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. 2024 May 21;16(5):e60738.
doi: 10.7759/cureus.60738. eCollection 2024 May.

Enhancing Healing Strategies: Negative-Pressure Wound Therapy and Delayed Primary Closure in Abdominal Wounds Post-emergency Laparotomy for Intestinal Perforation

Affiliations

Enhancing Healing Strategies: Negative-Pressure Wound Therapy and Delayed Primary Closure in Abdominal Wounds Post-emergency Laparotomy for Intestinal Perforation

Vivek Belsariya et al. Cureus. .

Abstract

Background Intestinal perforation is a life-threatening condition requiring immediate surgical intervention. Surgical-site infections (SSIs) and wound dehiscence are common complications associated with emergency laparotomy for intestinal perforation. Finding optimal wound management and postoperative strategies can significantly impact patient outcomes and reduce the risk of complications. Negative-pressure wound therapy (NPWT) is a relatively recent tool employed in the care of wounds to control SSIs and foster healing. Methodology A prospective, observational, cohort study was conducted among 150 patients who underwent emergency exploratory laparotomy due to intestinal perforation at the general surgery department of a tertiary care hospital in New Delhi between July 2022 and December 2023. Preoperatively, all patients underwent initial resuscitation. Intraoperatively, the extent of peritonitis was determined and was categorized according to the Centers for Disease Control and Prevention (CDC) classification. Postoperatively, NPWT dressing was applied to the patient's midline laparotomy wound on postoperative day (POD) two. Negative pressure was set at 75-125 mmHg with suction. The number of NPWT dressing changes required was documented. The wound was closed with vertical mattress sutures under local anesthesia, delayed primary closure (DPC). The incidence of SSIs, the duration for DPC, the incidence of fascial dehiscence, the number of NPWT dressing changes, and the length of hospital stay were documented according to CDC groups. Results The mean age in CDC categories 2, 3, and 4 were 31.789, 28.733, and 42.676 years, respectively. The most common cause of perforation was enteric fever (n = 42, 28%), followed by tuberculosis (n = 36, 24%). Most patients had no known comorbidities (n = 80, 53.3%). Overall, 16% of patients (n = 24) were both alcoholics and smokers. The most frequent bacteria in all CDC categories was Escherichia coli. Fourteen patients developed burst abdomen in the postoperative period and were excluded from the study. The mean duration of DPC increased with higher CDC categories, with CDC category 4 displaying the most extended mean duration at 10.70 days. The number of NPWT dressing changes increases with higher CDC categories, with CDC category 4 exhibiting the highest mean at 2.00 changes. The mean hospital stay increased with higher CDC categories, with CDC category 4 showing the most extended mean stay at 17.324 days. Statistical analysis revealed no significant association between SSI occurrence and CDC categories. Conclusions NPWT followed by DPC is a promising approach to managing gastrointestinal perforations, reducing SSIs, and potentially improving patient outcomes. However, further research is needed to explore the specific benefits of NPWT in conjunction with DPC and its efficacy in various clinical scenarios.

Keywords: abdominal laparotomy wounds; delayed primary closure; intestinal perforation; negative-pressure wound therapy; post-emergency laparotomy.

Conflict of interest statement

The authors have declared that no competing interests exist.

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Multicenter Study
. 2024 Jun 20;33(12):S8-S18.
doi: 10.12968/bjon.2024.0158.

Using a prognostic medical device for early identification of pressure ulcers: protocol for study design

Affiliations
Multicenter Study

Using a prognostic medical device for early identification of pressure ulcers: protocol for study design

Kim Keltie et al. Br J Nurs. .

Abstract

Background: An objective, physiological measurement taken using a medical device may reduce the incidence of pressure ulcers through earlier detection of problems signs before visual signs appear. Research in this field is hampered by variations in clinical practice and patient-level confounders.

Aim: The authors outline key considerations for designing a protocol for a study to assess the efficacy and safety of a prognostic medical device in reducing pressure ulcer incidence in a hospital, including comparators, randomisation, sample size, ethics and practical issues.

Method: Key issues relating to methodology and ethics are considered alongside a theoretical protocol, which could support future researchers in wound care trials.

Results: A prospective, three-armed, multi-centre, stratified cluster-randomised controlled trial is proposed. The third arm is recommended as it is expected that patients will need to be moved for the medical device to be used and repositioning is a preventive strategy. A minimum of 16 200 patients in 33 wards would needed to be recruited to achieve statistical significance. Ethical considerations in terms of consent or assent need to be considered.

