Tag: Pressure Injuries

Medical Device-related Pressure Injuries Associated With Electroencephalogram Leads in a Tertiary Care Children’s Hospital

Medical device-related pressure injuries (MDRPIs) present a substantial safety risk for children who are hospitalized. PURPOSE: This study aimed to describe patient and clinical characteristics of children who develop MDRPIs related to electroencephalogram (EEG) leads, determine risk factors associated with their development, and determine if there are common risk factors that can lead to actionable strategies to reduce MDRPIs related to EEG leads. METHODS: A retrospective review was completed of the electronic health records of all 3136 children who had EEG lead placements between January 1, 2014, and April 16, 2018, at a large tertiary care children’s hospital. Data abstracted included demographic variables, patient and pressure injury characteristics, as well as length of stay. RESULTS: Twenty-four (24) of the 3136 children (0.8%) developed an MDRPI. Most were stage 2 pressure injuries. Patients who developed a pressure injury were significantly younger than patients who did not (median age, 0.9 and 5.2 years … read more

Diabetic Foot Ulcers and Pressure Injuries: How Do You Tell the Difference?

In evaluating a patient with a wound on the foot, a question that often comes to mind is whether that wound is caused by pressure, diabetes mellitus (DM), ischemia, trauma, or a combination. For example, a patient with DM who happens to have an ulcer on the foot may have a diabetic foot ulcer (DFU) or possibly something else. One of the bigger challenges that many clinicians face is trying to determine the etiology of a foot ulcer. There has been a great deal of debate about DFUs and pressure injuries (PIs) on the feet of patients in terms of how to appropriately assess, classify, and treat them. The confusion and lack of evidence in differentiating between these two types of foot ulcers, particularly on the heel, can lead to misdiagnosis, which can increase both financial and patient-related costs … read more

Enhancing Pressure Injury Prevention Strategies Based on New Technology: From Learning More to Doing Better

he med-surg health care environment is constantly changing, driving complexity in care. The most recent findings from the Centers for Medicaid and Medicare Services state that pressure injuries develop in nearly 2.5 million patients annually, representing 8.3% of hospital admissions; the resulting financial burden for care is estimated to be between $3.3 and $11 billion annually.1 Although most occurrences of hospital-acquired conditions sharply decreased between 2010 and 2017, the Agency for Healthcare Research and Quality reported that pressure injuries increased by 6%.2

Pressure injuries develop when there is localized damage to the skin or underlying tissues due to pressure—and sometimes combined with shear—that impacts the skin’s ability to provide oxygen and nutrients and remove waste byproducts … read more

Reducing the incidence and severity of pressure injuries in a high level care residential aged facility: a quality improvement project

Aims Reduce pressure injuries (PIs) in residents of a high level care facility by increasing staff knowledge and skills through clinical support and a skin integrity education package.

Method This project was a quality improvement (QI) activity and data were de-identified and reported in aggregate. Pre- and post-implementation data included staff knowledge testing and PI prevalence and severity.

Results Pre-implementation data indicated that staff knowledge was very limited, skin inspections and PI risk assessment were not performed, and use of pressure redistribution devices was low, with point prevalence at 64% of mainly severe PIs. Despite ongoing external clinical … read more

Surgical treatment of pressure injuries in children: A multicentre experience

Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1–17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum  … read more

Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data … read more

Pressure Injuries (Pressure Ulcers) and Wound Care

Although the terms decubitus ulcer, pressure sore, and pressure ulcer have often been used interchangeably, the National Pressure Injury Advisory Panel (NPIAP; formerly the National Pressure Ulcer Advisory Panel [NPUAP]) currently considers pressure injury the best term to use, given that open ulceration does not always occur. [1] According to the NPIAP, a pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. It can present as intact skin or an open ulcer and may be painful. It occurs as a result of intense or prolonged pressure or pressure in combination with shear … read more

Dissemination of microbiota between wounds and the beds of patients with pressure injuries: a cross-sectional study

Pressure injuries (PIs) are localised injuries to the skin and/or underlying tissue caused by sustained pressure1, with a reported prevalence of 9–14.5% in the elder care setting2–4. Although their prevalence is declining due to advances in prevention and treatment5, up to 30% of PIs develop infections, which is a life-threatening complication6–8. Therefore, controlling wound infections is a crucial intervention after the development of PIs … Most patients with PIs are compromised hosts due to old age and malnutrition. Thus, treatment directed at improving the overall condition of the patient (e.g., nutritional support) is provided to treat those with PIs. Additionally, breaking the route of transmission of bacteria by using dressings is recommended … read more

Pandemic Underlines Importance of Alternative Support Surfaces in Pressure Wound Care

Hospital Acquired Pressure Injuries (HAPIs) – long a major healthcare problem for hospitalized patients – have the potential to increase with the increasing amount of patients requiring ICU care due to COVID-19. Regardless of primary diagnosis, when immobility, pressure, friction, shear, poor nutrition, and poor profusion plague the hospitalized patient, HAPIs often occur. Each year, more than 2.5 million patients suffer from these injuries, costing the U.S. healthcare system anywhere from $9.1 – 11.6 billion annually … read more

Adding a Hypochlorous Acid-Preserved Wound Cleanser to the Pressure Injury Management Toolbox: A Case Series

Pressure injuries (PIs) can impair quality of life, and the goal of management is to create an optimal local wound healing environment. PIs can be difficult to manage and are associated with significant morbidity and mortality. Wound cleansing is a routine part of managing these wounds and can aid in the removal of exudate, debris, and contaminants.3 PIs located on the sacrum or ischium are at high risk of infection due to exposure to urine and feces; for these wounds, regular cleansing is extremely important … read more

Electrical Stimulation for Pressure Injuries: A Health Technology Assessment

Background

Pressure injuries (bedsores) are common and reduce quality of life. They are also costly and difficult to treat. This health technology assessment evaluates the effectiveness, cost-effectiveness, budget impact, and lived experience of adding electrical stimulation to standard wound care for pressure injuries.

Methods

We conducted a systematic search for studies published to December 7, 2016, limited to randomized and non–randomized controlled trials examining the effectiveness of electrical stimulation plus standard wound care versus standard wound care alone for patients with pressure injuries. We assessed the quality of evidence through Grading of Recommendations Assessment, Development, and Evaluation (GRADE). In addition, we conducted an economic literature review and a budget impact analysis to assess the cost-effectiveness and affordability of electrical stimulation for treatment of pressure ulcers in Ontario. Given uncertainties in clinical evidence and resource use, we did not conduct a primary economic evaluation. Finally, we conducted qualitative interviews with patients and caregivers about their experiences with pressure injuries, currently available treatments, and (if applicable) electrical stimulation.

Results

Nine randomized controlled trials and two non–randomized controlled trials were found from the systematic search. There was no significant difference in complete pressure injury healing between adjunct electrical stimulation and standard wound care. There was a significant difference in wound surface area reduction favouring electrical stimulation compared with standard wound care.

The only study on cost-effectiveness of electrical stimulation was partially applicable to the patient population of interest. Therefore, the cost-effectiveness of electrical stimulation cannot be determined. We estimate that the cost of publicly funding electrical stimulation for pressure injuries would be $0.77 to $3.85 million yearly for the next 5 years.

Patients and caregivers reported that pressure injuries were burdensome and reduced their quality of life. Patients and caregivers also noted that electrical stimulation seemed to reduce the time it took the wounds to heal … read more