The prevalence, incidence, and associated factors of pressure injuries among immobile inpatients: A multicentre, cross‐sectional, exploratory descriptive study in China

Abstract

The aim of this study was to assess the prevalence, incidence, and the associated factors of pressure injuries (PIs) among immobile hospitalised patients in China. Being immobile during hospitalisation put these patients at a higher risk of PIs. There is little literature about pressure injury (PI) prevalence or PI incidence in immobile hospitalised patients in hospitals in China. This was a multicentre, cross‐sectional, exploratory descriptive study. A total of 23 985 immobile patients were recruited from 25 general hospitals in six provinces of China from November 1, 2015 to March 18, 2016. Information was collected on demographic characteristics, physical assessment information, and treatment and nursing care measures. The PI period prevalence was 3.38%, and the PI cumulative incidence was 1.23%. Most PIs (84.03%) were Stage 1 or Stage 2. A total of 48.22% of PIs occurred in the sacrum or heel region. In the multivariate analysis, the following factors were associated with higher PI prevalence: age, gender, length of immobility, type of hospital, modified Braden Scale score, urinary incontinence, faecal incontinence, low serum albumin, the usage of fixation or restraint devices, and patient's discharge diagnosis (lower limb fracture, malnutrition, and spinal cord injury). PI prevalence for immobile hospitalised patients in the study was lower than those reported in literature. However, because of the large population in China, the number of patients who suffer with PIs can be very high. The relating factors of higher PI prevalence identified in this study were consistent with current literature. Patients with a higher number of these associated factors should be monitored more closely, and preventative measures should be taken to prevent PI occurrence in high‐risk populations.

1. INTRODUCTION

Worldwide, studies conducted in recent years have shown that pressure injuries (PIs) occur frequently, with the prevalence of PIs varying from 1.58% to 16.6% among inpatients in different countries.1, 2, 3, 4, 5 PIs are a serious global health concern that can increase mortality, prolong hospital stay, reduce patients' quality of life,3, 6 increase workload for nurses,7 and increase health care cost.8, 9 Immobility put patients at a higher risk of developing PIs.3, 10 In the context of the increasing global ageing population, the incidence of chronic diseases is rising, and the number of immobile patients is consequently increasing.11, 12 It is essential to identify the specific factors associated with PIs among immobile patients. To date, most research on PIs among immobile patients has focused on specific high‐risk groups, such as patients with spinal cord injuries, the elderly, the disabled, and those admitted to intensive care units (ICUs). Little research has been published on PI prevalence and factors on the general population of immobile inpatients in hospitals. Because of discrepancies in research designs, existing studies have reported different findings for PI prevalence and risk factors.13, 14, 15, 16, 17, 18, 19 In addition, the sample sizes of published studies conducted in China were often small.10, 20 The aim of this study was to describe the prevalence, incidence, and relating factors of PIs among immobile hospitalised patients in China.

This study was part of a multicentre research project funded by the National Health Commission of the People's Republic of China. This project, which was conducted in 25 general hospitals in six different geographic regions of China (Beijing, Henan, Zhejiang, Guangdong, Hubei, and Sichuan) from November 1, 2015 to March 18, 2016, aimed to establish a standardised nursing intervention model to prevent major immobility complications (MICs) among immobile hospitalised patients. MICs refer to PIs, deep vein thrombosis, pneumonia, and urinary tract infections.

The baseline part of the project was designed as a prospective survey, carried out from the day of recruitment until all patients were observed and followed up regularly for 90 days, unless the patient died or treatment was withdrawn. In this paper, only the following data of the investigation during the hospitalisation period will be reported: the prevalence and incidence of PI and the demographic, physical, and therapeutic characteristics among immobile hospitalised patients in China and their association with PI prevalence. The aim of this paper is to answer the following research questions with a goal to inform the development of targeted PI prevention model in China: first, what is the period prevalence of PIs in hospitalised immobile patients in China? Second, what is the cumulative incidence of PI in hospitalised immobile patients in China? And third, what are the relationships between patient factors and PI prevalence?

