Perioperative pressure ulcer assessment and prevention efficacy study of a multi-layered pad for the operating room (OR)

Susan Scott-Williams, MSN, RN, CWOCN, Allan C. Lummas, PhD, Veteran Affair Medical Center, Memphis, TN

BACKGROUND:

Perioperative pressure ulcer (PrU) development has become a significant risk of surgery, but few studies have compared efficacy of various operating room (OR) pads for prevention. The purpose of this study was to determine the efficacy and safety of the experimental surface, in comparison with the standard of care for the prevention of perioperative PrU.

METHODS:

The study design was a single center, prospective matched control 2-group comparison study. Three hundred twenty three high-risk patients were separated into two groups. Groups were compared postoperatively for the outcome variable presence of a PrU. The control group (n=176) went through surgery on a standard OR table pad while the study group (n=147) utilized a multilayer pressure reduction surface (experimental). Selection criteria included age, procedure length, and absence of PrUs. There was no difference between the two groups according to their key risk factors of age, albumin, and American Society of Anesthesiologist (ASA) physical status scores. Baseline and follow-up visits included skin assessment noting any PrU Incidence, stage, Braden scale scores, and support surface.

RESULTS:

Statistically significant variables include age, albumin, race, ASAscores, and the study pad. The Braden scale was significant for NOTpredicting PrUs in this study. The experimental surface was effective (P< 0.000) in reducing the incidence of PrU compared with the standard pad. This study found that patients placed on a standard OR pad were 8 times more likely to develop a perioperative PrU than those on a multilayered pressure reduction pad. Age, albumin levels, and ASAscores combined were predictive of PrU. Further research is needed to develop and validate a risk assessment tool for the OR, and determine efficacy of other products on the market. Evidence-based best practices are necessary when developing a program to reduce healthcare acquired PrU.

References

Aronovitch SA. Intraoperatively acquired pressure ulcer prevalence: a national study. JWOCN. 1999;26(3):130–136.

Standards, recommended practices, and guidelines. Denver, CO: Association of peri-operative Registered Nurses (AORN), 2005.

Armstrong D, Bortz P, Jordan-Halter M. An integrative review of pressure relief in surgical patients. AORN. 2001;73(3):645–674.

Beckrich K, Aronovitch S. (1999) Hospital-acquired pressure ulcers: a comparison of costs in medical vs. surgical patients. Nurs Economics. 1999;17(5). Braden B, Bergstrom N. Aconceptual schema for the study of the etiology of pressure sores. Rehabil Nurs. 1987;12:8–12.

Schultz A. Home study program predicting and preventing pressure ulcers in surgical patients. AORN. 2005;81(5):986–1012.

Scott-Williams S, Lummas A. Assessment of pressure ulcers in surgical patients: pressure management study comparing standard table pads to a multi-layer pressure relief pad in the Operating Room. Unpublished data.

Guideline for prevention and management of pressure ulcers. Glenview, IL: Wound, Ostomy, Continence Nurses Society, 2003.

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