Initiative prevents tracheostomy-related pressure injuries (0% hospital injuries over four years using foam dressing at insertion point)

Medical Xpress / American Association of Critical-Care Nurses (AACN) / AACN Advanced Critical Care ^ | Feb. 13, 2023 | Hazel Holder et al

[ConservativeMind]

A New York hospital was able to reduce the incidence of medical device-related pressure injuries (MDRPIs) following a tracheostomy to zero for four years, according to a study.

NewYork-Presbyterian achieved the results in its intensive care unit (ICU), in part by integrating MDRPI prevention into the bedside procedure for tracheostomies that used the percutaneous dilation technique (PDT).

A key part of the new clinical process was a revised PDT tracheostomy procedural kit and documentation, with a polyurethane foam dressing placed under the tracheostomy flange during insertion and both secured with sutures and a flexible holder. The foam dressing remained in place for seven days, with primary care nurses assessing the site at least every 12 hours. The dressing was then changed to a standard nonwoven gauze drain sponge after seven to 10 days as clinically indicated.

The results showed that suturing a foam dressing as part of PDT tracheostomy insertion can reduce the incidence of associated MDRPIs.

"When COVID-19 increased demand for health care equipment, we were able to refine our processes, transition to a revised PDT tracheostomy kit and maintain the integrity of the initiative," Holder said.

Prior to the initiative, in 2018, the incidence of healthcare-associated pressure injuries (HAPIs) was 1.39% for all ICU patients, with tracheostomy MDRPIs accounting for 0.19% of the incidents (15 HAPIs, including two MDRPIs in 1,077 patients). However, of the two PDT tracheostomies performed, both patients experienced MDRPIs.

In 2019, the overall HAPI incidence decreased to 1.30%, with nine tracheostomies and no MDRPIs. The tracheostomy MDRPI incidence remained at zero for the next three years.

During the four years of this project, a total of 22 PDT tracheostomies were performed in the ICU, with the foam dressing placed at the point of insertion in all procedures.

[ConservativeMind]

Some simple, inexpensive changes led to a wonderful set of patient experiences from a bad situation.

[ConservativeMind]

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[House Atreides]

Very interesting. Sometimes small things can pay big dividends.

[heartwood]

They seem to be talking about pressure injury to the skin rather than to the lungs.