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1.
Rev. enferm. UERJ ; 28: e35054, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1117622

RESUMO

Objetivo: avaliar a mobilidade do cliente com dermatose imunobolhosa antes e após aplicação do curativo com gaze vaselinada. Método: estudo quase experimental, interinstitucional, com clientes com dermatoses imunobolhosas hospitalizados em um hospital estadual e um hospital federal do Estado do Rio de Janeiro e uma instituição do Mato Grosso do Sul. Utilizou-se a lógica fuzzy para classificar a mobilidade dos sujeitos antes, 24 horas após e uma semana após aplicação do curativo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Resultados: Incluídos 14 participantes, sendo nove com pênfigo vulgar, dois com pênfigo foliáceo e três com penfigóide bolhoso, entre 27 e 82 anos, predominando 11 mulheres. Após 24 horas, nenhum participante se considerou com baixa mobilidade, sete passaram a mobilidade média, e sete, alta, o que foi mantido uma semana após aplicação do curativo. Conclusão: constatou-se significativo aumento da mobilidade logo nas primeiras 24 horas após aplicação do curativo.


Objective: to assess the mobility of clients with immunobullous dermatoses, before and after applying vaseline gauze dressings. Method: in this quasi-experimental, interinstitutional study of inpatients with immunobullous dermatoses at a state hospital and a federal hospital in Rio de Janeiro State and an institution in Mato Grosso do Sul (Brazil), patient mobility before, 24 hours after, and one week after applying the dressing was classified using fuzzy logic. The study was approved by the research ethics committee. Results: 14 participants, nine with pemphigus vulgaris, two with pemphigus foliaceus, and three with bullous pemphigoid, aged between 27 and 82 years old, and predominantly (11) women. After 24 hours, none of the participants considered their mobility to be poor, seven began to be moderately mobile, and seven were highly mobile, and continued so one week after applying the dressing. Conclusion: mobility increased significant in the first 24 hours after applying the dressing.


Objetivo: evaluar la movilidad de clientes con dermatosis inmunobullosa, antes y después de la aplicación de apósitos de gasa con vaselina. Método: en este estudio cuasi-experimental, interinstitucional de pacientes hospitalizados con dermatosis inmunobullosa en un hospital estatal y un hospital federal en el estado de Río de Janeiro y una institución en Mato Grosso do Sul (Brazil), la movilidad del paciente antes, 24 horas después y una semana después la aplicación del apósito se clasificó mediante lógica difusa. El estudio fue aprobado por el comité de ética en investigación. Resultados: se incluyeron 14 participantes, nueve con pénfigo vulgar, dos con pénfigo foliáceo y tres con penfigoide ampolloso, con edades comprendidas entre 27 y 82 años, y predominantemente mujeres (n=11). Después de 24 horas, ninguno de los participantes consideró que su movilidad fuera pobre, siete comenzaron a ser moderadamente móviles y siete eran altamente móviles, y así continuaron una semana después de la aplicación del apósito. Conclusión: la movilidad aumentó significativamente en las primeras 24 horas después de la aplicación del apósitoconsideraba con baja movilidad, siete comenzaron a tener movilidad media y siete, alta, que se mantuvo una semana después de aplicar el apósito. Conclusión: hubo un aumento significativo en la movilidad en las primeras 24 horas después de aplicar el apósito.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vaselina/uso terapêutico , Bandagens , Dermatopatias Vesiculobolhosas/terapia , Penfigoide Bolhoso/terapia , Pênfigo/terapia , Limitação da Mobilidade , Brasil , Lógica Fuzzy , Lesão por Pressão/prevenção & controle , Prevenção Secundária , Ensaios Clínicos Controlados não Aleatórios como Assunto , Hospitais Públicos , Pacientes Internados , Cuidados de Enfermagem
3.
Rev Lat Am Enfermagem ; 28: e3357, 2020 Sep 07.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32901770

