Riemenschneider Karen J
Karen J. Riemenschneider, DNP, RN-BC, CWOCN, CNS, Albany Medical Center, Albany, New York.
J Wound Ostomy Continence Nurs. 2018 Mar/Apr;45(2):141-145. doi: 10.1097/WON.0000000000000410.
Prevention of hospital-acquired pressure injuries (HAPIs) remains a crucial clinical challenge especially for those patients undergoing surgery. The purpose of this project was to examine whether a 5-layer silicone foam dressing applied to the sacrum of patients undergoing vascular surgery decreased the occurrence of sacral pressure injuries and to explore participant characteristics associated with the development of operating room (OR)-related pressure injuries. A pre-/postintervention design, quality improvement project in a convenience sample of 81 patients undergoing vascular surgery, in a 700-bed level I trauma acute care setting, in the Northeastern United States. Eighty-one patients undergoing vascular surgery participated in this project. Thirty-seven were in the preintervention group who were identified from the housewide pressure injury prevalence data from May and December 2010 and received standard pressure injury prevention while hospitalized. Forty-four patients in the intervention group were identified from a hospital-based outpatient vascular surgery office and preoperatively received the 5-layer silicone foam dressing in addition to standard care. Data were collected on the third and seventh postoperative days via the electronic medical record and paper medical records. Collected data included age, gender, comorbidities (diabetes, hypertension, peripheral vascular disease and, smoking status), presence of a 5-layer silicone sacral foam dressing, and pressure injury occurrence. Analysis included descriptive statistics, Fisher exact test to compare groups, and logistic regression to identify associated risk factors. More than 50% (n = 19) in the preintervention group developed a hospital-acquired pressure injury while only 1 subject (n = 2%) in the intervention group developed a hospital-acquired pressure injury (P = .000). Findings indicate that, after controlling for age, gender, and other comorbidities, application of a 5-layer silicone sacral foam dressing significantly reduced the likelihood of development of a new pressure injury (OR= 0.04, 95% confidence interval, 0.00-40; P = .006). This pre-/postquality improvement project, using a 5-layer silicone sacral foam dressing in addition to standard operating room pressure injury preventive interventions, for elective vascular surgical cases, resulted in a significant decrease in sacral operating room-related pressure injuries. These findings suggest the effectiveness of a 5-layer silicone foam dressing when added to standard preventive interventions. The findings warrant further investigation of additional preventative interventions in the OR specific to high-risk populations.
预防医院获得性压疮（HAPIs）仍然是一项严峻的临床挑战，尤其是对于那些接受手术的患者。本项目的目的是研究应用于血管手术患者骶骨的五层硅胶泡沫敷料是否能降低骶骨压疮的发生率，并探索与手术室（OR）相关压疮发生相关的参与者特征。这是一项在美国东北部一家拥有700张床位的一级创伤急症护理机构中，对81例接受血管手术的患者进行的便利样本的干预前/后设计质量改进项目。81例接受血管手术的患者参与了本项目。37例在干预前组，从2010年5月和12月全院压疮患病率数据中确定，住院期间接受标准压疮预防措施。干预组的44例患者从医院门诊血管外科办公室确定，术前除接受标准护理外，还接受了五层硅胶泡沫敷料。术后第三天和第七天通过电子病历和纸质病历收集数据。收集的数据包括年龄、性别、合并症（糖尿病、高血压、外周血管疾病和吸烟状况）、是否使用五层硅胶骶骨泡沫敷料以及压疮发生情况。分析包括描述性统计、用于比较组间的Fisher精确检验以及用于识别相关危险因素的逻辑回归。干预前组超过50%（n = 19）发生了医院获得性压疮，而干预组只有1例患者（n = 2%）发生了医院获得性压疮（P = .000）。研究结果表明，在控制年龄、性别和其他合并症后，应用五层硅胶骶骨泡沫敷料显著降低了新发压疮的发生可能性（OR = 0.04，95%置信区间，0.00 - 40；P = .006）。这个干预前/后质量改进项目，对于择期血管手术病例，除了标准的手术室压疮预防干预措施外，使用五层硅胶骶骨泡沫敷料，使与手术室相关的骶骨压疮显著减少。这些发现表明，在标准预防干预措施基础上添加五层硅胶泡沫敷料是有效的。这些发现值得进一步研究针对高危人群在手术室的其他预防干预措施。
