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Surveillance for Pressure Injuries on Admission to Inpatient Rehabilitation Hospitals During the COVID-19 Pandemic
Jamila A Kendall1, Jack K Haberl2, Caitlin Hartsgrove1
1Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ.
Insights
The early COVID-19 pandemic saw increased pressure injury (PI) prevalence and severity on inpatient rehabilitation hospital (IRH) admission. This highlights the pandemic
Area of Science:
- Medical Research
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic placed unprecedented strain on healthcare systems globally.
- Understanding the impact of the pandemic on patient care, particularly for those requiring rehabilitation, is crucial.
- Pressure injuries (PIs) are a significant concern in healthcare settings, impacting patient outcomes and resource utilization.
Purpose of the Study:
- To investigate whether the incidence of pressure injuries (PIs) on admission to inpatient rehabilitation hospitals (IRHs) increased during the initial phase of the COVID-19 pandemic.
- To compare PI prevalence and severity during the COVID-19 pandemic with a pre-pandemic period.
- To assess if COVID-19 status influenced PI prevalence in IRH admissions.
Main Methods:
- A retrospective chart review was conducted on consecutive patient admissions to four acute IRHs within a single system.
- Data were collected for a 6-week period during the COVID-19 pandemic (April 1-May 9, 2020) and compared to a pre-pandemic period (January 1-February 19, 2020).
- The study analyzed the incidence and severity of PIs on admission, including patient COVID-19 status and length of acute care stay.
Main Results:
- The prevalence of PIs on IRH admission significantly increased by 14.9% during the COVID-19 pandemic compared to the pre-pandemic period (P<.001).
- PI severity, measured by wound stage, also worsened during the pandemic (P<.001).
- No significant difference in PI prevalence was observed between COVID-19-positive and COVID-19-negative patients (35.4% vs 35.7%).
Conclusions:
- The early COVID-19 pandemic was associated with a higher prevalence and severity of pressure injuries upon admission to IRHs.
- This increase may reflect the overall strain on healthcare resources caused by the pandemic, affecting all patients.
- Healthcare facilities must remain vigilant in PI prevention strategies, especially during public health crises.
Objective:
To determine if the incidence of pressure injuries (PIs) on admission to an inpatient rehabilitation hospital (IRH) system of care was increased during the early coronavirus disease 2019 (COVID-19) pandemic period.
Design:
Retrospective survey chart review of consecutive cohorts. Admissions to 4 acute IRHs within 1 system of care over the first consecutive 6-week period of admitting patients positive for COVID-19 during the initial peak of the COVID-19 pandemic, April 1-May 9, 2020. A comparison was made with the pre-COVID-19 period, January 1-February 19, 2020.
Setting:
Four acute IRHs with admissions on a referral basis from acute care hospitals.
Participants:
A consecutive sample (N=1125) of pre-COVID-19 admissions (n=768) and COVID-19 period admissions (n=357), including persons who were COVID-19-positive (n=161) and COVID-19-negative (n=196).
Main Outcome Measures:
Incidence of PIs on admission to IRH.
Results:
Prevalence of PIs on admission during the COVID-19 pandemic was increased when compared with the pre-COVID-19 period by 14.9% (P<.001). There was no difference in the prevalence of PIs in the COVID-19 period between patients who were COVID-19-positive and COVID-19-negative (35.4% vs 35.7%). The severity of PIs, measured by the wound stage of the most severe PI the patient presented with, worsened during the COVID-19 period compared with pre-COVID-19 (χ2 32.04%, P<.001). The length of stay in the acute care hospital before transfer to the IRH during COVID-19 was greater than pre-COVID-19 by 10.9% (P<.001).
Conclusions:
During the early part of the COVID-19 pandemic time frame, there was an increase in the prevalence and severity of PIs noted on admission to our IRHs. This may represent the significant burden placed on the health care system by the pandemic, affecting all patients regardless of COVID-19 status. This information is important to help all facilities remain vigilant to prevent PIs as the pandemic continues and potential future pandemics that place strain on medical resources.
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