Hospital Acquired Skin Injury in Children: Nurse-Led Interventions to Improve Outcomes

Background: Hospital-acquired skin injury (HASI) including pressure injury, epidermal stripping, incontinence associated dermatitis (IAD), and device-related injury is a serious, often preventable problem shown to increase costs, length of stay, and patient suffering. Although well documented in adults, there is little research evidence from the pediatric population. Nurses at our institution recognized areas for improvement; therefore, we set out to describe HASI in children and, based on the new knowledge generated from this study, develop nurse-led interventions to improve patient outcomes.        

Method: An IRB-approved study consisting of a series of skin injury prevalence surveys was conducted.  Hospital-wide, sixty nurses participated as unit-based “Skin Care Champions” (SCC) and performed standardized skin assessments utilizing a web-base database to document presence of HASI and review accuracy of clinical documentation. Summary statistics were used to determine prevalence for each HASI category. 

Results: Approximately 400 inpatients were assessed with each survey. The highest prevalence rates included:  device-related injury, diaper dermatitis/IAD, and epidermal stripping. Nurses identified practice changes based on study data, including changes in standards and procedures, development of educational resources, implementation of job aids, and acquisition of new products. All areas demonstrated decreased prevalence over time, including pressure injuries which decreased from 4.93% to 1.48%.

Implications: Staff nurses in the role of SCC were empowered to recommend clinical practice changes based on study results. These changes involved multiple disciplines and were targeted to specific areas of concern including new product trials as well as updated assessment and skin care practice standards. Ongoing prevalence surveys continue to monitor improvements in care and patient outcomes in areas of highest concern.