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DEPARTMENTS: Editorial

The Importance of Pressure Injury Evidence During COVID-19

Advances in Skin & Wound Care: August 2020 - Volume 33 - Issue 8 - p 399
doi: 10.1097/01.ASW.0000684272.94842.03
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Most clinicians agree that evidence-based/informed practice is the standard of care. However, the vast amount of evidence, particularly on pressure injuries (PIs), can be formidable. For instance, a PubMed clinical inquiry search for 2019 and 2020 (accessed June 16, 2020) using the terms “pressure injury” and “pressure ulcers” yields 11,334 clinical studies and 392 systematic reviews. At a time when science and data are so important, busy healthcare professionals may find keeping up with the number of publications daunting. This was true “BC” (before the novel coronavirus 2019 [COVID-19]) and certainly takes on new urgency “AC” (after COVID-19).

Keeping current with the published literature is a barrier to knowledge translation.1–7 One facilitating strategy is to have credible professionals curate and relay key messages to colleague and stakeholder audiences.2 This month’s continuing education article is an example of two interprofessional clinical experts (a nurse and physician) highlighting key articles from the PI literature along with expert analysis. Saindon and Berlowitz reviewed 550 articles and selected six with clinically relevant pearls for practice. All but one of the articles are on the topic of prevention, including the role of microclimate, predicting PI in critical care, the use of support surfaces, and a cost analysis. The last article is on complications and surgical repair of PI.

This year started with a focus on how clinicians would implement the newly-released joint European, US, and pan-Pacific PI guideline. When COVID-19 became a global pandemic, the world was suddenly confronted with adapting and modifying health delivery systems to provide care during physical distancing, as well as issues specifically relevant in skin and wound care such as preventing facial skin injuries from personal protective equipment among healthcare workers. Even now, there are few data to guide evidence-based/informed practice. Because of their importance, two relevant articles have been fast-tracked for this issue to help address this. These articles provide evidence from Bahrain and New York City that healthcare professionals are using ingenuity to solve clinical problems. The innovative solutions include a method to protect frontline workers from N95 mask facial skin damage and the use of telemedicine to manage patients with wounds during the health crisis.

Who would have thought that in 2020 the incidence and prevention of medical device-related PIs for healthcare professionals would be a hot topic? In the early weeks of the pandemic, there was a paucity of data to prevent clinical facial damage from prolonged N95 mask use. In the original Bahrain investigation by Smart and colleagues, their creative use of a nontraumatic dressing cut into strips and placed on the face of nurses with type 2-6 Fitzpatrick skin types was evaluated. Through collaboration with the hospital’s Pressure Injury Prevention Committee, the Nursing Quality Committee, and infection control, the safety of using this dressing under personal protective equipment was determined by fit testing and oxygen saturation assessment. Further, the HELP mnemonic and enabler was created to assist providers in remembering key prevention strategies.

Skin and wound care has been changed by the need to protect healthcare providers from COVID-19 with physical distancing. Dr Ernest Chiu, director of the Wound Center at NYU Langone Health, and an interprofessional team were early innovators in providing virtual skin and wound care. Their telemedicine experience is illustrated with actual patient cases, and they carefully highlight the advantages and disadvantages of using this technology. Although COVID-19 may have accelerated adoption of this care format, the authors explain that this might just be the right modality at the right time. Be sure to watch their accompanying video featured on www.ASWCjournal.com.

We hope you agree that equipped with the latest important information and research, science can help us save the skin, heal wounds, and win the COVID-19 battle.

Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN

R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM

REFERENCES

1. Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006;26:13.
2. Grimshaw J, Eccles M, Lavia J, Hill S, Squires J. Knowledge translation of research findings. Implement Sci 2012;7:50.
3. Kitson A, Staus SD. The knowledge-to-action cycle: identifying the gaps. CMAJ 2010;182(2):E73–7.
4. Oborn E, Barret M, Racko G. Knowledge Translation in Healthcare: A Review of the Literature. Working Paper Series. Cambridge Judge Business School. May 2010. www.jbs.cam.ac.uk/fileadmin/user_upload/research/workingpapers/wp1005.pdf. Last accessed June 17, 2020.
5. Straus SE, Tetroe JM, Graham ID. Defining knowledge translation. CMAJ 2009;181:165–8.
6. Straus SE, Tetroe JM, Graham ID. Knowledge translation is the use of knowledge in health care decision making. J Clin Epidemiol 2011;64:6–10.
7. Wensing M, Bosch M, Grol R. Developing and selecting interventions for translating knowledge to action. CMAJ 2010;182:E85–8.
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