2. METHODS

2.1. Design

This is a national multicentre, cross‐sectional, exploratory descriptive study.

2.2. Setting and sample

This multicentre study was conducted in medical and surgical inpatient wards and critical care units in 25 general public hospitals covering six different geographic locations in China. The inclusion criteria for the patient sample were adult >18 years of age and being immobile for at least the first 24 hours after admission. Reasons for being immobile include: disease‐related immobility, under sedation post‐surgery, and bed rest requirements for disease management. The exclusion criteria were being aged <18 years and suffering from two or more kinds of MICs during the first day of assessment.

2.3. Variables and data collection

The data were recorded by research assistants using an MIC electronic data capture system. A case report form (CRF) was designed to collect patient demographic data, main factors that had been reported in literature as PIs predictors, and information on PIs.

The CRF contains the following items: (a) general patient data (age, gender, height, weight, education level, discharge diagnosis recorded according to the International Classification of Diseases Version 10, type of hospital, dates of admission and discharge, discharge outcome, and length of immobility); (b) physical assessment information (modified Braden Scale score, serum albumin value, haemoglobin value, faecal incontinence, and urinary incontinence); (c) treatment and nursing care information (sedatives usage, fixation devices and restraint devices usage, surgery during the hospitalisation, the preventive measures of repositioning and pressure‐redistributing support surfaces used); and (d) evaluation of PIs on the enrolment day and regularly after being enrolled into the study (categories, locations, and occurrence time defined according to the National Pressure Ulcer Advisory Panel—European Pressure Ulcer Advisory Panel [NPUAP–EPUAP] definitions and classification system).12 The demographic data were recorded on the first day of enrolment into the study; other information was evaluated and recorded by data collectors daily during the immobile hospitalised period. Follow up on each participant concluded at either 90 days since enrolment or at hospital discharge, whichever occurred first.

2.4. Data collection procedure

To ensure the data quality, 787 registered nurses from the 25 general hospitals were appointed as data collectors, with a ratio of one data collector per 15 beds. A two‐step training programme was provided for these data collectors. At first, onsite training was provided to data collectors by the investigators, which lasted 3 hours. Topics covered included the study design, the inclusion and exclusion criteria, data collection timing and frequency, the use of the electronic system, the NPUAP–EPUAP definition and classification system for PI, and the modified Braden Scale scoring criteria. After the training, a 15‐minute quiz was administered to confirm that the data collectors understood the information given. The nurses who attended the training achieved at least 85% accuracy for the quiz. Every data collector also received a training video and handbook prepared by the project steering group. Next, a quality control procedure was followed. First, head nurses of the 256 selected units were responsible for checking the recorded data each day. Second, each hospital appointed a coordinator whose duty was to audit compliance to study protocol such as patient inclusion criteria checking. Third, through monitoring and auditing the data recorded in the electronic system, the project steering group gave feedback on errors identified by the local data collection team once per week via e‐mail and teleconference. The investigators attended two on‐site data quality control meetings at each site during the study.

2.5. Ethical considerations

Ethical clearance was given by the Chinese Academy of Medical Science and Peking Union Medical College Ethics Committees. We obtained written informed consent from all patients. For patients with impaired mental capacity to consent, consent was signed by family members. Participation in the study was voluntary, and patients were free to withdraw at any time. All data were kept confidential and processed anonymously.

