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1. N424 – Essentials of Nursing Research
N424 – Essentials of Nursing ResearchN424 – Essentials of Nursing ResearchIn surgical
patients (P), does the use of prophylactic pressure injury dressings for prolonged cases (I)
reduce the incidence of hospital acquired skin injuries/ulcers (O) when compared to
surgical patients without a pressure injury prevention dressing in place (C)?The review and
analysis of resources in this paper are to discern the efficacy of pressure protection
dressings in prevention of pressure injuries/ulcers. Surgical patients who have long-lasting
cases are at risk for the development of pressure injuries/ulcers. Patients in the operating
room are not only immobile, but may be placed one position for several hours depending on
the type of surgery they are receiving. Long-lasting surgeries, age of the patient and
comorbidities make them more prone to developing pressure injuries/ulcers. Recovering
from their surgery should be the only problem patients are faced with once they are out of
the post-operative setting. The primary study cited compared incidences of pressure ulcers
in post-operative patients who did not receive proper protective dressings in the operating
room, to patients who were positioned on a low-profile overlay that provides alternating
pressure (AP-overlay) in addition to current facility protocol. Findings indicate the
reduction of pressure injuries/ulcers for surgical patients when pressure protective
dressings and protective overlay are utilized.Key Words: Operating room, pressure injury
prevention, risk of pressure ulcers for surgical patients, use of pressure preventing
dressingsPreventing Pressure Injuries in Prolonged Surgical CasesThere are a number of
contributing factors that not only increase the potential for pressure related wound
development, but also slow or prevent the healing of them once they occur. Those with
chronic health conditions or other contributing factors, typically have lengthier hospital
stays and increased expenses for the patient and patient care facilities. For these patients, a
long surgical case means that they are immobilized and solely dependent on healthcare
workers to position and protect them appropriately. Yet, according to Black, Fawcett, and
Scott (2014) up to 45 percent of hospital acquired pressure injuries (HAPI’s) could be
attributed to the operating room. A search of evidence-based studies produced several
informational documents on pressure injury development in the operative phase of care, as
well as a study on what changes can be made in the operating room versus the areas that
are invariable. Surgical patients, especially those who undergo procedures lasting greater
than four hours, are especially at risk of developing a pressure related injury. Their body
has no sensation, their core temperature is lowered; reducing circulation, and in most cases,
the patient cannot be moved during the procedure (Gefen, 2020). Implementing a standard

2. protocol for protection from sheering and pressure injuries in the operating room would
significantly reduce the overall HAPI’s and lessen the burden of additional expenses. N424 –
Essentials of Nursing ResearchORDER NOW FOR ORIGINAL, PLAGIARISM-FREE
PAPERSFocusing on More Than Surgery in Operating RoomThe very definition of a pressure
ulcer describes the primary factors involved in its development. They develop when tissue
damage occurs and may be caused by a multitude of factors such as; ischemia from
occlusion, prolonged deformation of the tissues from shearing, or reperfusion injury
(Cooper, Jones, & Currie, 2015). Additionally, surgical patients are at risk of developing
decubitus ulcers as they undergo mechanical ventilation, immobility, use of vasopressors,
and can have prolonged case times (Cooper, Jones, & Currie, 2015). Studies have also shown
pressure injuries/ulcers that were caused in the operating room could take as long as 72
hours to appear, which in all likelihood means that pressure injuries acquired in the
operating room are being under-reported (Goudas & Bruni, 2019). Not only do these
preventable injuries lead to poor patient outcomes, they give rise to increased hospital cost
as well; when a surgical patient acquires a pressure ulcer in can add approximately 44
percent to the cost of their surgical stay (Al-Majid, Vuncanon, Carlson, & Rakovski, 2017).
