Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Peripheral extracorporeal membrane oxygenation cannula dressing and securement practices across Australia and New Zealand

Introduction: Extracorporeal membrane oxygenation (ECMO) is a highly invasive method of cardiac and/or pulmonary support for critically ill patients where conventional therapies have failed. Along with other factors, ECMO success relies on effective placement and securement of large-bore cannulae used in therapy delivery. Effective dressing and securement of ECMO cannulae and associated circuitry plays an important role in preventing infection and accidental dislodgement. Limited data exists regarding ECMO cannula dressing and securement practice across Australia and New Zealand.Study Objectives: To determine ECMO cannula dressing and securement practices, and adherence to local guidelines.Methods: Prospective cross-sectional study of adult and paediatric patients receiving ECMO in 11 Australian and New Zealand intensive care units.Results: Dressing and securement practices for 290 cannulae from 127 patients are described. Over half (56%) of cannulae were sutured at the insertion site. Ninety percent of all cannulae were covered with a transparent semi-permeable dressing, however, only 11% of these dressings contained chlorhexidine gluconate (CHG) or had a CHG-impregnated disk underneath. Circuit tubing was secured typically by two fixation points (60%), however two backflow cannulae had no securement along the tubing length. Most frequently, circuit tubing was secured with a sutureless securement device only (33%), followed by a securement combination of sutures plus clipping or taping to a fixed object (13%). One in four cannulae and circuits (24%) were not dressed and secured in accordance with local hospital policy.Conclusions: The use of transparent semi-permeable dressings at ECMO cannula insertion sites is common practice however use of CHG-containing dressings/disks, demonstrated to reduce bloodstream infection rates in central lines, is rare. Further investigation is warranted to determine the role of CHG-impregnated dressings/disks in reducing ECMO cannula-related infections. Cannula and circuit securement practices vary indicating a lack of standardisation due to an evidence gap in this area.<br/

Peripheral Extracorporeal Membrane Oygenation Cannula Dressing and Securement Practices Across Australia and New Zealand

Introduction: Extracorporeal membrane oxygenation (ECMO) is a highly invasive method of cardiac and/or pulmonary support for critically ill patients where less invasive therapies have failed. Along with other factors, ECMO success relies on effective placement and securement of large-bore cannulae used in therapy delivery. Effective dressing and securement of ECMO cannulae and associated circuitry has an important role to play in preventing infection and accidental dislodgement. Limited data exists regarding peripheral ECMO cannula dressing and securement practice across Australia and New Zealand

The intensive care unit environment from the perspective of medical, allied health and nursing clinicians: A qualitative study to inform design of the ‘ideal’ bedspace

Background: While the impact of the intensive care environment on patients’ experiences and outcomes has been extensively studied, relatively little research has examined the impact on clinicians and their provision of care in the intensive care unit (ICU). Understanding staff experience and views about the environment is needed to optimise the ICU environment, patient outcomes and staff wellbeing. Objective: The objective of this study was to inform design of an optimised intensive care bedspace by describing clinicians’ views about the current environment, including experience, impact on performance of clinical duties, and experience and outcomes of patients and family members. Methods: A pragmatic, qualitative descriptive study was conducted, with data collected in focus groups and interviews with 30 intensive care clinicians at a large cardiothoracic specialist hospital and analysed using the framework approach. Results: Participants acknowledged that the busy and noisy ICU provided a suboptimal healing environment for patients, was confronting for visiting families and exposed clinicians to risk of psychological injury. The bedspace, described as small and cluttered, hindered provision of clinical care of various kinds and contributed to an increased risk of staff physical injuries. Participants noted that the bland, sterile environment, devoid of natural light and views of the outside world, negatively affected both staff and patients’ mood and motivation. Aware of the potential benefits of natural light, cognitive stimulation and visually appealing environments for patients and families, clinicians were frustrated by their inability to personalise the bedspace. Some participants, while acknowledging the importance of family contact for patients, were concerned about the impact of visitors on care delivery, particularly within already crowded bedspaces, suggesting restrictions on visiting. Conclusions: Intensive care clinicians perceive that the current intensive care environment is suboptimal for patients, their families and staff and may contribute to suboptimal patient outcomes. The intensive care bedspaces need to be redesigned to ensure they are built around the needs of the people using them. Optimisation is dependent on engaging all stakeholders in future design processes.</p

Doing time in an Australian ICU; the experience and environment from the perspective of patients and family members

BackgroundThe intensive care environment and experiences during admission can negatively impact patient and family outcomes and can complicate recovery both in hospital and after discharge. While their perspectives based on intimate experiences of the environment could help inform design improvements, patients and their families are typically not involved in design processes. Rather than designing the environment around the needs of the patients, emphasis has traditionally been placed on clinical and economic efficiencies.ObjectiveThe main objective was to inform design of an optimised intensive care bedspace by developing an understanding of how patients and their families experience the intensive care environment and its impact on recovery.MethodsA qualitative descriptive study was conducted with data collected in interviews with 17 intensive care patients and seven family members at a large cardiothoracic specialist hospital, analysed using a framework approach.ResultsParticipants described the intensive care as a noisy, bright, confronting and scary environment that prevented sleep and was suboptimal for recovery. Bedspaces were described as small and cluttered, with limited access to natural light or cognitive stimulation. The limited ability to personalise the environment and maintain connections with family and the outside world was considered especially problematic.ConclusionsIntensive care patients described features of the current environment they considered problematic and potentially hindering their recovery. The perspective of patients and their families can be utilised by researchers and developers to improve the design and function of the intensive care environment. This can potentially improve patient outcomes and help deliver more personalised and effective care to this vulnerable patient population and their families

e-Screening revolution: a novel approach to developing a delirium screening tool in the intensive care unit

Delirium is common in the intensive care unit (ICU), often affecting older patients. A bedside electronic tool has the potential to revolutionise delirium screening. Our group describe a novel approach to the design and development of delirium screening questions for the express purpose of use within an electronic device. Preliminary results are presented.Our group designed a series of tests which targeted the clinical criteria for delirium according to Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) criteria against predefined requirements, including applicability to older patients.Candidate questions, including tests of attention and awareness, were devised and then refined by an expert multidisciplinary group, including geriatricians. A scoring scheme was constructed, with testing to failure an indicator of delirium. The device was tested in healthy controls, aged 20-80 years, who were recorded as being without delirium.e-Screening for delirium requires a novel approach to instrument design but may revolutionise recognition of delirium in ICU