Incidence of hospital-acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo, Brazil

This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.