis of the three published guidelines. Referencing formats, citation counts, and global distribution of citations of the 2009, 2014, and 2019 guidelines were searched in the citation database Scopus from 2009 to 2023. Duplicates were removed manually. The search identified 330 referencing formats with 2887 citations from 2009 to 2023 for the three guideline editions. Citations displayed geographical diversity, with citation peaks observed approximately 4 years after each edition's release and ongoing citations to the present. The International Clinical Practice Guidelines for preventing and treating pressure ulcers/injuries updated since 2009 were cited more than 2800 times in the scientific literature exceeding the thresholds of highly cited papers in the field of clinical medicine. This indicates successful dissemination worldwide.

The unavoidable pressure injury/ulcer: a review of skin failure in critically ill patients.

Due to an ageing population and prolonged lifespan, pressure injury (PI) incidence is increasing. Patients with a PI typically endure longer hospital stays, which create a significant burden on healthcare resources and costs. With appropriate preventive interventions, most PIs can be avoided; however, skin failure may become inevitable in particular instances. These are classified as unavoidable PIs. Patients in a critical condition are exposed to a unique set of therapies, medications and bodily states. Oftentimes, these instances decrease tissue tolerance, which may promote PI formation. Patients who are critically ill, especially those with extended stays in the intensive care unit, are susceptible to skin failure due to: prolonged immobility; mechanical ventilation; acute respiratory distress syndrome; COVID-19; sepsis; multiorgan system dysfunction; vasopressor use; and treatment with extracorporeal membrane oxygenation. Poor perfusion leading to skin breakdown results from the compounding factors of circulatory collapse, build-up of metabolites, compromised lymphatic drainage, patient comorbidities, and ischaemia via capillary blockage in patients who are critically ill. In addition, similar physiology is present during end-of-life multisystem organ failure, which creates unavoidable skin deterioration. The aim of this review is to provide an overview of circumstances which decrease tissue tolerance and ultimately lead to PI development, despite adequate preventive measures in patients who are critically ill.

The use of a multimodal wound matrix to treat a variety of hard-to-heal wounds: a case series surveillance.

OBJECTIVE: This case series examines the use of a multimodal wound matrix (MWM) trialled in a selection of clinical practice settings and on a variety of hard-to-heal wounds. The objective was to evaluate the effects of MWM and its performance in managing such wounds, regardless of clinical setting and ulcer type. METHOD: Treatment of the MWM was conducted by independent wound care practitioners on wounds that were of >4 weeks duration. Treatment was once a week. Assessment was taken after four weeks and at week 12 of the study to assess percentage area reduction (PAR) compared to baseline measurements taken at the first treatment visit. Complete (100%) re-epithelialisation was also recorded. RESULTS: A total of 63 wounds were treated with MWM, and ulcer types were grouped as: diabetic foot ulcers (n=21); venous leg ulcers (n=18); pressure injuries (n=10); and others (n=14). Of the wounds, 78% had 100% re-epithelialisation, with an average PAR of 57% at four weeks and 86% at 12 weeks. The average time to resolution for those wounds that closed was 7.9 weeks. CONCLUSION: Results from this series of independent case studies support the application of MWM to potentially benefit healing in hard-to-heal wounds of different aetiologies of any duration and in a variety of clinical settings.

Latent Profile Analysis of Pressure Injury Knowledge Levels Among Nursing Staff in Tertiary General Hospitals.

Aims/Background The prevalence of pressure injuries (PIs) is a widely used clinical indicator of patient safety and quality of care. Nurses' understanding of pressure injury (PI) can significantly impact the treatment outcomes for patients. This study, based on latent profile analysis (LPA), reveals the characteristics associated with PI knowledge levels among clinical nurses in district and county tertiary medical institutions. We aim to help nursing managers formulate training plans accurately so that clinical nurses can provide high-level skin care services for patients. Method In June 2023, 1482 nurse staff from 4 tertiary general hospitals at the district and county level in Chengdu were chosen as research subjects using the convenience sampling method. Responses to the general information questionnaire, the Chinese Version of Pressure Ulcer Knowledge Assessment Tool (C-PUKAT), and the Chinese Version of Attitude towards Pressure ulcer Prevention (C-APuP) were used to compare the population's characteristics based on LPA. Results Three latent profiles of nurses' PI knowledge were identified: weak foundation type (46.3%), strengthening foundation type (42.7%), and special improvement type (11.0%). Subjects' departments, administrative positions, highest degrees and PI prevention attitude scores, as well as whether they have participated in the training, all differed significantly between latent profile groups (p < 0.05). Conclusion The PI knowledge level of nursing staff at the district and county tertiary general hospitals requires urgent improvement. Nursing managers should prioritize the management level and quality of PI training among clinical nursing staff. Precise training programs can be developed based on different categories of nursing staff to enhance their PI knowledge, thereby effectively improving the quality of healthcare for inpatients.

