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International Wound Journal Jun 2024Noninvasive ventilation interfaces are one of the main factors contributing to pressure injuries caused by medical devices. Prevention is still the best course of action... (Review)
Review
Noninvasive ventilation interfaces are one of the main factors contributing to pressure injuries caused by medical devices. Prevention is still the best course of action when discussing noninvasive ventilation-induced pressure injuries. A systematic review was designed to summarize and analyse all published literature on strategies to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The protocol of the systematic review followed the PRISMA guideline. An extensive search from the beginning to May 16, 2023, using current articles in databases such as Web of Science (WOS), Scopus, PubMed, and Cochrane Library was conducted. Medical Subject Headings (MESH) were used as follows: "Pressure Injury," "Noninvasive Ventilation," "Prevention," and "Pressure Sore." Any language-published studies that met the inclusion criteria were included in this review. A risk of bias assessment was conducted using the Joanna Briggs Institute tool, including evaluation methodologies for all studies. Database searches yielded 2546 articles, which were reduced to 23 that met our criteria after reviewing full texts. A narrative synthesis was conducted. As a result, type of interface (14 studies), dressings (4 studies), adjustment of mask leakage (1 study), humidity (1 study), positioning (1 study), and design of personalized masks (2 studies) seem to be a practical approach to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The results of our study show the effectiveness of preventive methods in reducing the incidence of pressure injuries caused by masks. Given the significant occurrence of pressure injury related to noninvasive ventilation and the crucial role of prevention and treatment, it is imperative to conduct more rigorous studies to ascertain the efficacy of each strategy.
Topics: Humans; Pressure Ulcer; Masks; Noninvasive Ventilation; Female; Male; Aged; Middle Aged; Adult; Aged, 80 and over
PubMed: 38826030
DOI: 10.1111/iwj.14909 -
Journal of Dairy Science May 2024Podermatitis aseptica hemorrhagica circumscripta is associated with metalloproteinase 2 weakening of distal phalangeal suspensory structures and sinkage of the distal...
Molecular evidence sterile tissue damage during pathogenesis of pododermatitis aseptica hemorrhagica circumscripta is associated with disturbed epidermal-dermal homeostasis.
Podermatitis aseptica hemorrhagica circumscripta is associated with metalloproteinase 2 weakening of distal phalangeal suspensory structures and sinkage of the distal phalanx in the claw capsule. Pressure from the tuberculum flexorium on the sole epidermis and dermis produces hemorrhagic tissue injury and defective horn production appearing as yellow-red, softened claw horn in region 4 of the sole. A model of the MAPK/ERK signal cascade orchestrating epidermal-dermal homeostasis was employed to determine if sterile inflammatory responses are linked to disturbed signal transduction for epidermal homeostasis in sole epidermis and dermis. The objective was to assess shifts in target genes of inflammation, up- and downstream MAPK/ERK signal elements, and targeted genes supporting epidermal proliferation and differentiation. Sole epidermis and dermis was removed from lateral claws bearing lesions of podermatitis aseptica hemorrhagica circumscripta, medial claws from the same limb and lateral claws from completely normal limbs of multiparous, lactating Holstein cows. The abundance levels of targeted transcripts were evaluated by real-time QPCR. Lesion effects were assessed by ANOVA, and mean comparisons were performed with t-tests to assess variations between mean expression in ulcer-bearing or medial claw dermis and epidermis and completely normal lateral claw dermis and epidermis or between ulcer-bearing dermis and epidermis and medial claw dermis and epidermis. The lesions were sterile and showed losses across multiple growth factors, their receptors, several downstream AP1 transcription components, CMYC, multiple cell cycle and terminal differentiation elements conducted by MAPK/ERK signals and β 4, α 6 and collagen 17A hemidesmosome components. These losses coincided with increased cytokeratin 6, β 1 integrin, proinflammatory metalloproteinases 2 and 9, IL1B and physiologic inhibitors of IL1B, the decoy receptor and receptor antagonist. Medial claw epidermis and dermis from limbs with lateral claws bearing podermatitis aseptica hemorrhagica circumscripta showed reductions in upstream MAPK/ERK signal elements and downstream targets that paralleled those in hemorrhagic lesions. Inhibitors of IL1B increased in the absence of real increases in inflammatory targets in the medial claw dermis and epidermis. Losses across multiple signal path elements and downstream targets were associated with negative effects on targeted transcripts supporting claw horn production and wound repair across lesion-bearing lateral claws and lesion-free medial claw dermis and epidermis. It was unclear if the sterile inflammation was causative or a consequence of these perturbations.