2.6. Data analysis

Data were entered into and analysed using SPSS (Version 19.0). Continuous variables were summarised as means ± SD for normally distributed variables and median ± interquartile range for non‐normally distributed variables. Categorical data were synthesised using frequencies and percentages. In view of the operability of the data analysis, some variables were redefined, for example, faecal and urinary incontinence (at least recorded once), low serum albumin (low serum albumin was defined as equal to or less than 30 g/L)21 and low haemoglobin (for male, low haemoglobin was defined as equal to or less than 13.5 g/dL; for female, low haemoglobin was defined as equal to or less than 12.0 g/dL),22 sedatives usage, fixation or restraint devices usage, underwent surgery were defined as “yes”/“no” and recorded as “yes” if these things were present at least once during the period of observation. For nursing prevention measures, repositioning and the use of pressure‐redistributing support surfaces were recorded. Repositioning regime was assessed as “yes” when a pressure‐reducing mattress was used and the patient was repositioned at least every 4 hours or when patients were repositioned at least every 2 hours without the pressure‐reducing mattress. Following the EPUAP statement,23 PI period prevalence was calculated as follows: number of participants with a PI on the day of enrolment and those who developed new PIs during the study period divided by the number of all immobile patients enrolled in this study (including both with and without PI) × 100. PI cumulative incidence was calculated as: number of enrolled participants who developed new PIs since enrolment during the study period divided by the number of all participants enrolled in the study × 100. χ ² tests and the t‐test were used to compare the difference of characterisation between the PI group and the non‐PI group. A logistic regression model was used to explore the association between characteristics of immobile hospitalised patients and PI prevalence. Odds ratios (ORs), 95% confidence intervals (CIs), and corresponding P values were calculated to estimate the rate of PI prevalence. A multivariate analysis was conducted, including those significant variables in the univariate analysis (P value < 0.05).

3. RESULTS

A total of 23 985 patients were enrolled from November 1, 2015 to March 18, 2016. Patients' demographic characteristics are presented in Table 1. The mean age was 56.52 years (SD = 16.80), with a median of 58.00 years. The median immobile hospitalised period was 29.66 days (25th quartile = 3 days, 75the quartile = 11 days). In total, 810 patients were recorded as having 1516 PIs, which shows a period PI prevalence of 3.38% (calculated as 810/23985). During the length of inpatient stay, 296 participants developed new PIs, which translates to a PI cumulative incidence of 1.23% (calculated as 296/23985). The locations and stages of PIs are shown in Table 2.

Table 1.

Demographic, physical, and therapeutic information on immobile hospitalised patients (N = 23 985)