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OBJECTIVES: There is a lack of scientifically validated tools to measure the knowledge attitude and practice (KAP) of informal caregivers for patients with pressure injury (PI). This study aims to develop a KAP Scale for Informal Caregivers of PI Patients and to evaluate its reliability and validity. METHODS: Based on the KAP theory framework and relevant literature, an initial pool of items was created through expert brainstorming sessions. The initial scale was formed after a Delphi expert consultation and a preliminary survey. From April to October 2023, a convenient sample of informal caregivers for PI patients was recruited from an inpatient department of the Third Xiangya Hospital of Central South University, as well as its associated community and nursing homes. The first round included 186 participants, and the second round included 213 participants, who were used for item analysis and reliability and validity testing. After a 3-week interval, 20 participants from the initial group were randomly selected for a retest to assess the test-retest reliability of the scale. RESULTS: The KAP Scale for informal caregivers of PI patients consists of 3 dimensions with 19 items. The overall internal consistency (Cronbach's α) of the scale was 0.916. The item-level content validity index (I-CVI) ranged from 0.826 to 1.000, and the scale level-content validity index/average (S-CVI/Ave) was 0.94. Exploratory factor analysis extracted 3 common factors, accounting for 64.643% of the total variance. Confirmatory factor analysis showed that the model fit the data well, with χ2/df=2.54, root mean square error of approximation (RMSEA)=0.085, comparative fit index (CFI)=0.920, and standardized root mean square residual (SRMR)=0.059. CONCLUSIONS: The KAP scale for informal caregivers of PI patients demonstrates good reliability and validity and can be used to assess the KAP levels of informal caregivers regarding PI.

Characteristics of oral mucosal pressure injuries in children with orotracheal intubation in intensive care units: An observational study.

BACKGROUND: Tracheal intubation can be used for ventilation to ensure an unobstructed respiratory tract, and it is the most common respiratory support technique used in paediatric intensive care unit (PICU) patients. Orotracheal intubation is usually the preferred method of tracheal intubation. However, it can cause stress-related damage to the oral mucosa. Identifying the factors that cause oral mucosal pressure injury (OMPI) can prevent its occurrence in children with oral endotracheal intubation. AIMS: To examine the characteristics of OMPI in children who underwent orotracheal intubation in the PICU and to assess their influencing factors. STUDY DESIGN: An observational, prospective study. Data were gathered from the PICU of a tertiary hospital in China between January 2023 and October 2023. The patient data were obtained from the 'General Information Questionnaire', 'Paediatric Critical Illness Score', 'STRONGkids Scale' and 'OMPI Staging and Assessment Tools'. Data analysis was subsequently performed using univariate and logistic regression analyses. RESULTS: A total of 187 children who underwent orotracheal intubation were analysed. During the observation period, 44.92% (n = 84) of the children developed OMPI. It comprised 63.10% (n = 53) of stage I injuries, 33.33% (n = 28) of stage II injuries and 3.57% (n = 3) of stage III injuries. The common injury sites were the lower jaw (48.81%), upper jaw (29.76%), tongue (20.24%) and joints (10.71%). The logistic regression analysis results revealed that high critical illness (OR = 0.835, 95% CI: 0.726-0.961), long intubation time (OR = 1.043, 95% CI: 1.021-1.067), prone ventilation (OR = 6.708, 95% CI: 1.421-31.670), hypothermia (OR = 5.831, 95% CI: 1.208-28.149), use of dental pads (OR = 5.520, 95% CI: 1.150-26.487) and low albumin levels (OR = 6.238, 95% CI: 1.285-30.281) were the main contributing factors for OMPI in children with orotracheal intubation (p < .05). CONCLUSIONS: The occurrence of OMPI in children who underwent orotracheal intubation in the PICU was notable and was predominantly observed in stages I and II. Consequently, clinical nursing personnel should proactively recognize risk factors and administer timely interventions to mitigate the occurrence of OMPI in such children. RELEVANCE TO CLINICAL PRACTICE: The incidence of OMPI in children who underwent orotracheal intubation was relatively high. Nurses and doctors should closely monitor the risk factors for orotracheal intubation in children to prevent the occurrence of OMPI.

