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

Angel Cobos-Vargas; Paul Fulbrook; Josephine Lovegrove; María Acosta-Romero; Luís Camado-Sojo; Manuel Colmenero

doi:10.1016/j.aucc.2024.09.008

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

Aust Crit Care. 2024 Nov 7:101123. doi: 10.1016/j.aucc.2024.09.008. Online ahead of print.

Authors

Angel Cobos-Vargas¹, Paul Fulbrook², Josephine Lovegrove³, María Acosta-Romero⁴, Luís Camado-Sojo⁵, Manuel Colmenero⁶

Affiliations

¹ Critical Care Department, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain. Electronic address: angcobvar@gmail.com.
² School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland 4014, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia; School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa. Electronic address: paul.fulbrook@acu.edu.au.
³ Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland 4222, Australia; School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland 4006, Australia. Electronic address: j.lovegrove@griffith.edu.au.
⁴ Critical Care Department, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain. Electronic address: maria.acosta.sspa@juntadeandalucia.es.
⁵ Critical Care Department, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain. Electronic address: luis.camado.sspa@juntadeandalucia.es.
⁶ Critical Care Department, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain. Electronic address: manuel.colmonero.sspa@juntadeandalucia.es.

PMID: 39516150
DOI: 10.1016/j.aucc.2024.09.008

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.

Keywords: COMHON Index; Care bundle; Intensive care; Pressure injury; Preventative intervention; Risk assessment.