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Hair braids as a risk factor for occipital pressure ulcer development: a case study
Marilu Dixon1, Catherine Ratliff
1Sentara Virginia Beach General Hospital, Nursing Administration, Virginia Beach, VA 23454, USA. mxdixon@sentara.com
Insights
Hair braids in immobile pediatric intensive care unit patients may increase the risk of occipital pressure ulcers. Early intervention by releasing hair can prevent these serious skin injuries.
Area of Science:
- Pediatric critical care medicine
- Dermatology
- Wound care
Background:
- Pressure ulcers are a significant concern in acute care, particularly for critically ill patients in intensive care units (ICUs).
- Occipital pressure ulcer development is linked to immobility, young age, and medical devices, but other factors may contribute.
- Pediatric intensive care units (PICUs) present unique challenges for pressure ulcer prevention.
Purpose of the Study:
- To report a case of occipital pressure ulcers in a pediatric patient with severe sepsis and multi-organ failure.
- To identify hair braids as a potential, previously unrecognized risk factor for occipital pressure injury in immobile pediatric patients.
- To emphasize the importance of patient and staff education regarding hair management in preventing pressure ulcers.
Main Methods:
- Case study of a 7-year-old boy admitted to the PICU with severe sepsis and multi-organ failure.
- Clinical observation and documentation of wound development over a 4-week period.
- Assessment of potential contributing factors, including patient immobility and hair care practices.
Main Results:
- The patient developed five full-thickness occipital pressure ulcers after 4 weeks of immobility with hair in braids.
- The occipital lesions eventually healed, but resulted in scarring alopecia.
- This case highlights a novel association between hair braids and occipital pressure damage.
Conclusions:
- Hair braids, in conjunction with immobility in critically ill children, represent a potential risk factor for occipital pressure ulcers.
- Educating patients, families, and healthcare staff on releasing hair is crucial for preventing these injuries.
- Proactive hair management strategies should be integrated into pressure ulcer prevention protocols for pediatric ICU patients.
Abstract:
The development of pressure ulcers in acute care settings remains an important concern, especially in high-risk populations such as patients who are critically ill and admitted to an ICU setting. In addition to immobility and other risk factors associated with critical illness, occipital pressure ulcer development has been associated with young age (neonates, infants, and young children) and patient care devices (cervical collars, bed lateral rotation). A 7-year-old boy was admitted to the pediatric intensive care unit with severe sepsis that progressed to multi-organ failure including respiratory distress requiring mechanical ventilation, cardiovascular failure requiring extracorporeal membrane oxygenation, and renal failure requiring dialysis. At 4 weeks, hair braids that were placed before admission were taken down, revealing five full-thickness occipital lesions. All wounds eventually healed, but scarring alopecia at the site of the largest wound was visible. This is the first case study describing hair braids as a potential risk factor for occipital pressure-related skin dam- age and suggests that if a patient is immobile and admitted with braids, patient/family and nursing staff education should include discussing the importance of releasing the hair to decrease the risk of occipital ulcers.
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