Practice Tip of the Week | A Proactive Approach in Preventing Hospital Acquired Pressure Injuries

By Alyssa Railsback, BSN, RN, WCC

The wound care nurses at Baylor Scott and White Medical Center - Hillcrest (BSWMC-Hillcrest) decided to create a proactive approach in preventing hospital acquired pressure injuries (HAPIs).

During various case reviews on hospital-acquired pressure injuries (HAPIs), the Hillcrest Wound Care Nurses determined that updated interventions were needed to prevent further skin breakdown for their admitted patients. From July 2021 to December 2021, there were fourteen HAPIs reported in the Medical Intensive Care Unit (MICU) alone. 

The wound care nurses had clinical knowledge and direct experience with using a product called Cavilon Advanced Skin Protectant. This product was used with Negative Pressure Wound Therapy (NPWT). This product allowed the drape from the wound vac to adhere to the skin and helped to protect and prevent further breakdown when NPWT was applied. The product was applied twice weekly when the NPWT was due to be changed. While using the Cavilon Advanced Skin Protectant product, the peri-wound skin did not worsen during hospital admission, and some improvements were seen on the skin.

In a recent case study by Brennan et al. (2017), a review was conducted on 16 patients with partial skin loss and severe redness caused by Incontinence-Associated Dermatitis (IAD). The study demonstrated that the patients with partial skin loss had complete re-epithelization of the skin after 4-6 applications of the 3M Cavilon Advanced Skin Protectant (2017). The patients with severe redness had healthy, normal skin that returned after two to four applications of the 3M Cavilon Advanced Skin Protectant (2017)

The wound care nurses went to the MICU to allow the nurses to provide feedback on their challenges with the current skin barrier products. One area of concern from the nursing staff was that the protectant barrier cream was white, which made it difficult to assess the skin. Another product was a barrier spray that nurses felt did not provide adequate prevention of skin breakdown.  

After reviewing the literature, the BSWMC-Hillcrest wound care nurses felt that Cavilon Advanced Skin Protectant would protect the skin against Moisture-Associated Skin Damage (MASD), IAD and reduce HAPI rates. The Shared Governance Council and the executive team approved the project to begin in the MICU on January 4, 2022.

A process was created for the wound care nurses to go to each patient’s room and educate the nurse, patient, and family about the Cavilon product. Upon admission, nursing staff were requested to upload a picture into the electronic health record and apply the Cavilon Skin Protectant product to the patient’s buttocks, coccyx, and sacrum. Laminated signs were made to pass reports between nurses and other team members when Cavilon was applied, initiated, and where it was placed. An order was placed stating no other barrier creams or sprays should be applied where the Cavilon Advanced Skin Protectant was applied to provide clarification and instruction for the nursing staff. Nurses were directed to educate patients on the benefits of Cavilon Advanced Skin Protectant spray, specifically that re-application was only twice weekly rather than with every incontinence episode. Patients were allowed to decline the Cavilon product and opt for traditional skin barrier products, which remained in stock. 

The Cavilon trial ended on February 28, 2022. Eighty-four patients were eligible to participate in the trial. Four of the eighty-four patients refused. Of the eighty patients who completed the trial, 26% of them had wounds that were present on admission, and none of the wounds became worse in BSWMC-Hillcrest's care while using Cavilon Advanced Skin Protectant. There were no HAPIs identified during this trial period for the eighty patients who participated and had Cavilon applied. Of note, the MICU had only one HAPI during the trial period, however, the patient did not have Cavilon Advanced Skin Protectant applied.

MICU went over four months without a HAPI in 2022 after the trial ended. We have reduced the amount of HAPIs for fiscal year 2023 by 67%. Three inpatient units have had no Hospital Acquired Pressure Injuries for more than 365 days (about 12 months). The fiscal year 2024 goal is 35, and we are projected to meet it with only 20 HAPIs. As of 5/10/2024 we have been 55 days (about 2 months) without a HAPI.

Based on the reduction of skin break down and HAPIs seen in the hospital since the trial’s initiation, the application of Cavilon Advanced Skin Protectant on admission with re-application on Tuesdays and Fridays has successfully assisted in the prevention of MASD, IAD, and pressure injuries. In addition, Cavilon Advanced Skin Protectant costs $8.37 per wand versus $2.29 per tube of protective barrier and $3.53 per clear barrier spray. By switching to Cavilon, the hospital will save an average of $12.00 per patient each week.

REFERENCES

Brennan, M. R., Milne C. T., Agrell-Kann M., Ekholm B. P., (2017). Clinical evaluation of a skin protectant for the management of Incontinence-associated Dermatitis (IAD) in an open label, non-randomized, prospective study. Journal of Wound, Ostomy and Continence Nursing; 44(2):172-180.

Cavilon Advanced Skin Protectant