# Incidence and Risk Factors for Hospital-Acquired Pressure Ulcers in Patients With COVID-19

## TL;DR

This study found that patients with COVID-19 are at higher risk for hospital-acquired pressure ulcers, especially those with low albumin levels and limited independence in daily activities.

## Contribution

The study identifies specific risk factors for pressure ulcers in hospitalized patients with COVID-19, including the impact of isolation policies on care delivery.

## Key findings

- Low albumin and COVID-19 infection are independent risk factors for hospital-acquired pressure ulcers.
- In COVID-19 patients, low independence in activities of daily living is also a significant risk factor.
- Isolation policies may hinder frequent care, increasing pressure ulcer risk in high-risk patients.

## Abstract

Background: Hospital-acquired pressure ulcers (HAPU) are a major challenge in healthcare settings, especially in vulnerable populations such as patients with COVID-19. The aim of this study is to examine the association of COVID-19 infection with occurrence of HAPU, with the goal of enhancing care protocols and reducing HAPU incidence in at-risk populations.

Methods: A retrospective analysis was conducted for 8,158 hospitalized patients aged 20 years and older who were treated from April 2022 to March 2023. The study included COVID-19-positive patients and non-COVID-19 patients. Data were collected for age, sex, body mass index, total protein, albumin (ALB), hemoglobin, COVID-19 infection, and independence in activities of daily living (ADL). For patients with COVID-19, surgical history, intensive care unit admission, physical restraints, mechanical ventilation, and prone positioning therapy were also examined. Risk factors for HAPU were evaluated based on these variables.

Result: In all 8,158 patients, low ALB and COVID-19 infection were independent risk factors for HAPU. In the COVID-19 cohort (n=412), low independence in ADL was also an independent risk factor. These findings underscore the importance of targeted interventions to mitigate the occurrence of HAPU, particularly for high-risk COVID-19 patients.

Conclusion: This study showed that advanced age, low ALB, and COVID-19 infection are significant independent risk factors for HAPU. For COVID-19 patients, isolation policies may have reduced caregiver-patient interactions and hindered the delivery of frequent care, thereby increasing the risk of HAPU, particularly in patients with low ADL independence. For high-risk patients, a multidisciplinary approach is essential, with tailored PU prevention strategies implemented early to address individual needs and reduce the risk of HAPU.