Prevention of Tracheostomy-Related Hospital-Acquired Pressure Ulcers

Otolaryngol Head Neck Surg. 2017 Apr;156(4):642-651. doi: 10.1177/0194599816689584. Epub 2017 Feb 14.

Abstract

Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head. One year after the bundle was initiated, a retrospective analysis was performed to compare the percentage of tracheostomy patients who developed pressure ulcers versus the preintervention period. Results The incidence of tracheostomy-related pressure ulcers decreased from 20 of 183 tracheostomies (10.93%) prior to use of the standardized protocol to 2 of 155 tracheostomies (1.29%). Chi-square analysis showed a significant difference between the groups, with a P value of .0003. Discussion Adoption of this care bundle at our institution resulted in a significant reduction in the incidence of hospital-acquired tracheostomy-related pressure ulcers. The impact of any single intervention within our protocol was not assessed and could be an area of further investigation. Implications for Practice Adoption of a standardized posttracheostomy care bundle at the institution level may result in the improved care of patients with tracheostomies and specifically may reduce the incidence of pressure ulcers.

Keywords: PS/QI; acquired; bundle; hospital; pressure; prevention; tracheostomy; ulcer.

MeSH terms

  • Adult
  • Bandages*
  • Bandages, Hydrocolloid
  • Female
  • Humans
  • Iatrogenic Disease / prevention & control
  • Male
  • Middle Aged
  • Polyurethanes
  • Postoperative Care*
  • Pressure Ulcer / prevention & control*
  • Retrospective Studies
  • Tracheostomy / adverse effects*

Substances

  • Polyurethanes