Incidence of Hospital-Acquired Pressure Injury among Adult Inpatients at Kakamega County General Hospital, Kenya
Abstract
A hospital-acquired pressure injury is a largely preventable adverse health event, which has remained high volume and high cost globally hence a significant concern in healthcare. This study used a prospective cohort model between April and July 2021 to determine the incidence of these injuries among adults at the Kakamega County General Hospital in Kenya, thus informing the need for scaled-up intervention strategies to eliminate these preventable harms on patients receiving care in line with international patients’ safety goal. Eighty participants above 18 years of age, systematically drawn from the male and female medical, surgical, and orthopaedic hospitalisation units, were followed up through their hospital stay for the development of pressure injury. Sociodemographic characteristics, units of hospitalisation, diagnosis and clinical variables were studied and outcomes were recorded, coded, and analysed on the statistical package for social sciences version 26. This study found an overall incidence rate of 15%, with men at 17.5% against women at 12.5%. The most affected site was the sacrum region accounting for 35.7% of all cases, with a mean day of occurrence at 5.58 days post-hospitalisation. This high incidence signifies pressure injury as a threat to healthcare quality, equity, and cost in Kakamega and Kenya. The Ministry of Heath should therefore adopt, customise, and implement the international guidelines on pressure injury to curb this menace. A multidisciplinary approach should be used, prioritising patients at increased risk and providing suitable prevention and treatment from the earliest opportunity
Downloads
References
Ahmad, T., Panos, P., Denis, A., & Laila, H. (2018, July). Pressure Ulcers Prevalence in the Acute Care Settings: A System Review, 2000-2015. Journal of Clinical Nursing Research, 27(6), 643-659.
Al Mutairi, K., & Hendrie, D. (2018). Global Incidence and Prevalence of Pressure Injuries in Public Hospitals: A systematic review. Wound Med, 22-31.
Al, A. M., & Manna, B. (2019). Wound Pressure Injury Management. Treasure Island: StatPearls Publishing.
Anderson, E. S., & Karlsmark, T. (2008). Evaluation of Four Non-Invasive Methods for Examination and Characterization of Pressure Ulcers. Journal of Skin Research and Technology, 14(3), 270-276.
Archana Singh-Manoux, P., Alice Guéguen, P., Jane Ferrie, P., Martin Shipley, M., Pekka Martikainen, P., Sébastien Bonenfant, M., . . . Michael Marmot, F. (2008). Gender Differences in the Association Between Morbidity and Mortality Among Middle-Aged Men and Women. American Journal of Public Health, 98(12): 2251–2257.
Bennett, G., Dealy, C., & Posnett, J. (2004). The Cost of Pressure Ulcers in the UK. Journal of Age and Ageing, 33(3), 230-235.
Bergstrom, N. (., Braden, B., Champagne, M., Kemp, M., & Ruby, E. (1998). Predicting Pressure Ulcer Risk: A Multisite Study of the Predictive Validity of the Braden Scale. Journal of Nursing Research, 47(5), 261-269.
Bergstrom, N., & Braden, B. (1987). The Braden Scale for Predicting Pressure Sore Risk. Journal of Nursing Research, 36(4), 205-210.
Black, J. M., Cuddigan, J. E., Walko, M. A., Didier, L. A., Lander, M. J., & Kelpe, M. R. (2010). Medical Device Related Pressure Ulcers in Hospitalised Patients. International Wound Journal, 311-350.
Borsting, T., Tvedt, C., Skogestad, I., Granheim, T., Gay, C., & Lerdal, A. (2018). Prevelance of Pressure Ulcer and Associated Risk Factorsin Midle- and Old-aged Medical Inpatients in Norway. Journal of Clinical Nursing, 27(3-4), 530-540.
Braden, B., & Ayello, E. (2002). How and why to do Pressure Ulcer Risk Assessment. Adv Skin Wound Care, 129-137.
Brem, H., Maggi, J., Nierman, D., Rolnitzky, L., Bell, D., Rennert, R., . . . Vladeck, B. (2010). High Cost of Stage IV Pressure Ulcers. The America Journal of Surgery, 200(4), 473-477.