The effect of an educational intervention on perioperative registered nurse's knowledge, attitudes, and behaviors towards pressure injury prevention in surgical patients.

BACKGROUND: Pressure injuries continue to be a significant problem in perioperative patients. Surgical patients are particularly at risk due to lack of mobility and sensation during surgery and the early recovery period. The AORN (2024) recommends that healthcare organizations develop a comprehensive prevention program that includes risk assessment, prevention, and education. OBJECTIVES: To measure the effect of an educational intervention on perioperative nurses' knowledge, attitudes, and behaviors towards pressure injury prevention after one week and again after six months. METHODS: Nurse's knowledge, attitudes, and behaviors were measured at three different time periods using quantitative nonexperimental pretest posttest longitudinal design. Three hundred fifty-four perioperative registered nurses from 11 acute care hospitals participated. RESULTS: Nurses' knowledge scores were in the moderate range. Statistically significant differences were found between pre-test and posttest 1 scores, indicating that knowledge improved after nurses completed the education intervention and information was retained six months after. Nurses' attitudes were neither positive nor negative towards pressure injury prevention. Regarding behavior, the majority of nurses reported carrying out pressure injury prevention strategies, however only half reported carrying out daily risk assessment strategies. CONCLUSIONS: To prevent pressure injury in perioperative patients, it is imperative that guidelines for the prevention of perioperative pressure injury (AORN, 2024) are integrated into nursing practice.

Incidence, characteristics and risk factors of endotracheal tube-related pressure injuries in intensive care units.

BACKGROUND: Medical devices commonly used for the treatment and care of critically ill patients can cause pressure injuries in intensive care units (ICUs). The endotracheal tube (ETT) is one of the most common medical devices to cause pressure injuries. AIM: This study investigated the incidence of, characteristics of and risk factors for ETT-related pressure injuries for ICU patients. STUDY DESIGN: This study adopted a prospective descriptive research design. The sample consisted of 146 endotracheally intubated patients. Data were collected using a patient information form, an Endotracheal Tube-Related Pressure Injuries Assessment Form, the Braden Risk Assessment Tool and the Nutritional Assessment Test. RESULTS: The study revealed that 80.14% of the patients developed ETT-related pressure injuries. Over half of the ETT-related pressure injuries appeared on Day 3 or 4 (56.41%). High body mass index was found to be associated with the development of ETT-related pressure injuries (OR: 1.15, 95% CI: 1.05-1.26, p = .003). None of the other variables were statistically significant in the development of pressure injuries. CONCLUSIONS: The incidence of ETT-related pressure injuries was quite high in the internal, surgical and anaesthesia ICUs. High body mass index was associated with the development of ETT-related pressure injuries. Intensive care nurses should implement interventions to prevent ETT-related pressure injuries in critically ill patients receiving mechanical ventilation support. RELEVANCE TO CLINICAL PRACTICE: ETT-related pressure injuries are common in ICU patients. High body mass index was associated with the development of ETT-related pressure injuries in critically ill patients. The skin and mucosa should be assessed for the development of ETT-related pressure injuries during the daily assessment of the patients receiving mechanical ventilation support. The ETT should be repositioned regularly, and the most suitable ETT fixation method should be used.

The effect of evidence-based skin care and hydrocolloid dressing in the prevention of nasogastric tube-related pressure injury: A randomized controlled clinical trial.

