Back to Basics: Preventing Perioperative Pressure Injuries

Abstract

Pressure injury prevention is essential to patient safety in the perioperative setting. Perioperative nurses should be knowledgeable about the risk factors for pressure injury and the safety precautions that can be taken to prevent this injury from occurring. Perioperative nurses should be able to identify patients who are at high risk for developing a pressure injury. Perioperative patients are at risk for developing pressure injuries because they can experience intense or prolonged pressure during lengthy surgical procedures, may have increased pressure on bony prominences from positioning, are exposed to friction or shear during transfer to the OR bed and positioning, and often have significant comorbidities. This Back to Basics article examines the risk factors for pressure injuries in the perioperative patient population and discusses screening and prevention measures that can be implemented.

A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score

“…Many preventive intervention opportunities exist, such as the use of prophylactic multi-layer dressing, using alternative pressure mattress and vesico-elastic polymer pad (gel pad) on the operating table during surgery, patients' and caregivers' education on nutrition and skin care, frequent repositioning, and the use of positioning wedges. [38][39][40] Although many of these interventions had clinically demonstrated benefits for preventing PUs or accelerating the healing of PUs, some are costly or burdensome. Therefore, to avoid excessive cost and burden, we need to be able to identify cases of high risk and apply appropriate levels of prevention according to need.…”

“…Knowledge about preoperative risk factors is important so that nurses can implement preventive interventions before tissue injury begins. Many preventive intervention opportunities exist, such as the use of prophylactic multi‐layer dressing, using alternative pressure mattress and vesico‐elastic polymer pad (gel pad) on the operating table during surgery, patients' and caregivers' education on nutrition and skin care, frequent repositioning, and the use of positioning wedges …”

The Effect of Selected Risk Factors on Perioperative Pressure Injury Development

“…Risk factors for perioperative pressure injuries are categorized as preoperative, intraoperative, or postoperative . Studies have reported that preoperative risk factors include advanced age; male sex; low body mass index (BMI); low hematocrit (ie, less than 38%), hemoglobin, and albumin levels; inadequate nutrition; diabetes mellitus and other chronic diseases (eg, respiratory, heart); and immobilization .…”

“…Risk factors for perioperative pressure injuries are categorized as preoperative, intraoperative, or postoperative. 8,9,17,18 Studies have reported that preoperative risk factors include advanced age; 6,19-23 male sex; 8 low body mass index (BMI); [21][22][23] low hematocrit (ie, less than 38%), 6,19 hemoglobin, 21,24 and albumin levels; 6,24 inadequate nutrition; 6,21 diabetes mellitus [19][20][21][22][23] and other chronic diseases (eg, respiratory, heart); 6,11,19,20,23 and immobilization. 9,11,21 Intraoperative risk factors include type of anesthesia, 6 procedure type 6,23 and duration, 6,19,21,22 intraoperative position of patient, 6,20 materials used for positioning, 8,11,20 the type of surface on the OR bed, 8 moist skin, 8,20 intraoperative vasopressor use, 22 intraoperative hypotension, intraoperative hypothermia (ie, temperature less than 36.5° C [97.7° F]) or hyperthermia (ie, temperature greater than 37.5° C [99.5° F]), and use of warming devices.…”

Avoiding pressure injuries with Root Cause Analysis and Action

“…Successful pressure injury prevention strategies include risk assessment, standardization of equipment and devices, and implementation of AORN guidelines. 4,5…”