A Bundled Approach for Prevention of Moisture Associated Skin Damage (MASD) and the Correct Use of Support Surfaces in the Medical Intensive Care Unit (MICU)

In 2016, hospital-acquired pressure injuries (HAPI) affected 87 hospitalized patients at a level one trauma center. Out of the 87 patients, 17 of them were in the Medical Intensive Care Unit (MICU). In 2015, MICU purchased new support surfaces; however, there was no decrease in HAPI rates. Although turning, positioning and skin barriers have demonstrated to reduce HAPIs, other factors; such as, immobility and Moisture Associated Skin Damage (MASD) contribute to HAPIs. Knowing these obstacles, the Wound Care Team (WCT) worked collaboratively with MICU Wound Treatment Associates (WTA) and MICU Clinical Quality Nurse Leader (CQNL) to determine methods to reduce the rate of HAPIs in MICU. It became apparent the staff were not using the features on the support surfaces properly. The study method implemented in MICU included features the support surfaces had to offer. All support surfaces were set on a continual rotation for vented and sedated patients. The following settings included 70% rotation for two minutes to the right, one minute centered rotation, and 70% rotation to the left at two minutes. Patients who were awake, alert, oriented and bed-bound, the settings were 70% rotation for 25 minutes to the left and right with 10 minutes to the center. The study method also included one underpad and one flat sheet along with two new skin barrier products. One product being used on the north side of the unit and the other product on the south side of the unit. After three months of the study, the outcome revealed a reduction of 43% on the south side and 67% reduction on the north side. This pilot study demonstrated that a change in skin barrier products, continuous bed rotation, one underpad, and one flat sheet resulted in an overall reduction of HAPIs.