Pressure Injuries

Editor's Note: How can clinicians help support caregivers who look after family members with pressure injuries? In this interview, Kelly McFee, DNP, FNP-C, CWS, CWCN-AP, FACCWS, DAPWCA discusses how to educate caregivers on pressure injury prevention and what resources exist for caregivers for further insight.

Pressure injuries are injuries to the skin and deeper tissues that occur due to direct pressure, shear, or friction forces. It is estimated that in the United States, 2.5 million pressure injuries occur yearly in acute care facilities alone. The price of managing a single full-thickness pressure injury is as much as $70,000, and expenditures in the United States for pressure injury treatment have been estimated at $11 billion per year.

By the WoundSource Editors

Moist wound healing is the current cost-effective, evidence-based modality to achieve faster wound healing rates and decreased pain and infection. As part of the wound healing process, acute wounds produce reparative exudates consisting of growth factors to support extracellular matrix production; in contrast, chronic wounds contain inflammatory-producing exudates studded with cytokines and proteases that may help maintain the inflammatory phase but can exert destructive effects on the fragile wound bed and may extend to the periwound surface.

By Heidi Cross, MSN, RN, FNP-BC, CWON

As detailed in my last few blogs, nutrition plays a huge role in risk for skin breakdown as well as healing of wounds. Just about ALL wound litigation involves nutrition in one way or another, be it diabetes control (or lack thereof) or weight loss, which occurs often in patients with dementia and toward end of life, or general malnutrition.

Erythema: A result of injury or irritation that causes dilation of blood capillaries and manifests as patchy reddening of the skin. Occurs after a patient/resident is exposed to unrelieved pressure for 2 hours. It can be identified as a deep, localized redness; can also be blue or purple.

Hyperemia: The condition of having excess blood in vessels that supply an organ or area of the body. Occurs after patient/resident is exposed to 30 minutes of unrelieved pressure. It can be identified as a localized, non-blanchable redness.

Perfusion: The passage of blood through arteries and capillaries into tissues or organs. When insufficient, there is an increased chance that the patient may have complications.

Here’s a question for you: How long does it take for a pressure injury (PI) to form? Do you think it happens in 30 minutes? 2 hours? 8 hours? The answer is actually all of the above. The time it takes for a PI to develop depends on a number of different factors, which we will discuss here.

Do you remember that cartoon from the 1960s (and later reproduced in the 1980s), The Jetsons? It was about a futuristic family that had all kinds of amazing robot helpers and automatic appliances. Rosie the Robot was the wonderbot that would whisk about the house, frantically preforming housekeeping duties, monitoring the security of the home, and generally making sure that everything was online and functioning. Do you ever feel like this as a clinician?

In the last 2 years, hospitals and skilled nursing facilities have seen unprecedented surges in admissions attributed to the COVID-19 pandemic sweeping across the world. Just in the United States, we saw a high of 116,243 weekly hospital admissions in mid-January of 2021. This dropped to a low of 13, 424 in mid-June of 2021 and then bumped up again to 86,871 in August of 2021.¹ With this fluctuation of numbers, along with staffing shortages and burnout, wound care professionals have seen significant overcrowding in many hospitals and facilities.

A nurse recently shared some of her experiences as a charge nurse in a skilled facility during the COVID-19 pandemic. She worked evenings (3-11:30 pm) at a local facility and was overwhelmed by the high number of patients she was responsible for. She typically worked on a 26-bed floor with just one nurse assistant for the shift. She later transferred to the night shift, where she was the only person on a 16-bed unit for the 8 hours. When asked how she was able to reposition patients as frequently as was recommended, the nurse said that she did “the best I could.” She is, unfortunately, not alone.

Join Dr. Caroline Fife at WoundCon Fall 2021 for her talk on the angisome concept and how it applies to pressure injury development.