RESUMO

OBJECTIVE: to evaluate the use of realistic simulation as a strategy to promote teaching about pressure injuries. METHOD: This is a quasi-experimental study. A modified and translated version of the Pieper Pressure Ulcer knowledge test was applied. Kappa statistical analysis was used to assess the professionals' knowledge in the realistic simulation using the SPSS software. A p-value <0.05 was considered significant. RESULTS: Seventy-seven nursing professionals participated in the realistic simulation, the majority (72.7%) being nursing technicians. Regarding the knowledge of primary and secondary coverage techniques, the Kappa index went from 0.56 (p=0.002) in the pre-test to 0.87 (p=0.001) in the post-test. As for the sterile dressing technique, there was a variation from 0.55 (p=0.002) in the pre-test to 0.91 (p=0.001) in the post-test. Regarding the cleaning of pressure injuries, there was a variation from 0.81 (CI: 0.62-0.84) in the pre-test to 0.91 (0.85-0.97) in the post-test. The knowledge about the use of a sterile spatula to distribute the dressing in the wound increased from an agreement index from regular to good. CONCLUSION: The introduction of the realistic simulation in the clinical practice has created quality assessment indicators for the prevention and treatment of pressure injuries.


Assuntos
Competência Clínica , Lesão por Pressão/prevenção & controle , Bandagens , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Tradução
4.
J Wound Ostomy Continence Nurs ; 47(5): 430-434, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32868735

RESUMO

BACKGROUND: Medical device-related pressure injuries (MDRPIs) account for more than 30% of all hospital-acquired pressure injuries. The COVID-19 pandemic introduced a large population of patients at risk for MDRPIs due to prolonged intubation and prone positioning. We reviewed our experience with MDRPIs during the 2020 COVID-19 pandemic at an Academic Medical Center. CASES: We evaluated 30 cases of MDRPIs acquired during the peak of our pandemic, April 1 to May 31, 2020, and compared these to injuries seen over a similar time period prior to the pandemic. CONCLUSIONS: Our experiences with MDRPIs during this time has led the WOC team to begin development of a quality improvement project aimed at improving management of high-risk respiratory illness patients requiring intubation and prone positioning.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Equipamentos e Provisões/efeitos adversos , Pneumonia Viral/terapia , Lesão por Pressão/etiologia , Lesão por Pressão/patologia , Decúbito Ventral , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Posicionamento do Paciente , Pneumonia Viral/complicações , Lesão por Pressão/prevenção & controle , Melhoria de Qualidade , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Estudos Retrospectivos , Adulto Jovem
5.
J Wound Ostomy Continence Nurs ; 47(5): 435-438, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32868736

RESUMO

Patients admitted to the intensive care unit (ICU) are at a high risk for developing pressure injuries. A patient requiring multiorgan support is at a higher risk for pressure injuries related to immobility, sedation, vasopressors, and hypoxia. To mitigate pressure injuries, our hospital utilizes a bundle approach to prevent skin injury. However, despite efforts to prevent pressure injuries, we found our patients in the ICU with the diagnosis of COVID-19 went on to develop significant pressure and mucosal injuries. This is a case report of 4 patients diagnosed with COVID-19 who developed significant skin and mucosal injuries during their ICU admissions in the month of March 2020. We found that patients developed skin conditions that were initially thought to be deep-tissue injuries (DTIs) early in the admission. The DTIs progressed over the course of the admission in the ICU and evolved to thick adherent eschar that appeared to be unstageable pressure injuries, which extended beyond the soft tissue directly over the bony prominence. We also found that skin damage to the mucosa of the nares, tongue, lips, and urethra presented first as inflammation and then progressed to thick eschar. Despite maximum pressure relief with the use of a pressure-relieving turn and position system, bordered foam dressings, fluidized positioners, specialty beds, and leadership support for twice-a-week skin checks, our patients diagnosed with COVID-19 developed extensive skin damage across the fleshy portion of the buttocks and on the mucosa of the nares, tongue, lips, and urethra during minimal exposure to pressure. Although the initial presentation of the skin damage appeared to be related to pressure, the extent of the skin damage suggests a vascular inflammatory process beyond skin damage related to pressure.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Equipamentos e Provisões/efeitos adversos , Membrana Mucosa/lesões , Pneumonia Viral/terapia , Lesão por Pressão/etiologia , Lesão por Pressão/patologia , Adulto , Idoso , Infecções por Coronavirus/complicações , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Lesão por Pressão/prevenção & controle , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação
9.
J Wound Care ; 29(6): 312-320, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: covidwho-595654

