Hospital-Acquired Pressure Injury

Abstract

Background Although healthcare organizations have decreased hospital-acquired pressure injury (HAPI) rates, HAPIs are not eliminated, driving further examination in both nursing and health services research. Objective The objective was to describe HAPI incidence, risk factors, and risk-adjusted hospital variation within a California integrated healthcare system. Methods Inpatient episodes were included in this retrospective cohort if patients were hospitalized between January 1, 2013, and June 30, 2015. The primary outcome was development of a HAPI over time. Predictors included cited HAPI risk factors in addition to incorporation of a longitudinal comorbidity burden (Comorbidity Point Score, Version 2 [COPS2]), a severity-of-illness score (Laboratory-Based Acute Physiology Score, Version 2 [LAPS2]), and the Braden Scale for Predicting Pressure Ulcer Risk. Results Analyses included HAPI inpatient episodes (n = 1661) and non-HAPI episodes (n = 726,605). HAPI incidence was 0.57 per 1,000 patient days (95% CI [0.019, 3.805]) and 0.2% of episodes. A multivariate Cox proportional hazards model showed significant (p < .001) hazard ratios (HRs) for the change from the 25th to the 75th percentile for age (HR = 1.36, 95% CI [1.25, 1.45]), higher COPS2 scores (HR = 1.10, 95% CI [1.04, 1.16]), and higher LAPS2 scores (HR = 1.38, 95% CI [1.28, 1.50]). Female gender, an emergency room admission for a medical reason, and higher Braden scores showed significant protective HRs (HR < 1.00, p < .001). After risk adjustment, significant variation remained among the 35 hospitals. Discussion Results prompt the consideration of age, severity of illness (LAPS2), comorbidity indexes (COPS2), and the Braden score as important predictors for HAPI risk. HAPI rates may be low; however, because of significant individual site variation, HAPIs remain an area to explore through both research and quality improvement initiatives.

Large sacral/buttocks ulcerations in the setting of coagulopathy: A case series establishing the skin as a target organ of significant damage and potential morbidity in patients with severe COVID‐19

“…Other indirect risk factors that our patients variably displayed include immobility and recumbency for prolonged periods, mechanical ventilation (making it difficult to turn/examine patients), poor nutrition, and faecal contamination/ irritation. 6,7 In one study, average time to HAPI development after admission was 11.4 days. 6 Although it is unclear exactly when ulcerations in our patients first occurred, patient 3's ulcer was first documented significantly earlier than this average time, and patient 1's ulcer was first documented at approximately this average time but was already quite large (Table 1).…”

“…6,7 In one study, average time to HAPI development after admission was 11.4 days. 6 Although it is unclear exactly when ulcerations in our patients first occurred, patient 3's ulcer was first documented significantly earlier than this average time, and patient 1's ulcer was first documented at approximately this average time but was already quite large (Table 1). Both observations support the likelihood that factors directly related to COVID-19 are involved in their pathogenesis.…”

Nurse staffing and hospital‐acquired conditions: A systematic review

“…Various measures were used to examine the relationship between nurse staffing and hospital-acquired conditions. Hospital-acquired pressure injuries (formerly known as a pressure ulcers [Rondinelli et al, 2018] Table 3 presents the relationship between nurse staffing level and hospital-acquired conditions. As can be seen, the majority of the reviewed studies found negative relationships between nurse staffing levels and hospital-acquired conditions.…”

Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis

“…The National Pressure Ulcer Advisory Panel, the European Pressure Advisory Panel, and the Pan Pacific Pressure Injury Alliance categorise PIs into six clinical stages (ranging from superficial to deep tissue injuries, including suspected deep tissue injury and unstageable PI); and acknowledge the increase of the negative health impacts with the depth of the PI. One of the most common forms of PI are hospital acquired pressure injuries (HAPIs), defined as an area of damage to the skin/underlying tissue that develops during an inpatient hospital stay . From 2015 to 2016, the approximate rate of HAPIs in Australia totalled 9.7 injuries per 10 000 hospitalisations .…”

“…One of the most common forms of PI are hospital acquired pressure injuries (HAPIs), defined as an area of damage to the skin/ underlying tissue that develops during an inpatient hospital stay. 7 From 2015 to 2016, the approximate rate of HAPIs in Australia totalled 9.7 injuries per 10 000 hospitalisations. 8 The Australian Commission on Safety and Quality in Healthcare 9 has identified HAPIs as a serious and preventable hospital-acquired complication.…”