Surveillance for Pressure Injuries upon admission to Inpatient Rehabilitation HOSPITALS during the COVID-19 Pandemic

Kendall, Jamila A.; Haberl, Jack K.; Hartsgrove, Caitlin; Murphy, Lauren F.; DeLuca, Robert; Diaz-Segarra, Nicole; Kirshblum, Steven C.

OBJECTIVE: : To determine if the incidence of pressure injuries (PIs) upon admission to an inpatient rehabilitation hospital (IRH) system of care was increased during the early COVID-19 pandemic period. DESIGN: : Retrospective survey chart review of consecutive cohorts. Admissions to four acute IRHs within one system of care over the first consecutive 6-week period of admitting COVID-19 positive patients during the initial peak of the COVID-19 pandemic, April 1 to May 9, 2020. A comparison was made with the pre-COVID-19 period of 2020, January 1 to February 19, 2020. SETTING: : Four acute IRHs with admissions on a referral basis from acute care hospitals. PARTICIPANTS: : A consecutive sample of pre-COVID-19 admissions (n = 768) and COVID-19 period admissions (n = 357); including persons who were COVID positive (n = 161) and COVID negative (n = 196). MAIN OUTCOME MEASURE(S): : Incidence of PIs on admission to IRH. RESULTS: : Prevalence of PIs on admission during the COVID-19 pandemic was increased when compared to the pre-COVID-19 period by 14.9% (p < 0.001). There was no difference in the prevalence of PIs in the COVID-19 period between patients who were COVID-19 positive and COVID-19 negative (35.4% to 35.7%). The severity of PIs, measured by the wound stage of the most severe PI the patient present with, worsened during the COVID-19 period in comparison to pre-COVID-19 (chi-squared 32.04%, p < 0.001). The length of stay in the acute care hospital prior to transfer to the IRH during COVID-19 was greater than in pre-COVID-19 by 10.9 % (p < 0.001). CONCLUSIONS: : During the early part of the COVID-19 pandemic timeframe, there was an increase in the prevalence and severity of PIs noted on admission to our IRHs. This may represent the significant burden placed on the health care system by the pandemic, affecting all patients regardless of COVID-19 status. This information is important to help all facilities remain vigilant to prevent PIs as the pandemic continues, and potential future pandemics that place strain on medical resources.