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A comparison of hospital-acquired pressure injuries in intensive care and non-intensive care units: a multifaceted quality improvement initiative
  1. Laurie Goodman1,
  2. Ekta Khemani2,3,
  3. Francis Cacao4,
  4. Jennifer Yoon1,
  5. Vanessa Burkoski5,
  6. Scott Jarrett5,
  7. Barbara Collins5,
  8. Trevor N T Hall2
  1. 1 Professional Practice, Humber River Hospital, Toronto, Ontario, Canada
  2. 2 Department of Quality and Patient Safety, Humber River Hospital, Toronto, Ontario, Canada
  3. 3 Department of Anesthesia, Niagara Health, St. Catherines, Ontario, Canada
  4. 4 Critical Care, Humber River Hospital, Toronto, Ontario, Canada
  5. 5 Senior Administration, Humber River Hospital, Toronto, Ontario, Canada
  1. Correspondence to Laurie Goodman; lgoodman{at}


Hospital-acquired pressure injuries (HAPI) are a significant cause of morbidity and mortality, and represent a major health concern worldwide. Patients suffering from HAPI report a poor quality of life on several dimensions of health. Moreover, HAPI is reported to lengthen in-hospital stay in the acute setting, posing significant healthcare resource utilisations and costs. Given the clinical and economic burden of HAPI, recent best practice guidelines provide recommendations to reduce the prevalence of pressure injuries. Humber River Hospital (HRH), a large community hospital in Toronto, Canada, has a daily census of approximately 500 patients. The aim of this project was to reduce the prevalence of HAPI within the intensive care unit (ICU) and non-ICU setting at HRH within a 1-year period. Using the International Pressure Injury/Ulcer Prevalence (IPUP) Survey we established a baseline prevalence of HAPI of 27.6% (n=315) for non-ICU and 30% for ICU (n=33) patients at our institution in 2015. Using the Plan-Do-Study-Act (PDSA) method for quality improvement, we implemented a multifaceted approach aimed at improving equipment, digital documentation and education on risk assessment, prevention and treatment strategies. Over multiple PDSA cycles, our prevalence of HAPI reduced to 16% for non-ICU patients with no changes to the HAPI prevalence in ICU patients in 2016. Sustainability continues with HAPI prevalence currently at 10% in 2017 for non-ICU patients, which outperforms the Canadian prevalence (13.7%) by census size for 2017. However, the prevalence of HAPI in the ICU increased to 45% in 2017 despite multiple quality improvement initiatives, suggesting critically ill patients represent a unique challenge for reducing HAPI for these patients at our institution.

  • pressure injury
  • hospital acquired pressure injury
  • prevalence survey
  • quality initiative
  • critical care

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  • Contributors LG planned, conducted and reported the PDSA cycles, prevalence survey, data collection, analysis, overall content and submission of the article. EK contributed to data analysis and writing of the article. FC collected data for the intensive care unit prevalence survey and assisted in writing the article. TNTH contributed to data analysis and writing of the article. JY, VB, SJ, BC provided administrative support for the prevalence survey and the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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