Effect of COVID-19 Pandemic on Patient Repositioning for Pressure Injury Prevention: A survey of U.S. Acute Care Wound Nurses

Background and significance: Prevention programs for hospital-acquired pressure injuries (HAPI) are multi-faceted and complex.[i] Pressure injury prevention (PIP) programs require hands-on patient care ranging from skin inspection, to routine patient repositioning and rotating placement of medical devices.[ii]

This survey sought to learn how the pandemic may have affected patient repositioning as a routine PIP measure and whether wound care professionals were seeing increases in hospital-acquired pressure injuries.

Methods: Participants in an educational webinar delivered by Woundsource on patient repositioning in November 2020 were surveyed about COVID-19 impact on their facilities’ PIP programs. Participants were asked demographic questions about their location and work setting, and changes and barriers to PIP programs due to the pandemic.

Results: Out of 412 survey respondents, 120 identified themselves as either a wound care nurse or a wound care coordinator and practiced in U.S. acute care hospitals. Respondents worked in 37 different states. A total of 42% reported seeing an increase in HAPI at their institutions since the start of the pandemic. Fourteen percent reported seeing increased HAPI mainly on prone surfaces such as the face, and 4% reported increases to be primarily respiratory device related. A fifth of respondents (21%) reported that patients received less frequent repositioning due to isolation protocols. Sixty percent estimated their facility turn protocol adherence to be between 50% and 70%, and a third (31%) estimated it below 50%. Majority felt that competing priorities (53%) and insufficient staffing (28%) were the main barriers for timely patient repositioning during the pandemic.

Conclusions: The pandemic has had a profound effect on PIP programs in US hospitals and as a result, hospitals are seeing an increase in HAPI. Isolation protocols and staff safety concerns have changed how frequently patients are repositioned.