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PURPOSE: 

The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey.

DESIGN: 

Observational, cohort study with cross-sectional data collection and retrospective data analysis.

SUBJECTS AND SETTING: 

The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years.

METHODS: 

Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units.

RESULTS: 

Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups.

CONCLUSION: 

Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.

中文翻译：

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急性护理中压力性损伤预防策略的实施：2018-2019 年国际压力性损伤患病率调查结果

出口

目的： 

本研究的目的是利用 2018/2019 年国际压疮患病率 (IPUP) 调查的数据评估美国成人急性护理机构中压力性损伤 (PI)预防策略的实施情况。

设计： 

具有横断面数据收集和回顾性数据分析的观察性队列研究。

主题和设置： 

样本包括 296,014 名在美国 1801 家急症护理机构住院的患者，他们参与了 2018 年和/或 2019 年 IPUP 调查。略少于一半（49.4%，n = 146,231）为男性，50%（n = 148,997）为女性，0.6%（n = 17,760）未知。他们的平均年龄为 64.29 (SD 17.2) 岁。

方法： 

分析了 2018/2019 年 IPUP 数据库中的数据，以评估预防策略的实施情况，包括重新定位、支撑表面使用、床头 (HOB) 抬高、脚跟抬高、水分管理、最小化亚麻层和营养支持。实践分析了没有压力损伤的患者、1 期和 2 期医院获得性压力损伤 (HAPI) 患者以及严重 HAPI 患者（3 期、4 期、不可分期和深部组织压力损伤）之间的差异。急诊病房类型包括重症监护病房或重症监护病房、内外科住院病房和降级病房。

结果： 

PI预防策略的合规率HAPI 风险患者之间的差异（Braden Scale for Press Sore Risk score ≤18）。对 86% 的无 HAPI 患者和 96.8% 的重度 HAPI 患者进行了每日皮肤评估。74.6% 的所有患者和超过 90% 的严重 HAPI 患者使用了压力再分配；然而，据报道，对常规重新定位的依从性较低，分别在 67% 和 84% 之间。超过 60% 的严重 HAPI 患者报告了足跟抬高，而 31.9% 的患者没有接受足跟抬高，尽管只有 6% 的患者报告不需要抬高。在数据收集时，大多数患者的 HOB 大于 30°；据报道，减少亚麻层数 (≤3) 的依从性为 76% 或更多。据报道，超过 71% 的患者和 89% 的严重 HAPI 患者使用了水分管理策略。55% 至 82% 的患者使用了营养支持，并且仅在不到 2% 的所有组中记录为禁忌。

结论： 

研究结果表明，对 PI预防策略的遵守率很高。尽管如此，一些最基本的预防策略的实施仍有改进的潜力，包括重新定位、脚跟抬高、营养支持和水分管理。