Variables		Total n	PI Group	Non‐PI Group	χ2/t(+)	P
Gender	Male	13 567 (56.56%)	511	13 056	17.634	<0.001***
	Female	10 418 (43.44%)	290	10 128
Age		56.52 ± 16.80	62.66 ± 17.59	56.31 ± 16.72	−10.55+	<0.001***
Education level	Primary school or lower	9517 (39.68%)	381	9136	24.760	<0.001***
	Middle school	6894 (28.74%)	218	6676
	High school/technical secondary school	3958 (16.5%)	111	3847
	College/university/higher	3616 (15.07%)	91	3525
Patient discharge outcome	Discharged from hospital	22 057 (91.96%)	680	21 377
	Died in hospital	325 (1.36%)	274	51
	Still in hospital when study ended	1603 (6.68%)	1533	70
Length of patient being immobile (d)	D ≥ 10	7076 (29.50%)	621	6455	919.001	0.001**
	1 ≤ D ≤ 9	16 909 (70.50%)	180	16 729
Type of hospitals	Tertiary hospital	19 450 (81.09%)	726	18 724	49.233	<0.001***
	Non‐tertiary hospital	4535 (18.91%)	75	4460
ICU stay during hospitalisation	At least 1 d or more	4612 (19.23%)	323	4289	237.451	<0.001***
	Never	19 373 (80.77%)	478	18 895
Principal medical diagnoses
Cerebrovascular disease	Yes	4484 (18.70%)	176	4308	5.86	0.018 *
	No	19 501 (81.30%)	625	18 876
Diabetes mellitus (note: missing data on 297a patients)	Yes	1782 (7.52%)	31	1751	15.649	<0.001***
	No	21 906 (92.48)	766	21 140
Hemiplegia (note: missing data on 297a patients)	Yes	106 (0.45%)	22	84	99.036	<0.001***
	No	23 582 (99.55%)	775	23 210
Lower limb fracture	Yes	1884 (7.85%)	203	1681	350.16	<0.001***
	No	22 101 (92.15%)	598	21 503
Spinal cord injury	Yes	113 (0.47%)	38	75	322.67	<0.001***
	No	23 872 (99.53%)	763	23 109
Malnutrition	Yes	23 (0.1%)	5	18	24.14	0.001**
	No	23 962 (99.90%)	796	23 166
Modified Braden scale score (note: Missing data on 297a patients)	≤19	9479 (40.02%)	561	8918	316.98	<0.001***
	≥20	14 209 (59.98%)	236	13 973
Low serum albumin (≤30 g/L)	Recorded at least once	4348 (18.13%)	413	3935	624.08	<0.001***
	Never	19 637 (81.87%)	388	129 249
Low haemoglobin (for male, ≤13.5 g/dL; for female, ≤12.0 g/dL)	Recorded at least once	1191 (4.97%)	77	1114	37.927	<0.001***
	Never	22 794 (95.03%)	724	22 070
Urinary incontinence (note: Missing data on 297a patients)	Recorded at least once	862 (3.59%)	129	733	374.36	<0.001***
	Never	23 123 (96.41%)	672	22 451
Faecal incontinence	Recorded at least once	784 (3.31%)	137	647	496.496	<0.001***
	Never	22 904 (96.69%)	660	22 244
Sedatives usea	Recorded at least once	3755 (15.85%)	259	3496	171.302	<0.001***
	Never	19 933 (84.15%)	538	19 395
Fixation/restraint devices usea	Recorded at least once	4809 (20.30%)	401	4408	459.137	<0.001***
	Never	18 879 (79.70%)	396	18 483
Underwent surgery while in hospitala	Recorded at least once	11 226 (47.39%)	370	10 856	0.309	0.302
	Never	12 759 (52.61%)	427	12 035
Repositioning regimeb (the operational definition is noted below)	Yes	20 483 (89.90%)	268	20 215	2.58	0.108
	No	2300 (10.10%)	21	2279

Repositioning regime: the answer is yes when: a pressure‐reducing mattress was used and the patient was repositioned at least every 4 hours or patients were repositioned at least every 2 hours without the pressure‐reducing mattress.

^aSome physical assessment information was not recorded on 297 patients who were recruited and discharged on the same day, and 13 patients among them belong to the PI group.

^bWe were unable to record the application of preventive nursing measures for 297 patients who were recruited and discharged on the same day and 514 patients who were defined as developing pressure injuries, and 391 patients' repositioning information was missing for unknown reasons.

^* P < 0.05

^** P < 0.01

^*** P < 0.001.

Table 2.

Locations of pressure injuries by stage

Location	Classification N (%)
	Stage 1	Stage 2	Stage 3	Stage 4	Unstageable	DTPI	All
Sacrum/coccyx	257 (16.95%)	149 (9.83%)	32 (2.11%)	6 (0.40%)	13 (0.86%)	18 (1.19%)	475 (31.33%)
Heel	180 (11.87%)	24 (1.58%)	3 (0.20%)	1 (0.07%)	7 (0.46%)	41 (2.70%)	256 (16.89%)
Ankle	99 (6.53%)	15 (0.99%)	5 (0.33%)	1 (0.07%)	2 (0.13%)	18 (1.19%)	140 (9.23%)
Hip	28 (1.85%)	38 (2.51%)	12 (0.79%)	1 (0.07%)	8 (0.53%)	3 (0.20%)	90 (5.94%)
Occiput	66 (4.35%)	14 (0.92%)	1 (0.07%)	1 (0.07%)	0	3 (0.20%)	85 (5.61%)
Other regions	256 (16.89%)	148 (9.76%)	20 (1.32%)	4 (0.26%)	7 (0.46%)	35 (2.31%)	470 (31.00%)
All	886 (58.44%)	388 (25.59%)	73 (4.82%)	14 (0.92%)	37 (2.44%)	118 (7.78%)	1516

DTPI, deep‐tissue pressure injury.

