CS15-004 In the critically ill patient, what is the effect of air-fluidized therapy in comparison to the standard of care on preventing the deterioration of deep tissue injuries?

Bettina Magliato, MS, RN, CIC, CWCN, CHRNC, COCN1, Sharon Davis, BS, RN, CWCN, COCN2 and Barbara Kimsza-Mendes, BS, RN, CCRN, WCC2, (1)Nursing, Hospital of Central Connecticut, New Britain, CT, (2)Nursing, The Hospital of Central Connecticut, New Britain, CT
Critical care patients are the sickest patients in the hospital.  They are physiologically compromised and at great risk to develop pressure ulcers.  Despite the implementation of pressure ulcer prevention bundles, the prevalence of hospital acquired pressure ulcers in critical care continues to rise. Suspected deep tissue injury (sDTI) have been shown to evolve into full thickness, stage III and IV pressure ulcers relatively quickly, often despite early prevention interventions.  SDTIs remain poorly understood. In 2008, The Centers for Medicare and Medicaid declared hospital acquired stage III or IV pressure ulcers as “never events” that can be prevented.  In addition, the hospital is no longer reimbursed for the care related to the hospital acquired stage III or IV pressure ulcer. 

The development of a sDTI is complex and multifactorial.  In critical care, the patient is often being resuscitated with fluids and receiving multiple vasopressor medications to promote hemodynamic balance.  The patient is nutritionally depleted, totally immobile and cold.  Once the sDTI develops, it can quickly deteriorate into a stage III or IV pressure ulcer.  Managing this pressure ulcer will have a tremendous impact on the patient’s quality of life should he survive.  .

A cost effective, practical treatment for early deep tissue injury that the ICU staff RN can initiate was implemented. Once the sDTI is identified, the patient is placed on an air-fluidized bed and a honey impregnated dressing is placed over the pressure ulcer, and covered with a silicone foam dressing.  Forty one patients were treated with this protocol. The results are encouraging. Only 2/41 (4.4%) progressed to full-thickness. The benefit to the patient, nursing practice and the healthcare system will result in enhanced quality care, patient satisfaction,and financial savings for the institution.