Systematic review: Incidence and prevalence of mucous membrane pressure injury in adults admitted to acute hospital settings

Transient bacteremia following the removal of four different types of rapid palatal expanders

PURPOSE

General health related recommendations for prophylactic measures in connection with orthodontic treatments are limited due to the lack of evidence-based data. This study aimed to investigate the development of transient bacteremia following the removal of four types of rapid palatal expanders (RPE).

METHODS

Seventy-five individuals aged 10-18 years undergoing rapid palatal expansion with four types of RPE were categorized according to the type of RPE used in their treatment: banded tooth-borne (group A (1), n = 17), banded tooth- and tissue-borne (group A (2), n = 17), bonded tooth-borne (group B (1), n = 18), and bonded tooth- and tissue-borne (group B (2), n = 23). Gingival inflammation was assessed using the gingival index one day before RPE removal. Furthermore, samples of blood (5 ml each) were collected before and 3 min after RPE removal. The groups were statistically evaluated for comparability with respect to sex, age, or wear time of the RPE and to the gingival index. In addition, the prevalence of bacteremia in the different groups was evaluated and statistically compared.

RESULTS

No significant difference was found among the groups (p > 0.05) for sex, age, and RPE wear time. Mean gingival index was higher in group B (2) than in group A (1) (p < 0.05). The prevalence of bacteremia did not differ significantly between groups. Streptococcus species were identified in all bacteremia cases. The bacteremia prevalence of the groups was as follows: group A (1), 11.8%; group A (2), 23.5%; group B (1), 16.7%; and group B (2), 30.4%.

CONCLUSION

This investigation demonstrated that removal of a RPE could cause bacteremia, but the RPE design did not affect the prevalence of bacteremia. The results of this study support the necessity of prophylaxis measures before RPE removal in indicated patients.

Mucosal membrane pressure injury in intensive care units: A scoping review

AIM

To describe published work on the current situation of mucosal membrane pressure injury of patients in the intensive care unit.

BACKGROUND

Device-related pressure injuries in critically ill patients are mostly focused on skin surface injuries, and less attention is paid to mucosal membrane pressure injury.

METHODS

We searched PubMed, Embase, Web of Science, CINAHL, and Cochrane Library from database construction until March 1, 2023. Two researchers independently screened and extracted data.

RESULTS

Eighteen articles met our criteria and were published in 2014-2023. The included studies showed that the incidence of mucosal membrane pressure injury in critically ill patients ranged from 0.83% to 88.2%, and the prevalence ranged from 0.16% to 55.6%. The most frequently reported site of mucosal injury is the oral mucosa, followed by the nasal mucosa. Ten studies used Braden to assess the risk of mucosal membrane pressure injury, and only six studies reported specific stages of mucosal membrane pressure injury. Thirteen studies described 30 risk factors for mucosal membrane pressure injury, with albumin being the most frequently reported risk factor, followed by the vasoconstrictive drugs use. Thirty risk factors were summarized in six aspects: medical device-related factors, disease-related factors, treatment- related factors, physiological and biochemical parameters, demographic-related factors, and microbial colonisation.

CONCLUSIONS

The incidence or prevalence of mucosal membrane pressure injury varies widely, and specific risk assessment tools and standardized staging criteria need to be further determined. The risk factors of mucosal membrane pressure injury involve multiple aspects, and some risk factors have only been explored in few studies and need to be further verified, in order to detect the risk group of mucosal membrane pressure injury early and take targeted preventive measures.

IMPLICATIONS FOR CLINICAL PRACTICE

We synthesized the current research status of mucosal membrane pressure injury in critically ill patients, which can provide a valuable reference for the clinical staff to develop preventive and management measures for such patients.

Risk factors for medical device-related pressure injury in ICU patients: A systematic review and meta-analysis

BACKGROUND

Medical device-related pressure injury (MDRPI) in intensive care unit (ICU) patients is a serious issue. We aimed to evaluate the risk factors for MDRPI associated with ICU patients through systematic review and meta-analysis, and provide insights into the clinical prevention of MDRPI.

METHODS

We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, and China BioMedical Literature Database (CBM) (from inception to January 2023) for studies that identified risk factors of MDRPI in ICU patients. In order to avoid the omission of relevant literature, we performed a secondary search of the above database on February 15, 2023. Meta-analysis was performed using Revman 5.3.

RESULTS

Fifteen studies involving 4850 participants were selected to analyze risk factors for MDRPI in ICU patients. While conducting a meta-analysis, we used sensitivity analysis to ensure the reliability of the results for cases with significant heterogeneity among studies. When the source of heterogeneity cannot be determined, we only described the risk factor. The risk factors for MDRPI in ICU patients were elder age (OR = 1.06, 95% CI: 1.03-1.10), diabetes mellitus (OR = 3.20, 95% CI: 1.96-5.21), edema (OR = 3.62, 95% CI: 2.31-5.67), lower Braden scale score (OR = 1.22, 95%CI: 1.11-1.33), higher SOFA score (OR = 4.21, 95%CI: 2.38-7.47), higher APACHE II score (OR = 1.38, 95%CI: 1.15-1.64), longer usage time of medical devices (OR = 1.11, 95%CI: 1.05-1.19), use of vasoconstrictors (OR = 6.07, 95%CI: 3.15-11.69), surgery (OR = 4.36, 95% CI: 2.07-9.15), prone position (OR = 24.71, 95% CI: 7.34-83.15), and prone position ventilation (OR = 17.51, 95% CI: 5.86-52.36). Furthermore, we found that ICU patients who used subglottic suction catheters had a higher risk of MDRPI, whereas ICU patients with higher hemoglobin and serum albumin levels had a lower risk of MDRPI.