The characteristics of those with and without PIs were compared using univariate analysis (shown in Table 1). The results that showed significant differences at P < 0.05 were age, gender, education level, type of hospital, ICU stay during hospitalisation, patients' discharge diagnosis (cerebrovascular disease, diabetes mellitus, hemiplegia, lower limb fracture, spinal cord injury, and malnutrition), the length of patient being immobile, modified Braden Scale score, urinary incontinence, faecal incontinence, abnormal laboratory indexes (low albumin, low haemoglobin), sedatives usage, and fixation or restraint device usage (cast, brace, and constraint appliance).

The t‐test showed that patients of the PI group (mean age = 62.66 years, SD = 17.59) were significantly older than patients of the non‐PI group (mean age = 56.31 years, SD = 16.72). A χ ² test showed that the number of male patients with PIs was significantly higher than the number of male patients without PIs (63.80% versus 56.31%). Significantly more patients in the PI group had conditions including hemiplegia, fracture of lower limb, spinal cord injury, and malnutrition than in the non‐PI group (2.76% versus 0.36%, 25.34% versus 7.25%, 4.74% versus 0.32% and 0.62% versus 0.08%, respectively).

Comparing with the group without PIs, significantly more patients were treated in tertiary hospitals (3.73% versus 1.65%). More patients in the PI group had ICU stay during hospitalisation than those in the non‐PI group (90.64% versus 80.76%). In the group of patients who stayed in the bed for 10 days or more, 77.53% developed a PI, compared with the 27.84% of patients who stayed in bed for less than 10 days and developed a PI. Dividing patients into two groups according to the modified Braden Scale score (with 19 as the cut‐off value),24 there was a higher proportion of patients with scores of 19 or lower in the PI group than in the non‐PI group (70.39% versus 38.96%).

In the PI group, significantly more patients had underlying medical conditions than the non‐PI group, including urinary incontinence (16.10% versus 3.16%), faecal incontinence (17.19% versus 2.83%), low albumin (51.56% versus 2.95%), and low haemoglobin (9.61% versus 4.81%). Significantly more PI patients were given the sedatives than patients of non‐PI group (32.50% versus 15.27%). Patients who used the fixation or restraint devices were significantly found in the PI group more often, compared with the non‐PI group (50.31% versus 19.26%). However, there was no significant difference between the PI and non‐PI groups in terms of undergoing surgery or receiving repositioning measures. There were also no significant differences between the groups for patients with cardiovascular disease or diabetes.

The multivariate comparative analysis showed that 12 variables were significantly associated with a higher risk of PI occurrence among immobile hospitalised patients (P < 0.05): age (≥ 65 years), male, medical diagnosis (lower limb fracture, spinal cord injury, or malnutrition), length of immobility (≥10 days), type of hospital (tertiary hospital), modified Braden Scale score(≤19), low serum albumin (≤3.0 g/L), urinary incontinence, faecal incontinence, and fixation or restraint device usage (shown in Table 3).

Table 3.

Odds ratios from the multivariate logistic regression associated with PI prevalence

Variable	OR (95%CI of the PI period prevalence)	P value
Age (≥65 y)	1.42 (1.21–1.66)	<0.001
Gender (male)	0.75 (0.64–0.87)	<0.001
Length of immobility (≥10 d)	4.37 (3.48–5.49)	<0.001
Type of hospitals (tertiary hospital)	2.70 (2.09–31.52)	<0.001
Spinal cord injury	9.17 (6.18–14.05)	<0.001
Lower limb fracture	3.87 (3.17–15.27)	<0.001
Malnutrition	3.85 (1.34–11.10)	0.012
Urinary incontinence	2.53 (1.97–3.24)	<0.001
Faecal incontinence	1.64 (1.28–2.10)	<0.001
Low serum albumin (≤30 g/L)	2.16 (1.80–2.58)	<0.001
Modified Braden scale score (≤19)	2.03 (1.71–2.41)	<0.001
Fixation/restraint device use	1.47 (1.23–1.77)	<0.001
ICU stay during hospitalisation	1.22 (0.99–1.50)	0.062
Sedatives use	1.21 (1.00–1.46)	0.052
Low haemoglobin (for male, ≤13.5 g/dL; for female, ≤12.0 g/dL)	1.18 (0.89–1.57)	0.252

