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Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired
Jenny Alderden1, Mollie Cummins, Sunniva Zaratkiewicz
1Jenny Alderden, PhD, APRN, CCRN, CCNS, University of Utah College of Nursing, Salt Lake City. Mollie Cummins, PhD, RN, FAAN, FACMI, University of Utah College of Nursing, Salt Lake City. Sunniva Zaratkiewicz, PhD, RN, CWCN, Professional Development & Nursing Excellence, University of Washington Harborview Medical Center, Seattle. Yunchuan 'Lucy' Zhao, PhD, RN, School of Nursing, Boise State University, Boise, Idaho. Kathryn Drake, MS, Department of Computing, Boise State University, Boise, Idaho. Tracey L. Yap, PhD, RN, WCC, CNE, FGSA, FAAN, School of Nursing, Duke University, Durham, North Carolina.
Purpose:
Community-acquired pressure injuries (CAPIs) are present among approximately 3% to 8% of patients admitted to acute care hospitals. In the critical care population, little is known about hospital-acquired pressure injury (HAPI) development among patients with CAPIs because most studies exclude patients with CAPIs. The purpose of our study was to determine the incidence of HAPI development and the associated risk factors among surgical critical care patients with CAPIs.
Design:
Retrospective cohort study.
Subjects And Setting:
We used electronic health record data from adult critical care patients admitted to the surgical and cardiovascular surgical intensive care units (ICUs) at a level 1 trauma center and academic medical center between 2014 and 2018.
Methods:
Univariate analysis was used to compare patients with CAPIs who developed a HAPI and those who did not, as well as logistic regression analysis to identify independent risk factors for HAPIs among patients with CAPIs.
Results:
Among 5101 patients admitted to 2 surgical critical care units, 167 (3%) patients were admitted with CAPIs. Hospital-acquired pressure injuries were 4 times more common among patients with CAPIs compared to patients without CAPIs. Among the 167 patients with CAPIs, 47 patients (28%) went on to also develop a HAPI, whereas in the 4934 patients without CAPIs, 352 patients (7%) went on to develop a HAPI. Findings from the multivariate logistic regression analysis (n = 151) showed that decreased serum albumin (odds ratio [OR] = 0.47; 95% confidence interval [CI], 0.25-0.85; P = .02) and excessively dry skin (OR = 2.6; 95% CI, 1.1-6.22; P = .03) were independent predictors of HAPI development among patients admitted with CAPIs.
Conclusions:
Results from our study show that patients with CAPIs are at high risk for developing a HAPI, particularly among patients with decreased serum albumin or excessively dry skin. Patients with excessively dry skin may benefit from the application of skin moisturizers.