Brienza, D., Antokal, S., Herbe, L., Logan, S., Maguire, J., Van Ranst, J., & Siddiqui, A. (2015). Friction Induced Skin Injuries - are they pressure ulcers? An updated NPUAP white paper. Journal of Wound Ostomy and Continence Nursing, 42(1), 62-64.
Bryant, R. A., & Nix, D. P. (2012). Acute and Chronic Wounds: Current Management Concepts. St Louis: Elsevier.
Catherine, M., Amlung, S., & VanGilder. (2009). Results of the 2008–2009 International Pressure Ulcer Prevalence™ Survey and a 3-year, acute care, unit-specific analysis. Journal of Ostomy and Wound Management.
Chan, W., Pang, S., & Kwong, E. (2009). Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting. Journal of Clinical Nursing, 18(11), 1560-1570.
Chou, R., Dana, T., Bougatsos, C., Blazina, I., Starmer, A., Reitel, K., & Buckley, D. (2013). Pressure Ulcer Risk Assesment and Prevention: Comparative Effectiveness. In Database of Abstracts of Review of Effects (DARE): Quality. London: Centre for Review and Dissemination (UK).
Coleman, S., Gorecki, C., Nelson, E., Closs, S., Defloor, T., & Halfens, R. (2013). Patient Risk Factors for Pessure Ulcer Development: System Review. International Journal of Nursing Studies, 50(7), 970-1000.
Coleman, S., Nixon, J., Keen, J., Wilson, L., McGinnis, E., Dealey, C., . . . others. (2014). A New Pressure Ulcer Conseptual Framework. Journal of Advanced Nursing, 70(10), 2222-2234.
Cox, J. (2012). Predictive Power of The Braden Scale for Pressure Sore Risk in Adult Critical Care Patients: A Comprehensive Review. Journal of Wound Ostomy and Continence Nursing, 39(6), 613-621.
Cutting, K., & White, R. (2002). Maceration of the Skin 1: The Nature and Causes of Skin Maceration. Journal of Wound Care, 11(7), 275-278.
De Souza, D., Santos, V., Iri, H., & Sadasue, O. M. (2010). Predictive validity of the Braden Scale for pressure ulcer risk in elderly residents of long-term care facilities. Geriatric Nursing, 31(2), 93-105.
Delmore, B., Lebovits, S., Baldock, P., Suggs, B., & Ayello, E. A. (2011). Pressure ulcer prevention program. Journal of Wound Ostomy & Continence Nursing, 38(5), 505-513.
Department of Health and Human Services. (2008). Changes to the Hospital Inpatient Prospective Payments Systems and Fiscal Year 2009 Rates. Washington DC: Federal Register.
Dinkie, T. B., Mohammed, H. S., & Abebaw, E. A. (2018). Prevalence and Risk Factors of Pressure Ulcer in Hospitalised Adult Patients: A Single Centre Study from Ethiopia. Journal of BMC Research Notes, 11(1), 847.
Doughty, D., Junkin, J., Kurz, P., Selekof, J., Gray, M., Fader, M., . . . Logan, S. (2012). Incontinence Associated Dermatitis: Concensus Statements, Evidence Based Guidelines for Prevention and Treatment, and Current Challenges. Journal of Wound Ostomy and Continence Nursing, 39(4), 303-315.
Drake, D., Swanson, M., Baker, G., & al., e. (2010). The Association of BMI and Braden total score on the occurence of pressure ulcers. Journal of Wound Ostomy Continence Nursing, 37(4), 368-370.
Edsberg, L. E. (2007). Pressure Ulcer Tissue Histology: An Appraisal of Current Knowledge. Journal of Ostomy and Wound Management, 43-49.
Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. Journal of Wound Ostomy and Continence Nursing, 43(6), 585-597.
Edwine, B., Peter, N., & Di, M. (2019). Towards Universal Health Coverage in Kenya: Are We on the Right Path. Nairobi, Kenya: Health Economics Research Unit, KEMRI Welcome Trust Research Program.
