Do Prophylactic Dressings Decrease the Incidence of Sacral/Coccyx Pressure Ulcers in High-Risk Critical Care Unit (CCU) patients?

Do Prophylactic Dressings Decrease the Incidence of Sacral/Coccyx Pressure Ulcers in High-Risk Critical Care Unit (CCU) patients?

Purpose:  Hospital acquired pressure ulcers (HAPUs) are among the most serious adverse outcomes of care for critically ill patients and remain a focus for nursing study and intervention. Silicone dressings have been proposed as a way to reduce skin trauma by protecting from friction, shear, and maceration of skin. Our purpose was to examine the addition of silicone dressings to the existing protocol of preventive care on reportable sacral/coccyx HAPU incidence.

Methodology:  This descriptive cohort study of a change in protocol compared outcomes with historical data. Following training, CCU staff in the intervention period placed the sacral dressing, lifted it for daily skin inspections and replaced it every 3 days. Data for analysis included patients from each time period identified as high-risk by specific criteria, and incidence was generated for HAPUs reported during their hospitalization. Data analysis included descriptive summaries of high-risk patients in each period. The primary analysis compared the sacral/coccyx HAPU rate in the intervention period to that from historical data, using the Chi Square test (alpha set at .05).

Results:  Following implementation of the sacral dressing, the HAPU rate was 1% (1/100), compared to the 8.2% (61/742) historical rate (p=.009, Pearson's chi square). Examination of characteristics of high-risk patients in our CCU will be presented.

 

Conclusion: Nurses demonstrated significant reductions in sacral HAPUs by the addition of this dressing to our existing bundled approach. We continue to monitor HAPU rate as we explore expansion of this practice change, both to other vulnerable body sites and to other settings. In particular, we are examining its use in the OR which had experienced chest skin breakdowns among back surgery patients from extended positioning times, as well as among heart surgery patients.