Vijayalakshmi Nair

CK Birla Hospitals The Calcutta Medical Research Institute, India

Abstract Title:A Study on the Prevention and Management of Hospital-Acquired Pressure Injuries (HAPI) in Critical Care Settings of CKBH CMRI

Biography: With an experience of over 30 years in teaching, clinical, training and Administration, Ms Vijayalakshmi A Nair, is a highly skilled and diligent Nursing Administrator. She is a multifaceted Leader with excellent assessment and evaluative capabilities in a high stress situations.

Research Interest: 1. Problem Identified Hospital-Acquired Pressure Injuries (HAPI) remain a significant challenge in critical care settings, leading to increased morbidity, extended hospital stays, and additional healthcare costs. An RCA (Root Cause Analysis) conducted on affected patients revealed three primary concerns: 1. A majority of patients had whole-body dry skin, predisposing them to skin breakdown. 2. Many patients had low nutritional scores on the Braden Scale, indicating poor nutritional support as a contributing factor to skin integrity deterioration. 3. Lack of use of preventive strategies, especially for patients who were bedridden for a long time and had low Braden Scale scores, indicating high risk. Despite existing prevention strategies, a gap remains in targeted individual component management, preventive interventions for high-risk patients, and optimizing nutritional and moisture management approaches. 2. Background Pressure injuries occur due to prolonged pressure on the skin and underlying tissues, exacerbated by factors like immobility, poor nutrition, moisture imbalance, and inadequate preventive measures. The Braden Scale for Predicting Pressure Sore Risk is widely used to assess the likelihood of pressure injury development, focusing on sensory perception, moisture, activity, mobility, nutrition, and friction/shear. In critical care settings, patients are particularly vulnerable due to: • Reduced mobility and extended hospital stays • Compromised skin integrity from prolonged exposure to moisture (incontinence, sweat, or medical devices) • Nutritional deficiencies that impair skin integrity and tissue healing Traditional preventive measures include repositioning, moisture management, pressure-relieving devices, and nutritional optimization. However, our RCA findings indicate that moisture management and targeted nutritional interventions require more structured implementation. 3. Methodology 3.1 Study Design A structured observational study and pilot study were conducted in the ICU and critical care units of the hospital over three months. The study was divided into three phases: Phase 1: Baseline Data Collection • Identified patients with low Braden scores < 9 at risk of HAPI. • Assessed nutritional status and skin condition upon admission. • Recorded hospital days to evaluate the impact of extended stays. • Conducted an RCA on previously developed HAPIs. • The majority were on invasive mechanical ventilation and/or vasoactive drugs. • Predictive analysis was performed using the Braden Scale, and additional parameters such as height, weight, BMI, daily protein intake (kg/day), and caloric intake (kcal/day) were monitored. Phase 2: Implementation of Targeted Interventions Individual Component Management: • Each Braden Scale factor was addressed separately. • Silicone barrier spray was applied to all the high-risk areas in the body to protect skin integrity. Moisture Management Strategy: • A trial run with coconut oil-based moisturizing protocols showed significant improvement in skin condition. Nutritional Optimization: • Developed a structured nutritional chart in collaboration with doctors and dietitians. • Identified the most effective supplementary feeds and calculated required calorie intake per patient. • A process improvement strategy included a feeding chart tailored for different patient groups to ensure proper intake. • A separate feeding preparation area was established to enhance accuracy and consistency in nutritional support. Phase 3: Outcome Analysis & Results Interpretation • Compared pre- and post-intervention rates of HAPI occurrence. • Evaluated skin integrity improvement through visual assessment, Braden Scale scoring, and PUSH score for existing HAPI. • Assessed the impact of moisture management using coconut oil and its potential integration into pharmaceutical-grade products used in CKBH CMRI. • Analyzed the effectiveness of nutritional support through patient recovery rates and reduced incidence of pressure injuries. 4. Sample • The study was conducted exclusively on critical care patients. A majority of these patients were on invasive mechanical ventilation and/or vasoactive drugs. Predictive analysis was performed using the Braden Scale, followed by assessment of additional parameters such as height, weight, BMI, daily protein intake (kg/day), and caloric intake (kcal/day). To ensure process improvement, a feeding chart based on proper intake was developed for the different groups, and a separate feeding preparation area was established to maintain nutritional intake accuracy. 5. Results 5.1 Hospital Days and HAPI Incidence • Patients with extended hospital stays (>5 days) had a higher incidence of pressure injuries. • Early preventive interventions led to a 35% reduction in new cases. 5.2 Moisture Management & Skin Integrity • The coconut oil-based trial demonstrated improved skin hydration and reduced skin breakdown. • Patients who received pharmaceutical skin protection (silicone barrier spray + coconut oil-based moisturizer) showed a 50% lower rate of HAPI than those who only had standard care. 5.3 Nutritional Support & Braden Score Correlation • Patients with low nutritional Braden scores had a 2.5x higher risk of developing HAPI. • After implementing calorie-specific nutritional support, the average Braden nutrition score improved. • A structured nutritional monitoring system helped ensure proper dietary intake. 6. Way Forward Based on the trials, the following measures will be integrated into standard practice: 6.1 Enhanced Moisture Management Strategy • Shift from generic skin moisturizers to pharmaceutical-grade products containing coconut oil due to its effectiveness. 6.2 Standardized Nutritional Protocol • Develop individualized calorie charts based on patients’ Braden nutritional scores and doctor recommendations. • Implement routine monitoring of nutritional intake by nursing teams. 6.3 Focused Critical Care HAPI Prevention Plan • Targeted interventions specifically for ICU and critical care patients, where HAPI risk is highest. • Use silicone barrier spray proactively for patients with high Braden scores across all units. 6.4 Data-Driven Nursing Support System • Nurses will utilize Regular assessment of skin, Braden Scale trends and nutritional intake records to implement early preventive interventions. By integrating a structured moisture and nutrition management approach, leveraging targeted interventions, and enhancing nurse-driven care protocols, this study provides a sustainable, evidence-based model for reducing HAPI in critical care settings. Authors : Ms. Vijayalakshmi Nair1 - Chief of Nursing, CK Birla Hospitals, the Calcutta Medical Research Institute, Kolkata MSN, Ms. Sujata Saha Ray2 – Tissue Viability Nurse, CK Birla Hospitals, the Calcutta Medical Research Institute, Kolkata Ms. Monami Dawn3 – Staff Nurse, CK Birla Hospitals, the Calcutta Medical Research Institute, Kolkata Presenting Author : Ms. Vijayalakshmi A Nair Primary Affiliation: CK Birla Hospitals , Calcutta Medical Research Institute , CAHO Lifetime Member, ANEi Member, Certified NABH Assessor. Email : vijaya1068@gmail.com Contact No. : 9945040298 Keywords: Pressure Injury, Nutritional Deficiency, Preventive Strategies, Braden Scale, Predictive Analysis