A Change in Focus: Shifting From Treatment to Prevention of Perioperative Pressure Injuries

Abstract

Hospital‐acquired pressure injuries are a patient safety concern and can be costly for health care organizations. A multidisciplinary team of senior leaders, managers, nurses, and educators from departments that care for perioperative patients created an evidence‐based perioperative pressure injury prevention bundle that includes skin and risk assessments, visual and electronic health record cues, prophylactic protection of at‐risk skin, communication among providers and leaders regarding patient risk and injury throughout hospitalization, staff member education, compliance audits, root cause analyses, and wound care team follow‐up. The prevention bundle resulted in a 50% reduction in perioperative pressure injuries the first calendar year after implementation and a zero‐incidence rate for perioperative pressure injuries for at least a two‐year period. This article discusses hospital‐acquired pressure injuries related to the perioperative setting and outlines the full perioperative pressure injury prevention bundle.

Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in the context of the COVID‐19 pandemic

“…Prone positioning is used in many invasive procedures in different surgical fields. 6,7,17,20,28 Despite the large variety of operation types requiring prone positioning, there is no published research concerning the biomechanical efficacy of PUP technologies for protecting prone surgical patients. During the present COVID-19 pandemic, the use of prone positioning has expanded sharply, in ICUs, as those patients developing ARDS and who are mechanically ventilated are typically placed prone for sessions of approximately 16 hours or more and up to 24 hours, to improve their lung mechanics and tissue oxygenation.…”

“…Indeed, clinical reports describe forehead injuries associated with prone positioning as DTIs rather than as skin lesions. 7,[35][36][37][38][39] The involvement of the DTI pathway calls for applying a more holistic approach in protecting tissues so that the prophylactic measures target both the superficial and deeper facial soft tissue structures. The latter, deep tissue protection can be achieved, for example, by using the fluidised positioner technology, which has been demonstrated to have high biomechanical efficacy in protecting scalp tissues, and is, therefore, likely to also be effective in facial protection against PUs.…”

“…6 Intraoperatively-acquired PUs are reported to occur 5% to 66% of the times, correlating to an increase in the length of hospital stays by 6.7 days for those patients affected by PUs, therefore, adding approximately $1.3-billion in annual healthcare costs in the United States alone. [6][7][8][9][10] The longer the surgery time is, the greater the risk of an intraoperatively acquired PU. 11 In addition to surgery, the use of prone positioning is also rising sharply in intensive care units (ICUs) worldwide, where mechanically ventilated patients with acute respiratory distress syndrome (ARDS) resulting from the coronavirus 2019 disease (COVID- 19) are placed prone.…”

“…8,28 The overall thin facial tissue structures imply that the sustained deformations would have a damaging effect that extends beyond the skin, and indeed, there is anecdotal evidence that some of the facial PUs associated with a prone position is deep tissue injuries (DTIs). 7,[35][36][37][38][39] The DTI nature of these facial injuries (which are difficult to heal without significant scarring compared with category 1/2 PUs 35 ) requires a more comprehensive bioengineering approach to protect the facial soft tissues in prone positioning. Specifically, an adequate prophylactic intervention targeting the forehead and chin should have good biomechanical efficacy in alleviating both the superficial and deep facial soft tissue loads.…”

“…Prophylactic intervention alternatives for lowering the risk of facials PUs in such scenarios, therefore, reduce to conducting regular skin assessments, skin hygiene regimens, and redistributing the contact loads by means of head positioners and prophylactic dressings. 1,7,15,17,30,31,43,44 With reference to the latter, perioperative nursing guidelines highlight the protective benefits in using dressings prophylactically to pad the eyes and facial tissues during prone surgeries, 43 similarly to the practice of protecting other at-risk areas using dressings in supine procedures (ie, the sacrum and heels). 4,7,15,17,43,45,46 Also relevant is the common nursing practice of protecting the bridge of the nose using dressings cut to shape, prior to continuous positive airway pressure treatments in order to cushion the mask-face interface.…”