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The Characteristics and Risk Factors of Medical Device Related Pressure Injury in Intensive Care Unit Patients

중환자실 환자의 의료기기 관련 욕창 특성과 위험요인

  • Jo, Mi Hyeon (Medical Intensive Care Unit, Asan Medical Center ) ;
  • Choi, Hye-Ran (Department of Clinical Nursing, University of Ulsan )
  • 조미현 (서울아산병원 내과계중환자실 ) ;
  • 최혜란 (울산대학교 의과대학 임상전문간호학전공 )
  • Received : 2023.05.15
  • Accepted : 2023.06.21
  • Published : 2023.06.30

Abstract

Purpose : This study aimed to investigate the characteristics and risk factors associated with pressure injuries related to medical devices among patients admitted to the intensive care unit (ICU). Method : A retrospective study analyzed data from 462 ICU patients. Statistical analyses, including independent t-tests, Fisher's exact tests, and logistic regression were performed to analyze the data. Results : Among the 154 subjects, there were a total of 198 medical device-related pressure injuries (MDRPI). Stage 2 and deep tissue pressure injuries were the most frequent. MDRPI occurred most frequently on the face, with nasogastric tubes being its leading cause, followed by endotracheal tubes. The risk factors for MDRPI included male sex (odds ratio [OR]=1.78, 95% confidence interval [CI]=1.12-2.83), department at the time of ICU admission (OR=4.29, 95% CI=2.01-9.15), post-surgery ICU admission (OR=0.43, 95% CI=0.25-0.73), application of extracorporeal membrane oxygenation machines (OR=2.72, 95% CI=1.06-6.95), number of medical devices (OR=1.16, 95% CI=1.05-1.30), inotropic drug administration (OR=2.33, 95% CI=1.19-4.60), and sedative use (OR=2.53, 95% CI=1.17-5.45). Conclusion : These results enable the determination of the characteristics and risk factors associated with MDRPI. It is crucial to acknowledge the risk factors for MDRPI in ICU patients and establish a prevention strategy.

