School of Health Sciences Education, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil.
Enterostomal Therapy Post-graduation Program, Universidade de Sao Paulo, Sao Paulo, Brazil.
Wound Repair Regen. 2021 Jan;29(1):79-86. doi: 10.1111/wrr.12868. Epub 2020 Oct 26.
This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.
本研究旨在评估巴西圣保罗市五家医院（两家公立医院和三家私立医院）住院和重症监护病房（ICU）的医院获得性压力性损伤（PI）发生率及其危险因素。这是一项为期 6 个月的前瞻性队列研究（n=1937），于 2013 年 4 月至 9 月进行。基线和随访测量包括人口统计学和护理信息，以及营养不良（NRS-2002）和 PI（Braden 量表）风险评估。使用具有稳健方差的泊松回归进行数据分析。共有 633 名患者（32.60%）存在 PI 风险。PI 的发病率为 5.9%（公立医院为 9.9%，私立医院为 4.1%），ICU 高于住院病房（分别为 10%和 5.7%）。PI 风险随年龄增加而增加（RR=1.05；95%CI 1.04-1.07）；与私立医院相比，公立医院的风险更高（RR=4.39；95%CI 2.92-6.61）；与因手术原因入院的患者相比，因非手术原因入院的患者风险更高（RR=1.91；95%CI 1.12-3.27）；与住院时间较长的患者相比（RR=1.04；95%CI 1.03-1.06）；高血压（RR=1.76；95%CI 1.17-2.64）；或存在营养不良风险（RR=3.51；95%CI 1.71-7.24）。Braden 量表评分较高与 PI 风险降低相关（RR=0.79；95%CI 0.75-0.83）。我们的研究结果表明，所有患者中有 5.9%发生了 PI，护士在计划和实施 PI 预防措施时应考虑的最重要因素是：患者年龄、护理环境、住院时间、合并症、入院原因和营养状况。