Conclusion: The hypothetical study designed to evaluate the effectiveness of a diagnostic or prognostic medical device in reducing pressure ulcer incidence in secondary care, while accounting for biases, would require large sample sizes and involves risks of inter-operator and inter-device reliability, heterogeneity of users and the vague clinical interpretation of device results. Robust research in this field has the potential to influence or change policy and practice relating to the prevention of pressure ulcers in secondary care.

Keywords: Ethical considerations; Medical device; Pressure ulcer; Prevention; Randomised controlled trial; Skin assessment; Study design.

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. 2024 May 25;12(11):1084.
doi: 10.3390/healthcare12111084.

The Changing Prevalence of Pressure Injury among Ontarians with SCI/D at Rehabilitation Admission: Opportunities for Improvement

Affiliations

The Changing Prevalence of Pressure Injury among Ontarians with SCI/D at Rehabilitation Admission: Opportunities for Improvement

Beverley Catharine Craven et al. Healthcare (Basel). .

Abstract

Background: Despite preventability, 20-50% of patients with acute spinal cord injury/disease (SCI/D) develop hospital-acquired pressure injuries (PIs). The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC) aimed to mitigate PI risk through patient-reported daily skin checks alongside usual care.

Methods: This quality improvement initiative utilized an interrupted time series design, encompassing adults ≥ 18 years admitted for inpatient rehabilitation across five Ontario sites from 2020 to 2023. Patient demographics, etiology, and impairment data were obtained from a national registry, while participating sites gathered data on PI onset, location, and severity. Run charts depicted temporal trends, and statistical analyses, including chi-square and logistic regression, compared patients with and without PIs.

Results: Data from 1767 discharged SCI/D patients revealed that 26% had ≥1 PI, with 59% being prevalent and 41% incident. Most severe PIs (stages III and IV and unstageable) were acquired prior to admission. Process indicator fidelity was reasonable at 68%. Patients with PIs experienced longer hospital stays, lower Functional Independence Measure (FIM) changes, and FIM efficiency during rehabilitation.

Conclusions: PI prevalence is increasing, particularly sacral injuries at admission, while incident cases have decreased since 2021 due to regular skin checks. This trend calls for proactive health system interventions to reduce costs and improve patient outcomes.

Keywords: daily skin check; health system; pressure injury; spinal cord injury.

Conflict of interest statement

The authors declare no conflict of interest.

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Review
. 2024 Jun 14:S0965-206X(24)00081-0.
doi: 10.1016/j.jtv.2024.06.006. Online ahead of print.

Body mass index and pressure injuries risk in hospitalized adult patients: A dose-response analysis

Affiliations
Review

Body mass index and pressure injuries risk in hospitalized adult patients: A dose-response analysis

Yi-Jie Jia et al. J Tissue Viability. .

Abstract

Background: The association between underweight and pressure injuries (PIs) has been established in several studies. However, there is a lack of well-designed research investigating the connection between overweight and obesity with these injuries.

Objective: This meta-analysis aims to investigate the dose-response relationship between body mass index (BMI) and the risk of PIs in adult hospitalized patients.

Methods: PubMed, Web of Science, and MEDLINE Databases were searched from inception to May 2024. Observational articles with at least three BMI categories were included in the study. BMI was defined as underweight, normal weight, overweight, and morbid obesity for the meta-analysis. The non-linear relationship between BMI and the risk of PIs in hospitalized adults was investigated using restricted cubic spline models. Fractional polynomial modeling was used.

Results: Eleven articles reporting at least 3 categories of BMI met the inclusion criteria, including 31,389 participants. Compared to patients with normal weight, those with underweight, obesity, and morbid obesity exhibited an increased risk of PIs, with odds ratios of 1.70 (95%CI:1.50-1.91), 1.12 (95%CI:1.02-1.24), 1.70 (95%CI:1.13-2.55), respectively. A J-shaped dose-response model was established for the relationship between PI risk and BMI (Pnon-linearity < 0.001, Plinearity = 0.745).

Conclusion: The J-shaped dose-response pattern revealed that underweight, obesity and morbid obesity heightened the risk of PIs in hospitalized adults. Lower and higher BMI values may signify an increased risk for PIs, particularly among the elderly with lower BMI, providing valuable guidance for medical staff.

Keywords: Body mass index; Dose-response; Pressure injuries.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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. 2024 Jun 14.
doi: 10.1089/wound.2024.0041. Online ahead of print.

