Abstract: Reducing Perioperative Pressure Ulcers in Thoracic, Cardiovascular, and Spinal Surgery patients: Achieving ZERO Incidence is Possible! (44th Annual Conference (June 9-13, 2012))

Irene D. Castelino, RN, CNOR, University of Virginia Medical Center, Quality and Performance Improvement Coordinator Surgical Services, Charlottesville, VA, David M. Mercer, ACNP-BC, CWOCN, Univerisity of Virginia Medical Center, APN 2, Charlottesville, VA and James F. Calland, MD, FACS, University of Virginia Medical Center, Associate Chief Medical Officer, Acute Care; Medical Director Surgical Services Quality and Performance Improvement, Charlottesville, VA

Introduction

Reducing iatrogenic skin injuries is an institutional priority of all hospitals today¹. Historically, pressure ulcer prevention in surgical patients has focused on postoperative nursing practices such as assessment, pressure relief, nutrition, and skin care.² A preprocedure intervention that protects vulnerable skin from pressure, shear forces, and moisture may have utility for augmenting the capacity of post-procedure interventions to reduce the frequency and severity of decubitus ulcer.

Methods

A sample of adult spine, cardiac and thoracic surgical patients were treated by application of soft silicone self-adherent bordered foam dressing to anterior bony prominences during prone positioning for spine surgery* and sacral application for supine cardiac and thoracic surgical procedures⁴**. Multiple skin integrity assessments were integrated into the study, with final follow up at 72 hours post-operatively by certified nurse expert in wound evaluation and care.

Evaluation

In 71 patients positioned supine in OR there were ZERO pressure ulcers observed in the sacrococcygeal area as compared to 16.7% in historical controls. Two patients in this group experienced mild contact dermatitis from the dressing / device.

A second study with control group showed - In 104 patients there were ZERO pressure ulcers observed on the skin overlying the chest and iliac crests as compared to 12 injuries in control group of 114 patients without dressing, a rate of 10.5% reduction. 3 of 104 patients (2.9% ) suffered minor injuries in areas adjacent to dressing, none resulted in Stage 3 or greater pressure ulcers.

Conclusion

These findings prompted widespread adoption of this dressing as part of a comprehensive pressure ulcer prevention program. Pressure ulcer prevalence data continued favorably at our hospital for 3 quarters. A comprehensive approach can reduce pressure ulcers and ZERO incidences were possible in patients at a Level 1 Trauma hospital.

Product notation: *Mepilex Border by Molnlycke

Product notation: **Mepilex Border Sacrum by Molnlycke

6127 Reducing Perioperative Pressure Ulcers in Thoracic, Cardiovascular, and Spinal Surgery patients: Achieving ZERO Incidence is Possible!