Compliance with preventive measures recommended by an international study group for pressure injuries in adult critically ill patients

Abstract

The objective of this cross‐sectional descriptive study is to analyse the degree of compliance with the preventive measures for pressure injuries reported by an International Study Group in a cohort of adult critically ill patients. The level of risk of developing pressure injuries was determined using the Conscious level, Mobility, Hemodynamics, Oxygenation and Nutrition (COMHON) index. According to the level of risk, the preventive measures applied to each patient and scores on the different components of the index were recorded. Number, location and degree of pressure injuries were registered. Seventy‐three patients (male: 68%) with an acute physiology and chronic health evaluation (APACHE) II: 12,1 ± 6,2 and 56,1% of them with invasive mechanical ventilation. The prevalence of pressure injuries was 21,9%, with 43,7% of sacral location and 75% of grade II. The level of risk using the COMHON index was distributed between low 30,1%, intermediate 23,3% and high 46,6%. The compliance range from 0% (offloading heel devices) to the use of active mattress and incontinence pads (100%). Regarding repositioning the degree of compliance varies (from 20% to 80%) according if patients with contraindications (4 points in subscale of Mobility) or those with the capacity to mobilise themselves (2 points in subscale of Mobility) are included in the denominator. We have found that in our ICU there is a wide range of compliance with the use of the preventive measures recommended by the International Study Group. Some of them are related not by the general score of the COMHON scale, but to that obtained in its subscale components.

State‐wide prevalence of pressure injury in intensive care versus acute general patients: A five‐year analysis

“…In the Delphi study (Lovegrove et al, 2020), international consensus was that repositioning should occur at least four‐hourly for low‐risk intensive care patients and at least two‐hourly those at higher risk. In a recent observational study, in a Spanish intensive care unit in which the COMHON Index was used, there was poor compliance with four‐ and two‐hourly repositioning for low and moderate‐risk patients (22.7% and 20.0%, respectively), although compliance with two‐hourly repositioning was greater (58.8%) for high‐risk patients (Cobos‐Vargas et al, 2022). Based on their results, the authors suggested that further work was indicated to investigate the association between the mobility subscale of the COMHON Index and repositioning frequency.…”

Improving pressure ulcer care in intensive care units: Evaluating the impact of bundled care and silver nanoparticle dressings

“…Dietitians closely monitor the nutritional status of patients and design high-protein dietary plans to support wound healing. For patients who can orally consume food, oral nutritional supplements are administered in addition to standard nutrition[ 13 ]. Effective pain management and education for patients and families are integral.…”