Ask the Expert – Clinical Q&A: Pressure Injury Prevention

While operating rooms (ORs) see surgeries relieving various wounds and ailments, they’re also an environment where a common pain point can develop from prolonged patient immobility: pressure injuries (PIs). This poses a unique predicament for the healthcare community and the perioperative field in particular, where tailored care approaches are in demand. 

Adding more urgency to this issue is the absence of defined national PI protocols for ORs. At Medline Canada, our team partners with healthcare organizations of all types to help them develop effective approaches to treating PIs.

We sat down with two of Medline Canada’s experts, Aline Titizian RN, BScN, CPN (C), a clinical resource specialist, and Monika Stanfel MBA MScN RN NSWOC CWOCN, a skin health product manager,, to unpack common concerns about PIs and current treatments the community can receive. 

How do peri-operative PIs develop?

Aline: Besides all other usual risk factors in many healthcare settings, the OR presents a unique set of challenges. Patients are placed in complex positions, immobile for extended periods of time and cannot be significantly repositioned like in inpatient units. And, of course, patients under surgery cannot communicate themselves if they feel discomfort or pain. On top of all that, their bodies are covered with sterile drapes, so medical staff cannot easily visualize areas of risk for PI development.

How often do PIs happen?

Aline: The incident rate for PIs in the OR goes from 0.3% to 57%, impacted by the patient population and the type and length of surgery performed. For example, a patient having a tonsillectomy would be at lower risk, while someone undergoing a spinal surgery would have a significantly increased risk of developing PIs in the OR. (1,2,4)

What are the risks associated with prolonged or untreated PIs?

Monika: There is a significant impact on the patient's quality of life. After PI development, there is pain, and they need to have check-ups in wound care clinics. It can lead to loss of income due to time off work. PIs impact a patients’ body image as well because there can be long-standing scarring. On a more serious note, PIs put patients at higher risk for serious infection that can result in a death ­­— patients with PIs have a two times-higher mortality rate than patients with none. (1,2,4)

There is also a significant cost to the healthcare system. (3) In Canada, we are seeing an increase in the average length of a hospital stay from four to 11 days. This affects all of us because it reduces capacity and access to hospitals by having patients in for longer periods of time.

What are ways we can prevent peri-operative PIs?

Aline: An excellent example would be prophylactic multi-layer dressings that can be applied over bony prominences to reduce friction and shear. There is also the option of micro-repositioning — and I want to emphasize “micro” because a complete repositioning is impossible in the OR.

Education for staff on risk factors and preventative interventions for PIs is key. Policies and procedures for managing therapeutic surfaces and positioners are also very important.

What resources for PI prevention are available at Medline?

Monika: Medline provides a complete program for our customers on PI prevention. We recently launched a novel dressing called OptiView™. While evidence-based practice supports using a multi-layer dressing to prevent PIs, there are some challenges with using traditional five-layer silicone foam.

Optiview was designed to meet some of those challenges. It gives us a clear view that allows complete skin visualization without lifting the dressing, thereby extending wear time. It also has a unique HydroCore™ technology that promotes skin cooling to help maintain a healthy microclimate.

Most importantly, we have a robust team of clinicians who are experts in the field, developing programs to help reduce PIs and ready to work directly with our customers. We also have a system of products designed to reduce the four main contributing risk factors for PIs: pressure, shear, friction and moisture.

How does Medline incorporate this work into daily practice at partner healthcare facilities?

Monika: Medline helps audit the use of products and programs in collaboration with front-line staff and works alongside the leadership to raise awareness in facilities about the importance of skin health. We want to create partnerships to help understand healthcare facilities’ unique challenges and to bring forward solutions to help support the care that they provide.

For example, in long-term care, skin tears are a significant concern. Medline has supported evaluations and in-house studies on prevention methods that have led to a 50% reduction in skin tear occurrence.

In the absence of standardized protocols throughout Canada to treat pressure injuries, why is Medline’s work with its partners so important?

Aline: As a company, we recognize the significant impact to patients when they develop PIs. The OR is one high-risk setting. Hospitals are challenged with staffing shortages and surgical backlogs that can present barriers to prevention programs.

Through Medline’s experience in PI prevention, we support our customers in the development and implementation of robust programs customized to their patient population to help improve both the lives of patients and outcomes for facilities.

1. Zhou, F., Wu, Z., Yu, Y., & Xu, L. (2022). Establishment and Application of Pressure Injury Assessment Module in Operating Room Based on Information Management System. Journal of healthcare engineering, 2022, 1463826. https://doi.org/10.1155/2022/1463826
2. Song, Y. P., Shen, H. W., Cai, J. Y., Zha, M. L., & Chen, H. L. (2019). The relationship between pressure injury complication and mortality risk of older patients in follow-up: A systematic review and meta-analysis. International wound journal, 16(6), 1533–1544. https://org/10.1111/iwj.13243
3. Norton L, Parslow N, Johnston D, Ho C, Afalavi A, Mark M, et al. (2017). Best practice recommendations for the prevention and management of pressure injuries. In: Foundations of Best Practice for Skin and Wound Management. A supplement of Wound Care Canada. Retrieved from: www.woundscanada.ca/ docman/public/health-care-professional/bpr-workshop/172-bpr-prevention-andmanagement-of-pressure-injuries-2/file
4. Kimsey, D.B. (2019), A Change in Focus: Shifting From Treatment to Prevention of Perioperative Pressure Injuries. AORN J, 110: 379-393. https://doi.org/10.1002/aorn.12806