Predictors of superficial and severe hospital-acquired pressure injuries: A cross-sectional study using the International Pressure Ulcer Prevalence™ survey.

BACKGROUND

Prevalence of hospital-acquired pressure injuries has declined over time. However, it is unknown if this decline is consistent for different stages of pressure injuries. It is also unknown if risk factors differ between superficial (stage 1 and 2) and severe (stage 3, 4, deep tissue, and unstageable) pressure injuries.

OBJECTIVE

To examine changes in prevalence of superficial and severe hospital-acquired pressure injuries from 2011 to 2016. To evaluate differences between risk factors associated with superficial versus severe hospital-acquired pressure injuries.

DESIGN

Retrospective analysis of the 2011-2016 International Pressure Ulcer Prevalence™ data.

SETTING

Acute care hospitals in the USA.

PARTICIPANTS

216,626 patients had complete data.

METHODS

Prevalence of all, superficial, and severe hospital-acquired pressure injuries was calculated annually from 2011 to 2016 and linear trendlines were generated. Two logistic regressions examined risk factors for superficial and severe hospital-acquired pressure injuries.

RESULTS

Prevalence of superficial hospital-acquired pressure injuries declined significantly from 2011 to 2016. However, prevalence of severe pressure injuries did not show a reduction. Risk factors that significantly increased the risk of both superficial and severe pressure injuries were: increased age, male gender, unable to self-ambulate, all types of incontinence, additional linen layers, longer lengths of stay, and being in an intensive care unit. Body mass index (BMI) had a U-shaped relationship, where the likelihood of having either type of pressure injury was highest for low and high BMIs.

CONCLUSIONS

A decline in superficial, but not severe, hospital-acquired pressure injuries suggests current prevention techniques might not adequately prevent severe pressure injuries. Generally, risk factors for superficial and severe pressure injuries were highly similar where all 14 of the risk factors were significant in both regression models. However, five risk factors in particular - ICU stay, presence of an ostomy, patient age, ambulatory status, and presence of a fecal management system - had substantially different effect sizes.