OBJECTIVE: The aim of this study is to determine the effect of evidence-based skin care and hydrocolloid dressing in the prevention of nasogastric (NG) tube-related pressure injuries (PIs). DESIGN: This study was a three-arm parallel-group randomized controlled clinical trial registered on Clinicaltrials.gov (NCT04682925). METHODS: The study was conducted with 102 patients who underwent NG tube insertion immediately after admission to the anesthesiology and reanimation intensive care unit of a university hospital in Turkey. Patients were randomly assigned to three groups: a control arm (n = 34), a hydrocolloid dressing arm (n = 34), and a skin care arm (n = 34). Patients in the hydrocolloid dressing arm received daily application of hydrocolloid dressing to the nasal mucosa and alae nasi where the NG tube was inserted. Patients in the skin care arm received skin care interventions in preventing PIs twice daily. No interventions were administered to the control group. RESULTS: No NG tube-related PIs occurred in any patients in the hydrocolloid dressing arm. However, PIs occurred in 97.1 % of patients in the control arm and 94.1 % of patients in the skin care arm. According to the results of regression analysis, failure to apply hydrocolloid dressing increased the risk of NG tube-related PIs by 20.3 times [OR = 20.301, 95 % CI = 6.335-65.053, p < 0.001]. Additionally, a one-unit increase in the duration of ventilation days reduced the risk of NG tube-related PIs by 17.7 % (1-0.823) [OR = 0.823 (95 % CI = 0.684-0.989), p = 0.038]. CONCLUSION: Results revealed that hydrocolloid dressing is effective in preventing of NG tube-related PIs, whereas skin care did not demonstrate the same effectiveness.

Nursing students' knowledge, attitudes and learning occasions about pressure injuries at the time of graduation: A multi-method pre-post pandemic study.

INTRODUCTION: Pressure injuries (PIs) are a significant issue in healthcare system: nursing students are recommended to be prepared to assess the risk, prevent and manage them. However, despite the coronavirus disease-2019 (COVID-19) pandemic significantly affected nursing students' learning opportunities no data regarding their impact of PIs knowledge, attitudes and learning occasions have been documented to date. AIMS: To describe the post-pandemic knowledge and attitudes regarding PI prevention and management and to compare clinical learning opportunities in the field of PIs before and after the COVID-19 pandemic. METHOD: A descriptive multi-method study involving students at the time of their graduation in the before (n = 114) and after the pandemic (n = 113). The Italian versions of the Pressure Ulcer Knowledge Assessment Tool (PUKAT-IT) and Attitude Toward Pressure Ulcer Prevention (APuP-IT) scales were used. Data regarding pre- and post-pandemic learning opportunities were retrospectively collected from the Student Portfolio of Skills. RESULTS: The average PUKAT-IT score was 57.92 % (cut-off 60 %), which indicates insufficient knowledge; the average APuP-IT score was 78.19 % (cut-off 75 %), which shows positive attitudes towards PI. Comparing the pre- and the post-pandemic groups, learning opportunities in PI risk assessment and prevention significantly decreased (overall 38.90 vs 32.27 and 35.26 vs 25.97, respectively) while those regarding the PI management remained stable. CONCLUSION: In the post-pandemic times, nursing students' knowledge about PIs remains insufficient while their attitudes are adequate; the pandemic significantly reduced students' exposure to prevention and assessment learning opportunities during their internship, which suggests a need to update educational strategies to ensure appropriate knowledge and learning experiences in this field.

The value of epidemiological data for pressure ulcer/injury management.

Pressure ulcers/injuries (PU/Is) are a burden on healthcare systems worldwide. They are costly and have a negative impact on the quality of life of patients. PU/Is cause discomfort, prolong hospital stays and can even lead to death. Data on the incidence and prevalence of PU/Is are used to implement effective, tailored prevention practices. The aim of this paper is to highlight the importance and value of collecting epidemiological data in terms of its practical use in Slovakia. The prevalence of PU/Is was found to be low compared to global data. Shortcomings in the collection of epidemiological data are highlighted; however, the use of those available data in amending national standards, such as the mandatory reporting of PU/Is, is summarised. Several steps and activities related to the prevention and care of PU/Is have been carried out in Slovakia. It is important to know not only the prevalence in terms of field of care, time and provider, but also, more specifically, the risk characteristics and/or presence of PU/I in order to initiate more individualised and tailored patient care.

The complex interplay between mechanical forces, tissue response and individual susceptibility to pressure ulcers.

