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重症监护病房高危患者的专科床上用品与压疮

Specialty Linens and Pressure Injuries in High-Risk Patients in the Intensive Care Unit.

作者信息

Freeman Regi, Smith Andrew, Dickinson Sharon, Tschannen Dana, James Shandra, Friedman Candace

机构信息

Regi Freeman is a clinical nurse specialist in the cardiovascular intensive care unit, Samuel and Jean Frankel Cardiovascular Center, University of Michigan Health System, and a member of the clinical adjunct faculty, University of Michigan School of Nursing, Ann Arbor, Michigan. Andrew Smith is a staff nurse in the cardiovascular intensive care unit, Samuel and Jean Frankel Cardiovascular Center, Sharon Dickinson is a clinical nurse specialist in the surgical intensive care unit, and Candace Friedman is a senior project manager, Office of Clinical Safety, University of Michigan Health System, Ann Arbor, Michigan. Dana Tschannen is a clinical associate professor, vice chair of the Department of Systems, Population and Leadership, and director of the post-Master's DNP program, and Shandra James is a clinical assistant professor, University of Michigan School of Nursing, Ann Arbor, Michigan.

出版信息

Am J Crit Care. 2017 Nov;26(6):474-481. doi: 10.4037/ajcc2017530.

Abstract

BACKGROUND

The cardiovascular and surgical intensive care units had the highest unit-acquired pressure injury rates at an institution. Patients in these units had multiple risk factors for pressure injuries. Various interventions had been used to minimize pressure injuries, with limited results.

OBJECTIVES

To evaluate the effect of specialty linens on the rate of pressure injuries in high-risk patients. The specialty linen was a synthetic silklike fabric that addressed the microclimate surrounding the patient, with the purpose of minimizing friction, shear, moisture, and heat.

METHODS

The specialty linen was tried on 24 beds in the cardiovascular intensive care unit and 20 beds in the surgical intensive care unit, including sheets, underpads, gowns, and pillow cases. Data obtained from a retrospective review of electronic health records were compared for 9 months before and 10 months after specialty linens were implemented.

RESULTS

Total unit-acquired pressure injury rates for both units combined declined from 7.7% (n = 166) before to 5.3% (n = 95) after the intervention. The intervention was associated with a significant reduction in posterior (coccyx, sacrum, back, buttock, heel, and spine) pressure injury rates, from 5.2% (n = 113) before to 2.8% (n = 51) after specialty linens were implemented ( < .001).

CONCLUSION

Addressing the microclimate, friction, and shear by using specialty linens reduces the number of posterior pressure injuries. The use of specialty linens in addition to standard techniques for preventing pressure injuries can help prevent pressure injuries from developing in high-risk patients in intensive care units.

摘要

背景

在某机构中,心血管重症监护病房和外科重症监护病房的院内获得性压力性损伤发生率最高。这些病房的患者存在多种压力性损伤风险因素。已采用各种干预措施来尽量减少压力性损伤,但效果有限。

目的

评估特殊床单对高危患者压力性损伤发生率的影响。这种特殊床单是一种合成丝质面料,可调节患者周围的微气候,目的是尽量减少摩擦、剪切力、湿度和热量。

方法

在心血管重症监护病房的24张病床和外科重症监护病房的20张病床上试用了这种特殊床单,包括床单、床垫、病号服和枕套。对实施特殊床单前后分别进行了9个月和10个月的回顾性电子健康记录数据比较。

结果

两个病房合并后的院内获得性压力性损伤总发生率从干预前的7.7%(n = 166)降至干预后的5.3%(n = 95)。该干预措施与后部(尾骨、骶骨、背部、臀部、足跟和脊柱)压力性损伤发生率的显著降低相关,实施特殊床单后,后部压力性损伤发生率从之前的5.2%(n = 113)降至2.8%(n = 51)(P < .001)。

结论

使用特殊床单调节微气候、减少摩擦和剪切力可减少后部压力性损伤的数量。在预防压力性损伤的标准技术基础上使用特殊床单,有助于防止重症监护病房高危患者发生压力性损伤。

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