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A note on terminology: ‘pressure ulcer’, ‘pressure injury, ‘pressure sore’ or ‘bed sore’ are all commonly used terms. We use ‘pressure injury’ throughout this article to include all the above.
The need for a pre-operative skin assessment and risk assessment
The incidence of pressure injury among surgical patients was 17-22% in one study, with some studies reporting rates as high as 74.2%, and several studies in this review reporting rates in the 20–25% range for high-risk patient groups1.
Every prevented pressure injury saves a patient from unnecessary pain, extended care and potentially fatal complications.
Length of surgery and patient position can increase pressure injury risk
A key factor in assessing the risk of developing a pressure injury in the OR is the duration of the surgical procedure. Pressure may not be particularly intense at the beginning, but over time the patient’s body weight compresses the foam of the operating table surface and pressure will increase.
The patient position also matters. A procedure where the patient is prone is considered high risk as there are many potential pressure areas (face, sternum, hips, knees and front of feet).
BMI can affect a patient’s risk of pressure injury
A high or low BMI may increase the risk. A high BMI because of increased weight pressure; a low BMI because of less 'natural padding' around pressure areas.
A history of skin injuries may increase pressure injury risk
Always ask the patient about previous skin injuries and check for any existing pressure injuries. If an existing pressure injury is found, it’s important to get advice from a Wound specialist at your facility.
Summary
Quick checklist of criteria:
- Length of surgery (and position)
- BMI
- History of skin injuries
For more tips on the practical steps you can take to protect patients from pressure injuries in the OR, see our article on Practical steps for nurses.
