Prevention of Tracheostomy‐Related Hospital‐Acquired Pressure Ulcers

Abstract

Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head. One year after the bundle was initiated, a retrospective analysis was performed to compare the percentage of tracheostomy patients who developed pressure ulcers versus the preintervention period. Results The incidence of tracheostomy-related pressure ulcers decreased from 20 of 183 tracheostomies (10.93%) prior to use of the standardized protocol to 2 of 155 tracheostomies (1.29%). Chi-square analysis showed a significant difference between the groups, with a P value of .0003. Discussion Adoption of this care bundle at our institution resulted in a significant reduction in the incidence of hospital-acquired tracheostomy-related pressure ulcers. The impact of any single intervention within our protocol was not assessed and could be an area of further investigation. Implications for Practice Adoption of a standardized posttracheostomy care bundle at the institution level may result in the improved care of patients with tracheostomies and specifically may reduce the incidence of pressure ulcers.

Device-related pressure ulcers: SECURE prevention

“…Outcomes of studies on pressure redistribution at the interface of masks show that this approach reduces skin and subdermal tissue stress. 169,170 Robust quantitative data on the e ectiveness of other medical devices are still lacking in the literature. e development of bespoke o oading devices is required, potentially in collaboration between manufacturers of devices and manufacturers of prophylactic dressings.…”

Mortality associated with tracheostomy complications in the United States: 2007–2016

“…Although some causes of tracheostomy‐related mortality, such as tracheoinnominate fistula, are very difficult to prevent, others, such as tracheotomy wounds, have been characterized as never events based on analogy to decubital ulcers . This stance, although controversial, has spawned useful innovations, such as tracheostomy dressing bundles …”

“…27 This stance, although controversial, has spawned useful innovations, such as tracheostomy dressing bundles. 28…”

Medical-Device-Related Pressure Injury on Adults: An Integrative Review

“…The number of injuries decreased after the protocol was installed, which included hydrocolloid placement under the tracheostomy flange in the postoperative period, suture removal within seven days of the tracheostomy procedure, placement of a polyurethane foam dressing after suture removal and neutral head positioning. 22 Stay length in the ICU makes the patient more susceptible to new infections and various adverse events. The mean length of hospital stay was longer in patients with MDRPI (28 to 59 days) vs. those without injury (22 to 35 days).…”

“…In the specific case of stage 4 injuries, the patient was discharged with a longer hospitalization time of ten days or more. 22,24…”