Comparison of "semi-occlusive dressing" treatment using plastic wrap or low-adherent absorbent wound dressings versus occlusive dressing treatment for stage III/IV pressure injuries in the inflammatory phase: a randomized controlled trial

Affiliations

Comparison of "semi-occlusive dressing" treatment using plastic wrap or low-adherent absorbent wound dressings versus occlusive dressing treatment for stage III/IV pressure injuries in the inflammatory phase: a randomized controlled trial

Jun Takahashi et al. Adv Wound Care (New Rochelle). .

Abstract

Objective: To compare the effectiveness of "semi-occlusive dressing (SOD)" treatment using plastic wrap or low-adherent absorbent wound dressings with that of occlusive dressing (OD) treatment for National Pressure Injury Advisory Panel stage III/IV pressure injuries in the inflammatory phase.

Approach: This 12-week, open-label, randomized, controlled trial was conducted at one hospital and three care facilities. Seventy-seven participants were enrolled; 40 comprised the SOD group and 37 comprised the OD group. The primary outcome was the surface area reduction. Secondary outcomes included the Bates-Jensen wound assessment tool (BWAT) score reductions, incidence of adverse events, and material cost. This trial met the recommendations of CONSORT 2010 statement.

Results: The surface area reduction of the SOD group was greater than that of the OD group throughout the study period. The significant interaction was revealed between treatment and time course (P < 0.0001). The 95% confidence interval of the difference at 12 weeks was 3.4 to 21.9. The median BWAT score reduction of the SOD group at 12 weeks was 23, and that of the OD group was 18.5 (P = 0.0077). The incidence of adverse events was comparable between groups. The OD treatment cost was 3.0-times higher than the SOD treatment cost (P = 0.0012).

Innovation: Because the SOD does not completely occlude the wound, excess exudate drains from the wound. Therefore, SOD can treat the wound with abundant exudate effectively and safely.

Conclusion: SOD treatment is more effective and less expensive than OD treatment for stage III/IV pressure injuries.

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. 2024 Jun 10;19(6):e0305190.
doi: 10.1371/journal.pone.0305190. eCollection 2024.

Application of bundled process control in the prevention of pressure injury in patients with head and neck cancer

Affiliations

Application of bundled process control in the prevention of pressure injury in patients with head and neck cancer

Mianmian Chen et al. PLoS One. .

Abstract

This study aimed to explore the application effects of cluster process control and routine nursing on the prevention of pressure injury (PI) in patients undergoing head and neck cancer surgery and to provide a basis for reducing the occurrence of PI, thereby promoting the safety of the patients. This was a retrospective study. Patients with head and neck cancers who underwent surgical treatment in the Department of Otolaryngology at the Second Affiliated Hospital of Fujian Medical University from July 2022 to June 2023 were selected as the research participants. Participants were classified into experimental and control groups using a convenience sampling method. In the experimental group, cluster process control was implemented, while routine nursing management was applied in the control group. The incidence of PI (p = 0.028) and healing time (p = 0.035) in the experimental group were lower than those in the control group. The process management ability of nurses in the experimental group was significantly improved, with the results for the Braden scale (p = 0.023), effective decompression (p = 0.002), floating heel (p = 0.002), nutrition monitoring (p = 0.005), and patient satisfaction in the experimental group being higher than those in the control group (p = 0.007). This study effectively demonstrated the effect of cluster process control in reducing the incidence of PI in patients undergoing head and neck cancer surgery, thereby determining that cluster process control is suitable for clinical application.

Conflict of interest statement

The authors have declared that no competing interests exist.

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. 2024 Jun 1;92(6S Suppl 4):S408-S412.
doi: 10.1097/SAP.0000000000003954.

Improving the Care and Cost of Treating Community-Acquired Stage 3 and 4 Decubitus Ulcers

Affiliations

Improving the Care and Cost of Treating Community-Acquired Stage 3 and 4 Decubitus Ulcers

Paulina B Le et al. Ann Plast Surg. .

Abstract

Introduction: The healthcare costs for treatment of community-acquired decubitus ulcers accounts for $11.6 billion in the United States annually. Patients with stage 3 and 4 decubitus ulcers are often treated inefficiently prior to reconstructive surgery while physicians attempt to optimize their condition (debridement, fecal/urinary diversion, physical therapy, nutrition, and obtaining durable medical goods). We hypothesized that hospital costs for inpatient optimization of decubitus ulcers would significantly differ from outpatient optimization costs, resulting in significant financial losses to the hospital and that transitioning optimization to an outpatient setting could reduce both total and hospital expenditures. In this study, we analyzed and compared the financial expenditures of optimizing patients with decubitus ulcers in an inpatient setting versus maximizing outpatient utilization of resources prior to reconstruction.

