title: Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care.
abstract: BACKGROUND
  The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established.
  
  
  OBJECTIVE
  To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers.
  
  
  METHODS
  Characteristics of 5346 patients in pediatric intensive care units in whom pressure ulcers did and did not develop were compared. Multiple logistic regression was used to determine which prevention strategies were associated with less frequent development of pressure ulcers.
  
  
  RESULTS
  The overall incidence of pressure ulcers was 10.2%. Patients at greatest risk were those who were more than 2 years old; who were in the intensive care unit 4 days or longer; or who required mechanical ventilation, noninvasive ventilation, or extracorporeal membrane oxygenation. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets.
  
  
  CONCLUSIONS
  The overall incidence of pressure ulcers among critically ill infants and children is greater than 10%. Nursing interventions play an important role in the prevention of pressure ulcers.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Children's Hospital and Health System, Milwaukee, 53201-1997, USA. cschindl@mcw.edu
authors.forename: Christine A
authors.initials: CA
authors.lastname: Schindler
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Mikhailov
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Kuhn
authors.forename: Jean
authors.initials: J
authors.lastname: Christopher
authors.forename: Pat
authors.initials: P
authors.lastname: Conway
authors.forename: Debra
authors.initials: D
authors.lastname: Ridling
authors.forename: Annette M
authors.initials: AM
authors.lastname: Scott
authors.forename: Vickie S
authors.initials: VS
authors.lastname: Simpson
mesh_terms: D002648:Child; D002675:Child, Preschool; D004509:Education, Nursing, Continuing; D017144:Focus Groups; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008485:Medical Audit; D024802:Nurse's Role; D009732:Nursing Care / Q000379:methods*; D003668:Pressure Ulcer / Q000453:epidemiology / Q000451:nursing / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology