Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis

Abstract

PURPOSE: The purpose of this study was to determine overall pressure injury (PI) prevalence and hospital-acquired pressure injury (HAPI) prevalence in US acute care hospitals. Additionally, analysis of patient characteristics associated with HAPIs will be presented. DESIGN: Observational, cross-sectional cohort study. SUBJECTS AND SETTING: An in-depth analysis of data was performed from the International Pressure Ulcer Prevalence™ (IPUP) Survey database for years 2018-2019 that included 296,014 patients. There were 914 participating US acute care facilities in 2018 and 887 in 2019. Overall PI prevalence and HAPI prevalence over time were also examined for 2006-2019 acute care data from 2703 unique facilities (1,179,108 patients). METHODS: Overall PI prevalence and HAPI prevalence were analyzed from the 2006-2019 IPUP survey database. Recent data for 2018-2019 PI prevalence are reported separately for medical-surgical, step-down, and critical care unit types. PI stages, anatomic locations, Braden score associated with HAPIs, and body mass index were analyzed. RESULTS: Overall PI prevalence and HAPI prevalence data declined between 2006 and 2019; however, the prevalence plateaued in the years 2015-2019. Data from 2018 to 2019 (N = 296,014) showed that 26,562 patients (8.97%) had at least one PI and 7631 (2.58%) had at least one HAPI. Patients cared for in medical-surgical inpatient care units had the lowest overall PI prevalence (7.78%) and HAPI prevalence (1.87%), while critical care patients had the highest overall PI prevalence (14.32%) and HAPI prevalence (5.85%). Critical care patients developed more severe PIs (stage 3,4, unstageable, and deep-tissue pressure injuries [DTPIs]), which were proportionally higher than those in the step-down or medical-surgical units. The sacrum/coccyx anatomic location had the highest overall PI prevalence and HAPI prevalence, except for DTPIs, which most common occurred on the heel. CONCLUSIONS: Overall and HAPI prevalence has plateaued 2015-2019. Prevalence of HAPIs, especially in critical care units, remain high. While medical advancements have improved survival rates among critically ill patients, survival may come with unintended consequences, including PI development.

Prevalence, severity, and characteristics of medical device related pressure injuries in adult intensive care patients: A prospective observational study

“…Moreover, future research is needed to explore the relationship between the type of device and the depth of tissue involved in the MDRPI. Unlike other studies, 1,2,13,22 secondary analysis of the data showed a significant relationship between PI risk assessment and the development of MDRPI. A plausible explanation of this result is due to the number of patients who developed MDRPI and had classic PIs (n = 7/15, 46.7%) and the sample characteristics which included patients with a mean age of 70 years old patients were admitted to medical ICU with a higher risk of PI development (mean Braden score was 10.9).…”

“…The findings from this study represent different location sites for device-related injuries than other published data by Black et al, 1 Van Gilder et al 22 and Kayser et al 24 where the ears were the most frequent location of MDRIs, and Watts et al 25 and Apold and Rydrych 2 where cervical collars were the most common sites. Findings of this study identified the hands and wrist, nose and lips or mouth in addition to meatal orifice as the most common sites were partially similar to findings reported by Coyer et al 13 and Amirah et al 11 in those injuries related to nose, lips or mouth specifically caused by NG and ET tubes, devices commonly used in ICUs, although specific MDs that caused injuries were not reported in many studies.…”

“…Findings of this study identified the hands and wrist, nose and lips or mouth in addition to meatal orifice as the most common sites were partially similar to findings reported by Coyer et al 13 and Amirah et al 11 in those injuries related to nose, lips or mouth specifically caused by NG and ET tubes, devices commonly used in ICUs, although specific MDs that caused injuries were not reported in many studies. 9,22,23 An important finding from this study is reporting the number of mucous injuries (MDRPI-M) in contrast with only skin injuries in the other studies, 1,2,22,25 suggesting the need to include mucous membrane assessment with skin assessment when a medical device such as an NG and ET tubes or foley catheters are in use. This study reported MDRPI-M was 14/41(34.2%) and identified that C, cleaning skin under the device; M, moisturizing skin under the device; N, received supplemental nutrition ( †, patient received supplemental nutrition at least once over the observation period, X, patient did not receive any supplemental nutrition over the observation period); P, padding the device; R, repositioning the device.…”

“…Dissimilar to many studies, this study revealed that mucosal injuries were less than half of the reported injuries (14/41, 34.2%). 1,13,22 Considering the use of a large number of MDs for diagnosis, prevention, and treatment purposes, patients who developed MDRIs in this study had an average of 8 devices, suggesting the potential risk of device-related injuries was high, yet MDRI prevalence was almost 5%. Overall, inadequate prevention of MDRPIs and potential risk of having medical-related injuries was evident in this study and suggesting the need to establish effective prevention strategies for medical device-related pressure injuries.…”

“…Several studies reported MDRPIs in adult acute and intensive care patients. 1,[9][10][11]13,[21][22][23][24] The overall prevalence of MDRPIs from these studies was variable and ranged from 0.4% in Clark et al 9 to 44.7% in Arnold-Long et al 10 Comparison of data from this study with that of other studies is challenging due to lack of reporting the prevalence of MDRPIs and specific devices that caused the injuries were not reported, and variability in the type of population investigated based on age and medical diagnoses. In addition, many studies did not report the number of ICU patients screened precluding calculation of ICU MDRI prevalence rate.…”