Methods: Encounters of patients with stage 3 or 4 decubitus ulcers over a 5-year period were investigated. These encounters were divided into two groups: Group 1 included patients who were optimized totally inpatient prior to reconstructive surgery; group 2 included patients who were mostly optimized in an outpatient setting and this encounter was a planned admission for their reconstructive surgery. Demographics, comorbidities, paralysis status, and insurance carriers were collected for all patients. Financial charges and reimbursements were compared among the groups.

Results: Forty-five encounters met criteria for inclusion. Group 1's average hospital charges were $500,917, while group 2's charges were $134,419. The cost of outpatient therapeutic items for patient optimization prior to wound closure was estimated to be $10,202 monthly. When including an additional debridement admission for group 2 patients (average of $108,031), the maximal charges for total care was $252,652, and hospital reimbursements were similar between group 1 and group 2 ($65,401 vs $50,860 respectively).

Conclusions: The data derived from this investigation strongly suggests that optimizing patients in an outpatient setting prior to decubitus wound closure versus managing the patients totally on an inpatient basis will significantly reduce hospital charges, and hence costs, while minimally affecting reimbursements to the hospital.

Conflict of interest statement

Conflicts of interest and sources of funding: none declared.

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. 2024 Jun 7.
doi: 10.1111/wrr.13182. Online ahead of print.

Trends in inpatient burden from pressure injuries in the United States: Cross-sectional study National Inpatient Sample 2009-2019

Affiliations

Trends in inpatient burden from pressure injuries in the United States: Cross-sectional study National Inpatient Sample 2009-2019

Siri Choragudi et al. Wound Repair Regen. .

Abstract

Pressure injuries are a significant comorbidity and lead to increased overall healthcare costs. Several European and global studies have assessed the burden of pressure injuries; however, no comprehensive analysis has been completed in the United States. In this study, we investigated the trends in the burden of pressure injuries among hospitalised adults in the United States from 2009 to 2019, stratified by sociodemographic subgroups. The length of admission, total cost of hospitalisation, and sociodemographic data was extracted from the National Inpatient Sample provided by the Healthcare Cost and Utilisation Project, Agency for Healthcare Research and Quality. Overall, the annual prevalence of pressure injuries and annual mean hospitalisation cost increased ($69,499.29 to $102,939.14), while annual mean length of stay decreased (11.14-9.90 days). Among all races, minority groups had higher average cost and length of hospitalisation. Our findings suggest that while the length of hospitalisation is decreasing, hospital costs and prevalence are rising. In addition, differing trends among racial groups exist with decreasing prevalence in White patients. Further studies and targeted interventions are needed to address these differences, as well as discrepancies in racial groups.

Keywords: decubitis ulcer; epidemiology; pressure injuries.

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. 2024 Jun 2;33(6):441-449.
doi: 10.12968/jowc.2020.0331.

Pressure ulcer development in patients treated for acute ischaemic stroke

Affiliations
Free article

Pressure ulcer development in patients treated for acute ischaemic stroke

Esin Derin Cicek et al. J Wound Care. .
Free article

Abstract

Objective: The aim of this study was to determine the incidence of pressure ulcers (PUs) in patients treated for acute ischaemic stroke (AIS) and to evaluate comorbid/confounding factors.

Method: The study included patients treated for AIS who were divided into three treatment groups: those receiving intravenous tissue plasminogen activator therapy (tPA); patients receiving mechanical thrombectomy (MT); and those receiving both tPA and MT. PUs were classified according to the international classification system and factors that may influence their development were investigated.

Results: A total of 242 patients were included in this study. The incidence of PUs in patients treated for AIS was 7.4%. Most PUs were located on the sacrum (3.7%), followed by the gluteus (3.3%) and trochanter (2.9%). With regards to PU classification: 29% were stage I; 34% were stage II; and the remainder were stage III. Age was not a significant factor in the development of PUs (p=0.172). Patients in the tPA group had a lower PU incidence (2.3%) than patients in the tPA+MT group (15.7%) and MT group (12.1%) (p=0.001). Patients with PUs had a longer period of hospitalisation (18.5±11.92 days) than patients without a PU (8.0±8.52 days) (p=0.000). National Institute of Health Stroke Scale (NIHSS) scores at admission were higher in patients with PUs than in patients without a PU (14.33±4.38 versus 11.08±5.68, respectively; p=0.010). The difference in presence of comorbidities between patients with and without PUs (p=0.922) and between treatment groups (p=0.677) were not statistically significant. The incidence of PUs was higher in patients requiring intensive care, but this difference was not statistically significant (p=0.089).

