Hospital-Acquired Pressure Injuries and Acute Skin Failure in Critical Care

Abstract

PURPOSE The purpose of this study was to examine clinical characteristics and risk factors for critically ill patients who develop pressure injuries and identify the proportion of validated unavoidable pressure injuries associated with the proposed risk factors for acute skin failure (ASF). DESIGN: Retrospective case-control comparative study. SUBJECTS AND SETTING: The sample comprised adult critically ill participants hospitalized in critical care units such as surgical, trauma, cardiovascular surgical, cardiac, neuro, and medical intensive care and corresponding progressive care units in 5 acute care hospitals within a large Midwestern academic/teaching healthcare system. Participants who developed hospital-acquired pressure injuries (HAPIs) and patients without HAPIs (controls) were included. METHODS: A secondary analysis of data from a previous study with HAPIs and matching data for the control sample without HAPIs were obtained from the electronic health record. Descriptive and multivariate logistic regression analyses were conducted. RESULTS: The sample comprised 475 participants; 165 experienced a HAPI and acted as cases, whereas the remaining 310 acted as controls. Acute Physiology and Chronic Health Evaluation (APACHE II) mean score (23.8, 8.7%; P < .001), mortality (n = 45, 27.3%; P = .002), history of liver disease (n = 28, 17%; P < .001), and unintentional loss of 10 lb or more in 1 month (n = 20, 12%; P = .002) were higher in the HAPI group. Multivariate logistic regression analysis identified participants with respiratory failure (odds ratio [OR] = 3.00; 95% confidence interval [CI], 1.27-7.08; P = .012), renal failure (OR = 7.48; 95% CI, 3.49-16.01; P < .001), cardiac failure (OR = 4.50; 95% CI, 1.76-11.51; P = .002), severe anemia (OR = 10.89; 95% CI, 3.59-33.00; P < .001), any type of sepsis (OR = 3.15; 95% CI, 1.44-6.90; P = .004), and moisture documentation (OR = 11.89; 95% CI, 5.27-26.81; P <.001) were more likely to develop a HAPI. No differences between unavoidable HAPI, avoidable HAPI, or the control group were identified based on the proposed ASF risk factors. CONCLUSION: This study provides important information regarding avoidable and unavoidable HAPIs and ASF. Key clinical characteristics and risk factors, such as patient acuity, organ failure, tissue perfusion, sepsis, and history of prior pressure injury, are associated with avoidable and unavoidable HAPI development. In addition, we were unable to support a relationship between unavoidable HAPIs and the proposed risk factors for ASF. Unavoidability of HAPIs rests with the documentation of appropriate interventions and not necessarily with the identification of clinical risk factors.

Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial

“…The incidence of PIs found in the CG of the present study is similar to the values presented by other authors [ 1 , 2 ]. This high incidence indicates the lack of effectiveness of the current PI prevention strategies recommended in the guidelines, demonstrating the need to study new tools, such as NMES [ 3 , 25 ].…”

“…Critically ill patients are at a high risk of developing a pressure injury (PI) [ 1 , 2 ]. PIs can occur as a result of intense and/or prolonged pressure combined with shear forces [ 3 ].…”

A Crosswalk Analysis Between Magnet® Standards and Clinical Nurse Specialist Practice Competencies

“…Using interpersonal team strategies, nurse-driven protocols, and a standardized catheter care bundle, catheter-associated urinary tract infections were decreased by greater than 50% across a 2-year period, resulting in cost avoidance of $31 000 per case. An analysis of pressure injuries The novel, institutionally copyrighted instrument enabled clear identification of prevention opportunities in the organization and a mechanism to further expand scientific knowledge in the literature 20,21 Abbreviations: CLABSI, central line-associated blood stream infection; CPOT, Critical Care Pain Observation Tool; EHR, electronic health record.…”

Pressure Injury Prevention and Management

“…5 We assert that the rise of HAPI rates reported by the AHRQ indicates the complexity of PI prevention and evidence indicating that not all PIs are preventable or avoidable. 3 For example, Pittman and colleagues 3 reported that more than 40% of PIs in the critical care setting were unavoidable, indicating that approximately 60% were avoidable. As a result, hospitals must increase their attention to PI that can be prevented.…”