Pressure injury prevention in the perioperative setting: An integrative review

Background: Pressure injury (PI) has a significant impact on patients and their families, and is costly to health care institutions. Perioperative PI remains problematic, although little is reported about current perioperative pressure injury prevention (PIP) strategies. Aim: To identify the key perioperative PIP strategies, following a systematic review of published research, to describe existing gaps in the literature, and to inform the development of subsequent observational study. Design: An integrative literature review method developed by Whittemore and Knafl was used. Method: Research inclusion and exclusion criteria were identified a priori. Six data bases were searched and search terms included pressure ulcer/sore prevention, perioperative, operating room. Two review authors evaluated the quality of the studies using a validated tool, and a third author arbitrated when there was a discrepancy. Agreement between the two rates was measured using an intraclass correlation coefficient (ICC). Findings: Based on the inclusion and exclusion criteria, 270 papers were screened and ten quantitative studies were included. Quality scores ranged from 29 per cent to 89 per cent, resulting in an ICC of 0.955 (95 per centconfidence interval, 0.821 to 0.989, p < 0.0001). Five key PIP strategies were identified, including skin inspection, support surfaces and positioning aids, thermoregulation, medical devices and/or equipment, and interprofessional communication. Conclusions: This review confirmed the scarcity of current evidence of perioperative PIP practice and identified five key perioperative PIP strategies. Most of the reviewed studies focused on one main PIP strategy, and no direct observational studies have been undertaken in relation to perioperative PIP.