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Bates-Jensen BM, Crocker J, Nguyen V, Robertson L, Nourmand D, Chirila E, Laayouni M, Offendel O, Peng K, Romero SA, Fulgentes G, McCreath HE. Decreasing Intraoperative Skin Damage in Prone-Position Surgeries. Adv Skin Wound Care 2024; 37:413-421. [PMID: 39037095 DOI: 10.1097/asw.0000000000000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To determine if subepidermal moisture (SEM) measures help detect and prevent intraoperative acquired pressure injuries (IAPIs) for prone-position surgery. METHODS In this clinical trial of patients (n = 39 preintervention, n = 48 intervention, 100 historical control) undergoing prone-position surgery, researchers examined the use of multidimensionally flexible silicone foam (MFSF) dressings applied preoperatively to patients' face, chest, and iliac crests. Visual skin assessments and SEM measures were obtained preoperatively, postoperatively, and daily for up to 5 days or until discharge. Electronic health record review included demographic, medical, and surgery data. RESULTS Of the 187 total participants, 76 (41%) were women. Participants' mean age was 61.0 ± 15.0 years, and 9.6% were Hispanic (n = 18), 9.6% were Asian (n = 18), 6.9% were Black or African American (n = 13), and 73.8% were White (n = 138). Participants had a mean Scott-Triggers IAPI risk score of 1.5 ± 1.1. Among those with no erythema preoperatively, fewer intervention participants exhibited postoperative erythema on their face and chest than did preintervention participants. Further, fewer intervention participants had SEM-defined IAPIs at all locations in comparison with preintervention participants. The MFSF dressings overcame IAPI risk factors of surgery length, skin tone, and body mass index with fewer IAPIs in intervention participants. CONCLUSIONS Patients undergoing prone-position surgeries developed fewer IAPIs, and SEM measures indicated no damage when MFSF dressings were applied to sites preoperatively. The SEM measures detected more damage than visual assessment.
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Affiliation(s)
- Barbara M Bates-Jensen
- At the University of California, Los Angeles (UCLA), Los Angeles, California, US, Barbara M. Bates-Jensen, PhD, RN, FAAN, is Professor of Nursing and Medicine, Los Angeles School of Nursing and David Geffen School of Medicine; Jessica Crocker, BA, is Project Director, Division of Geriatrics, David Geffen School of Medicine; and Vicky Nguyen, MSN, is Graduate Student, School of Nursing. Lauren Robertson, BS, is Senior Quality Control Analytical Associate, ImmunityBio, Los Angeles, California. Deborah Nourmand, MSN, RN, is Registered Nurse, UCLA Santa Monica Surgery Center, Santa Monica, CA. At the School of Nursing, UCLA, Emily Chirila, BSN, is Nursing Student; Mohamed Laayouni, MSN, is Nursing Student; Ofelia Offendel, MSN, is Student Nurse; Kelly Peng, BA, is Graduate Student Research Assistant; and Stephanie Anne Romero, MSN, is Graduate Student Researcher. Gerry Fulgentes, MSN, RN, CWOCN, PCCN, is Clinical Manager, Wounds, Ostomy, and Continence Services, UCLA Santa Monica Medical Center. Heather E. McCreath, PhD, is Adjunct Professor, Division of Geriatrics, David Geffen School of Medicine, UCLA
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Xu X, Miao M, Shi G, Zhang P, Liu P, Zhao B, Jiang L. Operative Positioning and Intraoperative-Acquired Pressure Injury: A Retrospective Cohort Study. Adv Skin Wound Care 2024; 37:148-154. [PMID: 38393704 DOI: 10.1097/asw.0000000000000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To comprehensively assess the association between operative positioning with intraoperative-acquired pressure injury (IAPI) development. METHODS This retrospective cohort study included 455 patients who underwent surgery between October 2020 and January 2021. The authors grouped patients by operative positioning into the prone position and nonprone position groups. They used propensity-score matching at a 1:2 ratio to control for preoperative confounders, applied multiple logistic regression models to analyze the effects between positioning and IAPI, and assessed interactions of positioning and intraoperative factors on IAPI. RESULTS The final enrollment was 92 cases in the prone position group and 181 in the nonprone position group. Multivariable logistic analysis suggested that the prone position had a 2.92 times higher risk of IAPI than the nonprone position (odds ratio, 2.92; 95% CI, 1.13-7.57; P = .026). Subgroup analysis showed a significant multiplicative interaction between positioning and foam dressing on IAPI (P < .05), which was not observed in other intraoperative factors (P > .05). CONCLUSIONS This study provides evidence that prone operative positioning can increase IAPI risk. Patients in the prone position may particularly benefit from using dressings in Chinese populations. Further large-sample longitudinal studies are required to confirm these findings.