RESUMO

OBJECTIVE: Pressure ulcers (PUs) involve the destruction of skin and underlying tissue due to prolonged pressure and shear forces. These ulcers are painful and significantly reduce a person's quality of life. PUs are also expensive to manage and impact negatively on the achievement of cost-effective, efficient care delivery. METHOD: Prone positioning is a postural therapy that aims to enhance respiratory function through increasing oxygenation levels. In contemporary clinical practice, ventilation in the prone position is indicated for patients with severe acute respiratory distress syndrome. However, despite its advantages in terms of respiratory function, several studies have examined complications of prone position ventilation and have identified PUs (facial PUs as well as PUs on other weight-bearing areas of the body) as a frequent complication in patients who are already in a precarious medical situation. International data suggest that up to 57% of patients nursed in the prone position develop a PU. The aim of this clinical review is to identify and review evidence-based recommendations developed to facilitate the selection and application of preventive interventions aimed at reducing PU development in patients ventilated in the prone position. Given the current COVID-19 crisis, this review is timely as intensive care unit (ICU) patients with COVID-19 require ventilation in the prone position at a level that is disproportionate to the general intensive care population. Up to 28% of patients admitted to the ICU with confirmed infection due to severe COVID-19 are cared for in the prone position. The scope of this review is limited to adult individuals only. RESULTS: The skin assessment should be undertaken before proning and following positioning the patient back into the supine position. Although it is essential to keep the skin clean and moisturised, using pH-balanced cleansers, there is inconsistency in terms of the evidence to support the type of moisturiser. Use of positioning devices in addition to repositioning is recommended to offload pressure points on the face and body. Further, using dressings such as hydrocolloids, transparent film and silicone may be of benefit in decreasing facial skin breakdown. CONCLUSION: Given the importance of PU prevention in this cohort of patients, adopting a focused prevention strategy, including skin assessment and care, offloading and pressure redistribution, and dressings for prevention may contribute to a reduction in the incidence and prevalence of these largely preventable wounds.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Lesão por Pressão/prevenção & controle , Decúbito Ventral , Cicatrização/fisiologia , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Emergências , Medicina Baseada em Evidências , Feminino , Custos Hospitalares , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Posicionamento do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Lesão por Pressão/economia , Lesão por Pressão/terapia
10.
Gerokomos (Madr., Ed. impr.) ; 31(2): 107-112, jun. 2020. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-193892

RESUMO

OBJETIVO: Determinar el apósito con mayor efectividad (hidrocoloide o espuma de poliuretano) en neonatos ingresados en las unidades de cuidados intensivos neonatal y pediátrica del Hospital Clínico Universitario de Valencia, sometidos a ventilación mecánica no invasiva para la prevención de úlceras por presión nasales y/o faciales. MATERIAL Y MÉTODOS: Proyecto de investigación de tipo observacional, prospectivo y analítico cuya muestra estaba formada por 13 neonatos con ventilación mecánica no invasiva, hospitalizados en la unidad de cuidados intensivos neonatales y pediátrica. Los neonatos fueron divididos en dos grupos: en el grupo A (7 pacientes) se empleó el apósito de espuma de poliuretano y en el grupo B se utilizó el hidrocoloide (6 pacientes). La recogida de datos se realizó durante el período comprendido entre abril y mayo de 2018. RESULTADOS: De los neonatos incluidos en el estudio, 5 (38,5%) presentaron úlceras por presión nasales; el resto (62%) no presentó úlceras. Además, se obtuvo que, del total de pacientes con lesión, un 60% llevaba el apósito hidrocoloide y un 40% el de espuma de poliuretano. CONCLUSIONES: Tras el estudio, se determinó que el apósito de espuma de poliuretano presentaba un menor porcentaje de aparición de UPP en comparación con el hidrocoloide. Sin embargo, sería recomendable valorar la posibilidad de emplear alguno de ellos como medida de protección