4. DISCUSSION

4.1. PI period prevalence and cumulative incidence

To the best of our knowledge, this was the first prospective multicentre study with such a large sample size to describe the period prevalence and the cumulative incidence of PIs among immobile hospitalised patients in China. This study reported a period PI prevalence of 3.38% (calculated as 810/23985) and a PI cumulative incidence of 1.23% (calculated as 296/23985). Most previous research has focused on a specific group of patients with restricted mobility, such as ICU patients (PI prevalence: 8.8%–39.3%; PI incidence: 1%–56%),16, 25, 26, 27, 28 patients diagnosed with spinal cord injuries (PI prevalence: 26.4%–29.7%, PI incidence: 9.6%–49.2%),14, 29, 30 or elderly individuals with a hip fracture (PI prevalence: 12%–22.7%).20, 31, 32 The prevalence and incidence found in the present study was lower than those reported in the literature. This difference may be related to significant variations in PI prevention practices across settings, and the methodologies used to collect prevalence data, which makes it impossible to compare PI prevalence.2, 29 Finally, strong research evidence reported that repositioning is an effective preventive measure for PI.1 In this study, 89.9% of immobile inpatients received regular repositioning. In contrast, an Indonesian study reported that only 74% of stroke patients in the ICU/cardiovascular care unit and neurological ward were repositioned regularly.33 In addition, a Swedish survey conducted with a sample of 7377 residents in 60 nursing homes reported that repositioning was only performed for approximately 44.3% of the residents.34 A higher percentage of patients was repositioned regularly in the present study and might have contributed to the lower PI prevalence in hospitalised patients in China.

4.2. PI stage and location

In this study, 1516 PIs were recorded. Almost half of these were Stage 1, and more than one‐third were Stage 2. It has previously been noted that there may be a lack of identification and documentation of PIs, especially at Stage 1.2 The higher percentage of Stage 1 PIs in the present study may indicate, to some extent, timely assessments and early detection of changes in skin status. Our findings contrasted with the conclusion of several previous studies that Stages 2 and 3 are the most common PI stages.3, 32

In relation to PI location, about one third (31.33%) of PIs occurred in the sacrum/coccyx area, and 16.89% occurred in the heel. The sacrum/coccyx and heel were identified in the present study as the two most common anatomical areas for PIs to appear, which is consistent with findings from the literature.2, 5, 18, 35, 36 Therefore, nurses should pay more attention to these anatomical locations when caring for immobile hospitalised patients.

4.3. Characteristics of the PI group

This study compared the characteristics of immobile hospitalised patients with and without PIs using univariate and multivariate analyses. The results showed that age, gender, length of immobility, type of hospital, modified Braden Scale score, urinary incontinence, faecal incontinence, low serum albumin, fixation or restraint device, and patients' discharge diagnosis (lower limb fracture, malnutrition or spinal cord injury) showed a significant positive association with a higher prevalence of PIs.

This study has shown that the risk of PIs was higher for people aged over 65 years than for those aged 18 to 65 years. This result was consistent with the majority of published findings, which have shown a higher risk of PI at older age.3, 32, 37, 38, 39 However, Wielen et al14 and Magny et al31 found no significant association between age and the occurrence of PIs.

