title: Exploring the effects of wound dressings and patient positioning on skin integrity in a pediatric burn facility.
abstract: Although literature on the subject is scant, in practice, pressure ulcers in the pediatric burn population remain a challenge. An interdisciplinary team at an urban pediatric burn institution treats a population (average age 8 years, range 1 month to 21 years) that includes children too young or unable to articulate pressure-related pain from dressings or positioning techniques. After pressure ulcer data collection procedures were instituted, it was observed that elastic bandages, wet operating room dressings, and positioning appeared to contribute to pressure ulcer occurrence. To better understand the patient's experience and educate staff, an informal study was conducted by an interdisciplinary committee of clinicians to assess the amount of pressure in mm Hg created on bony prominences by care procedures. Three staff members volunteered and were placed in elastic dressings and various commonly used positions for several minutes and three pressure measurements were obtained. Pressure readings of 40 and 56 mm Hg were common, causing pain and placing a person at risk for skin ulceration. The information was used to educate staff on how to maintain therapeutic efficacy without compromising skin integrity and causing pain. Lectures and hands-on demonstrations elucidated correct dressing application. The committee continues to provide education to all staff members on methods to prevent pressure ulcers from occurring in the high-risk burn patient population and ways to reduce the use of elastic wraps and improve patient positioning.
authors.affiliation: Shriners Hospital for Children, Cincinnati, Ohio, USA. ahardy@shrinenet.org
authors.forename: Angela
authors.initials: A
authors.lastname: Hardy
authors.forename: Debbie
authors.initials: D
authors.lastname: Harrell
authors.forename: Kim
authors.initials: K
authors.lastname: Tran
authors.forename: Suzanne
authors.initials: S
authors.lastname: Smith
authors.forename: Teri
authors.initials: T
authors.lastname: Mattingly
authors.forename: Betty
authors.initials: B
authors.lastname: Zins
authors.forename: Kathy
authors.initials: K
authors.lastname: Zaeske
authors.forename: Juli
authors.initials: J
authors.lastname: Thomas
authors.forename: Patti
authors.initials: P
authors.lastname: Sharp
authors.forename: Lisa
authors.initials: L
authors.lastname: Annan
mesh_terms: D001458:Bandages; D001510:Bed Rest / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D002053:Burn Units; D002056:Burns / Q000150:complications* / Q000451:nursing; D002648:Child; D015400:Clinical Nursing Research; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D003422:Critical Care / Q000379:methods; D004509:Education, Nursing, Continuing; D006801:Humans; D015994:Incidence; D009730:Nursing Assessment; D009741:Nursing Staff, Hospital / Q000193:education; D009820:Ohio / Q000453:epidemiology; D010348:Patient Care Team / Q000458:organization & administration; D010371:Pediatric Nursing / Q000193:education / Q000379:methods; D011187:Posture; D011312:Pressure; D003668:Pressure Ulcer / Q000145:classification / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D017592:Skin Care / Q000009:adverse effects* / Q000379:methods / Q000451:nursing; D014945:Wound Healing