CONCLUSION

This study reported the risk factors for MDRPI in ICU patients. A comprehensive analysis of these risk factors will help to prevent and optimize interventions, thereby minimizing the occurrence of MDRPI.

Inter-rater reliability of descriptors for the classification of mucosal pressure injury: A prospective cross-sectional study

BACKGROUND

Mucosal pressure injuries (PIs) are usually caused by pressure from essential medical devices. There is no universally accepted criterion for assessment, monitoring, or reporting mucosal PI. Reliable descriptors are vital to benchmark the frequency and severity of this hospital-acquired complication.

OBJECTIVES

The objective of this study was to determine whether modified Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) descriptors improved the reliability of mucosal PI assessment. Secondary aims were to explore nurses' knowledge of and attitudes toward mucosal PI.

METHODS

A prospective cross-sectional survey was distributed to nurses from two tertiary affiliated intensive care units via REDCap® to capture demographic data, knowledge, attitudes, and inter-rater reliability (IRR) measures. Nurses were randomised at a 1:1 ratio to original or modified ROMPIS descriptors and classified 12 images of mucosal PI. IRR was assessed using percentage agreement, Fleiss' kappa, and intraclass correlation coefficients.

RESULTS

The survey response rate was 20.9% (n = 98/468), with 73.5% (n = 72/98) completing IRR measures. Agreement was higher with modified (75%) than original ROMPIS descriptors (69.4%). IRR was fair for the original (κ = 0.30, 95% confidence interval [CI] [0.28, 0.33], z 26.5, p < 0.001) and modified ROMPIS (κ = 0.29, 95% CI [0.26, 0.31], z 25.0, p < 0.001). Intraclass correlation coefficient findings indicated ratings were inconsistent for the original (0.33, 95% CI [0.18, 0.59], F 18.8 (11 df), p < 0.001) and modified ROMPIS (0.31, 95% CI [0.17, 0.57], F 17.6 (11 df), p < 0.001). PI-specific education and risk factor recognition were common.

CONCLUSION

Modified descriptors had marginally better agreement. Participants understand management and prevention but need to strengthen their perceived capacity for mucosal PI risk assessment. This work provides a foundation for future benchmarking and a platform from which further research to refine and test descriptors specific to mucosal PI can be generated.

Incidence and characteristics of hospital-acquired mucous membrane pressure injury: A five-year analysis

BACKGROUND

Pressure injuries on mucous membranes are caused by pressure from medical devices at the site of injury and differ to those on the skin. Intensive care patients, who have multiple devices in situ, are particularly vulnerable. There is a significant knowledge gap regarding mucous membrane pressure injury (MMPI) incidence in acute hospital settings.

AIM

To analyse MMPI incidence and characteristics in a tertiary acute general hospital.

METHODS

A secondary data analysis of hospital clinical incident reports was conducted. The sample included all adults with MMPIs between 2015 and 2019. The STROBE reporting guideline was followed.

RESULTS

There were 414 reports of MMPI. Most (91.5%, n = 379) were hospital-acquired with the majority found in intensive care patients (74.4%, n = 282). Hospital-acquired MMPI incidence was 0.1% (11 MMPI per 10,000 hospital episodes). In intensive care, the incidence was 2.4% (235 MMPI per 10,000 intensive care episodes). The median time from device insertion until reporting of an MMPI was 3 days. The most common sites of mucosal injury were the lips (35.6%) and mouth (28.8%). In all cases except one, MMPI was associated with medical device use at the site of injury. Five device types were identified (oral endotracheal tube-related 70.3%; urinary catheter 15.5%; gastric tube 8.3%; nasal prongs 3.5%; tracheostomy tube 2.4%). In intensive care, oral endotracheal tube-related devices were most often associated with MMPI (84.8%), whereas in non-intensive care MMPI it was the urinary catheter (51.4%).

CONCLUSIONS

While hospital-acquired MMPI incidence is relatively low, it is considerably higher in intensive care patients compared to those in non-intensive care settings. The most common sites are the lips and mouth.

RELEVANCE TO CLINICAL PRACTICE

Mucous membrane pressure injuries represent a significant proportion of all hospital-acquired pressure injuries.

PATIENT OR PUBLIC CONTRIBUTION

Neither patients nor the public were directly involved in this project.

Systematic review: Incidence and prevalence of mucous membrane pressure injury in adults admitted to acute hospital settings

Mucous membrane pressure injury (MMPI) is associated with a history of medical device use at the site of injury. The current international guideline recommends they should be reported in incidence and prevalence studies. The aim of this systematic review was to analyse the incidence and prevalence of hospital-acquired MMPI in adults admitted to acute hospital settings. Database searches (EBSCO CINAHL Complete, EBSCO Medline Complete, Embase, Scopus and Web of Science) were undertaken between October 2019 and February 2021, using search terms related to hospital-acquired, mucosal and device-related pressure injury/ulcer incidence and prevalence. Searches were limited to the English language. Articles published between 2008 and 2020, reporting incidence or prevalence of mucous membrane or medical device-related pressure injury in non-interventional samples were selected. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. Twenty-one studies met inclusion criteria; most provided incidence data. No studies were found that specifically reported MMPI incidence or prevalence. It was possible to calculate incidence or prevalence from four studies; all were in intensive care settings. MMPI incidence of 0.8% and 30.4%, and prevalence of 1.7% and 3.7% were found. One study provided data that enabled calculation of prevalence of 0.1% in a non-intensive care sample. Only one other study provided specific data about MMPI. It is concluded that there is insufficient evidence available to enable estimation of MMPI incidence or prevalence in either acute hospital or intensive care settings.