clinical digest

regarding IC practice, including eight items related to catheter selection in four case scenarios. Participants completed the questionnaire online after viewing a written explanation of the survey’s purpose, and completion of the questionnaire acted as consent to study participation.

All respondents indicated that they regularly taught IC within their practice, and 61.2% (n=210) stated that they were confident that 70% or more of patients or caregivers understood the instructions. However, responses varied considerably when asked about who was involved in IC education, with less than half (48.1%; n=165) responding that they included a lay caregiver or family member when teaching a patient to perform IC. Responses also varied when asked about catheter selection in four clinical scenarios, with 9.0–20.9% selecting inappropriate catheters. The vast majority (99.1%; n=340) indicated single catheter use, whereas 0.9% (n=3) indicated catheter cleaning and reuse. Respondents indicated awareness of various catheter designs, including uncoated, coated, hydrophilic and gelcoated catheters, as well as catheters of various lengths with various types of tips. The strongest consensus among nurses (99.1%) was related to teaching patients and caregivers to use single-use catheters versus reusable catheters that required cleaning between insertions. Similarly, responses varied when asked about the use of resources to guide IC practice, with 25.4% (n=87) indicating that they relied on their own best practice. Respondents indicated a variety of sources used to guide IC practice, including guidelines from the Society of Urologic Nurses and Associates, Centers for Disease Control and Prevention, American Urological Association, American Nurses Association and Association for Professionals in Infection Control and Epidemiology.

The findings showed considerable variability across the areas explored, indicating the need for additional research and evidence and consensusbased resources such as clinical guidelines of a decision-making algorithm, are needed.

Avoidable and unavoidable pressure injuries among residents living in nursing homes: a retrospective study Palese A, Zammattio E, Zuttion R et al. J Wound Ostomy Continence Nurs. 2020;47(3):230–235. https://doi.org/10.1097/WON.0000000000000643

Pressure injuries (PIs) remain a major concern for care providers in most healthcare settings. Palese et al (2020) stated that the incidence of PIs in longterm settings, defined as the number of new residents who develop a PI within a specific period of time after admission, has been reported to range from 2–23%.

In 2009, the Wound, Ostomy and Continence Nurses Society developed a position statement on avoidable pressure injuries (APIs) and unavoidable pressure injuries (UPIs). UPIs are defined as PIs that may occur in any setting in patients receiving the best preventive practices provided by healthcare professionals or lay caregivers as recommended by up-to-date evidence-based guidelines. According to the available evidence, PIs can be judged as ‘avoidable’ or ‘unavoidable’ only after their emergence, when the processes of care are critically evaluated.

The purpose of this retrospective study was to describe the prevalence of UPIs in residents of nursing homes and the characteristics of residents associated with UPIs living in the Friuli Venezia Giulia region of Italy. The study included residents aged 65 years or older residing in any of the 105 nursing homes in the region between January and December 2013. To be included in the study, each resident was required to have at least one multidimensional Val.Graf assessment recorded in the clinical record. The Val.Graf is a multidimensional assessment instrument that evaluates functional status (instrumental and daily activities), cognition (decline, aggressiveness and mood such as depression), social status (relationships with relatives and staff and social inadequacy), clinical problems and need for surveillance (pain, medication, hemodynamic instability and terminal illness), and interventions (blood transfusion, long-term oxygen therapy and artificial nutrition). The assessment is performed on all nursing home admissions, every 6 months, and on readmission if a resident has been transferred back to the nursing home from the hospital.

The study reviewed data from 7950 residents, 925 (11.6%) of whom had one or more documented PIs. Among these, 221 (23.9%) residents met the criteria for APIs and 704 (76.1%) for UPIs. The average age of residents with a PI was higher (mean=85.94 years; range: 85.32–86.56 years) compared to those without a PI (mean=84.91 years; range: 84.70–85.12 years; P=0.002). Females were more likely to have a PI (85.2%, n=5,984 vs 72.4%, n=670 in males; P<0.001). Residents with UPIs were more frequently hemodynamically unstable, terminally ill and had medical devices (all P<0.001) than residents with APIs. Moreover, residents with UPIs showed higher functional, cognitive and mood impairments compared to residents with APIs (all P<0.001).

Palese et al (2020) stated that the study found an overall prevalence of pressure injuries (PIs) of 11.6%, a rate similar to previous retrospective studies conducted in Canada (range, 2.4–28%), the US (11%) and Swedish residential care settings (12%).

The retrospective study findings suggested a high prevalence of UPIs compared to APIs among residents residing in nursing homes in one region of Italy. Additional research is needed to establish the prevalence of UPIs among nursing home residents country-wide, as well as to determine specific criteria that identify UPIs in long-term care settings and increase consistency in prevalence and incidence measurement models. GN