Title : Prevalence of pressure injuries over twenty years in a Western Australian hospital and evaluation of an intervention to reduce pressure injury prevalence
Background: Pressure injuries (PIs) impinge on patients’ emotional, mental, social and physical wellbeing and financially burden the Australian healthcare system. National and international evidence suggests that prevalence of hospital-acquired PIs (HAPIs) has decreased over time, but few studies provide a long-term (>20 years) picture.
Methods: Between 1997 and 2018, patients at a major Western Australian tertiary hospital completed a validated risk assessment tool to determine their risk of developing PIs. Patients’ demographic and treatment data were also collected, including age, sex, length of stay at time of audit, risk assessment score, mattress type and the site of their PI. Twenty years of data were combined to form a larger patient sample. Multivariate logistic regression analyses were undertaken to investigate the association between PIs and patients’ demographic and treatment data, and model change in prevalence over time.
An intervention to reduce the prevalence of PIs and hospital-acquired PIs (HAPIs) was designed and implemented. This involved updating the hospital’s existing PI prevention management plan and educating ward-based nursing personnel in its use over a 5-week period. Prevalence of PIs served as a baseline measure prior to the implementation of the intervention. PI prevalence was measured for a random sample of 392 consenting patients, over two eight-week periods post-intervention. Statistical process control (SPC) charts plotting PI prevalence over time were constructed to assess the short-term effectiveness of the intervention.
Results: Over the 21-year period, data from a total of 6,837 patients was analysed. Results indicated that 921 (13.5%) patients had at least one Stage 1 or above pressure injury, of which, 685 (10.0%) were hospital-acquired. There were 460 (6.7%) patients with at least one Stage 2 or above pressure injury, of which, 315 (4.6%) were hospital-acquired. Factors that were positively associate with a hospital-acquired pressure injury (HAPI) included older age, a lower Braden score, mattress type, and increased length of hospital stay at the time of audit. Relative to the start of data collection in 1997, pressure injury prevalence fell significantly over time (19.3% to 12.1%). However, following the initial significant decline observed towards the start of the millennium, no further significant reduction in pressure injury prevalence has been achieved.
Mean PI and HAPI prevalence over the historical 20-year period was 13.5% and 10.0% respectively. Mean PI and HAPI prevalence post-intervention was 8.4% and 2.0% respectively.
Conclusion: Pressure injury prevalence rates have plateaued over the past 21 years. A hospital-based intervention was implemented to reduce the burden of PIs. Short-term results suggest the intervention is tracking to significantly reduce the prevalence of PIs in this hospital setting, with prevalence of HAPIs already significantly lower than historical measures.