Authors (including presenting author) :
Cheng CL (1), Chan YY (1), Liu SKB (1), Yiu MC (1), Yeung KJ (1), Ng CP (1), Lee CH (1), Lo WPJ (1),Kwan YF (1)
Affiliation :
(1) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Introduction :
Pressure injuries (PI) significantly affect patients with limited mobility and critically often leading to prolonged ICU stays, increased morbidity, and mortality. Current risk assessments for PI, the Braden Scale, which can be subjective and overlook early signs of tissue damage. Critically ill patients often score low (<13) on the Braden Scale, but this scale does not specifically focus on high-risk body areas. Subepidermal moisture scanning (SEMS) offers objective measurement on the moisture level in the subepidermal skin layer with validated values limited to the sacrum and bilateral heels.
Objectives :
To compare the effectiveness of Sub-Epidermal Moisture (SEM), regular inspection, and conventional clinical judgment in early risk identification and reducing incidents of pressure injuries among critically ill patients
Methodology :
A prospective comparative observation was conducted among ICU patients at risk for PIs from April to August 2024. Newly admitted ICU patients (within 24 hours) unable to reposition independently were recruited, excluding those with existing PIs, undergoing resuscitation, with spinal injuries, or in prone positions. Participants were assessed by using SEM scanners, regular inspections (skin inspection, presence of incontinence, and vasoactive medication usage) and conventional clinical judgment in PYICU. Assessments were performed since admission and repeated daily until discharge or new PI developed. High-risk patients identified by SEM, inspections or clinical judgment received standardized preventive measures, including: (1) Increased frequency of repositioning; (2) Five-layer foam dressings to the sacrum; (3) Offloading heel boots; (4) Pressure-relieving overlays; (5) Incontinence care; and (6) Dietitian consultation.
Result & Outcome :
Results
Out of 77 samples, critically ill patients with various comorbidities were assessed. SEM values identified 39 high-risk patients, while conventional assessment identified 23. SEM identified 16 more patients (21% added predictive value for PI development). Ultimately, two patients developed PIs from non-invasive ventilation masks and scapula, both methods were able to identify the patients at risk. The ICU PI rate decreased from 7.02 to 6.84 per 1,000 bed days occupied, a 2.6% reduction (p=0.917).
Conclusion
SEM showed effectiveness in early risk identification. Regular inspections proved clinically significant in decreasing pressure injuries. Skin inspections are vital for effective prevention of pressure injuries. Further research is needed to explore PI preventive strategies across more body areas and over a longer study duration.
