Investigating the Efficacy of Hydrocolloid Dressing for Preventing Nasotracheal Tube-Related Pressure Injury in the PICU

Abstract Objective Discomfort and device-related pressure injury (DRPI) caused by N95 filtering facepiece respirators (FFRs) are common. The use of prophylactic hydrocolloid dressings is one of the strategies that may improve comfort and reduce DRPI. In this study, we investigated the impact of these dressings on N95 respirator fit. Methods We performed a repeat quantitative fit testing through the Respiratory Protection Program on 134 healthcare workers (HCWs), who applied hydrocolloid dressings on the bridge of their nose under the N95 FFRs that they passed the initial fit test but reported discomfort with. Results We found that the fit test pass rates, with the hydrocolloid dressings in place, for the semi-rigid cup style (3MTM 1860), the vertical flat-fold style (BYD), the duckbill style (BSN medical ProShield® and Halyard Fluidshield*), and the three-panel flat-fold style (3MTM Aura) N95 FFRs were 94% (108/115), 85% (44/52), 81% (87/108) and 100% (3/3) respectively. There was a statistically significant reduction in the overall fit factors for both the vertical flat-fold and duckbill type N95 respirators, after the application of hydrocolloid dressings. Conclusions Hydrocolloid dressings are likely to disturb the mask seal for non-rigid style N95 FFRs, in particular, the vertical flat-fold style and the duckbill style N95 FFRs. Given the risk of mask seal disturbance of N95 respirators as shown in this study, we advocate that any HCW requiring the use of prophylactic dressings should undergo repeat quantitative fit testing with the dressing in place prior to using the dressing and mask in combination.

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A cluster-controlled clinical trial of two prophylactic silicone sacral dressings to prevent sacral pressure injuries in critically ill patients

Wound Practice and Research ◽

10.33235/wpr.27.1.21-26 ◽

2019 ◽

pp. 21-26 ◽

Cited By ~ 1

Author(s):

Monica Stankiewicz ◽

Jodie Gordon ◽

Joel Dulhunty ◽

Wendy Brown ◽

Hamish Pollock ◽

...

Keyword(s):

Clinical Trial ◽

Intensive Care ◽

Similar Efficacy ◽

Care Patient ◽

Controlled Clinical Trial ◽

Cost Difference ◽

Increased Risk ◽

Pressure Injury ◽

Risk Patients ◽

The Mean

Objective Patients in the intensive care unit (ICU) have increased risk of pressure injury (PI) development due to critical illness. This study compared two silicone dressings used in the Australian ICU setting for sacral PI prevention. Design A cluster-controlled clinical trial of two sacral dressings with four alternating periods of three months' duration. Setting A 10-bed general adult ICU in outer-metropolitan Brisbane, Queensland, Australia. Participants Adult participants who did not have a sacral PI present on ICU admission and were able to have a dressing applied for more than 24 hours without repeated dislodgement or soiling in a 24-hour period (>3 times). Interventions Dressing 1 (Allevyn Gentle Border Sacrum™, Smith & Nephew) and Dressing 2 (Mepilex Border Sacrum™, Mölnlycke). Main outcomes measures The primary outcome was the incidence of a new sacral PI (stage 1 or greater) per 100 dressing days in the ICU. Secondary outcomes were the mean number of dressings per patient, the cost difference of dressings to prevent a sacral PI and product integrity. Results There was no difference in the incidence of a new sacral PI (0.44 per 100 dressing days for both products, p = 1.00), the mean number of dressings per patient per day (0.50 for both products, p = 0.51) and product integrity (85% for Dressing 1 and 84% for Dressing 2, p = 0.69). There was a dressing cost difference per patient (A$10.29 for Dressing 1 and A$28.84 for Dressing 2, p < 0.001). Conclusions Similar efficacy, product use and product integrity, but differential cost, were observed for two prophylactic silicone dressings in the prevention of PIs in the intensive care patient. We recommend the use of sacral prophylactic dressings for at-risk patients, with the choice of product based on ease of application, clinician preference and overall cost-effectiveness of the dressing.