Conclusion: In this study, patients treated for AIS with high NIHSS scores at admission and/or receiving MT were at higher risk for PUs, and so particular attention should be given to these patients in order to prevent PU development.

Keywords: International Pressure Ulcer Classification System; National Institutes of Health Stroke Scale; acute ischaemic stroke; intravenous tissue plasminogen activator therapy; mechanical thrombectomy; pressure ulcer; stroke; ulcer; wound; wound care; wound dressing; wound healing.

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Observational Study
. 2024 Jun 2;33(6):451-460.
doi: 10.12968/jowc.2021.0105.

Pressure ulcers related to prone positioning: a pandemic amidst a pandemic

Affiliations
Observational Study

Pressure ulcers related to prone positioning: a pandemic amidst a pandemic

Hassiel Aurelio Ramirez-Marin et al. J Wound Care. .

Abstract

Objective: To explore the epidemiology and risk factors associated with the development of pressure ulcers (PUs) in patients receiving prone positioning (PP) ventilatory therapy; to compare the inflammatory status of patients who develop PUs with those who do not; and to describe the experience and useful findings that have allowed us to improve the management of these patients to reduce the incidence of PUs.

Method: An observational, descriptive and longitudinal study was conducted, where sociodemographic and laboratory data were collected from patients who were hospitalised and required PP ventilatory therapy in critical care areas (CCA) during the months of May-October 2020.

Results: From the total number of patients who required PP during their CCA stay (n=240), 202 (84.2%) developed a PU. The four most frequent areas where a PU appeared were: the head and neck (n=115); the pinna (n=21); the torso (n=21); and the lower limbs (n=21). Patients who developed PU were more frequently males with higher initial levels of creatinine phosphokinase and ferritin. The incidence for each month of follow-up decreased from 8.3% to 5.8%.

Conclusion: Regardless of the intervention, a multidisciplinary approach is required to optimise the prevention and treatment of these wounds. While PUs are often the result of other medical conditions or poor health status in general, the vast majority of PUs are avoidable.

Keywords: COVID-19; SARS-CoV-2; chronic wound; hard-to-heal wound; pressure ulcer; prone position; wound; wound care; wound dressing; wound healing.

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. 2024 Jun 6;6(6):e1102.
doi: 10.1097/CCE.0000000000001102. eCollection 2024 Jun 1.

Reducing Tracheostomy-Related Acquired Pressure Injury by Flipping the Ventilator Circuit Position Study

Affiliations

Reducing Tracheostomy-Related Acquired Pressure Injury by Flipping the Ventilator Circuit Position Study

Abesh Niroula et al. Crit Care Explor. .

Abstract

Background: Tracheostomy-related acquired pressure injuries (TRPIs) are one of the hospital-acquired conditions. We hypothesize that an uneven ventilator circuit load, leading to non-neutral tracheostomy tube positioning in the immediate post-tracheostomy period, leads to an increased incidence of TRPIs. Does switching the ventilator circuit load daily, in addition to standard post-tracheostomy care, lead to a decreased incidence of TRPIs?

Methods: This is a prospective quality improvement study. Study was conducted at two academic hospital sites within tertiary care hospitals at Emory University in different ICUs. Consecutive patients undergoing bedside percutaneous tracheostomy by the interventional pulmonary service were included. The flip the ventilator circuit (FLIC) protocol was designed and implemented in selected ICUs, with other ICUs as controls.

Results: Incidence of TRPI in intervention and control group were recorded at post-tracheostomy day 5. A total of 99 patients were included from October 22, 2019, to May 22, 2020. Overall, the total incidence of any TRPI was 23% at post-tracheostomy day 5. Incidence of stage I, stage II, and stages III-IV TRPIs at postoperative day 5 was 11%, 12%, and 0%, respectively. There was a decrease in the rate of skin breakdown in patients following the FLIC protocol when compared with standard of care (13% vs. 36%; p = 0.01). In a multivariable analysis, interventional group had decreased odds of developing TRPI (odds ratio, 0.32; 95% CI, 0.11-0.92; p = 0.03) after adjusting for age, albumin, body mass index, diabetes mellitus, and days in hospital before tracheostomy.

Conclusions: The incidence of TRPIs within the first week following percutaneous tracheostomy is high. Switching the side of the ventilator circuit to evenly distribute load, in addition to standard bundled tracheostomy care, may decrease the overall incidence of TRPIs.

Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

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. 2024 May 31:17:1451-1462.
doi: 10.2147/RMHP.S458522. eCollection 2024.

Analysis of the Current Status of Nurses' Knowledge of Pressure Injuries and Factors Influencing It in Shaanxi Province, China: A Cross-Sectional Study

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Analysis of the Current Status of Nurses' Knowledge of Pressure Injuries and Factors Influencing It in Shaanxi Province, China: A Cross-Sectional Study

Liqun Luo et al. Risk Manag Healthc Policy. .

Abstract

Background: Pressure injuries are present in all healthcare environments and not only pose a significant health risk to individuals but also impose a heavy economic burden on society and families. Nurses, as the primary caregivers responsible for the prevention and management of pressure injuries, have knowledge that directly determines the incidence of pressure injuries.

Aim: To understand the current status of nurses' knowledge of pressure injuries in Shaanxi Province and the factors influencing it.

Design: A cross-sectional survey.

Methods: In April - May 2022, 16,599 nurses from hospitals at all levels in Shaanxi Province were selected as survey subjects by convenience sampling method. They were surveyed using the general information questionnaire and the Pieper-Zulkowski pressure injury Knowledge Questionnaire through the Questionnaire Star platform.

Results: 16,599 nurses had a pressure injury knowledge score of (44.32±10.11). Wound description and pressure ulcer staging dimensions were less than 60% correct. Comparison of pressure injury knowledge scores of nursing staff with different genders, hospital levels, titles, education, whether they were specialized nurses in wound stoma when they last attended a lecture on pressure ulcers, when they last read literature or books on pressure ulcers, and whether they ever looked for information about pressure ulcers on the Internet showed that the differences were statistically significant (P < 0.05), which were the influencing factors of the knowledge scores of the nursing staff in Shaanxi Province.

Conclusion: Clinical nurses' awareness of stress-related injuries still needs to be improved, and nursing administrators can improve the quality of pressure-related injury care by increasing nursing staff's awareness through continuing education, tiered training, and other measures.

Keywords: influencing factor; knowledge; management; pressure injury; prevention.

Conflict of interest statement

The authors report no conflicts of interest in this work.

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Published Erratum
. 2024 Jun 4:S0965-206X(24)00075-5.
doi: 10.1016/j.jtv.2024.05.013. Online ahead of print.

Corrigendum to "The relationship between pressure injuries and ultrasonographically measured rectus femoris muscle thickness" [J. Tissue Viability 33 (2024) 60-66]

Affiliations
Published Erratum

Corrigendum to "The relationship between pressure injuries and ultrasonographically measured rectus femoris muscle thickness" [J. Tissue Viability 33 (2024) 60-66]

Ayfer Durak et al. J Tissue Viability. .

Abstract

Aim: Pressure injuries (PI) are an important quality indicator in healthcare, we aimed to evaluate the relationship between PIs and ultrasonographic muscle mass measurements.

Materials and methods: This study was conducted prospectively between May 2022 and August 2022. The ultrasonography method was used for muscle mass measurement. The presence of PIs was assessed according to the PI classification system of the EPUAP (European Pressure Ulcer Advisory Panel), (NPIAP) National Pressure Ulcer Advisory Panel & PPPIA (Pan Pacific Pressure Injury Alliance).The demographics, age, sex, history of previous hospitalization, the place where patients are admitted (home/other service/intensive care unit), length of hospitalization, presence of a urinary catheter, diaper usage, and presence of tracheostomy were recorded.

Results: Of the included 50 patients (mean age: 77.2 ± 9.7 (48-92), female: 56%), 42% had PIs, mostly staged 2 in the sacrum. The patients with PIs had significantly more urinary catheter and diaper usage, lower albumin levels, and reduced rectus femoris muscle thickness (RF MT) and rectus femoris cross-sectional area (RF CSA) values (p = 0.014, 0.018, 0.016, 0.018, and 0.042, respectively). In multivariate logistic regression analysis, RF MT was found independently associated with the PIs (p = 0.048).

Conclusion: Pressure injuries are more common in patients cared for in palliative care settings than in the general population and severely affect the quality of life. We found an independent relationship between PIs and RF MT. We consider that ultrasonographic muscle mass assessment may be a useful predictor of PIs.

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. 2024 Feb;21(2):e14710.
doi: 10.1111/iwj.14710.

A survey of knowledge, attitudes, and practices among paediatric intensive care unit nurses for preventing pressure injuries: An analysis of influencing factors

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A survey of knowledge, attitudes, and practices among paediatric intensive care unit nurses for preventing pressure injuries: An analysis of influencing factors

Nan Song et al. Int Wound J. 2024 Feb.