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Affiliation(s)
- Xin Xu
- At the Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China, Xin Xu, MSN, is Clinical Nurse. Miao Miao, MSN, is Graduate, Shanghai Jiaotong University. Also at Xinhua Hospital, Guirong Shi, MSN, is Clinic Nurse; Peipei Zhang, BS, is Nursing Supervisor of the Emergency Operating Room; Ping Liu, MSN, is Associate Director of the Nursing Department RN; Bing Zhao, MSN, is Anesthetist Nurse; and Liping Jiang, PhD, is Professor and Chief Nursing Officer. Acknowledgments: The authors thank Chengnan Guo from the School of Public Health, Fudan University, Shanghai, China, who provided statistical guidance and support for this study. The authors have disclosed no financial relationships related to this article. Submitted January 5, 2023; accepted in revised form March 14, 2023
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Uslu Y, Adıgüzel Akbaba M. Evaluation of perioperative pressure injury in adults 65 years and older: A prospective cohort study. J Tissue Viability 2024; 33:43-49. [PMID: 38000967 DOI: 10.1016/j.jtv.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Old age is an important risk factor for the formation of pressure injury (PI). The aim of this study was to investigate the incidence, risk factors, characteristics of PI and suitability of risk assessment tools for patients aged 65 years and older. METHOD This prospective monocentric cohort study was conducted in Turkey between September 2022 and March 2023. Data were collected from a total of 240 surgical patients aged 65 years and older using a skin assessment form and the Braden and Munro scales for PI risk assessment. RESULTS The patients had a mean age of 72.90 ± 5.53 years, 123 (51 %) were male, 203 (85 %) had chronic diseases, and the mean operative time was 194.83 ± 99.45 min. PI occurred in 45 patients (18.8 %). PIs were most commonly stage I and located in the coccyx region. Postoperative Munro score, postoperative Braden score, and operative time were significant in univariate analyses (p < 0.001). According to the multiple logistic regression model, a postoperative Munro score ≥26 and postoperative Braden score ≤20 were independent factors associated with increased risk of PI. CONCLUSION Measures to prevent PI in surgical patients should begin in the preoperative period. Age alone may not be a risk factor in geriatric surgical patients. The Munro and Braden PI risk assessment scales can be used in geriatric surgical patients, but changes in cut-off score calculations may be required and additional age-related risk factors should be evaluated.
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Affiliation(s)
- Yasemin Uslu
- Faculty of Nursing, Istanbul University, Fatih, Istanbul, Turkey.
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Bentsen SB, Eide GE, Wiig S, Rustøen T, Heen C, Bjøro B. Patient positioning on the operating table and patient safety: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38186052 DOI: 10.1111/jan.16049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIM To identify occurrence of harmful incidents related to patient positioning on operating table. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information. REVIEW METHODS The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis. RESULTS Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]). CONCLUSIONS Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously. IMPACT This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as this is a review of previous research.
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Affiliation(s)
- Signe Berit Bentsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
| | - Geir Egil Eide
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Siri Wiig
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Tone Rustøen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Heen
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
| | - Benedikte Bjøro
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
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Zou Z, Lv S, Gao Q, Zhou X, Mao J. Operating room nurse's awareness and implementation status of the prevention of patient's intraoperative acquired pressure injuries: design and validation of a questionnaire. Front Surg 2024; 10:1308181. [PMID: 38239663 PMCID: PMC10794500 DOI: 10.3389/fsurg.2023.1308181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
Aim To compile the awareness and implementation status of patients with intraoperative acquired pressure injuries prevention by operating room nurses and to test its reliability and validity. Design This is an equipment development research based on recommendations for developing a reliable and valid questionnaire. Methods The research was carried out in two phases from February to November 2022. Through a panel discussion, expert consultation, and literature review, the questionnaire for operating room nurses on the current status of awareness and implementation of the prevention of intraoperative acquired pressure injuries was preliminarily formulated. The formal questionnaire was developed through validity analysis, reliability analysis and item analysis, and reliability and validity tests were conducted. Moreover, according to the questionnaire survey results, confirmatory factor analysis was carried out to construct the structural equation model. Results The initial questionnaire consisted of five dimensions with 48 items, which was finalized to five dimensions with 38 items after reliability and validity testing and analysis. The five dimensions included implementation of intraoperative acquired pressure injuries prevention, intraoperative acquired pressure injuries preventing cognitive conditions, preoperative intraoperative acquired pressure injuries preventing cognitive conditions, basic knowledge of pressure injuries, and implementation of intraoperative acquired pressure injuries prevention in special patients. Cronbach's α of the overall questionnaire was 0.969 while that of each dimension was 0.846-0.959. The KMO value of structural validity was 0.945 (P < 0.001), and the contribution rate of cumulative variance was 70.694%. The fitting of confirmatory factor analysis was found to be generally ideal: χ2/df = 2.382, RMR = 0.027, TLI = 0.894, RMSEA = 0.072, IFI = 0.905, CFI = 0.904. Conclusions The study and design of the questionnaire for operating room nurses on the current status of awareness and implementation of the prevention of intraoperative acquired pressure injuries are scientific and rational, providing a scientific basis for the standardized reform of hospitals and the optimization of the intraoperative acquired pressure injuries management system of the operating room.
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Affiliation(s)
- Zhenya Zou
- Operating Room, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shijiao Lv
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Qian Gao
- Specialty Care Outpatient, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaoyang Zhou
- Operating Room, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jinbao Mao
- Operating Room, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Wang Z, Fan J, Chen L, Xie L, Huang L, Ruan Y, Xu X, Liang Z. Strategies to preventing pressure injuries among intensive care unit patients mechanically ventilated in prone position: a systematic review and a Delphi study. Front Med (Lausanne) 2023; 10:1131270. [PMID: 37644983 PMCID: PMC10461099 DOI: 10.3389/fmed.2023.1131270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Background Although the incidence of pressure injury in the prone position is high for the mechanically ventilated patients in the intensive care unit, evidence-based strategies are still lacking. Propose To conduct a systematic review of current evidence, and to propose a series of strategies to prevent pressure injuries among mechanically ventilated patients with prone position in the intensive care unit. Methods The study was guided by the Medical Research Council framework. After a systematic review of current evidence of original articles, guidelines, expert consensus and theories, a strategy draft was developed. Then we invited 20 experts to modify and refine these strategies through two rounds of Delphi consensus method. Results After two rounds of Delphi process, the importance of coefficient of variation (Cv) and Kendall's coefficient of concordance in the strategies repository were 0.067 and 0.311, respectively. And the operability of Cv and Kendall's coefficient of concordance in the strategy draft was 0.055 and 0.294, respectively. Ultimately, we established 31 strategies for including 7 themes (assess risk factors, assess skin and tissue, body position management, skin care, nutrition, preventing medical device-related pressure injuries, education and supervision). In addition, we also developed a strategy framework to clarify our strategies. Conclusion According to the Medical Research Council framework, we developed 7 themes and 31 strategies to prevention prone-position pressure injuries among the intensive care unit mechanically ventilated patients. This study was considered to improve the clinical management of pressure injuries among prone position patients in the intensive care unit settings.
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Affiliation(s)
- Zonghua Wang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Jiangshan Fan
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Ling Chen
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Army Medical University, Chongqing, China
| | - Langlang Xie
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Lingfang Huang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Yang Ruan
- Department of Outpatient, The 79th Hospital of Group Army, Liaoning, China
| | - Xia Xu
- Department of Health Management and Geriatric Nursing, Daping Hospital, Chongqing, China
| | - Zeping Liang
- Department of Nursing, Daping Hospital, Chongqing, China
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