Pressure ulcer prevention of sacral stage2 and DTI in critical care: a pilot study

In 2008, the 20 bed ICU had a pressure ulcer incidence of 21.3%. Evidence-based prevention interventions had been instituted [1],  along with the addition of a nutritional supplement when appropriate. Despite this, in fiscal year 2009, 53 of ICU patients developed either DTI’s or stage 2 sacral pressure ulcers. This was a 12.5% incidence for the ICU as compared to a 3.4% overall pressure ulcer incidence for the total hospital. 

The ICU had implemented a VAP protocol with head of bed elevation. This was instrumental in reducing the VAP rate; however, the CWOCN noticed an increase in stage 2 sacral pressure ulcers and DTI’s and wanted to examine the possibility of preventing skin damage from shear. First steps were a review of the literature which addressed the influences of shear forces on skin. [2] Studies at Virginia Commonwealth University Health System have demonstrated that the prophylactic addition of a soft silicone dressing as an external protectant has supported promising results in preventing the development of sacral breakdown in ICU’s.[3]

The ICU incidence data were brought to the ICU Joint Practice Council to request approval to conduct a study for prophylactic use of a silicone foam sacral dressing similar to the study conducted by Brindle.  Both joint practice and IRB approval were obtained in fall 2009. The dressing product company provided the dressing and assisted with staff education, but had no influence on outcomes. The study commenced in January 2010.

Results demonstrated an overall ICU pre-study incidence for FY09 of 12.5% and a post study incidence for FY2010 of only 7%. Most of the pressure ulcers that did occur were not sacral. Going forward, the goal of nursing will be to spread this framework to other hospital units with higher pressure ulcer incidence to decrease hospital numbers overall.