Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury

Abstract

PURPOSE: Community-acquired pressure injuries (CAPIs) are present among approximately 3% to 8% of patients admitted to acute care hospitals. In the critical care population, little is known about hospital-acquired pressure injury (HAPI) development among patients with CAPIs because most studies exclude patients with CAPIs. The purpose of our study was to determine the incidence of HAPI development and the associated risk factors among surgical critical care patients with CAPIs. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: We used electronic health record data from adult critical care patients admitted to the surgical and cardiovascular surgical intensive care units (ICUs) at a level 1 trauma center and academic medical center between 2014 and 2018. METHODS: Univariate analysis was used to compare patients with CAPIs who developed a HAPI and those who did not, as well as logistic regression analysis to identify independent risk factors for HAPIs among patients with CAPIs. RESULTS: Among 5101 patients admitted to 2 surgical critical care units, 167 (3%) patients were admitted with CAPIs. Hospital-acquired pressure injuries were 4 times more common among patients with CAPIs compared to patients without CAPIs. Among the 167 patients with CAPIs, 47 patients (28%) went on to also develop a HAPI, whereas in the 4934 patients without CAPIs, 352 patients (7%) went on to develop a HAPI. Findings from the multivariate logistic regression analysis (n = 151) showed that decreased serum albumin (odds ratio [OR] = 0.47; 95% confidence interval [CI], 0.25-0.85; P = .02) and excessively dry skin (OR = 2.6; 95% CI, 1.1-6.22; P = .03) were independent predictors of HAPI development among patients admitted with CAPIs. CONCLUSIONS: Results from our study show that patients with CAPIs are at high risk for developing a HAPI, particularly among patients with decreased serum albumin or excessively dry skin. Patients with excessively dry skin may benefit from the application of skin moisturizers.

Evaluating the Effectiveness of an Alternating Pressure Overlay in Patients Undergoing Cardiothoracic Surgery

“…Of note, these common risk factors have been examined in the literature with varying results. 3,5,10 Surprisingly, some common factors discussed in the literature were found less frequently among our study participants, such as diabetes and having a ventricular assist device in place. 15,30 Qualitative results.…”

“…2 In a study by Alderden and colleagues that included 4,934 critical care patients who presented to the hospital with no preexisting PIs, 7% (n = 352) developed a HAPI; additionally, 50% of the stage 1 HAPIs worsened into more severe stages, although the study does not indicate the stages reached. 3 Patients who have undergone vascular surgery are at an elevated risk for developing PIs. A recent scop-ing review found that the incidence of PIs in these patients ranged from 17.2% to 45%, and varied according to procedure.…”

“…Stage 1 indicates a nonblanchable redness of the skin, with staging progressing to stage 2 (partial loss of skin), stage 3 (full-thickness skin loss), and stage 4 (full-thickness skin and tissue loss) 2. In a study by Alderden and colleagues that included 4,934 critical care patients who presented to the hospital with no preexisting PIs, 7% (n = 352) developed a HAPI; additionally, 50% of the stage 1 HAPIs worsened into more severe stages, although the study does not indicate the stages reached 3. Patients who have undergone vascular surgery are at an elevated risk for developing PIs.…”

Cerrahi Kliniklerde Çalışan Hemşirelerin Basınç Yaralanmalarını Önlemeye Yönelik Bilgi Düzeylerinin Belirlenmesi

“…Sağlık bakım sistemleri içerisinde kalite göstergelerinden biri olarak ele alınan ve hastanın gereksiz yere acı, ağrı çekmesine yol açan basınç yaralanmaları (BY) [1][2][3][4] , çoğunlukla "kemik çıkıntısı üzerinde, tıbbi ya da diğer bir cihazla ilgili ciltte ve/veya altta yatan yumuşak dokunun lokalize hasarı" olarak tanımlanmaktadır [4][5][6] . BY, sağlık bakım maliyetlerini, mortaliteyi, morbiditeyi ve hastanede kalış süresini arttırmakta, aynı zamanda hastanın ve ailenin yaşam kalitesini olumsuz yönde etkilemektedir.…”

Explainable Artificial Intelligence for Predicting Hospital-Acquired Pressure Injuries in COVID-19–Positive Critical Care Patients

“…Two of those-hemoglobin and serum albumin-are further evidence for the role of altered perfusion in HAPrI etiology. 1,22,34,35 Low levels of hemoglobin 36 and serum albumin 37,38 are previously identified HAPrI risk factors thought to affect tissue perfusion and therefore HAPrI risk through oxygen-carrying capacity (hemoglobin) and colloid osmotic pressure (serum albumin). 21 Furthermore, hemoglobin may be considered a modifiable factor, given that low levels can be corrected with blood transfusion; future research is needed to evaluate the effects of so-called permissive anemia 39 and blood transfusion on risk for HAPrI formation.…”