P28 – Development of the PRONEtect Practice Guidance Document: “Skin care considerations for the patient in the prone position” during the COVID-19/SARS-CoV-2 pandemic

3. Epidemiologi

Dimitri Beeckman1, 2, Anika Fourie2

1 Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden
2 Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium

Bakgrund: The rapid spread of COVID-19/SARS-CoV-2, resulted in an increased number of patients presenting with typical acute respiratory distress syndrome symptoms, prompting intensive care units to adopt prone positioning (PP), without necessarily having protocols and resources in place. PP is a lifesaving strategy – but with adverse consequences. Pressure ulcers (PUs) are of the most frequently observed adverse events at 34% (OR: 2.19; 95% CI: 1.55-3.09; p<0.0001; I2 0%), with incidences of anterior PUs up to 56.9%. Incidences of perioral PUs due to endotracheal tube placement are reported at 34.6%. Other threats to skin integrity in PP are moisture-associated damage related to increased secretions during PP.

Metod: A comprehensive literature review, international consultation with 11 experts (8 countries) and gap analysis study were done through November 2020. The team identified clinicians’ immediate need for a concise, simple, evidence-based guidance document to guide skin damage prevention strategies whilst the patient is in prone position.  

Resultat: The ‘PRONEtect Practice Guidance Document’ was developed, approved by the experts, and launched in December 2020. The document recommends a 3-step approach with a checklist: 1) prepare the patient (before prone manoeuvring), 2) position/reposition from supine to prone, and 3) management of the patient whilst in PP. The recommendations were translated into eight languages, including Swedish. Several hospitals have incorporated the recommendations into their own protocols.  

Slutsats: The PRONEtect document is the first tool in a planned education and training intervention pack – for an interdisciplinary team caring for the skin of critically ill patients in the prone position.