The largest physical hardship from the acquisition of a pressure ulcer is obviously carried
by the patient. The largest financial burden from a HAPI, is shouldered by the hospital. The
Virginia Commonwealth University Medical Center (VCUMC) is one group who has become
focused on the solution and prevention of HAPI’s, rather than just the treatment. This
approach has literally paid off; VCUMC increased their quarterly pressure ulcer surveys to
monthly rounds, they have a Champions of Skin Integrity (CSI) team who work
collaboratively with the hospital’s wound team, and after a year of implementing best
practice in ulcer prevention, they have a cost savings of $84,000 (Cooper, Jones, & Currie,
2015).Additional risk factors of pressure ulcers are numerous and wide-ranging. The
general health status of a patient must be considered in seeking prevention of pressure
ulcers. The patient may present with systemic diseases or be immune compromised.
Nutritional status and body mass are also important factors. However; according to Gefen
(2020), the utmost risk factors to consider are the things that cannot be changed during the
operative phase of care. There are many distinct limitations that apply in the operating
room which are not a concern elsewhere in the hospital. The operating table has to be
stable, offers little padding for the patient, and has seen scarce change in design over the
last century (Gefen, 2020). As if the challenges of the operating room table were not enough,
there is the inability to change the position of the patient during surgery. Gefen (2020)
writes from the perspective of a bioengineer and highlights a new overlay system that is
designed for use in the operating room. Keep in mind that patients in the operating room
are exposed to unique group of risk factors such as positioning aides, slowed perfusion,
blood loss, and a drop in core temperature (Gefen, 2020). These are all factors contributing
to pressure injury/ulcer development and they must be assessed and recognized promptly
to adequately decrease the likelihood of pressure wound occurrence. N424 – Essentials of
Nursing ResearchSummary of ArticleA peer-reviewed ing article is printed in, Wounds
International Journal on the website CINAHL. According to the published retrospective
study, Gefen (2020) researched the study and found that the “work demonstrated that none

3. of the patients who received the AP-overlay developed perioperative PUs, as opposed to an
incidence rate of 6% in the historical controls (i.e. 18 PUs for the 292 patients).” There was
a cohort of 100 patients in the study that were compared to with historical control group of
292 patients. The study monitored the blood flow of the sacral skin using a 2-mm, low-
profile laser to compare a standard operating room table pad with the AP-overlay. The
findings were significant in that there was 40 percent greater overall blood flow to the
patient when using the overlay in addition to the typical padding and a staggering 76
percent greater blood flow to the sacral skin when using the AP-overlay with the standard
padding (Gefen, 2020).ConclusionHAPI’s are devastating to patients and costly as well.
Acquiring a pressure injury in the operating room is more common than most realize, it
affects one out of every ten patients (Gefen, 2020). The debilitating effects of pressure
ulcers demand the implementation of stronger and consistent preventative measures for
surgical patients. Many steps are being taken to improve outcomes and reduce pressure
injuries for surgical patients and lacing protective dressings over at risk areas is a great
start. However; our surgeons and hospital staff must collaboratively work to seek the most
up to date research and implement best practice. Surgical patients do not deserve to wake
up with increased challenges to heal from, pressure injuries are preventable.ReferencesAl-
Majid, S., Vuncanon, B., Carlson, N., & Rakovski, C. (2017). The Effect of Offloading Heels on
Sacral Pressure. AORN journal, 106(3), 194–200.
https://doi.org/10.1016/j.aorn.2017.07.002Black, J., Fawcett, D., & Scott, S. (2014). Ten top
tips: preventing pressure ulcers in the surgical patient. Wounds International, 5(4), 14–
18.Cooper, D., Jones, S., & Currie, L. (2015). In Our Unit. Against All Odds: Preventing
Pressure Ulcers in High-Risk Cardiac Surgery Patients. Critical Care Nurse, 35(5), 76–82.
https://doi.org/10.4037/ccn2015434Gefen, A. (2020). Minimising the risk for pressure
ulcers in the operating room using a specialised low-profile alternating pressure
overlay. Wounds International, 11(2), 10–16.Goudas, L., & Bruni, S. (2019). Pressure injury
risk assessment and prevention strategies in operating room patients — findings from a
study tour of novel practices in American hospitals. Journal of Perioperative Nursing, 1(32),
33–38. N424 – Essentials of Nursing Research