Jenny Alderden is an assistant professor and Mollie Cummins is a professor, University of Utah College of Nursing, Salt Lake City.
Linda J. Cowan is associate director, VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans' Hospital and Clinics, Tampa, Florida.
Am J Crit Care. 2020 Nov 1;29(6):e128-e134. doi: 10.4037/ajcc2020810.
Hospital-acquired pressure injuries disproportionately affect critical care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined in relation to the risk for hospital-acquired pressure injuries.
To identify factors associated with hospital-acquired pressure injuries among surgical critical care patients. The specific aim was to analyze data obtained from routine nursing skin assessments alongside other potential risk factors identified in the literature.
This retrospective cohort study included 5101 surgical critical care patients at a level I trauma center and academic medical center. Multivariate logistic regression using the least absolute shrinkage and selection operator method identified important predictors with parsimonious representation. Use of specialty pressure redistribution beds was included in the model as a known predictive factor because specialty beds are a common preventive intervention.
Independent risk factors identified by logistic regression were skin irritation (rash or diffuse, nonlocalized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P < .001), minimum Braden Scale score (odds ratio, 0.858; 95% CI, 0.818-0.899; P < .001), and duration of intensive care unit stay before the hospital-acquired pressure injury developed (odds ratio, 1.003; 95% CI, 1.003-1.004; P < .001).
The strongest predictor was irritated skin, a potentially modifiable risk factor. Irritated skin should be treated and closely monitored, and the cause should be eliminated to allow the skin to heal.
医院获得性压疮不成比例地影响重症监护患者。尽管已经认识到了诸如潮湿、疾病严重程度和灌注不足等风险因素，但护理皮肤评估数据与医院获得性压疮的风险之间仍未得到充分研究。
确定外科重症监护患者发生医院获得性压疮的相关因素。具体目标是分析从常规护理皮肤评估中获得的数据以及文献中确定的其他潜在风险因素。
这是一项回顾性队列研究，纳入了一家一级创伤中心和学术医疗中心的 5101 名外科重症监护患者。使用最小绝对收缩和选择算子方法的多变量逻辑回归确定了具有简洁表示的重要预测因素。由于特殊的压力再分布床是一种常见的预防干预措施，因此将其在模型中作为已知的预测因素。
逻辑回归确定的独立风险因素包括皮肤刺激（皮疹或弥漫性、非局部性发红）（比值比，1.788；95%置信区间，1.404-2.274；P<0.001）、最低布雷登量表评分（比值比，0.858；95%置信区间，0.818-0.899；P<0.001）和发生医院获得性压疮之前的重症监护病房停留时间（比值比，1.003；95%置信区间，1.003-1.004；P<0.001）。
最强的预测因素是皮肤刺激，这是一个潜在可改变的风险因素。应治疗和密切监测有刺激的皮肤，并消除其原因以促进皮肤愈合。
