Research Alert

IU Health study finds some hospital-acquired pressure injuries are unavoidable

New research suggests the underlying issue behind unavoidable hospital-acquired pressure injuries may be acute skin failure, not lack of preventive nursing care


Newswise — Despite a vast array of prevention strategies, hospital-acquired pressure injuries (HAPI) continue to occur, especially in critical care. Using a descriptive retrospective design, researchers at Indiana University Health found 41% of HAPIs were unavoidable and developed in spite of consistent documentation of evidence-based preventive interventions.

Among the findings, patients who had longer lengths of stay before pressure injury development or a history of pressure injury were more likely to have an unavoidable HAPI. Specifically, for every additional day before pressure injury iden­tification, there was a 4% increase in the likelihood of having an unavoidable HAPI, and participants with a history of pressure injury were five times more likely to have an unavoidable HAPI.

  • Until recently, research on unavoidable HAPIs has been limited because of the lack of valid and reliable tools for measuring and evaluating the pro­vision of appropriate preventive interventions. The Pressure Ulcer Prevention Inventory (PUPI), which was developed at IU Health, provided an objective measure to identify unavoidable HAPIs. No other similar studies using such a tool were found in the literature.
  • This study is unique in being the first of its kind with the aim of objectively quantify­ing pressure injury prevention interventions in use before pressure injury development.
  • Another interesting finding of the present study was the high proportion (36%) of medical device-related HAPIs. This finding is most likely due to the nature of the study population and the large number of devices used in critical care areas.

A total of 165 adult critical and progressive care patients in six IU Health hospitals were included in this study. The researchers also identified risk factors that differentiate avoidable from unavoidable HAPIs. The findings suggest a possible etiology of acute skin failure rather than a lack of preventive nursing care.

"Hospital-Acquired Pressure Injuries in Critical and Progressive Care: Avoidable Versus Unavoidable" is published in American Journal of Critical Care.

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