Skin microclimate as an indirect risk factor for pressure injuries: a prognostic factor systematic review and...

Skin microclimate is a multidimensional construct comprised of temperature, humidity and airflow. Recently, microclimate has been conceptualised as an indirect risk factor for pressure injuries (PIs) because it can affect skin structure and function. The aim of this review was to determine the prognostic value of skin microclimate as an indirect risk factor for PI in adults in any clinical setting.

A prognostic factor systematic review and Cochrane-Campbell framework synthesis methodology was conducted. This PROSPERO-registered (CRD42023430167) review included eligible full-text studies in any language, published between 1970-2023. Included designs were prospective or retrospective cohorts, case-control or case series. Citations retrieved from four databases (PubMed, Embase, CINAHL and Cochrane Library) were independently screened by two authors, with adjudication as necessary. Data extraction and quality assessment were guided by tools developed for prognostic factors reviews and conducted independently by two reviewers, with adjudication if required.

The review included nine papers from eight studies. Skin temperature was the only microclimate dimension measured and reported. In some studies, two factors influencing microclimate-transepidermal water loss and ambient temperature-were measured. Decrease and increase in skin temperature, measured by thermometers, probes and infrared thermography, were associated with an increased PI risk. The limited and uncertain evidence means no definitive conclusions could be drawn about the relationship between skin microclimate and PI development.

Skin temperature change associated with PI development has been a primary focus of research. The type of device used to measure skin temperature should be considered when interpreting research findings. Further research is required to explore the contributions of humidity and airflow to improve our understanding of skin microclimate and PI development.