OBJECTIVE: The most recent edition of the International Clinical Practice Guideline for the Prevention and Treatment of Pressure Ulcers/Injuries was released in 2019. Shortly after, in 2020, the first edition of the SECURE Prevention expert panel report, focusing on device-related pressure ulcers/injuries, was published as a special issue in the Journal of Wound Care. A second edition followed in 2022. This article presents a comprehensive summary of the current understanding of the causes of pressure ulcers/injuries (PU/Is) as detailed in these globally recognised consensus documents. METHOD: The literature reviewed in this summary specifically addresses the impact of prolonged soft tissue deformations on the viability of cells and tissues in the context of PU/Is related to bodyweight or medical devices. RESULTS: Prolonged soft tissue deformations initially result in cell death and tissue damage on a microscopic scale, potentially leading to development of clinical PU/Is over time. That is, localised high tissue deformations or mechanical stress concentrations can cause microscopic damage within minutes, but it may take several hours of continued mechanical loading for this initial cell and tissue damage to become visible and clinically noticeable. Superficial tissue damage primarily stems from excessive shear loading on fragile or vulnerable skin. In contrast, deeper PU/Is, known as deep tissue injuries, typically arise from stress concentrations in soft tissues at body regions over sharp or curved bony prominences, or under stiff medical devices in prolonged contact with the skin. CONCLUSION: This review promotes deeper understanding of the pathophysiology of PU/Is, indicating that their primary prevention should focus on alleviating the exposure of cells and tissues to stress concentrations. This goal can be achieved either by reducing the intensity of stress concentrations in soft tissues, or by decreasing the exposure time of soft tissues to such stress concentrations.

Innovative air mattress for the prevention of pressure ulcers in neonates.

OBJECTIVE: Pressure ulcers (PUs) severely impact health outcomes in neonatal intensive care, with up to 28% prevalence and doubled mortality rates. Due to their only partially developed stratum corneum, neonates are highly susceptible to PUs because of a lack of adequate support surfaces. The occipital region of the head and hip are the main risk areas due to immobility and newborn body proportions. The main goal of the study was to investigate the impact of reduction in local pressure in these body areas by two air mattress designs and different filling states. METHOD: Two innovative air-filled mattress prototypes (prototype 1 and prototype 2), consisting of three different segments (head, trunk and feet regions), were developed to reduce local interface pressures by optimising pressure distribution, and were assessed with three air pressure filling states (0.2kPa, 0.4kPa and 0.6kPa). A baby doll was used to investigate pressure distribution and local pressure impact. It measured 51cm and the weight was modified to be 1.3kg, 2.3kg and 3.3kg, representing premature to term newborn weights, respectively. A specialised foam mattress and an unsupported surface were considered as controls. RESULTS: The interface pressures at the hip region for newborn models could be reduced by up to 41% with mattress prototype 1 and 49% with prototype 2 when filled with 0.2kPa air pressure. It was found that the size and the pressure inside air segments was crucial for interface pressure. CONCLUSION: Our results demonstrated that air mattresses achieved lower interface pressures compared to conventional support surfaces, and that the benefit of the air mattresses depended on their filling status. The importance of using innovative, segmented designs that were tailored to meet the specific needs of highly vulnerable paediatric patients was demonstrated.

Pressure injury incidence measurement as a quality improvement strategy: national trends in Switzerland.

OBJECTIVE: This study sought to determine the risk-adjusted (controlled for patient characteristics) trend in pressure injury (PI) incidence in Switzerland. METHOD: A secondary data analysis was conducted. The data originated from the national PI quality measurement based on a multicentre cross-sectional design with repeated annual measurements. Descriptive statistics, a Cochran-Armitage trend test and logistic (multilevel) regression modelling were applied. RESULTS: The analysis sample comprised 123,715 patients from 230 hospitals over 10 survey years (2011-2019 and 2022). The incidence of descriptive PI varied in Switzerland between 3.7% and 5.6% over the survey years. No linear trend could be found when patient characteristics were not considered. A non-linear trend was detected when controlling for patient characteristics and the time effect (repeated measurement). This was also reflected in the plotted risk-adjusted incidence, which revealed a decrease followed by a levelling off. When only considering the incidence of PIs rated category 2 and higher, there was also a non-linear decreasing trend when controlling for patient characteristics and time effects. If the incidence per survey year were estimated on the basis of patient characteristics, an increase in the incidence would have been expected. CONCLUSION: Although patients' risk of developing a PI increased between 2011-2022, the incidence of PIs in Switzerland first decreased and then levelled off. The results indicated that care quality in Swiss hospitals has improved regarding PIs. Nevertheless, in view of demographic trends and increasing staff shortages, it is important to continue to monitor PI incidence and to invest in PI prevention.

