INCIDENCE OF SKIN INJURIES, RISK AND CLINICAL CHARACTERISTICS OF CRITICAL PATIENTS

Monteiro, Dandara Soares; Borges, Eline Lima; Spira, Josimare Aparecida Otoni; Garcia, Taysa de Fátima; Matos, Selme Silqueira de

doi:10.1590/1980-265X-TCE-2020-0125

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Original Article • Texto contexto - enferm. 30 • 2021 • https://doi.org/10.1590/1980-265X-TCE-2020-0125 copy

INCIDENCE OF SKIN INJURIES, RISK AND CLINICAL CHARACTERISTICS OF CRITICAL PATIENTS

INCIDENCIA DE LESIONES DE PIEL, RIESGO Y CARACTERÍSTICAS CLÍNICAS DE PACIENTES CRÍTICOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the incidence of skin injuries, risk and clinical characteristics of critically ill patients.

Method:

a retrospective cohort study performed in the intensive care center with a sample of 125 patients whose outcome was skin injury.

Results:

the overall injury incidence was 28% (n=35), with 36.3% (n=8) being dermatitis associated with urinary and fecal incontinence, 19.2% (n=24) pressure injury, 7.2% (n=9) skin tears, and 0.8% (n=1) medical-adhesive-related skin injury. The appearance time of the injuries varied from 1 to 44 days. The average number of injuries per patient was 1.7. Factors such as enteral nutrition (p<0.001), mechanical ventilation (p=0.001), fecal incontinence (p=0.049), diaper use with a delayed urinary catheter or urinary diversion (p=0.004) were associated with injury onset.

Conclusions:

incontinence-associated dermatitis and pressure injury had a higher incidence in critically ill patients. Patients who developed pressure injuries were at higher risk.

DESCRIPTORS:
Wounds and injuries; Incidence; Critical care; Nursing care; Safety management

Characteristics	Emergence of skin injury				P-value	OR	CI_95%
	Yes		No
	n	%	n	%
Gender					0.981^‡
Female	21	60.0	52	57.8		1.1	0.49 to 2.43
Male	14	40.0	38	42.2		1.0
Breathing mode					<0.001^§
Ambient air	2	5.7	18	20.0		1.0
Catheter oxygen nasal therapy	9	25.7	58	64.4		1.4	0.27 to 7.06
Mechanical ventilation (OOT/TCT*)^¶	22	62.9	12	13.3		16.5	3.2 to 83.5
Non-invasive mechanical ventilation	2	5.7	2	2.2		9.0	0.78 to 103.7
Type of nutrition					<0.001^§
Oral	6	17.1	67	74.4		1.0
Enteral^¶	26	74.3	14	15.6		20.7	7.9 to 59.7
Parenteral	2	5.7	4	4.4		5.6	0.8 to 37.1
Suspended	1	2.9	5	5.6		2.2	0.2 to 22.4
Urinary incontinence					0.003^§
Continent with diaper	6	17.1	41	44.4		1.0
IDC^† and diaper^¶	27	77.1	44	48.85		4.1	1.5 to 11.1
Incontinent with diaper	0	0.0	4	4.4		^\|\|	^\|\|
Urinary diversion and diaper^¶	2	5.7	1	1.1		13.7	1.0 to 174.8
Fecal incontinence					0.049^‡
Yes	9	25.7	9	10.0		3.1	1.1 to 8.6
No	26	74.3	81	90.0		1.0
Serum albumin					0.269^‡
<3.5 g/dL	30	88.2	57	77.0		1.0
3.5 to 5.7 g/dL	4	11.8	17	23.0		0.5	0.1 to 1.5
No information	1	-	16	-

Diseases	Emergence of skin injury				P-value
	Yes		No
	n	%	n	%
Hypertension
Yes	19	54.2	56	62.2	0.542^*
No	16	45.7	34	37.8
Diabetes Mellitus
Yes	11	31.4	36	40.0	0.495^*
No	24	68.6	54	60.0
Cancer
Yes	12	34.3	15	16.7	0.056^*
No	23	65.7	75	83.3
Depression
Yes	1	2.9	3	3.3	1.000^†
No	34	97.1	87	96.7
Chronic obstructive pulmonary disease
Yes	4	11.4	3	3.3
No	31	88.6	87	96.7	1.000^†
Hypothyroidism
Yes	6	17.1	13	14.4	0.095^†
No	29	82.9	77	85.6
Dyslipidemia
Yes	6	17.1	18	20.0	0.911^*
No	29	82.9	72	80.0
Peripheral obstructive arterial disease
Yes	3	8.6	6	6.7	0.709^†
No	32	91.4	84	93.3
Chronic renal failure
Yes	6	17.1	21	23.3	0.608^*
No	29	82.9	69	76.7
Alzheimer’s
Yes	1	2.9	4	4.4	1.000^†
No	34	97.1	86	95.6
Obesity
Yes	5	14.3	8	8.9	0.514^†
No	30	85.7	82	91.9
Heart failure
Yes	5	14.3	3	3.3	0.384^†
No	30	85.7	87	96.7
Alcohol consumption
Yes	3	8.5	3	3.3	0.087^†
No	29	83.0	85	94.5
Abstinence	3	8.5	2	2.2
Smoking
Yes	3	8.5	3	3.3	0.178^†
No	26	74.3	78	86.7
Abstinence	6	17.2	9	10.0

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Dandara Soares Monteiro dandahmonteiro@hotmail.com