EPUAP, NPIAP, & PPPIA. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. (N. P. European Pressure Ulcer Advisory Panel, Ed.) Emily Haesler (Ed.).
Gorecki, J., Brown, A., Nelson, M., Briggs, L., & Schoonhoven, C. (2009). Impact of Pressure Ulcers on the Quality of Life in Older Patients: Asystematic Review. Journal of American Geriatrics Society, 57(7), 1175-1183.
Graves, N., Birrell, F., & Whitby, M. (2005). Effect of Pressure Ulcers on the Length of Hospital Stay. Journal of Infection Control and Hospital Epidemiology, 26(3), 293-297.
Gray, M., Ratliff, C., & Donovan, A. (2002). Perenial Skin Care for Incontinent Patient. Journal of Advances in Skin and Wound Care, 15(4), 170-175.
Gyeong, H. K., Jin, Y. L., Jayeun, K., Hyun, J. K., & Ji-Ung, P. (2019, March). Prevalence of Pressure Injuries Nationwide from 2009 to 2015: Results from the National Inpatient Sample Database in Korea. International Journal of Environmental Research and Public Health, 16(5), 704.
Harvey, L. (2017). Pressure ulcers: A scourge for all but particularly for those living in low and middle income countries. Spinal Cord, 435-650.
Huang, T.-T., Tseng, C.-E., Lee, T.-M., Yeh, J.-Y., & Lai, Y.-Y. (2009). Preventing Pressure Sores of the Nasal ala after Nasotracheal Tube Intubation. Journal of Oral and Maxillofacial Surgery, 67(3), 543-551.
Iranmanesh, S., Rafiei, H., & Sabzevari, S. (2012). Relationship between Braden Scale Score and Pressure Ulcer Development in Patients Admitted in Trauma Intensive Care Unit. International Wound Journal, 9(3), 248-252.
Jan Noel, M., & Emmanuel, E. (2011). Pressure Ulcer Incidence and Risk Factors Among Hospitalised Orthopedic Patients: Results of a Prospective Cohort Study. Osteomy Wound Management, 57(10), 60-70.
Jane, M. N., Priscillah, N. K., & James, O. (2021). Nurses’ Management of Patients with Pressure Ulcers in Selected Health Facilities in Murang’a County, Kenya. East African Journal of Health and Science, 3(1).
JCI. (2019, September 17). International Patient Safety Goals (IPSG). World Patient Safety Day.
Jiricka, M., Ryan, P., Carvalho, M., & Bukvich, J. (1995). Pressure Ulcer Risk in an ICU Population. American Journal of Critical Care, 4(5), 361-367.
Kayser, S., VanGilder, C., & Lanchenbruch, C. (2019). Predictors of Superficial and Severe Hospital-Acquired Pressure Injuries: A Cross-sectional Study using the International Pressure Ulcer Prevelance Survey. International Journal of Nursing Studies, 89, 40-50.
Kenya Gazette Supplement No. 101 (Acts No. 21). (2017). The Health Act, 2017. (T. P. Kenya, Ed.) Nairobi: The Government Printer, Nairobi.
Kenya National Bureau of Statistics. (2019). 2019 Kenya Population and Housing Census. Nairobi: KNBS.
Langley, J., & Brenner, R. (2004). What is an Injury. Journal of Injury Prevention, 60-69.
Lumelcandela. (2021). Boundless Anatomy and Physiology. UK: Online Access. Retrieved April 4, 2022, from https://courses.lumenlearning.com/boundless-ap/chapter/the-hip/
Lyder, C. H., Shannon, R., Empleo-Frazier, O., McGeHee, D., & & White, C. (2002). A comprehensive program to prevent pressure ulcers in long-term care: Exploring costs and outcomes. Journal of Ostomy Wound Management, 48(4), 52-62.
Lyder, C., Yu, C., Emerling, J., & others. (1999). The Braden Scale for pressure ulcer risk: evaluating the predictive validity in black and Latino/Hispanic elders. Journal of Applied Nursing and Research, 12(2), 60-68.