OBJECTIVE: To determine the most effective dressing (hydrocolloid or polyurethane foam) in neonates admitted by the Neonatal and Pediatric Intensive Care Unit of the Hospital Clínico Universitario de Valencia, subjected to non-invasive mechanical ventilation for the prevention of pressure ulcers nasal and/or facial. MATERIAL AND METHODS: observational, prospective and analytical research project whose sample considered of 13 neonates with non-invasive mechanical ventilation hospitalized in the Neonatal and Pediatric Intensive Care Unit. They were divided into two groups, where group A (7 patients) used the polyurethane foam dressing and group B used the hydrocolloid dressing (6 patients). The data collection was carried out during the period from April to May 2018. RESULTS: Of the neonates included in the study, 5 presented nasal pressure ulcers (38.5%) and the rest did not (62%). In addition, it was obtained that, of the total of patients with injury, 60% wore the hydrocolloid dressing and 40% that of polyurethane foam. CONCLUSIONS: After the study, it was determined that the polyurethane foam dressing had a lower percentage of appearance of pressure ulcers compared to the hydrocolloid. However, it would be advisable to appraise the possibility of using any of them as a protection measure


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lesão por Pressão/enfermagem , Ventilação não Invasiva/métodos , Ventilação não Invasiva/enfermagem , Bandagens/normas , Unidades de Terapia Intensiva Neonatal , Lesão por Pressão/prevenção & controle , Traumatismos Faciais/enfermagem , Nariz/lesões , Estudos Prospectivos
11.
Adv Skin Wound Care ; 33(8): 418-427, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32530822

RESUMO

OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath an N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high-risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when performing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored, created, and tested a stepwise process to protect the skin under these masks while ensuring that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. Staff also self-reported increased comfort with less friction. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method enabling staff to apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.


Assuntos
Infecções por Coronavirus/prevenção & controle , Traumatismos Faciais/etiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Lesão por Pressão/prevenção & controle , Bandagens , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Desenho de Equipamento , Traumatismos Faciais/fisiopatologia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pneumonia Viral/epidemiologia , Lesão por Pressão/etiologia , Estudos Prospectivos , Estados Unidos
12.
Cochrane Database Syst Rev ; 6: CD009958, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32484259

