title: Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison.
abstract: BACKGROUND
  Hospital-acquired pressure injury is associated with increased morbidity and mortality and considered to be largely preventable. Pressure injury prevalence is regarded as a marker of health care quality.
  
  
  OBJECTIVE
  To compare the state-wide prevalence, severity and location of pressure injuries of intensive care unit patients compared to patients in non-intensive care wards.
  
  
  METHODS
  The study employed a secondary data analysis design to extract and analyse de-identified pressure injury data from all Queensland Health hospitals with level I-III intensive care facilities that participated in Queensland Bedside Audits between 2012-2014. The sample included all adult ICU and non-ICU patients that provided consent for the Queensland Bedside Audits, excluding those in mental health units.
  
  
  RESULTS
  Excluding Stage I, overall hospital-acquired pressure injury prevalence from 2012 to 2014 was 11% for intensive care patients and 3% for non-intensive care patients. Intensive care patients were 3.8 times more likely (RR 2.7-5.4, 95% CI) than non-intensive care patients to develop a pressure injury whilst in hospital. The sacrum/coccyx was the most common site of hospital-acquired pressure injury in all patients (intensive care patients 22%; non-intensive care patients 35%) however, mucosal pressure injury proportion was significantly higher in intensive care patients (22%) than in non-intensive care patients (2%). Stage II HAPI prevalence was the most common stage reported, 53% for intensive care patients compared to 63% for non-intensive care patients.
  
  
  CONCLUSIONS
  There are significant differences in hospital-acquired pressure injury prevalence by stage and location between intensive care and non-intensive care patients reflecting the possible impact of critical illness on the development of skin injury. This has implications for resource funding for pressure injury prevention and the imposition of government initiated financial penalties for hospital-acquired pressure injury. For future comparisons to be effective between intensive care units, benchmarking partners should share similar characteristics and relevant targets.
authors.affiliation: School of Nursing, Queensland University of Technology, QLD Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Metro North Health Service District, QLD Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK. Electronic address: f.coyer@qut.edu.au.
authors.forename: Fiona
authors.initials: F
authors.lastname: Coyer
authors.affiliation: Nursing and Research Practice Development Centre, The Prince Charles Hospital, Metro North Health Service District, QLD Australia; School of Nursing, Midwifery and Paramedicine (Brisbane), Australian Catholic University, QLD Australia. Electronic address: sandra.miles@acu.edu.au.
authors.forename: Sandra
authors.initials: S
authors.lastname: Miles
authors.affiliation: RBWH Safety and Quality Unit, Royal Brisbane and Women's Hospital, QLD Australia. Electronic address: Sandra.Gosley@health.qld.gov.au.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gosley
authors.affiliation: Nursing and Research Practice Development Centre, The Prince Charles Hospital, Metro North Health Service District, QLD Australia; School of Nursing, Midwifery and Paramedicine (Brisbane), Australian Catholic University, QLD Australia; School of Health Sciences, University of Tasmania, Australia. Electronic address: paul.fulbrook@acu.edu.au.
authors.forename: Paul
authors.initials: P
authors.lastname: Fulbrook
authors.affiliation: Patient Safety and Quality Improvement Service, Clinical Excellence Division, Queensland Health, Herston, QLD Australia. Electronic address: Kirstine.Sketcher-Baker@health.qld.gov.au.
authors.forename: Kirstine
authors.initials: K
authors.lastname: Sketcher-Baker
authors.affiliation: School of Nursing, Queensland University of Technology, QLD Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, QLD Australia. Electronic address: janelouise.cook@qut.edu.au.
authors.forename: Jane-Louise
authors.initials: JL
authors.lastname: Cook
authors.affiliation: Patient Safety and Quality Improvement Service, Clinical Excellence Division, Queensland Health, Herston, QLD Australia. Electronic address: Jacqueline.Whitmore@health.qld.gov.au.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Whitmore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000145:classification / Q000453:epidemiology*; D015995:Prevalence; D011787:Quality of Health Care; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors
keywords: Benchmarking; Critically ill patient; Intensive care; Pressure injury; Pressure ulcer; Prevalence