Factors associated with medical devicerelated pressure ulcers occurrence in hospital setting: a systematic review protocol

Trapassi, Stefano; Piemonte, Guya; Lumini, Enrico; Righi, Lorenzo; Isemann, Christian Ramacciani; Silvana, Mecheroni; Bertò, Luisa; Francioni, Stefania; Marini, Fulvia; Becattini, Giovanni

doi:10.2478/fon-2025-0002

Abstract

Objective

To identify the principal factors associated with the occurrence and development of medical device-related pressure injuries (MDRPI) in adults admitted to hospitals. MDRPI, a peculiar subtype of pressure injuries (PI), result from the pression exerted by devices (or their fixation systems) applied for diagnostic and therapeutic purposes. MDRPI represent a serious problem for patients and healthcare systems. Understanding potential risk factors is an important step in implementing effective interventions.

Methods

In this study, we will perform a systematic review; if possible, also a meta-analysis will be performed. The review will follow the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines for systematic reviews. A rigorous literature search will be conducted both in electronic databases (Medline/PubMed, Embase, CINAHL, Web of Science, Scopus, Cochrane Library) to identify studies published since 2000 and in gray literature for unpublished studies. Pairs of researchers will identify relevant evidence, extract data, and assess risk of bias independently in each eligible study. Factors associated with the occurrence of MDRPI are considered the primary outcome. Secondary outcomes are prevalence and incidence of MDRPI, length of hospital stay, infections, and death. The evidence will be synthesized using the GRADE methodology.

Results

Results are not currently available as this is a protocol for a systematic review.

Conclusions

This systematic review will identify evidence on risk factors for developing MDRPI. We are confident that the results of this review will help to improve clinical practice and guide future research.

References

Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised national pressure ulcer advisory panel pressure injury staging system. J Wound Ostomy Continence Nurs. 2016;43:585–597.
Search in Google Scholar Back to article
VanDenKerkhof EG, Friedberg E, Harrison MB. Prevalence and risk of pressure ulcers in acute care following implementation of practice guidelines: annual pressure ulcer prevalence census 1994-2008. J Healthc Qual. 2011;33:58–67.
Search in Google Scholar Back to article
Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA. 2006;296:974–984.
Search in Google Scholar Back to article
Bambi S. Hospital-acquired injuries: Device-related pressure ulcers, falls, and restraints. In: Comisso I, Lucchini A, Bambi S, Giusti GD, Manici M, eds. Nursing in Critical Care Setting. Cham: Springer; 2018;335–373.
Search in Google Scholar Back to article
Moore Z. US Medicare data show incidence of hospital-acquired pressure ulcers is 4.5%, and they are associated with longer hospital stay and higher risk of death. Evid Based Nurs. 2013;16:118–119.
Search in Google Scholar Back to article
Schuurman JP, Schoonhoven L, Keller BP, van Ramshorst B. Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation. J Clin Nurs. 2009;18:2456–2463.
Search in Google Scholar Back to article
Gorecki C, Brown JM, Nelson EA, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009;57:1175–1183.
Search in Google Scholar Back to article
Are We Ready for This Change? Preventing Pressure Ulcers in Hospitals: a Toolkit for Improving Quality of Care. Rockville, MD: Agency for Healthcare Research and Quality; April 2011. http://www.ahrq.gov/professionals/systems/long-term-care/resources/pressure-ulcers/pressureulcertoolkit/utool1.html. Accessed January 10, 2023.
Search in Google Scholar Back to article
Posnett J, Gottrup F, Lundgren H, Saal G. The resource impact of wounds on health-care providers in Europe. J Wound Care. 2009;18:154–161.
Search in Google Scholar Back to article
Gou L, Zhang Z, Yongde A. Risk factors for medical device-related pressure injury in ICU patients: a systematic review and meta-analysis. PLoS One. 2023;18:e0287326.
Search in Google Scholar Back to article
Black JM, Cuddigan JE, Walko MA, Didier LA, Lander MJ, Kelpe MR. Medical device related pressure ulcers in hospitalized patients. Int Wound J. 2010;7:358–365.
Search in Google Scholar Back to article
Jaul E. Cohort study of atypical pressure ulcers development. Int Wound J. 2014;11:696–700.
Search in Google Scholar Back to article
National Pressure Ulcer Advisory Panel. Mucosal Pressure Ulcers: An NPUAP Position Statement. Washington DC: National Pressure Ulcer Advisory Panel; 2008. https://cdn.ymaws.com/npuap.site-ym.com/resource/resmgr/position_statements/muco-sal_pressure_ulcer_posit.pdf. Accessed February 9, 2023.
Search in Google Scholar Back to article
Jackson D, Sarki AM, Betteridge R, Brooke J. Medical device-related pressure ulcers: a systematic review and meta-analysis. Int J Nurs Stud. 2019;92:109–120.
Search in Google Scholar Back to article
Apold J, Rydrych D. Preventing device-related pressure ulcers: Using data to guide statewide change. J Nurs Care Qual. 2012;27:28–34.
Search in Google Scholar Back to article
Kim JY, Lee YJ, Korean Association of Wound Ostomy Continence Nurses. Medical devicerelated pressure ulcer (MDRPU) in acute care hospitals and its perceived importance and prevention performance by clinical nurses. Int Wound J. 2019;16(suppl 1):51–61.
Search in Google Scholar Back to article
National Pressure Ulcer Injuries Panel. Best Practices for Prevention of Medical Device-Related Pressure Injuries: posters. https://npiap.com/page/MDRPI-Posters. Accessed January 10, 2023.
Search in Google Scholar Back to article
Barakat-Johnson M, Lai M, Wand T, Li M, White K, Coyer F. The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review. J Wound Care. 2019;28:512–521.
Search in Google Scholar Back to article
Hu J. Incidence and prevalence of medical devicerelated pressure ulcers in children and adults. Evid Based Nurs. 2020;23:62.
Search in Google Scholar Back to article
Morgan RL, Whaley P, Thayer KA, Schünemann HJ. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int. 2018;121(Pt 1):1027–1031.
Search in Google Scholar Back to article
Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and metaanalysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.
Search in Google Scholar Back to article
Warren MJ. Five ways to look at Cohen’s kappa. J Psychol Psychother. 2015;1:4.
Search in Google Scholar Back to article
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Search in Google Scholar Back to article
Moola S, Munn Z, Tufanaru C, et al. Systematic reviews of etiology and risk. In: Aromataris E, Munn Z, eds. Joanna Briggs Institute Reviewer’s Manual. Adelaide, Australia: The Joanna Briggs Institute; 2020;219–269. https://reviewersmanual. joannabriggs.org/. Accessed November 27, 2022.
Search in Google Scholar Back to article
Higgins JPT, Thomas J, Chandler J, et al, editors Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester, UK: John Wiley & Sons; 2019.
Search in Google Scholar Back to article
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.
Search in Google Scholar Back to article
Brożek J, Guyatt G, Oxman A (eds.). The GRADE Working Group. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. Updated October 2013. https://gdt.gradepro. org/app/handbook/handbook.html. Accessed November 27, 2022.
Search in Google Scholar Back to article