Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence.

OBJECTIVE: To determine the effect of the training given to intensive care unit (ICU) nurses to prevent medical device-related pressure injuries (MDRPIs) on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs. RESEARCH METHODOLOGY/DESIGN: A pre-post test intervention study without a control group. SETTING: The study was conducted between May and July 2023 with ICU nurses in three phases: pre-training phase (E0) (104 nurses, 116 patients), training implementation phase (E) and post-training phase (E1) (89 nurses, 120 patients). MAIN OUTCOME MEASURES: The data were collected by using the Patient (E0, E1) and Nurse (E0) Characteristic Forms, MDRPI Follow-up and Prevalence Form (E0, E1), D.E.V.I.C.E Performance Observation Checklist (E0, E1), MDRPI Knowledge Assessment Questionnaire (E0, E1), Braden Pressure Ulcer Risk Assessment Scale (E0, E1), Pressure Injury Grading Form (E0, E1), and Feedback Form about the Training Process (E). RESULTS: The mean MDRPI knowledge score of the nurses increased significantly from E0 to E1 (13.23 ± 1.43 vs. 20.02 ± 1.30, p = 0.001), with the highest improvement in the staging and prevention themes. Nurses' MDRPI prevention performance increased significantly from E0 to E1 (2.15 ± 1.01 vs. 11.17 ± 1.65, p = 0.001). There was a significant difference between the PP rate at E0 (61.2 %) and E1 (27.5 %) (p = 0.001). CONCLUSION: The study indicated that the training on MDRPIs given to ICU nurses increased their knowledge and prevention performance and decreased the prevalence of MDRPIs. However, further studies with a larger sample size are needed to confirm these findings. IMPLICATIONS FOR CLINICAL PRACTICE: Since MDRPIs have more complex staging and prevention practices than conventional PIs, they require the adoption of a training approach that includes visual materials and practical methods in addition to theoretical knowledge. Accurate definitions of medical device dimensions and fixation, skin assessment, and prevention practices will lead to the desired outcome of reducing MDRPIs in ICUs.

Terapia de fotobiomodulação em lesões por pressão relacionada a dispositivos médicos: relato de caso em lábio de um paciente adulto / Photobiomodulation therapy for medical device-related pressure injuries: a case report of an adult with lip involvement

Lesão por pressão relacionada a dispositivos médicos é uma complicação bastante comum e geralmente oriunda da fixação do dispositivo utilizado na intubação endotraqueal para ventilação mecânica. Desta forma, o presente estudo reportou o caso de um paciente do sexo masculino, 65 anos, leucoderma, internado em uma unidade de terapia intensiva, e que desenvolveu lesão ulcerada na região de fixação do dispositivo utilizado para intubação orotraqueal. Após alívio da pressão local exercida, terapia de fotobiomodulação foi proposta como única estratégia para cicatrização da lesão e diminuição do edema. Após 3 sessões diárias foi possível observar excelente curso de reparação tecidual e remissão dos sinais flogísticos. De acordo com o presente caso, a terapia de fotobiomodulação parece ser bastante eficiente para o tratamento de lesões por pressão relacionada a dispositivos médicos(AU)

Medical device-related pressure injuries are very common complications and usually arise from the fixation of the device used in endotracheal intubation for mechanical ventilation. Thus, the present study reports a case of a Caucasian male patient, 65 years old, who was admitted to an intensive care unit and developed later an ulcerated lesion on the region of fixation of the device used for orotracheal intubation. After relieving the local pressure exerted, photobiomodulation therapy was proposed as the only strategy for wound healing and edema reduction. After 3 daily sessions, it was possible to note an excellent tissue repair course and remission of phlogistic signs. According to the present case, photobiomodulation therapy appears to be a quite efficient treatment strategy for medical device-related pressure injuries(AU)

Development of prone positioning and skin damage prevention digital education: the PRONEtect project.

OBJECTIVE: The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educating clinicians on how to reposition and manage the patient safely in a prone position plays a vital role in preventing adverse events. This project aimed to develop accessible online educational content to assist clinicians in safely executing the prone manoeuvre and minimise skin/tissue damage. METHOD: The development of the educational content was based on: a gap analysis and comprehensive review of available educational resources; evidence-based scientific literature; advice from international experts; and a qualitative study exploring the learning needs of 20 clinicians in Belgium and Sweden between February-August 2022. RESULTS: Volunteer clinicians assisted with the creation of eight simulation videos which were professionally filmed and edited. The interactive videos included the supine-to-prone and prone-to-supine manoeuvres, endotracheal and nasogastric tube securement, eye care, stoma care, protecting high-risk areas from pressure damage, and incontinence-associated dermatitis prevention. A prone positioning protocol, a checklist summarising the key aspects of the protocol, and teaching aids (slide deck for didactic lecturing) were developed and validated by a review of the relevant evidence-based literature and the international expert panel. A website was designed to host the content, with free user access, at www.pronetection.com. CONCLUSION: Education is one strategy towards prevention of complications of prone positioning. Accessible education could assist clinicians unfamiliar with prone positioning or current clinicians requiring refresher training to safely manage patients in this position.

