Use of a Comprehensive Pressure Ulcer Prevention Program to Reduce the Incidence of Hospital-acquired Pressure Ulcers in an Intensive Care Unit Setting

Objectives: To assess the effectiveness of a formal, year-long HAPU prevention program in the adult intensive care unit (ICU) of our hospital, with a goal of achieving at least a 50% reduction in 2013, compared with 2011.

Methods: Planning for the prevention program began in 2012, and the program was rolled out in the first quarter of 2013. Program components included use of Braden algorithm scores, a revised skin care protocol, fluidized repositioners, and Allevyn Life Silicone Adhesive Dressings (Smith & Nephew, Inc, St. Petersburg, FL). Allevyn Life was used for a Braden score <14 and were encouraged to be used whenever there were pressure points. The most common placement was the sacrum, but dressings were also used on heels, elbows, and under C-collars. Incidence of HAPUs was calculated as the percentage of all patients in the ICU developing a HAPU. Cumulative incidence of HAPU was gathered over a 12 month period following initiation of the protocol.

Results: Baseline demographics, including number of admitted patients and stage of ulcer, are provided in Table 1. Reasons for admission to the adult ICU were varied, with patients having a variety of traumatic injuries, cardiovascular events, and post-surgical complications. Across all years, the majority of HAPUs were stage II.

In 2011, prior to beginning the prevention program, there were a total of 45 HAPUs occurring in 9.8% of patients and costing approximately $1.7 million dollars. In 2013, the overall reduction in incidence of HAPUs to 17 (3.0% of patients affected) represented a decrease of over two-thirds (69%) compared with 2011, exceeding our original goal of a 50% reduction.

Conclusions: The convincing results in ICU have led to approval of a hospital-wide roll out of the HAPU prevention program, along with a commitment to ensure that prevention of device-related HAPUs remains a priority.