H.11 Preventing hospital-acquired pressure injuries in the intensive care unit

1. Clinical Need
1. Patients who are critically ill in the intensive care unit at the hospital can develop hospital-acquired pressure injuries (HAPIs) over time, commonly known as bedsore wounds, that often cause significant morbidity and mortality. These wounds can affect multiple areas of the body, including the scalp, sacrum, hips, and heels, and can get worse over time, get infected, or cause severe tissue death. While there has been significant clinical research focusing on identifying the risk factors for hospital-acquired pressure injuries, we still primarily rely on manual turning and repositioning of the patient. This intervention is insufficient at preventing HAPIs. Furthermore, any costs of care related to treatment of HAPIs is not reimbursed by government or private payors, so these costs must be covered by the hospital. Therefore, hospital systems are also financially incentivized to reduce their HAPI rates. 
2. Current technologies available
1. Manual turning and repositioning of the patient
1. Most hospitals still rely on nurses and technicians to physically turn and reposition the patient from supine to their sides at arbitrary intervals (i.e. every four hours) to attempt to prevent HAPI’s. This intervention is still the most prevalently used method today, and it is labor-intensive. 
2. Research has shown that despite frequent turning, pressure accumulates in certain areas over time (ischium, sacrum), and pressure injuries still happen 
2. Blue foam wedges
1. Foam pillows that used to tilt patients to one side. It does not have any dynamic sensing or repositioning capabilities by itself, relying on clinicians to reposition the patient. Allows patient to be wedged up on one side. 
3. Alternating air pressure mattresses
1. There are several alternating air pressure mattresses available that are used by some hospital systems that may modestly help reduce the incidence of HAPIs. However, these mattresses are basic in that it simply provides variable air pressure in the mattress over regular intervals. It has no sensing capabilities and no specificity to target certain areas of the body.  Adoption of these mattresses have not eliminated HAPIs. 
4. Air fluidized therapy mattress
1. There is a Clinitron bed (https://ethosoutcomes.com/products/air-fluidized-therapy/) that has a special mattress that pushes air through sand like material to provide effective pressure redistribution of the patient. However, it involves a very large bulky specialized bed that is not available everywhere, very loud when operating (prevents sleep for many patients), and can be uncomfortable to the patient as they can feel like they are sinking. Furthermore, given its high cost, it is often only utilized for select patients with chronic wounds, therefore not practical to be utilized for all intensive care patients. 
5. Wound care nurses and surgical teams
1. Once a pressure injury is diagnosed, typically in most hospitals a wound care team follows the patient and wound. They may examine the wound once a week and alert the surgical team if the wound needs to be surgically debrided. In severe cases, wounds can go deep to the bone and cause bone infections that require major amputations and/or cause death. 
6. Variety of dressing materials and wound care
1. Once a HAPI is diagnosed, in addition to therapies listed above there are a variety of cushioned and anti-infective dressings to help with wound healing. However unless the source of the wound (pressure accumulation) is properly addresses, it does not address the cause of the HAPIs.
3. Perceived impact of addressing the problem
1. If we can develop a novel solution where pressure over the patient’s body can be reduced and/or redistributed much more intelligently and cost-effectively, this would provide both incredible value to 1) the patient in preventing and treating pressure injuries, and 2) reducing costs to the hospital system.