Abstract

To explore the knowledge, attitudes and practice (KAP) status of preventing pressure injury among clinical nurses working in paediatric ICU, and to examine factors affecting nurses' KAP. A questionnaire survey was conducted among 1906 paediatric ICU nurses in 18 children's hospitals by convenience sampling method. The survey tools were self-designed general data questionnaire, KAP questionnaire for the prevention of pressure injury and the influencing factors were analysed. A total of 1906 valid questionnaires were collected. The scores of overall KPA, knowledge, attitudes, and practice were 101.24 ± 17.22, 20.62 ± 9.63, 54.93 ± 5.81and 25.67 ± 6.76, respectively. The results of multiple linear regression analysis showed that education background, professional title, age and specialist nurse were the main influencing factor of nurses' knowledge of preventing PI; education background and specialist nurse were the main influencing factors of nurses' attitudes of preventing PI; knowledge, attitudes and education background were the main influencing factors of nurses' practice of preventing PI. Paediatric ICU nurses have a positive attitude towards the prevention of PI, but their knowledge and practice need to be improved. According to different characteristics of nurses, nursing managers should carry out training on the knowledge of prevention of PI to establish a positive attitude, so as to drive the change of nursing practice and improve the nursing practice level of ICU nurses to prevent of PI.

Keywords: cross‐sectional study; intensive care units; knowledge–attitude–practice; nurses; nursing administration research; paediatric; pressure injury.

Conflict of interest statement

The authors declare that they have no competing interests.

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Review
. 2024 Jun;21(6):e14928.
doi: 10.1111/iwj.14928.

A systematic review on the impact of sub-epidermal moisture assessments on pressure ulcer/injury care delivery pathways

Affiliations
Review

A systematic review on the impact of sub-epidermal moisture assessments on pressure ulcer/injury care delivery pathways

Pinar Avsar et al. Int Wound J. 2024 Jun.

Abstract

To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub-epidermal moisture (SEM) delta (∆ ≥ 0.6). We undertook a systematic review of the literature, and included original research studies using either a prospective or retrospective study design that report the impact that assessment using SEM assessments have on healthcare practitioners' delivery of PI/PU care pathways in adults at risk of developing PI/PUs. The review protocol was registered on PROSPERO (CRD42023416975). A literature search was conducted in May 2023, using PubMed, CINAHL, Scopus, Cochrane, EMBASE, Web of Science and Science Direct databases. Data were extracted using a data extraction tool including elements such as country, setting, sample size, intervention, control and quality appraisal was undertaken using the Evidence-based Librarianship. We identified nine papers published between 2017 and 2022. The majority of these studies were conducted in England (n = 6; 67%). The systematic review included studies conducted across multiple care settings including acute care, medical-surgical units, and palliative care, highlighting the importance of PI/PU prevention and management across diverse patient populations. The PI/PU care pathways implemented in the studies varied, but commonly included elements such as the application or increased use of pressure-redistributing mattresses/cushions, implementation of repositioning plans, management of incontinence and moisture, regular skin inspection, and assessment of patient mobility. Out of the nine studies identified, seven reported PI/PU incidence. A meta-analysis of seven studies (N = 18 451) demonstrated a statistically significant reduction in visual PI/PU development in favour of SEM-guided care pathways compared to usual care (the odds ratio = 0.36 [95% confidence interval: 0.24-0.53, p < 0.00001]). This systematic review provides evidence that implementing SEM assessments in patients at risk of developing PI/PUs prompts anatomy-specific clinical actions. The subsequent implementation of enhanced and targeted skin care interventions leads to consistent and sustained reductions in hospital-acquired PU incidence. The findings emphasise the importance of incorporating SEM assessments as part of comprehensive PI/PU prevention strategies in all care settings and patient populations. This systematic review is limited by the predominance of observational studies and variable study quality. Future research should focus on randomised trials in different care settings that monitor the efficacy of preventive interventions and their impact in reducing PI/PU incidence when implemented based on SEM assessments.

Keywords: pressure ulcer/injury; prevention; sub epidermal moisture; systematic review.

Conflict of interest statement

The authors declare no conflicts of interest. We disclose the following financial interest or relationship related to this article: the RCSI School of Nursing & Midwifery has a research collaboration with Bruin Biometrics.

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. 2024 May-Jun;51(3):191-198.
doi: 10.1097/WON.0000000000001076. Epub 2024 May 27.