RESUMO

BACKGROUND: A pressure injury (PI), also referred to as a 'pressure ulcer', or 'bedsore', is an area of localised tissue damage caused by unrelieved pressure, friction, or shearing on any part of the body. Immobility is a major risk factor and manual repositioning a common prevention strategy. This is an update of a review first published in 2014. OBJECTIVES: To assess the clinical and cost effectiveness of repositioning regimens(i.e. repositioning schedules and patient positions) on the prevention of PI in adults regardless of risk in any setting. SEARCH METHODS: We searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, and EBSCO CINAHL Plus on 12 February 2019. We also searched clinical trials registries for ongoing and unpublished studies, and scanned the reference lists of included studies as well as reviews, meta-analyses, and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA: Randomised controlled trials (RCTs), including cluster-randomised trials (c-RCTs), published or unpublished, that assessed the effects of any repositioning schedule or different patient positions and measured PI incidence in adults in any setting. DATA COLLECTION AND ANALYSIS: Three review authors independently performed study selection, 'Risk of bias' assessment, and data extraction. We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We identified five additional trials and one economic substudy in this update, resulting in the inclusion of a total of eight trials involving 3941 participants from acute and long-term care settings and two economic substudies in the review. Six studies reported the proportion of participants developing PI of any stage. Two of the eight trials reported within-trial cost evaluations. Follow-up periods were short (24 hours to 21 days). All studies were at high risk of bias. Funding sources were reported in five trials. Primary outcomes: proportion of new PI of any stage Repositioning frequencies: three trials compared different repositioning frequencies We pooled data from three trials (1074 participants) comparing 2-hourly with 4-hourly repositioning frequencies (fixed-effect; I² = 45%; pooled risk ratio (RR) 1.06, 95% confidence interval (CI) 0.80 to 1.41). It is uncertain whether 2-hourly repositioning compared with 4-hourly repositioning used in conjunction with any support surface increases or decreases the incidence of PI. The certainty of the evidence is very low due to high risk of bias, downgraded twice for risk of bias, and once for imprecision. One of these trials had three arms (967 participants) comparing 2-hourly, 3-hourly, and 4-hourly repositioning regimens on high-density mattresses; data for one comparison was included in the pooled analysis. Another comparison was based on 2-hourly versus 3-hourly repositioning. The RR for PI incidence was 4.06 (95% CI 0.87 to 18.98). The third study comparison was based on 3-hourly versus 4-hourly repositioning (RR 0.20, 95% CI 0.04 to 0.92). The certainty of the evidence is low due to risk of bias and imprecision. In one c-RCT, 262 participants in 32 ward clusters were randomised between 2-hourly and 3-hourly repositioning on standard mattresses and 4-hourly and 6-hourly repositioning on viscoelastic mattresses. The RR for PI with 2-hourly repositioning compared with 3-hourly repositioning on standard mattress is imprecise (RR 0.90, 95% CI 0.69 to 1.16; very low-certainty evidence). The CI for PI include both a large reduction and no difference for the comparison of 4-hourly and 6-hourly repositioning on viscoelastic foam (RR 0.73, 95% CI 0.53 to 1.02). The certainty of the evidence is very low, downgraded twice due to high risk of bias, and once for imprecision. Positioning regimens: four trials compared different tilt positions We pooled data from two trials (252 participants) that compared a 30° tilt with a 90° tilt (random-effects; I² = 69%). There was no clear difference in the incidence of stage 1 or 2 PI. The effect of tilt is uncertain because the certainty of evidence is very low (pooled RR 0.62, 95% CI 0.10 to 3.97), downgraded due to serious design limitations and very serious imprecision. One trial involving 120 participants compared 30° tilt and 45° tilt with 'usual care' and reported no occurrence of PI events (low certainty evidence). Another trial involving 116 ICU patients compared prone with the usual supine positioning for PI. Reporting was incomplete and this is low certainty evidence. Secondary outcomes No studies reported health-related quality of life utility scores, procedural pain, or patient satisfaction. Cost analysis Two included trials also performed economic analyses. A cost-minimisation analysis compared the costs of 3-hourly and 4-hourly repositioning with 2-hourly repositioning schedule amongst nursing home residents. The cost of repositioning was estimated at CAD 11.05 and CAD 16.74 less per resident per day for the 3-hourly or 4-hourly regimen, respectively, compared with the 2-hourly regimen. The estimates of economic benefit were driven mostly by the value of freed nursing time. The analysis assumed that 2-, 3-, or 4-hourly repositioning is associated with a similar incidence of PI, as no difference in incidence was observed. A second study compared the nursing time cost of 3-hourly repositioning using a 30° tilt with standard care (6-hourly repositioning with a 90° lateral rotation) amongst nursing home residents. The intervention was reported to be cost-saving compared with standard care (nursing time cost per patient EUR 206.60 versus EUR 253.10, incremental difference EUR -46.50, 95% CI EUR -1.25 to EUR -74.60). AUTHORS' CONCLUSIONS: Despite the addition of five trials, the results of this update are consistent with our earlier review, with the evidence judged to be of low or very low certainty. There remains a lack of robust evaluations of repositioning frequency and positioning for PI prevention and uncertainty about their effectiveness. Since all comparisons were underpowered, there is a high level of uncertainty in the evidence base. Given the limited data from economic evaluations, it remains unclear whether repositioning every three hours using the 30° tilt versus "usual care" (90° tilt) or repositioning 3-to-4-hourly versus 2-hourly is less costly relative to nursing time.