PubMed: 38825113
DOI: 10.3168/jds.2023-24577 -
Journal of Tissue Viability May 2024The aim of this study is to examine related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey,...
OBJECTIVE
The aim of this study is to examine related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy.
METHODS
A descriptive and cross-sectional design was used. The study was conducted between March and September 2023. Data were collected with an online questionnaire created on Google Forms, consisting of a Nurse Information Form, a Surgery-related Pressure Injury Awareness Form, and the Attitude towards Pressure Ulcer Prevention Instrument.
RESULTS
The sample of the study consisted of 258 operating room nurses working in Turkey, Croatia, and Italy. It was found that the majority of the participants (70.90 %) did not use a risk scale, had not received education on pressure injury prevention and treatment (58.10 %) but wanted to receive it (86 %). Mean attitude scores of operating room nurses by country were at an adequate level in Turkey (42.48 ± 4.30) but not at the desired level in Croatia (37.48 ± 3.44) and Italy (36.20 ± 4.02). While there was a significant positive relationship between the awareness and attitudes of operating room nurses in Turkey (p = 0.002) and Croatia (p < 0.001), no relationship was found between these variables of nurses in Italy (p = 0.109). A statistically significant difference was found between nurses' consideration of themselves sufficient and their attitudes and awareness in all three countries (p < 0.05). It was also determined that reading articles affected nurses' awareness in all countries.
CONCLUSIONS
While operating room nurses' attitudes towards preventing pressure injuries were adequate in Turkey, it was determined that those of the nurses in Croatia and Italy were not at the desired level. Nurses should receive regular training on surgical pressure injuries to increase their awareness and to support them in implementing the recommendations of pressure injury guidelines in accordance with institutional policy.
PubMed: 38821842
DOI: 10.1016/j.jtv.2024.05.003 -
Joint Commission Journal on Quality and... Apr 2024Hospital-acquired complications add to patient morbidity and mortality, costs, length of stay, and negative patient experience. Patient Safety Indicators (PSIs) are a...
BACKGROUND
Hospital-acquired complications add to patient morbidity and mortality, costs, length of stay, and negative patient experience. Patient Safety Indicators (PSIs) are a validated and widely used metric to evaluate hospital administrative data on preventing these events. Although many studies have addressed PSI validity, few have aimed to reduce PSI through clinical care. The authors aimed to reduce PSI events by addressing both validity and clinical care.
METHODS
Frontline clinicians used a deep dive template to provide input on all PSI cases, which were then reviewed by a PSI task force to identify performance gaps. After analyzing the frequency of gaps and cost-vs.-impact of potential solutions, five interventions were implemented to address the three most common, highly weighted PSIs: pressure ulcers, postoperative venous thromboembolism (VTE), and postoperative sepsis. Clinical care interventions included increasing patient mobility by creating a specialized mobility technician position, skin care audits to prevent pressure ulcers, and increasing use of pharmacologic VTE prophylaxis. Administrative interventions addressed improving clinician-coding concordance for sepsis and increasing documentation of comorbidities.
RESULTS
After interventions, the number of PSI events for composite PSI, VTE, and sepsis decreased by 41.3% (p = 0.039), 85.2% (p = 0.0091), and 51.5% (p = 0.063), respectively, relative to the preintervention period. Pressure ulcers increased by 33.3% (p = 0.0091).
CONCLUSION
Hospital complications cause substantial burden to hospitals, patients, and caregivers. Addressing administrative and clinical factors with targeted interventions led to reduction in composite PSI. Further efforts are needed locally to reduce the pressure ulcer PSI.
PubMed: 38821745
DOI: 10.1016/j.jcjq.2024.04.010 -
Annals of Vascular Surgery May 2024Pedal arch interrogation by ultrasound through systolic acceleration time measurement (Pedal Acceleration Time [PAT]) is a recently described technique that offers...
BACKGROUND
Pedal arch interrogation by ultrasound through systolic acceleration time measurement (Pedal Acceleration Time [PAT]) is a recently described technique that offers valuable insights into foot hemodynamics. Previous studies have demonstrated a correlation between PAT and the ankle-brachial index and PAT has been proposed as a prognostic tool for wound healing in patients with peripheral artery disease. This study aims to assess the correlation between PAT and Transcutaneous Pressure of Oxygen (TcPO2) in the diabetic foot population.
METHODS
In this single-center cross-sectional study PAT and TcPO2 were measured in diabetic patients with ischemic foot ulcers. The assessment of wound status was performed between the 12th and 16th week after the first evaluation. The primary outcome was to assess the correlation between the values obtained for PAT and TcPO2. The secondary outcome was to establish a cut-off value for wound healing.
