Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement project

Øystein Øygarden Flæten; Siv K Stafseth; Hilde Vinje; Edda Johansen; Kjetil Sunde; Hilde Wøien; Dimitri Beeckman; Antonija Petosic

doi:10.1016/j.iccn.2023.103587

Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement project

Intensive Crit Care Nurs. 2024 Apr:81:103587. doi: 10.1016/j.iccn.2023.103587. Epub 2023 Nov 28.

Authors

Øystein Øygarden Flæten¹, Siv K Stafseth², Hilde Vinje³, Edda Johansen⁴, Kjetil Sunde⁵, Hilde Wøien⁶, Dimitri Beeckman⁷, Antonija Petosic⁸

Affiliations

¹ Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Lovisenberg Diaconal University College, Oslo, Norway. Electronic address: oeyoey@ous-hf.no.
² Lovisenberg Diaconal University College, Oslo, Norway; Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.
³ Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.
⁴ University of South-Eastern Norway, Faculty of Health and Social Sciences, Borre, Norway; General Intensive Care, Vestre Viken Hospital Trust, Drammen, Norway.
⁵ Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁶ Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway.
⁷ Ghent University, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent, Belgium; Örebro University, Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Örebro, Sweden; Odense University, Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark.
⁸ Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; The Norwegian Intensive Care Registry, Haukeland University Hospital, Helse Bergen, Bergen, Norway.

PMID: 38029679
DOI: 10.1016/j.iccn.2023.103587

Abstract

Objectives: To determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units.

Setting: Four intensive care units in a Norwegian University Hospital.

Research methodology: A prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals.

Results: The 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pressure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]).

Conclusion: The 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable.

Implications for clinical practice: Awareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.

Keywords: Critical care nursing; Equipment and supplies; Incidence; Intensive Care Units; Pressure injury; Pressure ulcer.

Publication types

Observational Study

MeSH terms

Humans
Incidence
Intensive Care Units
Pressure Ulcer* / epidemiology
Pressure Ulcer* / etiology
Pressure Ulcer* / prevention & control
Prospective Studies
Quality Improvement