Keywords

References

  1. European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. Emily Haesler (Ed.). Osborne Park, Western Australia: EPUAP/NPIAP/PPPIA: 2019. 
  2. Black JM, Cuddigan JE, Walko MA, Didier LA, Lander MJ, Kelpe MR. Medical device related pressure ulcers in hospitalized patients. International Wound Journal. 2010;7(5):358-65. https://doi.org/10.1111/j.1742-481X.2010.00699.x 
  3. Cooper KL. Evidence-based prevention of pressure ulcers in the intensive care unit. Critical Care Nurse. 2013;33(6):57-66. https://doi.org/10.4037/ccn2013985 
  4. He M, Tang A, Ge X, Zheng J. Pressure ulcers in the intensive care unit: an analysis of skin barrier risk factors. Advances in Skin & Wound Care. 2016;29 (11):493-8. https://doi.org/ 10.1097/01.ASW.0000494779.66288.c9 
  5. Health Insurance Review & Assessment Service, Pressure ulcer [Internet]. Republic of Korea: Health Insurance Review & Assessment Service; 2020 [cited 2021 October 11]. Available from: http://opendata.hira.or.kr/op/opc/olap3thDsInfo.do 
  6. Korea Institute for Healthcare Accreditation, hospital certification standards 4th [Internet]. Republic of Korea: Korea Institute for Healthcare Accreditation; 2021 [cited 2021 October 27]. Available from: https://www.koiha.or.kr/web/kr/index.do 
  7. Lee JK. The relationship of risk assessment using braden scale and development of pressure sore in neurologic intensive care unit. The Journal of Korean Academic Society of Adult Nursing. 2003;15(2):267-77. 
  8. Lee YJ. An analysis of pressure ulcer rate and the risk factors of pressure ulcer in hospitalized patients [master's thesis]. Seoul: Seoul National University; 2011. p. 29-33. 
  9. Lee ER. The prevalence and risk factors of pressure ulcers in a tertiary hospital [master's thesis]. Daegu: Kyung-Pook National University; 2014. p. 17-31. 
  10. Kim YK. Evaluation of predictive validity for the pressure ulcer risk assessment tool 2. Health & Nursing. 2000;12(2):37-51. 
  11. Lahmann NA, Kottner J, Dassen T, Tannen A. Higher pressure ulcer risk on intensive care-comparison between general wards and intensive care units. Journal of Clinical Nursing. 2012;21(3-4):354-61. https://doi.org/10.1111/j.1365-2702.2010.03550.x 
  12. Martel T, Orgill DP. Medical device-related pressure injuries during the COVID-19 pandemic. Journal of Wound Ostomy & Continence Nursing. 2020;47(5):430-4. https://doi.org/10.1097/WON.0000000000000689 
  13. Lindgren M, Unosson M, Fredrikson M, Ek AC. Immobility-a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scandinavian Journal of Caring Sciences. 2004;18(1):57-64. https://doi.org/10.1046/j.0283-9318.2003.00250.x 
  14. Coyer FM, Stotts NA, Blackman VS. A prospective window into medical device-related pressure ulcers in intensive care. International Wound Journal. 2014;11(6):656-64. https://doi.org/10.1111/iwj.12026 
  15. Apold J, Rydrych D. Preventing device-related pressure ulcers: using data to guide statewide change. Journal of Nursing Care Quality. 2012;27(1):28-34. https://doi.org/10.1097/NCQ.0b013e31822b1fd9 
  16. Hanonu S, Karadag A. A prospective, descriptive study to determine the rate and characteristics of and risk factors for the development of medical device-related pressure ulcers in intensive care units. Ostomy Wound Manage. 2016;62(2):12-22. 
  17. Pittman J, Beeson T, Kitterman J, Lancaster S, Shelly A. Medical device-related hospital-acquired pressure ulcers: development of an evidence-based position statement. Journal of Wound Ostomy & Continence Nursing. 2015;42(2):151-4. https://doi.org/10.1097/WON.0000000000000113 
  18. Wille J, Braams R, Haren WH, Werken C. Pulse oximeter-induced digital injury: frequency rate and possible causative factors. Critical Care Medicine. 2000;28(10):3555-7. https://doi.org/10.1097/00003246-200010000-00036 
  19. Willock J, Harris C, Harrison J, Poole C. Identifying the characteristics of children with pressure ulcers. Nursing Times. 2005;101(11):40-3. 
  20. Choi MA. Risk factors for medical device-related pressure injuries in patients with spinal surgery in the prone position [master's thesis]. Busan: Pu-Kyong University; 2020. p. 20-33. 
  21. Jun SS, Kim HJ, Jang YJ. Pressure ulcers caused by equipment and supplies in intensive care unit. Journal of Korean Academic Society of Home Health Care Nursing. 2017;24(3):255-63. https://doi.org/10.22705/JKASHCN.2017.24.3.255. 
  22. Kim HK, Kim YH, Son HM. Characteristics influencing the occurrence of respiratory medical device-related pressure ulcers in the pediatric intensive care unit. Child Health Nursing Research. 2019;25(2):133-42. https://doi.org/10.4094/chnr.2019.25.2.133 
  23. Koo MJ, Sim YA, Kang IS. Risk factors of medical device-related pressure ulcer in intensive care units. Journal of Korean Academy of Nursing. 2019;49(1):36-45. https://doi.org/10.4040/jkan.2019.49.1.36 
  24. Lee YJ, Kim JY, Korean Association of Wound Ostomy Continence Nurses. Medical device related hospital related pressure ulcer in Korea. Journal of Korean Wound Management Society. 2015;11(2):87-91. 
  25. Lee YJ, Kim JY. A study on the nursing knowledge, attitude, and performance towards pressure ulcer prevention among nurses in Korea long-term care facilities. International Wound Journal. 2019;1(1):29-35. https://doi.org/10.1111/iwj.13021 
  26. Kang MK, Kim MS. Risk factors for medical device -related oral mucosa pressure ulcer development of intubated patients in adult intensive care unit. Journal of Korean Biological Nursing Science. 2020;22(4):271-8. https://doi.org/10.7586/jkbns.2020.22.4.271 
  27. Im HS. Case-control study method. Journal of Korean Academy of Family Medicine 1994;15(1):18-23. 
  28. Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportional hazards regression analysis II. Accuracy and precision of regression estimates. Journal of Clinical Epidemiology. 1995;48(12):1503-10.  https://doi.org/10.1016/0895-4356(95)00048-8
  29. Galetto SGDS, Nascimento ERPD, Hermida PMV, Busanello J, Malfussi LBH, Lazzari DD. Medical device-related pressure injury prevention in critically ill patients: nursing care. Brazilian Nursing Journal. 2021;74(2):e20200062. https://doi.org/10.1590/0034-7167-2020-0062 
  30. Kayser SA, VanGilder CA, Ayello EA, Lachenbruch C. Prevalence and analysis of medical device-related pressure injuries: results from the international pressure ulcer prevalence survey. Advances in Skin & Wound Care. 2018;31(6):276-85. https://doi.org/10.1097/01.ASW.0000532475.11971.aa 
  31. VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008-2009 international pressure ulcer prevalence survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage. 2009;55(11):39-45. 
  32. Manzano F, Navarro MJ, Roldan D, Moral MA, Leyva I, Guerrero C, et al. Pressure ulcer incidence and risk factors in ventilated intensive care patients. Journal of Critical Care. 2010;25(3):469-76. https://doi.org/10.1016/j.jcrc.2009.09.002 
  33. Sin ES, Jung AR, Lee EJ, Cho EY, Kwak KO, Choi JH, et al. Risk degree of pressure sore according to hospital days in ICU patients. Nursing and Health Issues(NHI). 2006;11(1):39-49. 
  34. Wang HN, Campbell J, Doubrovsky A, Singh V, Collins J, Coyer F. Pressure injury development in critically ill patients with a cervical collar in situ: A retrospective longitudinal study. International Wound Journal. 2020;17(4):944-56. https://doi.org/10.1111/iwj.13363 
  35. Tam SF, Mobargha A, Tobias J, Schad CA, Okochi S, Middlesworth W, et al. Pressure ulcers in paediatric patients on extracorporeal membrane oxygenation. International Wound Journal. 2019;16(2):420-3. https://doi.org/10.1111/iwj.13049 
  36. Kumta N, Coyer F, David M. Perioperative factors and pressure ulcer development in postoperative ICU patients: A retrospective review. Journal of Wound Care. 2018;27(8): 475-85. https://doi.org/10.12986/jowc.2018.27.8.475