Incidence, prevalence and risk factors of device-related pressure injuries in adult intensive care unit: A meta-analysis of 10,084 patients from 11 countries.

Device-related pressure injuries (DRPIs) prevail in the intensive care unit (ICU) and have much to do with medical devices and patients' conditions. This meta-analysis aims to systematically assess the incidence, prevalence and risk factors related to DRPIs among adults in ICU. Web of Science, Cochrane Library, MEDLINE, PubMed and CINAHL were searched from inception to March 2023. Observational studies were included, and the Newcastle-Ottawa scale (NOS) was used to assess literature quality. The primary outcomes were the incidence, prevalence and risk factors regarding DRPIs among adults in ICU. The 19 studies conformed to the criteria for inclusion in the review. The estimated pooled incidence of DRPIs was 14.7% (95% CI: 9.7%-19.6%) in 10 studies (4866 participants). The estimated pooled prevalence of DRPIs was 19.0% (95% CI: 13.6%-24.3%) in 9 studies (5218 participants). The most significant risk factor for DRPIs was using mechanical ventilation. The pooled analysis of the four studies showed that DRPIs were more likely to occur in patients who required mechanical ventilation compared with patients who did not use mechanical ventilation (OR: 9.67, 95% CI: 5.03-18.61, p < 0.001) and using vasopressors, age, length of ICU stays, APACHE II score, Braden score, fever, sex, oedema, diabetes and number of medical devices, SOFA score was also related to pressure injuries risk. The incidence and prevalence of DRPIs in adult ICU were high, and the most significant risk factor for DRPIs was using mechanical ventilation. It is imminent to identify patients of increased risk with DRPIs early.

Incidence of medical device-related pressure injuries in the intensive care unit and related risk factors.

AIM: At present, physicians employ medical devices extensively in the treatment of numerous diseases and in the care and follow-up of patients. However, these medical devices are a potential cause of pressure injuries.The study aimed to investigate the incidence and affecting risk factors of medical device-related pressure injuries (MDRPIs) in an adult intensive care unit. MATERIALS AND METHODS: This is a longitudinal descriptive/analytical and cross-sectional study. The researchers conducted this study with 213 intensive care patients between 15.06.2021 and 15.12.2021. The skin and mucosa under and around each medical device were observed once a day for MDRPIs during the stay of patients who had been hospitalized in the intensive care unit for at least 24 h. The data were collected using Patient Information Form developed by the researchers based on the literature, Medical Device-Related Pressure Injury Monitoring Form, the Jackson/Cubbin Pressure Area Risk Calculator (Jackson/Cubbin BARHATr)-Turkish Version, the National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System and the Glasgow Coma Scale. RESULTS: The incidence of MDRPIs was 28.6% (61/213). The study revealed that 48.4% (46/95) of these injuries were caused by medical devices for respiratory system, 26.3% (25/95) by devices for gastrointestinal and genitourinary system. The study also revealed that 70.5% of MDRPIs occurred on the skin and 29.5% on the mucosal membrane, and that 82.1% of the MDRPIs occurring on the skin were at Stage 1. In terms of anatomical location, 21.1% of these injuries developed on the fingers and 13.7% on the mouth/lip. In multivariate analysis, parenteral + enteral (p = 0.006, OR = 0.083, 95%CI = [0.014-0.497]) and oral nutrition (p = 0.037, OR = 0.210, 95%CI = [0.049-0.908]), a higher number of devices (nine or more) (p = 0.002, OR = 5.387, 95%CI = [1.840-15.772]) and the duration of device wear (p < 0.05) were identified as independent risk factors for the occurrence of MDRPIs. CONCLUSIONS: The study showed that the incidence of MDRPIs was relatively high and was associated with various factors. It is critical for intensive care nurses, who encounter MDRPIs more frequently, to consider these factors while caring for their patients and to take appropriate preventive measures to reduce the incidence of these injuries.

