Pressure Injury Prevention in COVID-19 Patients With Acute Respiratory Distress Syndrome

Abstract

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019 and became a pandemic in a short period of time. While most infected people might have mild symptoms, older people and people with chronic illnesses may develop acute respiratory distress syndrome (ARDS). Patients with ARDS with worsening hypoxemia require prone positioning to improve the respiratory mechanics and oxygenation. Intubated patients may stay in a prone position up to 12–16 h, increasing the risk of pressure injury (PI). Frequent skin inspections and PI risk assessment in COVID-19 patients will be challenging due to hospital infection control measures aimed to reduce the risk for health professionals. In this perspective article, we summarize the best practice recommendations for prevention of PI in SARS-CoV-2-infected ARDS patients in prone positioning. Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. Once a patient is in prone position, it is recommended to (1) use the swimmer's position, (2) reposition the patient every 2 h, and (3) keep the skin clean. When the patient is repositioned to supine position, healthcare professionals are advised to (1) assess the pressure points and (2) promote early mobilization.

Clinical profile of the SEM Scanner — Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning

“…These pressure-induced injuries are a significant burden to hospitals and severely reduce patient quality of life, with yearly treatment costs ranging from £1.4 -£2.1 billion in the UK to exceeding $26.8 Billion (USD) in the US [2][3][4][5][6][7][8][9]. Looking back at how the COVID-19 pandemic has evolved and progressed globally, epidemiological data suggest an increase in PI prevalence within COVID-19 patients [10][11][12][13][14]. In resource-limited critical care settings, severe respiratory disorders and multi-organ dysfunctions associated with emerging pathogens like Severe acute respiratory syndrome (SARS-CoV), avian influenza A (H5N1), the 2009 influenza A (H1N1) pandemic, Middle East respiratory syndrome coronavirus (MERS-CoV), and avian influenza A (H7N9), increase the concomitant risk factors for PI/PU incidence [10,15].…”

“…In resource-limited critical care settings, severe respiratory disorders and multi-organ dysfunctions associated with emerging pathogens like Severe acute respiratory syndrome (SARS-CoV), avian influenza A (H5N1), the 2009 influenza A (H1N1) pandemic, Middle East respiratory syndrome coronavirus (MERS-CoV), and avian influenza A (H7N9), increase the concomitant risk factors for PI/PU incidence [10,15]. The pathophysiological congruity between severe respiratory disorders, etiology, PIs due to prolonged prone positioning and medical device-related PIs is evident [10][11][12][13][14][15][16][17][18][19][20][21].…”

Telenursing: How do caregivers treat and prevent pressure injury in bedridden patients during the COVID-19 pandemic in Thailand? Using an embedded approach

“…This aligns with the existing research on telenursing for skin cleaning, repositioning, and protecting tissue prominences during social distancing. 18 , 19 Interestingly, participants’ views on the consistent use of the skin cleaning PI handbook and telecare consultation with a professional nurse as a challenge to treat and prevent PI. However, previous research specific to PI exudates from COVID-19 patients, 20 we found that CGs training and formalising continuing education with telenursing can reduce skin cleaning PI at home.…”

Pressure Injury Surveillance and Prevention in Australia: Monash Partners Capacity Building Framework

“…As an emergency response to the COVID-19 outbreak in Melbourne, we have developed an infographic on HAPI prevention in the patients with COVID-19 with an acute respiratory distress syndrome in the prone position and communicated it to the partnering health services (57). The need to improve the skills of acute care clinicians in HAPI management emerges with the influx of COVID-19 aged care residents with PI detected on admission (58).…”