Some medical devices are posing a surprising risk to children in pediatric hospitals: pressure ulcers.

This finding was part of a larger study published online in May in the journal Pediatrics about a program at Cincinnati Children’s to reduce pressure ulcer rates among patients.

“These devices include facemasks used in delivering mechanical ventilation to the sickest patients, tracheotomy tubes, pulse oximeters (used to measure oxygen saturation in the blood), and orthopedic casts,” says Marty Visscher, PhD, director of the Skin Sciences Program at Cincinnati Children’s and lead author of the study.  “While often life-saving, these devices can cause pressure ulcers that can be quite serious. Their incidence is higher in critically ill patients, with increased infection, pain and prolonged hospitalization.”

An unscientific survey taken at Cincinnati Children’s prior to the study revealed a 10 percent pressure ulcer rate among children in the hospital -- more than twice as high as was thought to occur in pediatrics. Cincinnati Children’s assembled a patient safety collaborative to investigate the problem.

While more than 70 percent of pressure ulcers in adults occur due to pressure over bony body parts, researchers discovered that most pressure ulcers in children occur due to contact with medical devices. In response, the medical center developed a quality improvement bundle of solutions that reduced pressure ulcers in its pediatric intensive care unit (PICU) by 50 percent within a year.

“While this initial intervention has proved to be efficacious, we need to use established skin evaluation methods, identify early tissue changes and test additional interventions to reduce harm from medical devices,” says Dr. Visscher. “The unanticipated increase in pressure ulcers from pulse oximeters indicates that new products must be evaluated before widespread use.”

Now, each inpatient unit at Cincinnati Children’s has designated “skin champions,” staff members trained in early detection of skin injury who serve as resources during rounds and bedside skin assessments.  In addition, Cincinnati Children’s has established a Pediatric Advanced Wound and Skin Service, directed by Sundeep Keswani, MD, that includes wound treatment and academic research.