Macdonald, D., & Bridge, R. (1991). Gender Steriotyping and Nursing Care. Residents Nursing Health, 14(5), 374-379.
Mahoney, M., Rozenboom, B., Doughty, D., & Smith, H. (2011). Issues Related to Accurate Classification of Buttocks Wounds. Journal of Wound Ostomy and Continence Nursing, 38(6), 635-642.
Mary, E., Merrilyn, B., Beck, D., & Schols, J. M. (2015, April). The Role of Nutrition for Pressure Ulcer Management: National Pressure UlcerAdvisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance White Paper. Wound Care, 41-56.
Matozinhos, F., Velasquez-Melendez, G., Tiensoli, S., Moreira, A., & Gomes, F. (2017). Factors Associated with the Incidence of Pressure Ulcer During Hospital Stay. Rev Esc Enferm USP, 2-9.
McNichol, L., Lund, C., Rosen, T., & Gray, M. (2013). Medical Adhesives and Patient Safety: State of the Scienceconcensus Statements for the Assesment, Prevention, and Treatment of Adhesives-Related Skin Injuries. Journal of the Dermatolog Nurses’ Association, 5(6), 323-338.
Molon, J. N., & Estrella, E. P. (2011). Pressure Ulcer Incidence and Risk Factors Among Hospitalised Orthopedic Patients: Results of a Prospective Cohort Study. Journal Of Ostomy- Wound Management, 57(10), 64.
Nam, J. (1992). Sample size determination for case-control studies and the comparison of stratified and unstratified analyses. Journal of Biometrics, 48(2), 389-395.
Nangole, F. W., Khainga, S. O., & Kiboi, J. (2009, December). Pressure Ulcers Presentation and Management at Kenyatta National Hospital and Spinal Injury Hospital. East African Medical Journal, 86(12).
National Pressure Ulcer Advisory Panel. (2009). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Cambridge: Cambridge Media.
NPIAP. (2019). Pressure Injury Incidence/Prevalence. National Pressure Injury Advisory Panel.
NPUAP, Black, J., Edsberg, L., Baharestani, M., & Langemo, D. (2011). Pressure Ulcers: Avoidable or Unavoidable? Results of the NPUAP Concensus Confererence. Journal of Ostomy Wound Management, 57(2), 24-37.
Onigbinde, A. T., Gbolade, I. O., & Shuaib, O. O. (2012, June). Pressure ulcer incidence among high-risk inpatients in Nigeria. British journal of nursing, 20(12), 4-12.
Padula, W., Mishra, M., Makic, M., & Sullivan, P. (2011). Improving the Quality of Pressure Ulcer Care with Prevention: A Cost-Effectiveness Analysis. Journal of Medical Care, 49(4), 385-394.
Parliamentary Service Comission, (PSC 2018), Parliamentary Budget Office. (2018). Eye on the ‘Big Four’: Budget Watch for 2018/2019 and the Medium Term. Nairobi, Kenya: Parliamentary Budget Office.
Quigley, S. M., & Curley, M. A. (1996). Skin integrity in the pediatric population: Preventing and managing pressure ulcers. JSPN, 1(1), 7-18.
Ranzani, O., Simpson, E., Japiassú, A., & Noritomi, D. (2016). The challenge of predicting pressure ulcers in critically ill patients. A multicenter cohort ctudy. Ann ATS, 1770-1779.
Schessel, E. S., Ger, R., & Oddsen, R. (2012). The cost and outcomes of treating a pressure ulcer in a patient with a deep pressure ulcer in a patient with quadriplegia. Journal of Ostomy Wound Management, 58(2), 51-56.
Sociedad Iberolatino America. (2011). Declaration of Rio De Janeiro on Pressure Ulcers Prevention as a Universal Human Right. Rio De Janeiro: Ibero-Latin-American Society on Wounds.
