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. 2022 Nov;19(7):1887-1900.
doi: 10.1111/iwj.13967. Epub 2022 Oct 17.

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study

Guido Ciprandi  1 , Serena Crucianelli  1 , Mario Zama  1 , Giancarlo Antonielli  2 , Riccarda Armani  3 , Stefano Aureli  4 , Gianmarco Barra  3 , Charlie Joseph Charles Beetham  5 , Giulio Bernardini  6 , Federica Cancani  5 , Andrea Carai  7 , Marta Cajozzo  1 , Laura Carlesi  8 , Alessandra Cialdella  6 , Italo Ciaralli  9 , Gaetano Ciliento  10 , Tiziana Corsetti  11 , Benedetta De Chirico  6 , Paolo Di Corato  1 , Andrea Dotta  12 , Sergio Filippelli  6 , Marina Franci  13 , Jacopo Frattaroli  1 , Francesca Grussu  1 , Silvia Lico  8 , Patrizia Losani  14 , Marjola Giergji  9 , Simonetta Magli  8 , Simone Faustino Marino  1 , Antonella Mongelli  11 , Martina Nazzarri  4 , Mauro Pace  13 , Giancarlo Palmieri  1 , Ilaria Pannacci  8 , Franca Paparozzi  9 , Manuel Pomponi  1 , Anna Portanova  14 , Alessandra Preziosi  13 , Angela Ragni  12 , Massimiliano Raponi  10 , Tommaso Renzetti  7 , Mirialda Rizzo  1 , Marco Roberti  6 , Eleonora Sasso  14 , Immacolata Savarese  12 , Simone Secci  3 , Daniele Selvaggio  6 , Laura Serafini  3 , Giorgio Spuntarelli  1 , Urbano Urbani  1 , Valentina Vanzi  15 , Roshani Permatunga  16 , Nick Santamaria  16
Affiliations

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study

Guido Ciprandi et al. Int Wound J. 2022 Nov.

Abstract

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy.

Keywords: double protection strategy (DPS); paediatric pressure ulcers; prevention; prophylactic dressings.

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Conflict of interest statement

The authors declare no potential conflict of interest.

Figures

DIAGRAM 1
DIAGRAM 1
DPS study flow chart
FIGURE 1
FIGURE 1
Wound prevention team (WPT) meeting
FIGURE 2
FIGURE 2
DPS interventions on different paediatric patients
FIGURE 3
FIGURE 3
DPS intervention in a neurosurgical patient
See this image and copyright information in PMC

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