226 - Prophylactic Silicone Dressing for Pressure Injury Prevention in the Operating Room

Description: Prophylactic Silicone Dressing for Pressure Injury (PI) Prevention in the Operating Room
Kathryn Asadoorian MSN, RN, CNOR; Windell Cadelina, MPA, BSN, CAPA

Background:
AORN e-guidelines for Pressure Injury Prevention indicate that the risk of pressure injuries increases by 33% every 30 minutes after 4 hours and is higher in specialties such as cardiovascular and orthopedic surgeries with a prevalence of 38% among these surgical patients. Surgeries lasting longer than 3 hours significantly increase the risk, and AORN e-guidelines recommend preoperative risk assessment and consideration of surgery times greater than 2 hours as part of risk stratification. Evidence shows that silicone dressings are effective in pressure injury prevention in the OR. Yet, it is unclear if nurses working in perioperative services have gaps in knowledge or barriers to implementing silicone dressings.

Purpose:
The purpose of this EBP project was to 1) assess perceived barriers and staff readiness to implement prophylactic silicone dressings; 2) determine changes in nurse readiness before and after a vendor-guided education in-service for silicone dressings; and 3) determine if there is a reduction in postoperative pressure injuries in the 3 months following the education intervention.

Design:
Pre-/Post Intervention

Methods:
We surveyed a sample of nurses, PCTs, and CNAs in perioperative services (n=18) working in Preop, OR, and Recovery Units. We partnered with silicone dressing vendor Molnlycke to provide an educational in-service to all staff. The in-service included dressing application training and a guideline-based resource guide for patient positioning. Based on the survey, we made the prophylactic pressure dressings more accessible to staff by placing them in each OR.

Results:
Almost 95% of survey respondents were RNs, and 5% were ancillary staff. Prior to the educational in-service, 67% of respondents reported barriers preventing the use of prophylactic silicone dressings. The most frequent barriers included time constraints (61.1%), location/hard to find (61.1%), lack of education (33.3%), and lack of knowledge about appropriate dressing (33.3%). In the 6 months prior to in-service (October 2024-March 2025), there were 2 pressure related redness/skin injuries. In the 3 months after in-service (April 2025-June 2025), there were no redness/skin injuries.

Conclusions:
By partnering with prophylactic pressure injury dressing vendors, education in-services offered effective learning opportunities to fill gaps in nursing staff knowledge and increased readiness and adoption of evidence-based prophylactic pressure injury dressings. By placing a dedicated supply of dressings in each Operating Room, we reduced the perceived barrier of not having such supplies easily accessible when preparing patient for positioning. Staff will be surveyed again for knowledge and adoption of prophylactic dressings, and ongoing in-services will be planned to reinforce information. OR nurses, with Molnlycke, are developing a resource poster reviewing the appropriate dressing recommendations for each surgical position and for various pressure points susceptible to skin injuries. Reporting of skin injuries to staff will be included as part of quality improvement within the department.