Ambulance referral of more than 2 hours could result in a high prevalence of medical-device-related pressure injuries (MDRPIs) with characteristics different from some inpatient settings: a descriptive observational study.

BACKGROUND: Medical device-related pressure injuries(MDRPI) are prevalent and attracting more attention. During ambulance transfer, the shear force caused by braking and acceleration; extensive medical equipment crowed in a narrow space add external risk factors for MDRPIs. However, there is insufficient research on the relationship between MDRPIs and ambulance transfers. This study aims to clarify the prevalence and characteristics of MDRPI during ambulance transfer. METHOD: A descriptive observational study was conducted with convenience sampling. Before starting the study, six PI specialist nurses certified by the Chinese Nursing Association trained emergency department nurses for three MDRPI and Braden Scale sessions, one hour for each session. Data and images of PIs and MDRPIs are uploaded via the OA system by emergency department nurses and reviewed by these six specialist nurses. The information collection begins on 1 July 2022 and ends on 1 August 2022. Demographic and clinical characteristics and a list of medical devices were collected by emergency nurses using a screening form developed by researchers. RESULTS: One hundred one referrals were eventually included. The mean age of participants was (58.3 ± 11.69) years, predominantly male (67.32%, n = 68), with a mean BMI of 22.48 ± 2.2. The mean referral time among participants was 2.26 ± 0.26 h, the mean BRADEN score was 15.32 ± 2.06, 53.46% (n = 54) of participants were conscious, 73.26% (n = 74) were in the supine position, 23.76% (n = 24) were in the semi-recumbent position, and only 3 (2.9%) were in the lateral position. Eight participants presented with MDRPIs, and all MDRPIs are stage 1. Patients with spinal injuries are most prone to MDRPIs (n = 6). The jaw is the area most prone to MDRPIs, caused by the cervical collar (40%, n = 4), followed by the heel (30%, n = 3) and nose bridge (20%, n = 2) caused by the respiratory devices and spinal board. CONCLUSION: MDRPIs are more prevalent during long ambulance referrals than in some inpatient settings. The characteristics and related high-risk devices are also different. The prevention of MDRPIs during ambulance referrals deserves more research.

Development and psychometric property testing of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool.

AIMS: We aimed to develop and test the psychometric properties of a Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool. BACKGROUND: Assessment of nurses' knowledge and practices is critical in the prevention of Medical Device-related Pressure Injuries. DESIGN: This was an instrument development and testing study. METHODS: The sample of the study consisted of nurses (n = 189). The study was conducted in three phases between January and February 2021. In the first phase, multiple-choice items contained within Aetiology/Risk Factors, Prevention Interventions, and Staging domains were created. In the second phase, content validity and criterion validity were evaluated, and the tool was pre-tested. The third phase examined item difficulty, discrimination index and distractor quality. The test-retest method was used for reliability. RESULTS: The Content Validity Index was found to be 0.75, 0.86 and 0.96 for the domains of Aetiology/Risk Factors, Prevention and Staging, respectively. The item difficulty values of the items were between 0.18 and 0.96. A positive, strong and significant relationship was found between the results and a positive, moderate and significant relationship between the tools administered for the proof of scale validity. The Cronbach's alpha reliability coefficient was found to be 0.54. CONCLUSIONS: The tool is a suitable measurement instrument for use in nursing education, research and clinical settings.

Medical device-related pressure injuries: Knowledge levels of nurses and factors affecting these.

AIM: The knowledge level of nurses plays a key role in preventing medical device-related pressure injuries. This research aimed to investigate the knowledge levels of nurses with regard to medical device-related pressure injuries and the factors affecting these. MATERIALS AND METHODS: This descriptive and cross-sectional study was conducted with 355 nurses between December 15, 2020 and March 31, 2021. Data were collected using the Nurse Information Form and the Medical Device-Related Pressure Injuries Knowledge Questionnaire. RESULTS: The mean score of the nurses for the Medical Device-Related Pressure Injuries Knowledge Questionnaire was 22.11 ± 5.79. The nurses obtained the highest score from the "Description" sub-dimension of the test, whereas the lowest scores pertained to the "Staging" sub-dimension. Only 23.1% of the nurses stated that they had general knowledge about medical device-related pressure injuries. A significant difference was determined between the mean scores that the nurses got from the Medical Device-Related Pressure Injuries Knowledge Questionnaire and their gender, work experience in the intensive care unit, frequency of encountering a medical device-related pressure injuries and their previous training on such injuries. In addition, a positive relationship was determined between the level of knowledge about medical device-related pressure injuries and age and seniority. RESULTS: It was concluded that the level of knowledge of nurses about medical device-related pressure injuries was insufficient. We therefore recommend that a regular training program be provided to nurses on medical device-related pressure injuries in order to reduce the incidence of these injuries and to provide a quality and safe care service to patients.

