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A hospital-acquired pressure injury (HAPI) is a localized injury to the skin and/or underlying tissue during an inpatient hospital stay and is associated with longer hospital stays and increased morbidity and mortality. It is the result of pressure, shear, or both, and is additionally a result of other factors such as advanced age, immobility, perfusion, nutritional status, illness severity, and the presence of diabetes (Rondinelli et al., 2018).

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Why is the prevention of HAPIs important?

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Why is the prevention of HAPIs important?

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HAPIs are clinically relevant and preventable with many patients throughout the hospital and are also identified as a quality indicator in the National Database of Nursing Quality Indicators (Henry, 2019). HAPIs are also very costly and a study suggested that a HAPI could cost a patient $10,708 on average, which then would cost the United States approximately $26.8 billion annually based on 2.5 million reported cases (Padula & Delarmente, 2019).

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Clay tablet describing medical measures. Mesopotamians treating/healing a patient. 

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Wound care and healing have basically been around since humankind first began. A clay tablet from 2200 BC describes the “three healing gestures”—washing the wounds, making the plasters, and bandaging the wound" (Shah, 2011). Many cultures and countries used different products to promote wound healing such as mud, plant, and herb plasters, oils, beer, honey, grease, lint, wine, vinegar, and water.

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Jean-Martin Charcot discovered and coined the classification of bedsores (Levine, 2019). He classified bedsores into three categories: decubitus acutus, chronicus, and ominosus.

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Body Casts in WWII: A Historical Perspective on Medical Device Related Pressure Ulcers | Jeffrey M Levine, MD

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There was an uptick in interest in defining a staging process for pressure injuries in the mid-1900s with World War II and the soldiers that died due to paraplegia and spinal cord injuries. In 1975, Dr. J. Darrell Shea proposed a 4-grade pressure injury staging system which is still in use today. Shea's staging system was adopted by the National Pressure Ulcer Advisory Panel (NPUAP) in 1989 (Levine, 2019).

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NPIAP Pressure Injury Staging Illustrations

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Dr. Shea's staging system was published in clinical practice guidelines in 1992. The NPUAP, now known as The National Pressure Injury Advisory Panel (NPIAP) is currently in control of defining and updating pressure injury stages and terms. 2016 was the year of their most recent update to the definition and terms of pressure injuries. A portion of their new definition of a pressure injury is “localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device” (National Pressure Injury Advisory Panel, 2019).