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Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care
Christine A Schindler1, Theresa A Mikhailov, Evelyn M Kuhn
1Department of Pediatrics, Medical College of Wisconsin, Children's Hospital and Health System, Milwaukee, 53201-1997, USA. cschindl@mcw.edu
Insights
The incidence of pressure ulcers in critically ill children is over 10%. Implementing specific nursing interventions, such as using specialty beds and regular repositioning, can significantly reduce pressure ulcer development.
Area of Science:
- Pediatric Critical Care
- Nursing Research
- Patient Safety
Background:
- The incidence of pressure ulcers in critically ill infants and children ranges from 18% to 27%.
- Risk factors and effective nursing interventions for preventing pressure ulcers in this population remain underexplored.
Purpose of the Study:
- To determine the incidence of pressure ulcers in critically ill children.
- To compare patient characteristics associated with pressure ulcer development.
- To identify nursing interventions that reduce pressure ulcer incidence.
Main Methods:
- A comparative analysis of 5346 pediatric intensive care unit patients.
- Utilized multiple logistic regression to identify effective prevention strategies.
Main Results:
- The overall incidence of pressure ulcers was 10.2%.
- Risk factors included age over 2 years, prolonged intensive care unit stay (≥4 days), and mechanical ventilation (including noninvasive ventilation or extracorporeal membrane oxygenation).
- Preventive strategies associated with lower incidence included specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, regular repositioning (every 2-4 hours), blanket rolls, foam wedges, pillows, and draw sheets.
Conclusions:
- The incidence of pressure ulcers in critically ill children exceeds 10%.
- Targeted nursing interventions are crucial for preventing pressure ulcers in this vulnerable group.
Background:
The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established.
Objectives:
To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers.
Methods:
Characteristics of 5346 patients in pediatric intensive care units in whom pressure ulcers did and did not develop were compared. Multiple logistic regression was used to determine which prevention strategies were associated with less frequent development of pressure ulcers.
Results:
The overall incidence of pressure ulcers was 10.2%. Patients at greatest risk were those who were more than 2 years old; who were in the intensive care unit 4 days or longer; or who required mechanical ventilation, noninvasive ventilation, or extracorporeal membrane oxygenation. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets.
Conclusions:
The overall incidence of pressure ulcers among critically ill infants and children is greater than 10%. Nursing interventions play an important role in the prevention of pressure ulcers.
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