Cutaneous integrity protocol for critical patients in the intensive care unit

Background

The occurrence of decubitus ulcers in the intensive care unit (ICU) is a significant comorbidity and reflects quality of care. In addition, it has great impact on the patient's quality of life. The skin is the first line of defense in protecting the body from constant changes in the environment. Far too often, the attention needed for keeping skin integrity is only realized after it has been disrupted.

Objective

To evaluate the new cutaneous integrity protocol (CIP) implemented in our critical patients.

Methodology

A total of 542 patients were studied (253 before and 289 after the initiation of the protocol) between May and October 2002 in a 24-bed medical/surgical ICU. Patients who received the new CIP care were submitted to pressure-reducing devices such as a pyramidal mattress, topic fatty acids after corporal hygiene, the Braden scale and changes in bed position as indicated by the Lowthien revolving clock.

Results

Both groups were comparable regarding sex, age and origin of admission (P > 0.05). In the group before implementation of the CIP 45.7% of patients were male and 48.6% were between 60 and 80 years old, whereas in the CIP group 63.1% were male and 73.7% were between 60 and 80 years old. The main sites of ulceration were, in order of importance: the sacrum region, the head, the auricular pavilion and the intergluteous fissure. The number of ulcers developed in the ICU decreased from 13.8% to 6.57% (P < 0.05). The mean number of ulcers developed by patients was 2.49 versus 1.63 before and after the implementation of the protocol, respectively (P < 0.05).

Conclusion

These data suggest that simple and low-cost measures can significantly improve the quality of patient care in the ICU by reducing the occurrence of decubitus ulcers. All patients should benefit from a well-designed program to keep skin integrity and prevent the development of pressure sores.