Healthcare Acquired Pressure Ulcers

HAPUs (hospital-acquired pressure ulcers) are a major difficulty in treating admitted patients. Mortality, life quality, and morbidity are also influenced by HAPUs. HAPUs cover over 50 percent of the ischial tuberosities, sacrum, trunk bony prominences, and femoral trochanters [1, 4]. Tissue necrosis causes the subcutaneous and skin tissues to break down, resulting in PUs (pressure ulcers). HAPUs are inconvenient, costly, and do not cure with standard wound treatment [1]. PUs arising in the perioperative environment result in up to 45 percent of all HAPUs, as per the “National Pressure Ulcer Advisory Panel (NPUAP, 2016)” [2]. The first step in preventing HAPUs is to recognize patients at a high risk of developing them. In the clinical environment in the local setting, there is a high frequency of HAPUs. This educational paper aims to evaluate the evidence base currently being used to direct nursing practice in coping with the HAPUs challenge. More so, the paper will discuss the implementation of evidence in a nursing practice environment and explain three main articles applicable to enhance nursing practice when coping with HAPUs.

Evidence-Based to Guide Management of HAPUs

Steps have been taken all over the globe to reduce the prevalence of HAPUs in patients [2]. Despite the efforts, HAPUs are becoming more prevalent, resulting in serious problems and patient mortality [1]. PU risk-assessment scales (RAS) are anti-invasive, cost-effective instruments for determining a person’s risk of contracting HAPUs [2]. The Waterlow, Braden, and Norton RASs are the most popular HAPU RASs [2]. Determining the likelihood of a person contracting HAPUs would involve calculating a composite score based on several risk factors. The occurrence of HAPUs differs greatly around the world and in settings. For example, the prevalence of HAPUs in nursing homes in the UK is 4.70 percent. In hospitals in the US, UAE, and Nigeria, the prevalence of HAPUs is 12.30 percent, 14 percent, and 36.80 percent, respectively [3-6]. Since various medical facilities involve individuals with diverse health problems and HAPU risk levels, prevalence studies might not be the strongest predictor or measurement of the standard of treatment patients obtain within a healthcare environment. Because of the conspicuous vertebral characteristics at these anatomical sites, feet are the common location of HAPUs, and the head and sacrum are alluded to as the “jeopardy areas” [1, 2]. The prevention or handling of HAPUs costs billions of dollars for healthcare professionals [7]. Therefore, HAPUs have major detrimental effects on patients regarding physical, psychological, and social functioning in relation to the monetary expenses [8].

The muscle or fat ratio, the ligaments and tendons concerned, and the degree and length of IP (interface pressure) are all aspects that contribute to the development of HAPUs [8, 9]. The friction between a person’s body and a supportive surface is classified as IP [6]. IP might induce partial or total compression of blood circulation inside capillaries, resulting in the development of PUs. Evidence has shown that a prolonged IP of “60 mmHg for 60 minutes” will cause soft tissue harm and contribute to the formation of PUs [9]. Further research showed that IPs of “32-47 mmHg” would cause the formation of PUs [7]. The main argument is that a smaller IP for a prolonged period would possibly do as much damage as a higher IP for a brief time.

Consequently, in certain healthcare environments, the usage of secure patient repositioning procedures and IP redistributing mattresses and cushions is a common procedure to minimize the likelihood of HAPU forming [5, 6]. Evidence has demonstrated that HAPUs can arise in radiography due to direct interaction with medical equipment and high IPs. The length of certain radiographic processes, as well as some of the procedures used, can raise the risk of HAPUs in patients undergoing radiographic examinations. An abdominal restraint strap, for instance, can be tightened over the abdominal area during intravenous urography to intensify the contrast and fill the renal pelvis and the uterus. Using a compression band requires an increase in the IP between the patient and the scanning screen surface [7]. Patients must stay in the cramped role for multiple minutes, often up to 50 minutes, based on their health history and individual needs. The clinical consequence is that patients who undergo repeated radiographic operations, like “intravenous urography,” may be at risk of developing HAPU. Regrettably, pressure injury may require longer to manifest. The evidence indicates that, owing to lengthy radiographic techniques, radiographers and radiologists might be unsure of the HAPU’s development. Preventing HAPUs needs a thorough knowledge of the predisposing factors. All healthcare practitioners should be worried about the incidence of HAPUs in facilities.

Implementation of Evidence on HAPUs in a Nursing Practice Environment

A high consensus on guidance is needed for practical implementation [2.3]. HAPU management solution must provide evaluation, recording of the patient’s pressure relief, prevention of shearing pressure, and condition of the skin [5]. Implementation of a current holistic strategy for the treatment and care of HAPU victims includes photographing all wounds on specific days for continuing review and maintenance. Substitution of surfaces supporting the surgical procedure may help to avoid deep tissue damage and skin degradation. Besides, the introduction of nursing employee-driven guidelines with the committee’s guidance is a significant step toward the execution of EBP guidelines. Guidelines that fall under this category include one guideline directing nurses to introduce prevention steps for patients who ranked 18 or lower on the “Braden Scale” and begin care of phase one or phase two pressure ulcers. The procedure outlines the basic course of action for such patients. The nurses can begin wound care management without consulting the physicians.

