Clinical Burden of Inpatient Wound Care in Internal Medicine Units During the First Wave of COVID-19 Outbreak

Abstract

Objective: To explore the clinical burden and epidemiologic profile of hospitalized patients with wounds during the first wave of COVID-19.Methods: A retrospective and observational study was conducted to analyze the inpatient episodes of wound care in the University Hospital of Salamanca (Spain) during the initial COVID-19 crisis from March 1, 2020, to June 1, 2020. Data were collected from nursing care reports and clinical discharge reports. Included patients were 18 years or older, had a hospital length of stay of 1 day or longer, and were hospitalized in an internal medicine unit. Surgical and traumatic wounds and pediatric patients were excluded.Results: A total of 116 patients and 216 wounds were included. The overall wound prevalence was 7.6%, and incidence was 3.5% in the internal medicine units. Pressure injuries (PIs) were the most common wound type, and patients with COVID-19 had significantly higher PI risk (odds ratio [OR], 2.0; 95% confidence interval [CI], 1. 1-4.0; P = .042). Significant differences in PI staging were noted: 83.2% of wounds in patients with COVID-19 were stages I-II versus 67.8% in patients without COVID-19; the probability of stage III-IV PIs among patients without COVID-19 was doubled (OR, 2.3; 95% CI, 1.2-4.5; P = .009). The probability of acute wounds tripled in patients with COVID-19 (OR, 3.7; 95% CI, 2.1-6.6; P < .001). Patients with COVID-19 also had longer mean hospital stays and higher ICU admission rates. No case fatality rate differences were observed. Conclusions:In this context of clinical practice, protocolized assessment and implementation of preventive measures must be ensured among older adult populations, patients with associated comorbidities, and ICU patients.

Changes in Interprofessional Practice During the COVID-19 Pandemic and the Effect on Patient Outcomes

“…In the initial COVID-19 cohorts, HAPIs increased around the globe and at our institution. Nieto-Garcia et al reported a 2 times higher risk of pressure injury for patients admitted with COVID-19 from March to June 2020 (same as our cohort 1) 18 . In our study, mechanical ventilation and proning were independent predictors of HAPIs.…”

“…Nieto-Garcia et al reported a 2 times higher risk of pressure injury for patients admitted with COVID-19 from March to June 2020 (same as our cohort 1). 18 In our study, mechanical ventilation and proning were independent predictors of HAPIs. Multiple other studies identified proning as a contributing factor for increased HAPIs in patients with COVID-19, leading to the development of specialty proning teams, proning procedures with positioning supports, and increased use of various products to prevent HAPIs associated with proning.…”