Development of a Tool for Pressure Ulcer Risk Assessment and Preventive Interventions in Ancillary Services Patients Monica S. Messer Abstract The incidence of nosocomial pressure ulcers has increased 70 percent in U.S. hospitals over the past 15 years despite implementation of preventive guidelines and the wide-spread use of validated risk assessment tools. Most preventive efforts have been focused primarily on patients who are bed-ridden or immobile for extended periods. What has not been well studied or identified is the risk for pressure injury to patients undergoing diagnostic procedures in hospital ancillary units where extrinsic risk factors such as high interface pressures on procedure tables and friction and shear from positioning and transport can greatly magnify the effect of patient-specific intrinsic risk factors which might not otherwise put these patients at high risk on an inpatient unit. The purpose of this study was to develop a risk assessment tool designed explicitly to quantify the combination of these intrinsic and extrinsic risk factors in individual patients undergoing ancillary services procedures, and to identify targeted preventive interventions based on the individual level of risk. Empirically and theoretically-derived risk factors for the tool were tested in a nation-wide hospital database of over 6 million patient discharge records using bivariate and multivariate analysis to identify significant predictors of pressure ulcer outcomes. The statistically significant factors emerging were then used to develop the risk assessment scale. These predictors included; advanced age, diabetes, human immunodeficiency virus infection, sepsis, and fever. The scale was tested for internal validity using the split-sample cross-validation method, and for accuracy using the area under the Receiver Operating Characteristics curve. The optimum score cut point was identified to provide a predictive accuracy of 71 percent. Interventions for the tool were identified from national clinical practice guidelines and aligned in sets based on patient levels of risk identified by the scoring portion of the tool. The entire tool was evaluated for content validity by a panel of five international nurse experts in pressure ulcer prevention and tool development. The content validity index calculated from their ratings was .91 indicating excellent agreement on content validity.

Les plaies chroniques restent un problème de santé important dans le monde. La compression de la jambe inférieure est un traitement efficace dans la prévention des maladies veineuses et lymphatiques, avec des résultats qui dépendent fortement du gradient de compression appliqué de bas en haut le long de la jambe. Un outil d'aide à la pose des bandes et au contrôle du maintien des niveaux de pressions dans le temps serait donc très utile pour améliorer l'efficacité du traitement. L'objectif de cette étude est donc de développer un "système de mesure embarqué" capable de détecter les pressions de contention et d'enregistrer automatiquement leur valeur en fonction du temps, à distance et sans fil de connexion. Ceci nécessite de mettre au point un capteur de pression souple et fin et un système électronique embarqué miniaturisé qui communiquera les valeurs mesurées à une station d'enregistrement. Ce travail a été réalisé au sein du Laboratoire de recherche et de conception (LRC) d'URGO à Chenôve du Laboratoire d'Electronique, d'Informatique et d'Images (LE2I - uMR 5158) de l'Université de Bourgogne. Il s'inscrit dans le cadre d'un projet de recherche européen associant des partenaires industriels et universitaires (CEA-Léti, Philips, Fraunhofer, etc.).Ce projet collaboratif, intitulé STELLA (STretchable ELectronic for Large area Applications) nous a permis de bénéficier de l'aide de tous nos partenaires. L'optimisation du capteur de pression représente l'avancée majeure de ce travail de thèse. En effet, le fait d'ajouter des éléments d'une certaine dureté à l'interface entre le capteur et la peau a permis d'améliorer les caractéristiques métrologiques liées à la mesure de pression en thérapie de compression. Cette réalisation a fait l'objet d'un dépôt d'une demande de brevet (FR0950147). Nos choix pour la réalisation du prototype final ont été détaillés dans ce mémoire de thèse. Ils ont été guidés par un cahier des charges fonctionnel établi en début de projet. / Chronic wounds are a major health problem worldwide.The compression of the lower leg is an effective treatment in preventing venous and lymphatic disease, with results that depend strongly on the gradient of compression applied upward along the leg. A tool for laying tape and control the maintenance of pressure levels over time would be very useful to improve the effectiveness of treatment. The objective of this study is to develop a "board measurement system" capable of detecting pressure containment and automatically record their value over time, distance and wireless electrical connection. This requires to develop a pressure sensor thin and flexible and a miniaturized electronic system to communicate the values measured at a recording station. This work was performed at the Laboratoires Recherche et Conception (LRC) of URGO Chenôve and at the Laboratoire d'Electronique d'Informatique et d'Images (LE2I - UMR 5158) of the University of Burgundy. It is part of a European research project involving partners from industry and academia (CEA - LETI, Philips, Fraunhofer, etc.). This collaborative project, called STELLA (STretchable ELectronic for Large Area Applications) enabled us to benefit from the assistance of our partners. The optimization of the pressure sensor is the major breakthrough of this thesis. Indeed, the addition of elements of a certain hardness at the interface between the sensor and the skin has improved matrological characteristics related to the measurement of pressure in compression therapy. This achievement has been the subject of an application for a patent (FR0950147). Our choices for the realization of the final prototype were detailed in this thesis. They were guided by functional requirements established at the beginning of the project.

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