Enhanced Skin Assessment Methodology to Detect Early Tissue Damage and Prevent Pressure Injuries

Affiliations

Enhanced Skin Assessment Methodology to Detect Early Tissue Damage and Prevent Pressure Injuries

Joyce Pittman et al. J Wound Ostomy Continence Nurs. 2024 May-Jun.

Abstract

Purpose: The purpose of this study was to evaluate a skin assessment technique, subepidermal moisture (SEM) assessment, to assess, identify, and prevent pressure injuries (PIs) in critically ill adults.

Design: This was a retrospective, descriptive, comparative research study.

Subjects and setting: The sample comprised 69 critically ill adults; their mean age was 58.8 years (SD 18.1 years). The majority were male (n = 40, 58%), 29 (42%) were African American (AA), and 36 (52%) were White. The study setting was a surgical trauma intensive care unit (STICU) in a southern US Gulf Coast academic level I trauma hospital. Data were collected from September to November 2021.

Methods: We conducted a retrospective medical record review of subjects who had undergone SEM assessment. We also collected demographic and pertinent clinical information, including Braden Scale cumulative scores and subscale scores, documented PI prevention interventions, and PI occurrence and characteristics if developed within 7 days of SEM measurement. We also evaluated whether PI prevention interventions were appropriate. To examine nurse perception of the SEM device, we conducted a web-based survey of nurses providing care in our facility's STICU. Comparison of responses was done using Fisher's test or Chi-square test, and the mean responses from groups were compared using t test.

Results: Thirty-five (57%) subjects had a sacral SEM delta ≥0.6; 14 (40%) were AA; 20 (57%) were White; and 11 (31%) had a hospital-acquired PI (HAPI) or present-on-admission (POA) PI. Among the 14 HAPI and POA PI subjects with sacral SEM delta, 11 (79%) had sacral SEM delta ≥0.6. Among 26 AA subjects with sacral SEM delta, 5 had a HAPI or POA PI, and of those, 4 (80%) had sacral SEM delta ≥0.6. A significant and negative correlation was observed between cumulative Braden Scale scores on day 2 and sacral SEM delta (r = -0.28, P = .03) and R heel delta (r = -0.29, P = .03) scores, indicating higher PI risk. Of the 35 patients with a sacral SEM delta ≥0.6, 24 (69%) subjects did not have appropriate PI prevention interventions. Nurses (n = 13) indicated that the SEM device was easy to use and helped them perform an accurate skin assessment on patients with darker skin tones.

Conclusions: This study demonstrates that SEM technology is beneficial to address racial disparities in skin assessment, enhance skin assessment accuracy beyond existing PI care, improve the accuracy of risk assessment, and promote appropriate location-specific PI prevention interventions.

Conflict of interest statement

The authors declare no conflicts of interest related to this manuscript.

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. 2024 May-Jun;51(3):185-190.
doi: 10.1097/WON.0000000000001072. Epub 2024 May 27.

Maintaining Skin Integrity of Patients Diagnosed With SARS CoV2: A Quality Improvement Project

Affiliations

Maintaining Skin Integrity of Patients Diagnosed With SARS CoV2: A Quality Improvement Project

Charleen Singh et al. J Wound Ostomy Continence Nurs. 2024 May-Jun.

Abstract

Purpose: This purpose of this quality improvement project was to develop and evaluate a protocol (intervention bundle) designed to prevent pressure injuries in patients admitted with SARS-CoV2 and required prone positioning.

Participants and setting: The sample comprised 267 patients aged 18 years and older, who were admitted with SARS-CoV2 and required prone positioning. Their age ranged from 32 to 76 years; a majority (54%, n = 145) were intubated. The study setting was an urban 220 bed acute care hospital in Northern California.

Approach: A task force comprising the quality management team, certified wound care nurses and nursing leadership used the plan-do-study-act cycle completed a quality improvement project designed for preventing pressure injuries among patients admitted with SARS-CoV2 and managed with prone positioning, either with or without mechanical ventilation. The five phases of the quality improvement project were protocol development, education, implementation, and evaluation. Data collection period for this quality improvement was between April 2020 and August 2020. Outcomes were evaluated using descriptive statistics.

Outcomes: Sixteen patients (6%) experienced a total of 25 pressure injuries. The time between initial prone placement and change back to supine positioning was 24 hours (36 ± 12 hours). The most common pressure injuries were deep tissue injuries, primarily over the heels and sacrum.

Implications for practice: This protocol maintained the skin integrity of 94% of a group critically ill patients admitted with SARS-CoV2 and managed by prone positioning.

Conflict of interest statement

The authors declare no conflicts of interests.

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