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Release of the Third Edition of The International Pressure Injury Guideline

Wound Practice and Research ◽

10.33235/wpr.27.4.156 ◽

2019 ◽

Vol 27 (4) ◽

pp. 156

Author(s):

Keryln Carville ◽

Emily Haesler

Keyword(s):

The Third ◽

International Pressure ◽

Pressure Injury

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Relationship between skin moisture and medical device related pressure injury (MDRPI) in intensive care units: Prospective study

Enfermería Clínica ◽

10.1016/j.enfcli.2019.11.009 ◽

2020 ◽

Vol 30 ◽

pp. 420-423

Author(s):

Juhelnita Bubun ◽

Saldy Yusuf ◽

Muhammad Darwis

Keyword(s):

Intensive Care ◽

Prospective Study ◽

Medical Device ◽

Intensive Care Units ◽

Pressure Injury ◽

Skin Moisture

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41250 Machine Learning to Identify Predictors of Iatrogenic Injury Using Empirical Bayes Estimates: A Cohort Study of Pressure Injury Prevention

Journal of Clinical and Translational Science ◽

10.1017/cts.2021.530 ◽

2021 ◽

pp. 1-2

Author(s):

William V. Padula ◽

David G. Armstrong ◽

Patricia M. Davidson

Keyword(s):

Machine Learning ◽

Cohort Study ◽

Injury Prevention ◽

Empirical Bayes ◽

Iatrogenic Injury ◽

Bayes Estimates ◽

Pressure Injury ◽

Pressure Injury Prevention

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Hospital acquired pressure injury prediction in surgical critical care patients

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01371-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jenny Alderden ◽

Kathryn P. Drake ◽

Andrew Wilson ◽

Jonathan Dimas ◽

Mollie R. Cummins ◽

...

Keyword(s):

Risk Assessment ◽

Model Performance ◽

Routine Care ◽

Predictor Variables ◽

Classification Algorithms ◽

Data Set ◽

Icu Patients ◽

Pressure Injury ◽

Surgical Icu ◽

Hospital Acquired

Abstract Background Hospital-acquired pressure injuries (HAPrIs) are areas of damage to the skin occurring among 5–10% of surgical intensive care unit (ICU) patients. HAPrIs are mostly preventable; however, prevention may require measures not feasible for every patient because of the cost or intensity of nursing care. Therefore, recommended standards of practice include HAPrI risk assessment at routine intervals. However, no HAPrI risk-prediction tools demonstrate adequate predictive validity in the ICU population. The purpose of the current study was to develop and compare models predicting HAPrIs among surgical ICU patients using electronic health record (EHR) data. Methods In this retrospective cohort study, we obtained data for patients admitted to the surgical ICU or cardiovascular surgical ICU between 2014 and 2018 via query of our institution's EHR. We developed predictive models utilizing three sets of variables: (1) variables obtained during routine care + the Braden Scale (a pressure-injury risk-assessment scale); (2) routine care only; and (3) a parsimonious set of five routine-care variables chosen based on availability from an EHR and data warehouse perspective. Aiming to select the best model for predicting HAPrIs, we split each data set into standard 80:20 train:test sets and applied five classification algorithms. We performed this process on each of the three data sets, evaluating model performance based on continuous performance on the receiver operating characteristic curve and the F1 score. Results Among 5,101 patients included in analysis, 333 (6.5%) developed a HAPrI. F1 scores of the five classification algorithms proved to be a valuable evaluation metric for model performance considering the class imbalance. Models developed with the parsimonious data set had comparable F1 scores to those developed with the larger set of predictor variables. Conclusions Results from this study show the feasibility of using EHR data for accurately predicting HAPrIs and that good performance can be found with a small group of easily accessible predictor variables. Future study is needed to test the models in an external sample.

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Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

Anaesthesia and Intensive Care ◽

10.1177/0310057x7500300306 ◽

1975 ◽

Vol 3 (3) ◽

pp. 209-217 ◽

Cited By ~ 7

Author(s):

G. C. Fisk ◽

W. de C. Baker

Keyword(s):

Endotracheal Tube ◽

Main Bronchus ◽

Squamous Metaplasia ◽

Nasotracheal Intubation ◽

Newborn Infants ◽

Respiratory Epithelium ◽

Lower Trachea ◽

Nasotracheal Tube ◽

Mucosal Changes ◽

The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

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