Assuntos
Posicionamento do Paciente/métodos , Lesão por Pressão/prevenção & controle , Idoso , Leitos , Análise Custo-Benefício , Humanos , Pessoa de Meia-Idade , Posicionamento do Paciente/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
13.
J Wound Care ; 29(6): 312-320, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32530776

RESUMO

OBJECTIVE: Pressure ulcers (PUs) involve the destruction of skin and underlying tissue due to prolonged pressure and shear forces. These ulcers are painful and significantly reduce a person's quality of life. PUs are also expensive to manage and impact negatively on the achievement of cost-effective, efficient care delivery. METHOD: Prone positioning is a postural therapy that aims to enhance respiratory function through increasing oxygenation levels. In contemporary clinical practice, ventilation in the prone position is indicated for patients with severe acute respiratory distress syndrome. However, despite its advantages in terms of respiratory function, several studies have examined complications of prone position ventilation and have identified PUs (facial PUs as well as PUs on other weight-bearing areas of the body) as a frequent complication in patients who are already in a precarious medical situation. International data suggest that up to 57% of patients nursed in the prone position develop a PU. The aim of this clinical review is to identify and review evidence-based recommendations developed to facilitate the selection and application of preventive interventions aimed at reducing PU development in patients ventilated in the prone position. Given the current COVID-19 crisis, this review is timely as intensive care unit (ICU) patients with COVID-19 require ventilation in the prone position at a level that is disproportionate to the general intensive care population. Up to 28% of patients admitted to the ICU with confirmed infection due to severe COVID-19 are cared for in the prone position. The scope of this review is limited to adult individuals only. RESULTS: The skin assessment should be undertaken before proning and following positioning the patient back into the supine position. Although it is essential to keep the skin clean and moisturised, using pH-balanced cleansers, there is inconsistency in terms of the evidence to support the type of moisturiser. Use of positioning devices in addition to repositioning is recommended to offload pressure points on the face and body. Further, using dressings such as hydrocolloids, transparent film and silicone may be of benefit in decreasing facial skin breakdown. CONCLUSION: Given the importance of PU prevention in this cohort of patients, adopting a focused prevention strategy, including skin assessment and care, offloading and pressure redistribution, and dressings for prevention may contribute to a reduction in the incidence and prevalence of these largely preventable wounds.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Lesão por Pressão/prevenção & controle , Decúbito Ventral , Cicatrização/fisiologia , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Emergências , Medicina Baseada em Evidências , Feminino , Custos Hospitalares , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Posicionamento do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Lesão por Pressão/economia , Lesão por Pressão/terapia
14.
J Wound Care ; 29(5): 245-259, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: covidwho-294439

RESUMO

The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more indepth guidance on long-term strategies for prevention, for both themselves and patients.


Assuntos
Infecções por Coronavirus/prevenção & controle , Equipamentos e Provisões/efeitos adversos , Controle de Infecções/normas , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Lesão por Pressão/prevenção & controle , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Traumatismos Faciais/etiologia , Traumatismos Faciais/prevenção & controle , Humanos , Controle de Infecções/métodos , Pneumonia Viral/etiologia , Pneumonia Viral/transmissão , Lesão por Pressão/etiologia , Pele/lesões , Dermatopatias/etiologia , Dermatopatias/prevenção & controle
16.
Artigo em Inglês | MEDLINE | ID: mdl-32354041

RESUMO

Pressure injuries (PIs) are a major health problem with severe implications for patients. Professionals who care for people at risk should have high knowledge about PIs prevention. The actual knowledge can be measured using different tools, but we have found no questionnaire to measure the knowledge on PIs prevention developed and validated for Spanish-speaking countries. The aim of this study was to develop a questionnaire in Spanish to measure the knowledge about PIs prevention based on current international guidelines. Content validity was evaluated by 12 experts in wound care. A convenience sample of 438 nursing professionals from Spain participated to evaluate the questionnaire using item analysis, Rasch model, and known-groups validity. The PI Prevention Knowledge (PIPK) questionnaire shows good discrimination and difficulty indices. The 31-item PIPK shows good fit and reliability of 0.98 for items and 0.72 for people; also, it has enough evidence for construct validity. Because the questionnaire has been developed based on the recommendations from international guidelines, the English version of this questionnaire could be used in further studies to test its psychometric properties.