In the present study, a positive association was examined between gender (male) and the prevalence of PIs in the multivariate analysis. Okuwa et al40 and Campanili et al35 also found that male immobile patients were at higher risk, compared with female immobile patients. However, some prospective cohort studies that focused on immobile patients with hip fractures or spinal cord injuries in ICU settings found no significant differences between female and male immobile patients.14, 15, 31, 37, 41

We found that PI prevalence is much higher for patients remaining immobile for 10 or more days, which suggests that more rigorous monitoring and management is needed to prevent PIs when patients remain in bed for 10 or more days or are expected to be immobile for a long time. This result is consistent with current literature which found that the length of immobility is an important predictor for PIs in immobile patients in ICUs and general wards.3, 42

The type of hospital emerged as a highly significant predictor for PI occurrence in this study, with PI prevalence being much higher among inpatients in tertiary hospitals than among those in non‐tertiary hospitals. There are several possible interpretations for this finding. The length of hospital stay is often longer, and patient acuity is often much higher in tertiary hospitals than non‐tertiary hospitals because most patients with complex or serious diseases choose to receive treatment in tertiary hospitals in China. As we discussed earlier, length of hospital stay and underlying condition are both predictors of higher PI prevalence. However, because of the differences in sample sizes between the two categories of hospitals in this study, this result should be interpreted with caution.

Our results showed that immobile hospitalised patients suffering from malnutrition, lower limb fractures, or spinal cord injuries are at risk of higher PI prevalence. Malnutrition is closely related to problems such as muscle loss and reduced mobility, which have previously been established as significant risk factors for the development of PIs.21, 26, 43 Patients with lower limb fractures or spinal cord injuries had a greater risk of PIs, which could be defined as a significant PI‐related factor in the present study. It has been found in previous studies that lower limb fractures and spinal cord injuries, which are accompanied by decreased sensation and lower mobility ability, were contributors to PIs.20, 44 Similarly, the results from this study support the findings from existing literature on predictors of PI, including urine incontinence and faecal incontinence.45, 46

The present study also found the association between the use of casts, braces, or restraint devices and significantly higher risk of PI occurrence. According to Ham44 and Black,47 patients using these devices were at a higher risk of developing PIs. One possible explanation for this finding is related to changes in the skin microclimate under such devices. Another possible explanation is that these devices restrict patient mobility and increase pressure and shear forces.44

4.4. Limitations

This study had several limitations. First, the enrolled hospitals were not chosen at random, which may influence the generalisability of the results. Second, because this study was a part of a larger project aimed to explore four kinds of common complications among immobile hospitalised patients, the sample excluded immobile patients with two or more kinds of MICs. Thus, the prevalence and incidence of PIs found in this study among immobile hospitalised patients in China might be lower than the actual rate. Third, there was a lack of documentation related to patient's history of PIs, so the relationship between PI history and the occurrence of PIs during this study could not be ascertained. Fourth, a multivariate analysis was not performed to define the independent risk characteristics of participants who developed new PIs during the length of inpatient stay in this study, which would be examined in further studies. Finally, although the use of nursing prevention measures was recorded in the study, the reliability of the data collected and compliance with using prevention guidelines were not evaluated. Therefore, we were unable to discuss the extent to which these interventions were correctly implemented. Based on these limitations, prospective research should be conducted to explore the specific risk factors, as well as nursing preventive interventions.

5. CONCLUSIONS

This was the first multicentre survey with such a large sample to describe PI prevalence and incidence among immobile hospitalised patients in China. Our finding of a period prevalence of 3.38% and cumulative incidence of 1.23% provides a baseline reference for PI prevalence in China. This study also demonstrated the specific medical conditions and underlying health issues associated with higher PI prevalence among immobile patients. These findings will inform future research and practice improvement initiatives to prevent PIs in immobile hospitalised patients. To some degree, the results from this study, consistent with what have been reported in literatures, can inform nurses in their decision‐making in using PI prevention strategies when caring for patients with these relating factors of higher PI prevalence.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to report.

Liu Y, Wu X, Ma Y, et al. The prevalence, incidence, and associated factors of pressure injuries among immobile inpatients: A multicentre, cross‐sectional, exploratory descriptive study in China. Int Wound J. 2019;16:459–466. 10.1111/iwj.13054