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Pressure Injuries in the OR: Minimize the Risk – Maximize Patient Safety

Clinical team in OR.

Awareness around perioperative pressure injuries (PIs) and the identification of perioperative extrinsic factors is surging within the surgical and medical device community. As a result, more initiatives for better policies and safety strategies to improve patient safety and quality of care are being researched and recommended throughout the healthcare industry.

Unfortunately, pressure injuries (PIs) negatively impact patients with results ranging from infection to extended hospital stays, which can contribute to emotional suffering.1,2 What’s more, the negative impact of PI does not end with the patient. Hospital systems often become responsible for costly non-reimbursable services related to the PI treatment, costing between $14,000 and $40,000 per patient. The average estimated cost of treatment is $750 million to $1.5 billion per year.3

Research suggests that surgery-related pressure injuries may account for as much as 45% of all Hospital- Acquired Pressure Injuries (HAPIs) and the highest incidence reported is 54.8%1. With the average length of surgery lasting at least three hours, the likelihood of a PI forming also increases by 8.5%.3

So why are surgery-related PIs so common? The Perioperative/Procedural (PP) patient has unique extrinsic risk factors that can play a direct role in forming a pressure/skin injury. These factors include:4

  • Type of anesthesia
  • Room temperature
  • Patient’s position on the operating table
  • Table surface
  • Devices used
  • Shear
  • Moisture
  • Length of surgery   

Luckily, improving the table surface pad your patient is laying on is a simple strategy that has been shown to decrease pressure injuries. In fact, research indicates that “Patients were eight times more likely to develop a pressure injury when positioned on the foam surface compared with the multi-layer pressure-redistributing surface.”5

Fortunately, Hillrom offers perioperative table pads that meet criteria established by the Association of periOperative Registered Nurses (AORN) outlined in the Guidelines6 for Positioning the Patient. These guidelines have been adopted by the National Pressure Ulcer Advisory Panel, the European Pressure Ulcer Advisory Panel and the Pan Pacific Pressure Injury Alliance’s recommendations.7

  • Indentation Force Deflection: Actual 28.8 lbs./50 in2
  • Nominal Density: Actual 5.8 lbs/ft3
  • Pad thickness (3.5”) exceeds standard pads (multi-layered pad)

Hillrom’s viscous elastic pad design improves the ability to maintain the patient’s position via its enveloping properties. In addition:

  • The pad provides pressure redistribution and cradles the bony prominence, which can cause inter-operative pressure injury if not protected.
  • The 3.5" thick balanced pad goes above and beyond the standard 2" OR table pad, decreasing the potential “bottom out” effect that occurs with the thinner pad.
  • The table pad strategically protects the occiput with the standard integrated head cradle.

In short, to reduce the risk of perioperative pressure injuries in the OR, hospitals need to implement risk management strategies and evidence-based interventions which will empower clinicians with the tools they need to improve patient outcomes. Hillrom Surgical Solutions table pads can help. Contact us today.

Author photo of Heather D Kooiker

By Heather D. Kooiker, Senior Clinical Liaison, Hillrom

Heather D. Kooiker, MSN, RN, CNL, CNOR, CRNFA is a mastered prepared, board certified Clinical Nurse Leader (CNL) who holds a Certified Perioperative Nurse (CNOR) certificate along with a Certification as an RN First Assistant (CRNFA). 

Heather has worked as a clinical consultant for Hillrom for three years and has recently joined Hillrom full time within the Global Surgical Solutions Clinical Insights Team as the Senior Clinical Liaison. Heather maintains her clinical practice within her specialty field of perioperative nursing by working one day a month as a CRNFA for an ambulatory plastic surgery center.

The foundation of Heather's knowledge has been built through her 26 years of surgical services work. Heather is the current president of her local AORN chapter and is active with the ANA mentoring program and the CCI CNOR coaching program. Most recently she has joined the Board of Directors for the National Assistant at Surgery Certification (NASC).


Connect with Heather: 

Heather.Kooiker@hillrom.com 

References
  1. AORN Position Statement on Perioperative Pressure Ulcer Prevention in the Care of the Surgical Patient, 2019 AORN.
  2. Comparison of Interface Pressures and Subjective Comfort of Pressure-Relieving Overlays on the Operating Table for Healthy Volunteers. (2021). International Journal of Environmental Research and Public Health, 18(5), 2640.
  3. Engels, D., Austin, M., McNichol, L., Fencl, J., Gupta, S., & Kazi, H. (2016). Pressure Ulcers: Factors Contributing to Their Development in the OR. Association of Operating Room Nurses. AORN Journal, 103(3), 271-281.
  4. Strasser, L. (2012) Improving Skin Integrity in the Perioperative Environment Using an Evidence-Based Protocol. Journal of the Dermatology Nurses’ Association 4 (6): 351-359.
  5. Scott SM. Perioperative Pressure Injuries: Protocols and Evidence‐Based Programs for Reducing Risk. Patient Safety & Quality Healthcare. 2016;13(4):21‐28. https://www.psqh.com.
  6. AORN Guidelines for Perioperative Practice. 2012-2018. 
  7. The National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. East Washington, DC: National Pressure Ulcer Advisory Panel; 2014. [IVA]