devices are posing a surprising risk to children in pediatric hospitals:
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.
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.”
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.
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.”
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.