A Predictive Model of Pressure Injury in Children Undergoing Living Donor Liver Transplantation Based on Machine Learning Algorithm.

AIMS: The aim of our study was to formulate and validate a prediction model using machine learning algorithms to forecast the risk of pressure injuries (PIs) in children undergoing living donor liver transplantation (LDLT). DESIGN: A retrospective cohort study. METHODS: The research was carried out at China's largest paediatric liver transplantation centre. A total of 438 children who underwent LDLT between June 2021 and December 2022 constituted the study cohort. The dataset was partitioned randomly into 70% for training datasets (306 cases) and 30% for testing datasets (132 cases). Utilising four machine learning algorithms-Decision Tree, Random Forest, Gradient Boosting Decision Tree and eXtreme Gradient Boosting-we identified risk factors and constructed predictive models. RESULTS: Out of 438 children, 42 developed PIs, yielding an incidence rate of 9.6%. Notably, 94% of these cases were categorised as Stage 1, and 54% were localised on the occiput. Upon evaluating the four prediction models, the Decision Tree model emerged as the most effective. The primary contributors to pressure injury in the Decision Tree model were identified as operation time, intraoperative corticosteroid administration, preoperative skin protection measures and preoperative skin conditions. A visualisation elucidating the logical inference process for the 10 variables within the Decision Tree model was presented. Ultimately, based on the Decision Tree model, a predictive system was developed. CONCLUSION: Machine learning algorithms facilitate the identification of crucial factors, enabling the creation of an effective Decision Tree model to forecast pressure injury development in children undergoing LDLT. IMPACT: With this predictive model at their disposal, nurses can assess the pressure injury risk level in children more intuitively. Subsequently, they can implement tailored preventive strategies to mitigate the occurrence of PIs. PATIENT OR PUBLIC CONTRIBUTION: Paediatric patients contributed electronic health records datasets.

Effects on tissue oxygenation in the gluteal region with a smart pressure redistribution wheelchair cushion compared to a pressure relief manoeuvre.

OBJECTIVE: The study examines the effects of the air-bladder offloading mode of a smart pressure redistribution wheelchair cushion on tissue oxygenation in the gluteal tissue of non-disabled participants. The hypothesis is that the cushion's offloading mode, which involves sequentially deflating its five air-bladders one at a time for a specific duration, would improve tissue oxygenation during sitting. METHODS: Two procedures were conducted. The first compared the cushion's offloads to a loaded control (LC) with the cushion on static mode, and the second compared the cushion's offloading mode to a standard manual offload performed by the participant. Three trials of each procedure were performed in randomized order. Tissue oxygenation was continuously monitored with three oxygenation parameters analysed: oxygen saturation (SO2), oxygenated haemoglobin (OxyHb), and deoxygenated haemoglobin (DeoxyHb). Data recordings were segmented in each step of the offloading sequence for analysis. A paired t-test was performed for comparisons with significance considered at α = 0.05. Ten healthy adults participated in the study. IMPACT: Results showed that as the air bladders deflated over time, the three evaluated parameters changed, affecting oxygenation even when other tissue areas were offloaded. The results indicated that the cushion's sacral offload had the greatest impact on improving tissue oxygenation among the five air-bladders in all ten subjects (p < 0.05). Furthermore, SO2 during the cushion's offload in the sacral region was similar to a manual offload. The study results suggest that the cushion could benefit tissue oxygenation, especially for individuals unable to change positions independently. Further research is needed to determine its effectiveness for wheelchair users.

The cushion's offloads, which involved deflating its five air-cell bladders one at a time for a specific duration, improved tissue oxygenation in the gluteal region of non-disabled individuals while seated.The cushion's offload in the sacral region had the greatest impact on improving tissue oxygenation among the five air-bladders in all ten subjects.This cushion could be an alternative for users who have limitations in performing pressure relief manoeuvres for the prevention of pressure injuries.A cushion that enhances tissue oxygenation while the user remains seated allows longer sitting periods, improving their quality of life, regardless of their ability to perform pressure relief manoeuvres.