Journal Article Review
Denise Nix MS, RN, CWOCN
Name of peer reviewed journal article
Black JM, Cuddigan JE, Walko MA, Didier LA, Lander MJ, Kelpe MR. Medical device related
pressure ulcers in hospitalised patients. Int Wound J 2010; 7:358–365
Why I chose this article
I am passionate about this topic because Minnesota has reported that for the past 2 years, up to
30% of our hospital acquired stage 3, 4, and unstageable pressure ulcers (PU) were from medical
devices. Minnesota Hospitals are working together to combat this problem. I was interested in
learning how Dr. Black and colleagues’ findings compared to our experiences in Minnesota.
Description of study
This article reports results from a secondary analysis of a subset of existing data collected during
eight quarterly PU prevalence and incidence studies at Nebraska Medical Center. Data was
analyzed from the medical records of 2178 adult subjects who were PU free on admission and in
critical care, step-down or medical surgical units on the days of the surveys. Under the direction
of certified wound care nurses, researchers gathered data on risk factors, preventive care
processes and PU outcomes.
Discussion and learnings
Most of the study findings are similar to what we have found in Minnesota hospitals through
analysis of adverse health event (AHE) reports of stage III, IV, and unstageable PU s. Examples
include:
 PU from medical devices account for one third of all HA PU
 PU risk assessment tools do not differentiate between device related and tradition PUs
 PU from devices often mimic the shape of the device
 The majority of full thickness PU from devices are unstageable
 The number of PU related to medical devices decreases with quality initiatives.
Perhaps the few differences we have found through the analysis of Minnesota AHE reports are
related to the exclusion of stage I, II, sDTI, and mucosal PU (the Nebraska study included all
stages). Minnesota’s most commonly reported device related PUs are unstageables on the head
and neck of ICU patients from cervical collars and respiratory devices while Nebraska Medical
Center’s were stages I and IIs on the ears and lower extremities found almost equally in ICU,
step-down, and med/surg units.
The difference in anatomical locations may also be related to the initiatives many of the
Minnesota hospitals conducted several years back to decrease PU under antiembolism stockings.
Back then, PU from other types of medical devices were drastically undetected or under
reported. The article did not include an analysis of stage III, IV, and unstageable device related
PU as a subset so it is unknown if Nebraska Medical Center’s ICU housed most of the head and
neck full thickness device related PU.as seen in Minnesota.
In summary, I thought this article was great! It offered a statistical analysis that suggested
patients with medical devices at the Nebraska Medical Center were 2·4 times more likely to
develop a PU of any kind. The article included a terrific literature review and for me, further
validation of the work we have been doing with the Minnesota SAFE SKIN initiative. The article
reviewed many of the concerns and common themes that Minnesota has been experiencing (i.e
proper fit, edema, and moisture and skin inspection around and under devices).which lead to the
development of the MHA guidance documents to prevent hospital acquired PU from cervical
collars and respiratory devices last year (http://www.mnhospitals.org/index/tools-app/tool.353).