What is the incidence of medical device-related pressure injuries in adults within the acute hospital setting? A systematic review.

Medical devices provide effective therapeutic care for patients. However, medical device-related pressure injuries (MDRPI) are caused by prolonged pressure or shear from a medical device on any location on the body, including mucosal cavities. The primary outcome of this quantitative systematic review was to identify the incidence of MDRPIs in adults within the acute hospital setting. Secondary outcomes include grading, anatomical location and devices that caused such injuries. Electronic databases (CINAHL Plus with Full Text, MEDLINE, EBSCO Host, Health Business Elite Web of Science, PsychINFO, Google Scholar, and Research Gate) were searched for all potential primary studies between November 2019-January 2020. Studies were refined to the English language only, had no time limit from publication, and had to include participants over the age of 18 years with an MDRPI in the acute hospital setting and 720 potential primary studies were identified. Fourteen articles were identified that matched the predefined criteria and were included in the review. All included studies were critically appraised using the evidence-based librarianship critical appraisal tool and data analysis and narrative synthesis were completed. The incidence of MDRPIs in adults within the acute care setting was 28.1% (SD: 29.1%, min: 1.14%, max: 100%). 71.3% of studies documented anatomical locations of MDRPIs, 36.2% included grading of MDRIs, and 71.4% studies documented the offending medical devices. The mean quality appraisal percentage of all included studies was 76.67% (SD: 4.61%; min: 66.6%, max: 83.3%). Despite the heterogeneity of the studies, the review has identified that MDRPIs are prevalent among individuals cared for within the acute hospital setting. Thus, given the morbidity associated with these wounds, it is important to develop strategies to reduce the scope of this problem.

[Strategy of nursing care on the face skin injuries caused by wearing medical-grade protective equipment].

For effective resistance to virus attack and infection, reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. This paper summarizes the development causes, common locations, and prevention ways about the device related pressure injuries on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the nursing strategy for device related pressure injuries and other nursing strategy is proposed to take care efficiently the device related pressure injuries. Meantime, a corresponding nursing strategy is also suggested to deal with the correlative skin diseases during the application of medical-grade protective equipment. These paper aims to provide reference for the prevention of device related pressure injuries and the care of skin-related diseases for clinical working staff, especially to the respectable personnel in front line of fighting against Corona virus disease 2019.

Strategy of nursing care on the face skin injuries caused by wearing medical-grade protective equipment / 中华烧伤杂志

For effective resistance to virus attack and infection, reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. This paper summarizes the development causes, common locations, and prevention ways about the device related pressure injuries on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the nursing strategy for device related pressure injuries and other nursing strategy is proposed to take care efficiently the device related pressure injuries. Meantime, a corresponding nursing strategy is also suggested to deal with the correlative skin diseases during the application of medical-grade protective equipment. These paper aims to provide reference for the prevention of device related pressure injuries and the care of skin-related diseases for clinical working staff, especially to the respectable personnel in front line of fighting against Corona virus disease 2019.

Strategy of nursing care on the face skin injuries caused by wearing medical-grade protective equipment / 中华烧伤杂志

For effective resistance to virus attack and infection, reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. This paper summarizes the development causes, common locations, and prevention ways about the device related pressure injuries on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the nursing strategy for device related pressure injuries and other nursing strategy is proposed to take care efficiently the device related pressure injuries. Meantime, a corresponding nursing strategy is also suggested to deal with the correlative skin diseases during the application of medical-grade protective equipment. These paper aims to provide reference for the prevention of device related pressure injuries and the care of skin-related diseases for clinical working staff, especially to the respectable personnel in front line of fighting against Corona virus disease 2019.

Recommendations for prevention and treatment of device-related pressure injuries during COVID-19 period / 药学实践杂志

With the outbreak of COVID-19, non-stop working medical staff need to wear protective equipment for a long time, which could easily cause device-related pressure injuries to nose, cheek, forehead or the back of auricle, and might even cause facial skin swelling and ulceration. The above problems reduce work efficiency and increase the infection risk for healthcare people. This article introduces the concept of device-related pressure injuries and summarizes the progress of the treatment for device-related pressure injuries at home and abroad in recent years, aiming at providing guidance for frontline medical staff to prevent device-related pressure injuries.