Methods: A one-day skin prevalence survey was conducted in the spring of 2005 in a tertiary-care university-affiliated children's hospital. Each patient was assessed for diaper dermatitis, peristomal skin breakdown, epidermal stripping and abrasions, pressure ulcers, skin injury related to medical devices and invasive tubes, and any other alteration in skin integrity. Pressure ulcer risk was assessed using the Braden Q Scale. All patients listed on the 09:00 census on the survey date were included. We excluded patients over 18 years-of-age and patients dying after the redirection of care.

Results: 100% of eligible patients (N=253) were physically examined. Of the 148/253 (58%) incontinent patients, 15% developed diaper dermatitis. Of the 94/253 (38%) patients with peripheral intravenous catheters, five were infiltrated. Forty-three percent of patients had wounds; a quarter of these patients required at least twice daily dressing changes. Ten patients had gastrointestinal or urinary ostomies; half were newly created. Of the 6% of patients at risk for pressure ulcers (Braden Q = 16), 1.6% (4/253) developed pressure ulcers. An additional 5% of patients exhibited pressure-related skin injuries from medical devices and 8% had epidermal stripping from tape products. The mean Braden Q score was 24.5 ± 3.9. The prevalence of common ambulatory pediatric dermatologic skin problem (dermatitis, eczema, rashes) was <10%.

Conclusions: Alterations in skin integrity represents a serious problem in the pediatric inpatient setting. The data presented identify skin integrity challenges in the hospitalized patient and can serve as a benchmark for similar pediatric facilities. Based on these data, additional staff resources were developed, such as a support surface reference tool, a pressure ulcer prevention policy, and a pressure ulcer treatment algorithm.