Additionally, another intervention identified a hospital-wide pressure ulcer surveillance mechanism, quarterly and monthly. Practitioners should use relevant device-rounded reports in the surveillance. The reports explicitly described patients who were diagnosed with either a “present on admission” (POA) or a “hospital-acquired pressure ulcer” (HAPU). The wound management committee checked this information, and each hospital admissions nursing department got its HAPU rate. The material is then posted quarterly on the unit-specific hospital cornerstone boards for all employees to review. The committee urged administrators and executives to have weekly morning pauses to discuss wound care problems. Monthly meals to admitted units with zero HAPU ratings to broaden involvement. Most repositioning strategies focus on historical guidance backed by existing best management standards [8]. (Mallah et al.) Also, the investigators suggested that the bed-bound patient should be repositioned after two hours to prevent the formation of HAPUs [7]. To allow the workers to reposition the bed-bound patient every two hours, the committee requested the approval of board management and nurse leaders to raise the number of nurse associates in each department to three or four and mandate hourly repositioning of bed-bound patients. The freshly recruited team supported non-bedridden people moving out of bed and into a chair, which was crucial to fulfilling the purpose of a repositioning procedure.

The Articles that Can Improve the Nursing Practice in Dealing with Hapus

Ebi et al.[7] analyzed nurses’ awareness of HAPU prevention in public hospitals. The authors used a quantitative method to gather data from 212 randomly chosen nurses using a comprehensive multifocal cross-sectional sample layout. The study gathered relevant data using two standardized, approved self-administered PU awareness research tools to assess nurses’ awareness. The “Mann-Whitney U and Kruskal-Wallis” measures assessed mean ratings. Nursing staff awareness levels and obstacles to HAPU prevention were defined using frequencies, means, and standard deviation. According to the findings of the study, 91.5 percent of participants had insufficient information about HAPU prevention. According to the report, relevant nurses read publications (0.000) and obtained instruction (p = 0.003). The most often reported perceived challenges to practicing HAPU prevention were a lack of pressure-alleviating equipment, a scarcity of staff, and a shortage of experience. The research concludes that there are places where stakeholders should take action to enhance HAPU reduction in public hospitals, such as increasing routine appropriate additional instruction for nurses on HAPUs and their prevention points.

Subsequently, Singh et al. [8] studied the frequency, length, and result of HAPU recovery deterioration and those accessing home care whose situation stayed the same. The report also identified the home care nursing strategies used to mitigate the likelihood of HAPU worsening. The recovery strategy of patients with HAPU was tracked and checked in an exploratory analysis. According to the results, 17 percent of the 24 patients recorded to have HAPU healed fully, with “Degree I and Degree II pressure ulcers healing fully throughout 15 to 20 days and patients with III- and IV-degree pressure ulcers showing subsequent progress in the level of HAPU.” The authors conclude that HAPU is not only a big worry in hospitals, but it is still a severe problem in contemporary healthcare organizations. It is an important nursing function and a widely utilized benchmark for quality treatment, and it is always avoidable. HAPU incidence tends to grow amid the reality that pressure ulcer avoidance is a basic technique that is not new, is affordable, and impacts patient protection and quality results. Improving and redefining the function of home care nurses is important for improving patient protection and general patient outcomes.

Finally, Daz-Caro and Garca [9] performed a report to describe the characteristics of patients with low risk on the “Norton-MI scale” who obtain PUs during hospital admission, as well as to determine the prevalence of HAPU. Between 2014 and 2017, a retrospective analysis was carried out. The study examined social and demographic factors, hospital admission units, Morton-MI ranking, and HAPU predisposing factors. Besides, they assessed the prevalence of PU using 5530 participants, with 1260 listed as “low risk” and a median of 16 on the “Norton-MI scale. The study’s total age was 76, and 52.5 percent were female. Excessive pressure and altered skin sensitivity are statistically important risk factors for HAPU. Concerning severity, 55 percent of the HAPUs were classified as “category I,” while 42.6 percent were classified by the investigators as category II, owing to “anatomical Sacro-coccygeal location.” The authors concluded that HAPU emerged in 65.2 percent of the patients during the first week of hospital admission. To reduce the occurrence of HAPUs, it would be prudent to specifically monitor the risk of PUs in hospital settings, especially within the first week of a patient’s hospitalization.

Conclusion

There have been several experiments on HAPUs that apply to nursing practice. The available evidence, though, offers some proof that some clinical procedures and environments placed patients at an elevated risk of contracting PU. More research involving this highly specialized area is needed to help resolve the issue of the possibility of HAPU formation. Besides, precautionary steps should be enforced in nursing practice to reduce the likelihood of HAPUs while minimizing the exacerbation of any current PUs. This is a drawback of this analysis, which reveals a shortage of studies on the possibility of HAPUs in nursing. More researchers should deal with understanding the dangers of HAPUs to the patient population's healthcare.

References

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