Pittman J, Beeson T, Dillon J, Yang Z, Mravec M, Malloy C, Cuddigan J, et al.
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy an.... Date of publication 2021 Jan 1;volume 48(1):20-30.
1. J Wound Ostomy Continence Nurs. 2021 Jan-Feb 01;48(1):20-30. doi:
10.1097/WON.0000000000000734.
Hospital-Acquired Pressure Injuries and Acute Skin Failure in Critical Care: A
Case-Control Study.
Pittman J(1)(2)(3)(4)(5)(6)(7), Beeson T(1)(2)(3)(4)(5)(6)(7), Dillon
J(1)(2)(3)(4)(5)(6)(7), Yang Z(1)(2)(3)(4)(5)(6)(7), Mravec
M(1)(2)(3)(4)(5)(6)(7), Malloy C(1)(2)(3)(4)(5)(6)(7), Cuddigan
J(1)(2)(3)(4)(5)(6)(7).
Author information:
(1)Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, Indiana University
Health-Academic Health Center, Indianapolis.
(2)Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health-Academic
Health Center, Indianapolis.
(3)Jill Dillon, MSN, RN, CCRN, ACNS-BC, Indiana University Health-Academic Health
Center, Indianapolis.
(4)Ziyi Yang, MS, Indiana University School of Medicine, Indianapolis.
(5)Michelle Mravec, BSN, RN, Indiana University School of Nursing, Indianapolis.
(6)Caeli Malloy, BSN, RN, Indiana University School of Nursing, Indianapolis.
(7)Janet Cuddigan, PhD, RN, FAAN, University of Nebraska Medical Center, College
of Nursing, Omaha.
PURPOSE: The purpose of this study was to examine clinical characteristics and
risk factors for critically ill patients who develop pressure injuries and
identify the proportion of validated unavoidable pressure injuries associated
with the proposed risk factors for acute skin failure (ASF).
DESIGN: Retrospective case-control comparative study.
SUBJECTS AND SETTING: The sample comprised adult critically ill participants
hospitalized in critical care units such as surgical, trauma, cardiovascular
surgical, cardiac, neuro, and medical intensive care and corresponding
progressive care units in 5 acute care hospitals within a large Midwestern
academic/teaching healthcare system. Participants who developed hospital-acquired
pressure injuries (HAPIs) and patients without HAPIs (controls) were included.
METHODS: A secondary analysis of data from a previous study with HAPIs and
matching data for the control sample without HAPIs were obtained from the
electronic health record. Descriptive and multivariate logistic regression
analyses were conducted.
RESULTS: The sample comprised 475 participants; 165 experienced a HAPI and acted
as cases, whereas the remaining 310 acted as controls. Acute Physiology and
Chronic Health Evaluation (APACHE II) mean score (23.8, 8.7%; P < .001),
mortality (n = 45, 27.3%; P = .002), history of liver disease (n = 28, 17%; P <
.001), and unintentional loss of 10 lb or more in 1 month (n = 20, 12%; P = .002)
were higher in the HAPI group. Multivariate logistic regression analysis
identified participants with respiratory failure (odds ratio [OR] = 3.00; 95%
confidence interval [CI], 1.27-7.08; P = .012), renal failure (OR = 7.48; 95% CI,
3.49-16.01; P < .001), cardiac failure (OR = 4.50; 95% CI, 1.76-11.51; P = .002),
severe anemia (OR = 10.89; 95% CI, 3.59-33.00; P < .001), any type of sepsis (OR
= 3.15; 95% CI, 1.44-6.90; P = .004), and moisture documentation (OR = 11.89; 95%
CI, 5.27-26.81; P <.001) were more likely to develop a HAPI. No differences
between unavoidable HAPI, avoidable HAPI, or the control group were identified
based on the proposed ASF risk factors.
CONCLUSION: This study provides important information regarding avoidable and
unavoidable HAPIs and ASF. Key clinical characteristics and risk factors, such as
patient acuity, organ failure, tissue perfusion, sepsis, and history of prior
pressure injury, are associated with avoidable and unavoidable HAPI development.
In addition, we were unable to support a relationship between unavoidable HAPIs
and the proposed risk factors for ASF. Unavoidability of HAPIs rests with the
documentation of appropriate interventions and not necessarily with the
identification of clinical risk factors.
Copyright © 2021 by the Wound, Ostomy and Continence Nurses Society.
DOI: 10.1097/WON.0000000000000734
PMCID: PMC8078725 [Available on 2022-01-01]
PMID: 33427806 [Indexed for MEDLINE]
Conflict of interest statement: The authors have no relevant conflicts of
interest to disclose.