Sookyung, H., Xiaobai, L., Brenda, V., Cheryl, N., Monica, F., Pacharmon, K., . . . Elizabeth, L. (2014, November). Body Mass Index and Pressure Ulcers in Intensive Care Patients. American Journal of Criical Care, 23(6), 495-501.
Squitieri, L., Waxman, D. A., Mangione, C. M., Saliba, D., Clifford, K. Y., Needleman, J., & Ganz, D. A. (2018). Evaluation of the Present-on-Admission Indicator among Hospitalized Fee-for-Service Medicare Patients with a Pressure Ulcer Diagnosis: Coding Patterns and Impact on Hospital-Acquired Pressure Ulcer Rates. Journal of Health Services Research, 53(1), 2970-2987.
Tayyib, N., Coyer, F., & Lewis, P. (2016). Saudi Arabian Adult Intensive Care Unit Pressure Ulcer Incidence and Risk Factors: A Prospective Cohort Study. International Wound Journal, 13(5), 912-919.
Theisen, S., Drabik, A., & Stock, S. (2012). Pressure ulcers in older hospitalised patients and its impact on length of stay: A retrospective observational study. Journal of Clinical Nursing, 21(4), 384-389.
Vanderwee, K., Clark, M., Dealey, C., Gunningberg, L., & Defloor, T. (2007, April). Pressure Ulcer Prevalence in Europe: a pilot study. Journal of Evaluation in Clinical Practice, 13(2), 227-235.
VanGilder, C., LachenBruch, C., Algrim-Boyle, C., & Stephanie, M. (2017, February). The International Pressure Ulcer Prevalence Survey: 2005 - 2015: A 10-Year Pressure Injury Prevelance and Demographic Trend Analysis by Care Setting. Journal of Wound Ostomy and Continence Nursing, 44(1), 20-28.
Wangia, E. D., & Kandie, C. D. (2019). Refocusing on Quality of Care and Increasing Demand for Services; Essential Elements in attaining Universal Health Coverage in Kenya. Nairobi: The Health Sector Monitoring and EvaluationUnit, Ministry of Health.
Weng, M.-H. (2008). The Effect of Protective Treatment in Reducing Pressure Ulcers for Non-Invasive Ventilation Patients. Journal of Intensive and Critical Care Nursing, 24(5), 295-299.
WHO. (2005). Health Financing: Universal Health Coverage. Geneva: World Health Organisation.
Woodbury, S., & Houghton, P. (2004). Prevalence of Pressure Ulcers in Canadian Health-Care Settings. Journal of Ostomy Wound Management, 50(10), 22-38.
Woolson, R., Bean, J., & Rojas, P. (1986, December). Sample size for case-control studies using Cochran’s statistic. Journal of Biometrics, 42(4), 927-932.
World Health Organization. (2017). Patient Safety: Making health care safer. Geneva: WHO.
Xianghong, Z., Na, Z., Zhilong, L., Xiangtao, X., Tang, L., & Guoping, O. (2021). The Global Burden of Decubitus Ulcers from 1990 to 2019. Scientific Reports, 11(21750), 83 - 87.
Zaratkiewicz, S., Whitney, J. D., Baker, M. W., & Lowe, J. R. (2015). Defining Untageable Pressure Ulcers as Full-Thickness Wounds: Are These Wounds Being Misclassified. Journal of Wound Ostomy and Continence Nursing, 42(6), 583-588.
Zaratkiewicz, S., Whitney, J., JR, L., Taylor, S., O’Donnell, F., & Minton-Foltz, P. (2010). Development and implementation of a hospital-acquired pressure ulcer incidence tracking system and algorithm. Journal for healthcare quality, 32(6), 44-51.
Zhaoyu, L., Frances, L., Lukman, T., & Wendy, C. (2020). Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. International Journal of Nursing Studies. Retrieved March 17, 2022, from 10.1016/j.ijnurstu.2020.103546. Epub 2020 January 31. PMID: 32113142.
Copyright (c) 2022 Otieno Laban Sterly Makori, Rose Olayo, PhD, Edwin Kadima Wamukoya, PhD
This work is licensed under a Creative Commons Attribution 4.0 International License.
