3070 — Perioperative Pressure Ulcer Assessment and Prevention: Efficacy Study of a Multi-Layer Pressure Relief Pad in the Operating Room (OR)

Lummus AC (University of Tennessee Health Science Center)

Objectives:
Perioperative pressure ulcer (PPrU) development has become a significant risk of surgery. A 1998 study of 1,128 surgical patients, revealed the incidence of nosocomial PrU related to the operating room (OR) was 23%. The purpose of this study was to compare the safety and efficacy of the experimental OR table pad with the facility’s standard OR table pad. In addition, this study reported correlations between patient risk and incidence of PrU development during select surgical procedures.

Methods:
The study design was a single center, prospective matched control two-group comparison study. A convenience sample of 323 high-risk patients was assigned to one of two groups. The control group (n=176) was placed on a standard OR table pad, while the study group (n=147) was placed on a unique multilayer pressure redistribution surface. Study selection criteria included age, procedure length, and absence of pressure ulcers. Patient age, serum albumin, and American Society of Anesthesiologist (ASA) physical status scores did not vary significantly between groups. Prior to surgery and for three days post-op a member of the research team performed skin assessments observing for signs of pressure damage.

Results:
Statistically significant factors included age, serum albumin, ethnicity, ASA scores, and presence of pulmonary disease, Braden Scale scores, and the experimental pad. The multi-layer pressure redistribution surface was statistically significant (P < 0.001) in reducing PrU incidence when compared with the "Standard" OR table pad. The Braden score was statistically significant for NOT predicting pressure ulcers in this population. Other variables that were not significant included: co-morbid conditions, type of surgery, and intra-operative variables such as time on the table, hypothermia, and hypotension.

Implications:
Development of healthcare associated PrU's is a patient safety issue. This data indicates that multi-layer pressure redistribution pads are more effective than standard OR pad in reducing incidence of pressure injuries. Secondary analysis confirmed that age, serum albumin and ASA scores as a group were the factors most significantly associated with PrU development risk.

Impacts:
The Scott Triggers (Age, Albumin and ASA scores) though not validated as a PrU risk assessment tool is the first evidence-based triggers that may identify high risk surgical patients.