RESULTS
Sixty limbs with ischemic foot ulcers were evaluated. The results showed a correlation between PAT and TcPO2 [F (1.52) = 16.928; R = 0.246; P < 0.001]. The receiver operating characteristics curve analysis showed an optimal cut-off value at PAT >186 ms for predicting a nonhealing ulcer with a 96% specificity (area under the curve = 0.774; confidence interval 0.648-0.872; P < 0.001).
CONCLUSIONS
PAT showed a significant correlation with TcPO2 with high specificity to identify nonhealing foot ulcers due to insufficient foot perfusion with a potential prognostic value in the diabetic foot population.
PubMed: 38821473
DOI: 10.1016/j.avsg.2024.03.031 -
Journal of Wound, Ostomy, and...The purpose of this study was to evaluate a skin assessment technique, subepidermal moisture (SEM) assessment, to assess, identify, and prevent pressure injuries (PIs)...
PURPOSE
The purpose of this study was to evaluate a skin assessment technique, subepidermal moisture (SEM) assessment, to assess, identify, and prevent pressure injuries (PIs) in critically ill adults.
DESIGN
This was a retrospective, descriptive, comparative research study.
SUBJECTS AND SETTING
The sample comprised 69 critically ill adults; their mean age was 58.8 years (SD 18.1 years). The majority were male (n = 40, 58%), 29 (42%) were African American (AA), and 36 (52%) were White. The study setting was a surgical trauma intensive care unit (STICU) in a southern US Gulf Coast academic level I trauma hospital. Data were collected from September to November 2021.
METHODS
We conducted a retrospective medical record review of subjects who had undergone SEM assessment. We also collected demographic and pertinent clinical information, including Braden Scale cumulative scores and subscale scores, documented PI prevention interventions, and PI occurrence and characteristics if developed within 7 days of SEM measurement. We also evaluated whether PI prevention interventions were appropriate. To examine nurse perception of the SEM device, we conducted a web-based survey of nurses providing care in our facility's STICU. Comparison of responses was done using Fisher's test or Chi-square test, and the mean responses from groups were compared using t test.
RESULTS
Thirty-five (57%) subjects had a sacral SEM delta ≥0.6; 14 (40%) were AA; 20 (57%) were White; and 11 (31%) had a hospital-acquired PI (HAPI) or present-on-admission (POA) PI. Among the 14 HAPI and POA PI subjects with sacral SEM delta, 11 (79%) had sacral SEM delta ≥0.6. Among 26 AA subjects with sacral SEM delta, 5 had a HAPI or POA PI, and of those, 4 (80%) had sacral SEM delta ≥0.6. A significant and negative correlation was observed between cumulative Braden Scale scores on day 2 and sacral SEM delta (r = -0.28, P = .03) and R heel delta (r = -0.29, P = .03) scores, indicating higher PI risk. Of the 35 patients with a sacral SEM delta ≥0.6, 24 (69%) subjects did not have appropriate PI prevention interventions. Nurses (n = 13) indicated that the SEM device was easy to use and helped them perform an accurate skin assessment on patients with darker skin tones.
CONCLUSIONS
This study demonstrates that SEM technology is beneficial to address racial disparities in skin assessment, enhance skin assessment accuracy beyond existing PI care, improve the accuracy of risk assessment, and promote appropriate location-specific PI prevention interventions.
Topics: Humans; Pressure Ulcer; Male; Middle Aged; Retrospective Studies; Female; Aged; Adult; Critical Illness; Intensive Care Units; Skin Care; Surveys and Questionnaires
PubMed: 38820216
DOI: 10.1097/WON.0000000000001076 -
Journal of Wound, Ostomy, and...This purpose of this quality improvement project was to develop and evaluate a protocol (intervention bundle) designed to prevent pressure injuries in patients admitted...
PURPOSE
This purpose of this quality improvement project was to develop and evaluate a protocol (intervention bundle) designed to prevent pressure injuries in patients admitted with SARS-CoV2 and required prone positioning.
PARTICIPANTS AND SETTING
The sample comprised 267 patients aged 18 years and older, who were admitted with SARS-CoV2 and required prone positioning. Their age ranged from 32 to 76 years; a majority (54%, n = 145) were intubated. The study setting was an urban 220 bed acute care hospital in Northern California.
