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COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review
Adrienn N Bourkas1, Michele Zaman, R Gary Sibbald
1At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD, MAPWCA, JM is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022; published ahead of print January 27, 2023. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com ).
Insights
Hospital-acquired pressure injury (HAPI) incidence is high in COVID-19 positive men with prolonged hospital stays, prone positioning, and lacking skin experts. Future research should refine HAPI guidelines.
Area of Science:
- Medical research
- Infectious disease epidemiology
- Wound care science
Background:
- Hospital-acquired pressure injuries (HAPI) are a significant concern in healthcare settings.
- The COVID-19 pandemic introduced new challenges and patient care complexities.
- Understanding HAPI risk factors in COVID-19 patients is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the relationship between COVID-19-related variables and the incidence of hospital-acquired pressure injuries (HAPI).
Main Methods:
- A systematic literature search was conducted across four databases (Cochrane, MEDLINE, EMBASE, CINAHL).
- Key terms included "COVID-19," "hospital-acquired pressure injuries," and related terms.
- Nineteen peer-reviewed publications reporting HAPI incidence in hospitalized COVID-19 patients were included after screening 489 articles.
Main Results:
- Data were narratively synthesized due to heterogeneity, with HAPI incidence as the primary outcome.
- Higher HAPI incidence was observed in male COVID-19 patients.
- Factors associated with increased HAPI incidence included prolonged hospitalization and prone positioning.
Conclusions:
- COVID-19 patients with prolonged hospital stays, prone positioning, and care teams lacking skin/wound experts exhibited higher HAPI rates.
- The review highlights the need for improved methodologies in future research.
- Quantitative modeling is recommended to enhance inpatient HAPI guidelines.
Objective:
To investigate the relationship between COVID-19-related variables and hospital-acquired pressure injury (HAPI) incidence.
Data Sources:
The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as "COVID-19," "hospital-acquired pressure injuries," "pressure ulcer," "pressure injury," "decubitus ulcer," and "hospitalization."
Study Selection:
The systematic search of the literature identified 489 publications that matched the inclusion criteria. Articles were included in the review if they were peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously, and 19 publications were included.
Data Extraction:
Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies.
Data Synthesis:
The authors carried out a narrative synthesis of the extracted data because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence.
Conclusions:
This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should use more robust methodology and focus on quantitative modeling to iteratively improve inpatient HAPI guidelines.
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