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.

Objective-To enhance the case definition of unintentional injuries in childhood by applying an objective severity measure to fatal and non-fatal cases. Design-A descriptive prospective epidemiological study of a defined resident childhood population (<16 years of age) for a one year period, 1990 Unintentional injury is the leading cause of death of children after the age of 1 year, accounting for one third of all deaths in those 1-15 years.'2 It is also a major cause of ill health because deaths represent only the 'tip of the iceberg' of the spectrum of morbidity.Although there has been a welcome increase in the medical literature on the epidemiology of non-fatal childhood injuires,3-5 few British studies have measured the total frequency of unintentional injury among a cohort of children over a fixed time period. This type of information is essential because injury prevention programmes are not just aimed at fatal cases, but also are intended to reduce the impact of non-fatal injuries.In a previous publication, based on retrospective data, we highlighted the epidemiological difficulties in attempting to use health service based data (for example hospital admissions) as a direct measure of the population frequency and distribution of non-fatal childhood injuries.5 Such difficulties relate to 'selection biases' that is factors that influence hospital attendance or admission. We argued that these selection biases function primarily at the 'mild' end of the injury spectrum and could be avoided by focusing attention on the more 'severe' injuries. This paper, based on a prospective study, examines the epidemiology of unintentional injury in a cohort of children, using a variety of data sources to measure the frequency of injury at different levels of severity. MethodsThe study population was children under the age of 16 years resident in Newcastle upon Tyne in 1990; this was estimated at 54 400 children.6 All deaths, all admissions to local hospitals, and a sample of attendances at local accident and emergency departments of resident children as a consequence of unintentional injury during 1990 were studied. An earlier retrospective sample study had shown no outward flow of Newcastle resident children for hospital admission of injuries,5 and it is likely that accident and emergency attendance would follow the same pattern.Deaths were identified from the local coroner's files and hospital inpatients were identified from examination of the admission books. Thereafter, the relevant inpatient case notes were obtained from the medical records departments. A 200/ random sample of accident and emergency department attenders was drawn from monthly listings of resident child-

Objectives: The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries (PI) among frontline healthcare workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. The primary outcome of interest was the incidence of facial PIs. The secondary outcomes of interest were facial pain while wearing PPE and ease of use of the care bundle. Methods: This study used a voluntary survey by questionnaire, supplemented by a qualitative analysis of interviews from a small purposive sample that took place in one large Irish hospital over a two-month period in 2020. The hospital was a city-based public university teaching hospital with 800 inpatient beds. The intervention was a care bundle consisting of skin protection, face mask selection, material use, skin inspection, cleansing and hydration developed in line with international best practice guidelines. All staff working in COVID-19 wards, intensive care units and the emergency department in the hospital were given a kitbag containing the elements of the care bundle plus an information pamphlet. Data were collected via a survey and interviews. Results: A total of 114 staff provided feedback on the use of the care bundle. Before using the care bundle 29% (n=33) of the respondents reported developing a facial PI, whereas after using the care bundle only 8% (n=9) of the respondents reported developing a facial PI. The odds ratio (OR) of skin injury development was 4.75 (95% confidence interval (CI): 2.15–10.49; p=0.0001), suggesting that after the care bundle was issued, those who responded to the survey were almost five times less likely to develop a skin injury. Interviews with 14 staff determined that the bundle was easy to use and safe. Conclusion: Among those who responded to the survey, the use of the bundle was associated with a reduction in the incidence of skin injury from 29% to 8%, and respondents found the bundle easy to use, safe and effective. As with evidence from the international literature, this study has identified that when skincare is prioritised, and a systematic preventative care bundle approach is adopted, there are clear benefits for the individuals involved.

This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Study Objective-The aim was to improve the epidemiological information concerning child accidental injuries which can be extracted from routine inpatient and coroners' inquest data.Design-This was a retrospective study of coroners' inquest reports and inpatient case notes to undertake objective severity scaling and to extract basic data. This material was related to denominators from OPCS midyear population estimates, to 1981 census ward populations, and to sociodemographic data collected in a local census in 1986. Setting-The study population was derived from three north east health districts and their corresponding census enumeration districts.Participants-A stratified sample of 500 children aged [0][1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]