Reducing Pressure Ulcers in the Surgical Cardiovascular Patient Population

Pressure ulcer incidence in cardiac surgery patients is reported to be as high as 29.5%, due to their many intrinsic risk factors which include: numerous co-morbidities, advanced age and compromised cardiovascular status.  These factors are compounded by the factors related to the peri-operative period including prolonged immobility, numerous lateral transfers and hemodynamic changes. Previous projects at this 571 bed academic medical center implemented a prophylactic silicone dressing on high risk patients in 2 different ICU settings, resulting in a 64% and 24% reduction in the SICU and MRICU units from 2009-2013. However, with a 12 month incidence rate of 8.7%, further preventative measures were required in the CICU population.

 The heels and the sacrum are the highest anatomical location for OR PU. A review of literature indicated randomized controlled trials showing success in reducing both sacral and heel HAPU with the use of prophylactic dressings in the ED and OR populations.^1,2. Additionally, the NPUAP 2014 Guidelines also recommend considering their use.³   Consequently, we expanded preventive interventions by adding the use of the heel dressing and by applying both the sacral and heel dressing prior to surgery, in addition to our prior policy for their application for the duration of their ICU stay.  Skin assessments were performed pre-operatively, post-operatively and daily. Other Bundle components already in effect included: off-loading, nutritional support, specialty beds, re-positioning and moisture management.

Sixty five patients were followed from September through December 2014.  One patient developed a pressure ulcer (immediately post-op).  No pressure ulcers on the sacrum or heels have been noted in the 9 months since initial implementation of the dressing. In conclusion, based on our experience and review of best-practice guidelines, use of prophylactic dressings is recommended: throughout the peri-operative period on cardiac surgery patients and on the sacrum and heels of all ICU patients.