Practice Innovations
The Operating Room (OR) is a high-risk environment for hospital-acquired pressure injuries (HAPI) due to patients’ prolonged immobility and positioning on a relatively hard surface.1,2 In 2019, 38% of all HAPI at a 500+ bed teaching hospital were contributed to the OR. The 2019 Guidelines recommend considering expected surgical time and patient position in HAPI risk assessment and using soft silicone multi-layered foam dressings to protect high pressure areas.3
The purpose of this study was to test whether OR-related HAPIs could be reduced with perioperative HAPI risk screening tool which triggers an OR skin prevention bundle and soft silicone multi-layered foam dressings for at-risk surgical patients.
Methods:
A pre/post-test design was used. The baseline period was 10/2019-9/2020 and the intervention period was10/2020-9/2021. The Acero – Kurtz Perioperative Skin Bundle was implemented for all surgeries under general anesthesia. The bundle includes standard prevention measures and the application of a soft silicone multi-layered foam dressing. The bundle consists of six risk indicators requiring a yes/no response. Any 1 “yes” answer triggers OR standard prevention measures which include pre-surgical skin assessment, safe patient handling and use of positioning devices. Any 2 “yes” answers or 1 “yes” which is “repeated OR/surgery” during the same admission is a stand-alone criterion identifies the patient as high risk and triggered the use of a soft silicone multi-layered foam dressing in addition to the OR standard prevention measures. OR staff and nursing leadership were educated about the screening tool and HAPI prevention protocol. Statistical significance of pressure injury outcomes was determined using Fisher’s Exact Test.
Results:
100% staff education attendance was achieved. Thirty-five surgical patients met the modified PRAMS criteria for high-risk and received OR skin bundle and prophylactic dressing. OR-related HAPI incidence was 0% compared to 1.9% in the baseline (p=.0001).
Discussion:
HAPI can be reduced with staff education and preventative care including prophylactic soft silicone multi-layered foam dressings triggered by an OR-specific risk screening process.