APPROACH
A task force comprising the quality management team, certified wound care nurses and nursing leadership used the plan-do-study-act cycle completed a quality improvement project designed for preventing pressure injuries among patients admitted with SARS-CoV2 and managed with prone positioning, either with or without mechanical ventilation. The five phases of the quality improvement project were protocol development, education, implementation, and evaluation. Data collection period for this quality improvement was between April 2020 and August 2020. Outcomes were evaluated using descriptive statistics.
OUTCOMES
Sixteen patients (6%) experienced a total of 25 pressure injuries. The time between initial prone placement and change back to supine positioning was 24 hours (36 ± 12 hours). The most common pressure injuries were deep tissue injuries, primarily over the heels and sacrum.
IMPLICATIONS FOR PRACTICE
This protocol maintained the skin integrity of 94% of a group critically ill patients admitted with SARS-CoV2 and managed by prone positioning.
Topics: Humans; Quality Improvement; COVID-19; Pressure Ulcer; Middle Aged; Male; Female; Adult; Aged; SARS-CoV-2; Prone Position; Patient Positioning; California; Skin Care
PubMed: 38820215
DOI: 10.1097/WON.0000000000001072 -
Disability and Rehabilitation May 2024To determine whether short-term wear of textured insoles alters balance, gait, foot sensation, physical activity, or patient-reported outcomes, in people with diabetic...
PURPOSE
To determine whether short-term wear of textured insoles alters balance, gait, foot sensation, physical activity, or patient-reported outcomes, in people with diabetic neuropathy.
MATERIALS AND METHODS
53 adults with diabetic neuropathy were randomised to wear textured or smooth insoles for 4-weeks. At baseline and post-intervention, balance (foam/firm surface; eyes open/closed) and walking were assessed whilst barefoot, wearing shoes only, and two insoles (textured/smooth). The primary outcome was center of pressure (CoP) total sway velocity. Secondary outcomes included other CoP measures, spatiotemporal gait measures, foot sensation, physical activity, and patient-reported outcomes (foot health, falls efficacy).
RESULTS
Wearing textured insoles led to improvements in CoP measures when standing on foam with eyes open, relative to smooth insoles ( ≤ 0.04). The intervention group demonstrated a 5% reduction in total sway velocity, indicative of greater balance. The intervention group also showed a 9-point improvement in self-perceived vigour ( = 0.03). Adjustments for multiple comparisons were not applied.
CONCLUSIONS
This study provides weak statistical evidence in favour of textured insoles. Wearing textured insoles may alter measures of balance, suggestive of greater stability, in people with diabetic neuropathy. Plantar stimulation, through textured insoles, may have the capacity to modulate the perception of foot pain, leading to improved well-being.IMPLICATIONS FOR REHABILITATIONShort-term wear of textured insoles can lead to improvements in centre of pressure sway measures when standing on a compliant supporting surface.Wearing textured insoles may have the capacity to help relieve foot pain leading to enhanced self-perceived vitality in people with diabetic peripheral neuropathy.
PubMed: 38819206
DOI: 10.1080/09638288.2024.2360658 -
Neonatal Network : NN May 2024In a sixty-eight-bed level-IV NICU, an increased incidence of hospital-acquired pressure injuries (HAPIs) from noninvasive ventilation (NIV) devices was identified. The...
In a sixty-eight-bed level-IV NICU, an increased incidence of hospital-acquired pressure injuries (HAPIs) from noninvasive ventilation (NIV) devices was identified. The aim of this quality improvement project was to decrease HAPIs from NIV by 10%. A literature review and the Plan-Do-Study-Act were implemented. The intervention included a customized silicone foam dressing under NIV, an NIV skincare bundle, and multidisciplinary support. Hospital-acquired pressure injury rates were tracked over 3 years postinterventions. The incidence of HAPIs declined by 20% from 0.2 per 1,000 patient days to 0.05 per 1,000 patient days. Relative risk was 4.6 times greater prior to intervention ( = .04). Continuous positive airway pressure (CPAP) failure was not noted and measured by the percentage of patients on ventilators pre- and postintervention. Customized silicone foam dressings under NIV, NIV skincare bundle, and multidisciplinary team support may decrease HAPIs in neonates without CPAP failure.
Topics: Humans; Infant, Newborn; Pressure Ulcer; Noninvasive Ventilation; Bandages; Female; Quality Improvement; Intensive Care Units, Neonatal; Male; Silicones; Patient Care Bundles; Skin Care; Iatrogenic Disease
PubMed: 38816221
DOI: 10.1891/NN-2023-0070 -
International Journal of Nursing Studies Aug 2024
Topics: Pressure Ulcer; Humans; Patient Care Bundles; Inpatients
PubMed: 38815543
DOI: 10.1016/j.ijnurstu.2024.104810