Implementation of a risk-stratified intervention bundle to prevent pressure injury in intensive care: A before-after study.

Abstract

Background: Hospital-acquired pressure injury is an enduring problem in intensive care. Several intensive care-specific pressure injury risk assessment tools have been developed, but to date, only the COMHON Index has been aligned with risk-stratified preventative interventions.

Objectives: The aim of this study was to evaluate the effectiveness of a risk-stratified intervention bundle to reduce pressure injury in intensive care and to assess compliance with bundled interventions.

Methods: A controlled before-after study was undertaken. All patients admitted to a single intensive care unit were included. Standard care was provided in the before phase, and the risk-stratified intervention bundle was implemented in the after phase. The primary outcome measure was pressure injury incidence.

Results: The sample comprised 761 intensive care admissions. In the after phase, pressure injury incidence was reduced (2.1% vs 3.9%; 46% relative risk reduction), injury severity was lower, and there were fewer pressure injuries on the sacrum, buttocks, and heels. Logistic regression modelling identified three significant factors associated with pressure injury development: intensive care length of stay (odds ratio: 1.2); COMHON Index admission score (odds ratio: 1.2), and the before phase (odds ratio: 4.2). In the after phase, individual intervention compliance was variable (range: 40%-100%), but the all-or-nothing compliance was poor (33%).

Conclusions: Implementation of bundled preventive measures associated with COMHON Index risk level reduced pressure injury incidence. Likewise, injury severity decreased, and the location of pressure injuries changed following the intervention. The results from this study support the use of risk-stratified interventions to prevent pressure injury in intensive care. However, further research is needed to examine the effectiveness of the COMHON Index bundle before it can be recommended for widespread clinical practice.