PURPOSE:The purpose of this systematic review was to identify and evaluate the use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries (HAPIs). METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis Statement (PRISMA). SEARCH STRATEGY: Four researchers independently conducted searches in Health Source, Cochrane of Systematic Reviews, CINAHL, and PubMed. Search terms included: "pressure* OR skin breakdown AND sacrum*"; "ICU patient* OR critical care patient*"; and "foam dressing OR prophylactic* or prevent*." FINDINGS: The search identifi ed 380 articles; 14 met eligibility criteria. The methodological quality of the included studies was variable. Findings from all studies included in our review support a decrease in HAPI incidence with use of sacral foam dressings. IMPLICATIONS: Findings from this review suggest that prophylactic foam dressings decrease sacral HAPI occurrences in critical care patients. While additional research is needed, current best evidence supports use of prophylactic foam sacral dressings for patients at risk for HAPI.

Background: A pilot project promoting optimal antibiotic usage in patients admitted with pneumonia within the first 24 h of their admission was commenced at Angliss Hospital (AH) and Maroondah Hospital (MH). The aim of this project was to support initial management of CAP with goals of (i) identifying the best strategy to identify patients in a timely fashion, (ii) assess appropriateness of initial antibiotic prescribed, (iii) provide feedback and education to prescribers, (iv) monitor uptake of recommendations and (v) determine impact, if any, on patient length of stay. It was planned to incorporate this into usual workflow. Methods:Patients admitted with CAP to the ward under General Medicine within 24 h would be assessed by the Infectious Diseases (ID) registrar and real-time feedback provided to the treating doctors. Adult patients over 18 years who presented with pneumonia to AH and MH ED were enrolled. Appropriateness of antibiotic use was assessed using Therapeutic Guidelines (TG) Antibiotics Guidelines, 1 by an independent ID advance trainee using CORB score.2 If change in antibiotics on patient's medication chart occurred within 24 h of advice, the advice was considered taken. The primary endpoint of this analysis are the pre-and post-intervention antibiotic prescribing patterns of antibiotic use in accordance with TG or endorsed local guidelines including antimicrobial choice, appropriate dosage, route and duration. Analysis was performed using the Microsoft Excel 2010 software. Chi-square analysis was performed for ordinal and categorical variables with Student t-test for continuous variables. Statistical tests were two-tailed and differences considered statistically significant if P ≤ 0.05. The study protocol was approved by Eastern Health Office of Research and Ethics as a quality assurance project. Results:The most common initial prescribed regimen on admission was ceftriaxone and azithromycin (31%). For patients with a CORB score of 0 and 1 (mild and moderate pneumonia), less than a third followed guidelines. Only half of the patients were prescribed total antibiotic courses of up to 7 days. 70% of patients received 4 days or less of intravenous antibiotics. The most common advice provided by ID registrar was for deescalation in patients with a CORB score of 0 and 1 (79%) from a ceftriaxone-based regimen (including azithromycin or doxycycline) to (i) benzylpenicillin (and doxycycline) or (ii) oral antibiotics. Adherence to recommendations was 71% where clinicians followed the recommendations within 24 h. Post-review by the ID registrar, appropriateness of prescribed antibiotic regimen showed significant difference in patients with CORB scores of 0 and 1 (P = 0.000016). The average length of stay for patients admitted with pneumonia reviewed by ID registrar (n = 100) was 5.3 compared to 6.8 days for the group not reviewed (n = 271). There was a reduction of 1.5 days (P = 0.19). Conclusion:Our result suggests that the involvement of ID registrar in patients admitted with CAP within the first 24 h of...