Assuntos
Competência Clínica , Enfermeiras e Enfermeiros , Lesão por Pressão , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/prevenção & controle , Psicometria , Reprodutibilidade dos Testes , Espanha , Inquéritos e Questionários , Adulto Jovem
17.
PLoS One ; 15(5): e0233471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469916

RESUMO

INTRODUCTION: Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes. METHODS: Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses. RESULTS: A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers. CONCLUSION: Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.


Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Lesão por Pressão/prevenção & controle , Programas Médicos Regionais , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Instituição de Longa Permanência para Idosos/economia , Humanos , Estudos Longitudinais , Masculino , Auditoria de Enfermagem/economia , Casas de Saúde/economia , Lesão por Pressão/epidemiologia , Lesão por Pressão/enfermagem , Prevalência , Estudos Prospectivos , Programas Médicos Regionais/economia , Programas Médicos Regionais/estatística & dados numéricos , Programas Médicos Regionais/tendências , Suíça/epidemiologia
19.
J Wound Care ; 29(5): 245-259, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32421479

RESUMO

The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more indepth guidance on long-term strategies for prevention, for both themselves and patients.


Assuntos
Infecções por Coronavirus/prevenção & controle , Equipamentos e Provisões/efeitos adversos , Controle de Infecções/normas , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Lesão por Pressão/prevenção & controle , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Traumatismos Faciais/etiologia , Traumatismos Faciais/prevenção & controle , Humanos , Controle de Infecções/métodos , Pneumonia Viral/etiologia , Pneumonia Viral/transmissão , Lesão por Pressão/etiologia , Pele/lesões , Dermatopatias/etiologia , Dermatopatias/prevenção & controle
20.
Medicine (Baltimore) ; 99(20): e20254, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443363

RESUMO

BACKGROUND: This study will be designed to appraise the effects of intraoperative pressure ulcer preventive nursing (IPUPN) on inflammatory markers (IMs) in patients with high-risk pressure ulcers (HRPU) based on high quality randomized controlled trials (RCTs). METHODS: In this study, we will perform a rigorous literature search from the following electronic databases: Cochrane Library, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. All electronic databases will be retrieved from their initial time to March 1, 2020 without limitations of language and publication status. We will only consider high quality RCTs that explored the effects of IPUPN on IMs in patients with HRPU. Two investigators will identify relevant trials, extract data, and appraise risk of bias in each eligible trial. Data will be pooled by either a fixed-effects model or a random-effects model according to the results of heterogeneity identification. The primary outcomes include IMs, and incidence of new pressure ulcers. The secondary outcomes are time to ulcer development, quality of life, length of hospital stay, and adverse events. Statistical analysis will be undertaken using RevMan 5.3 software. RESULTS: This study will summarize high quality clinical evidence of RCTs to evaluate the effects of IPUPN on IMs in patients with HRPU. CONCLUSION: The expected findings may provide helpful evidence to determine whether IPUPN is an effective intervention on IMs in patients with HRPU. INPLASY REGISTRATION NUMBER: INPLASY202040029.


Assuntos
Biomarcadores/análise , Inflamação/sangue , Lesão por Pressão/prevenção & controle , Biomarcadores/sangue , Protocolos Clínicos , Humanos , Inflamação/fisiopatologia , Complicações Intraoperatórias/enfermagem , Complicações Intraoperatórias/prevenção & controle , Metanálise como Assunto , Lesão por Pressão/enfermagem
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