Bioengineering: The Missing Link in Pressure Injury Prevention

bioengineering and pressure ulcer prevention

The war on pressure injuries may be in the verge of gaining a powerful new ally.

The world of biomedical engineering is ready to deploy its considerable power and creativity to solve one of the most pervasive problems medical facilities face - pressure injuries caused by medical devices.

According to Amit Gefen, Professor in Biomedical Engineering at Tel Aviv University, as much as one-third to one-half of all pressure injuries in hospitals and acute care centers are caused by medical devices. The true rate is typically greater than formally reported due to liability issue, and is as high in pediatrics as well. These pressure injuries could be due to oxygen masks, ventilation and feeding tubes, pulse oximeters or other devices directly touching the patient’s skin.

Medical equipment is rarely, if ever, designed with any consideration for the risk of pressure injuries. In intensive care units, the hectic pace of treatment and the priority on saving lives and supporting vital organ function makes it difficult for medical personnel to keep track of the potentially extended exposure patients have to equipment that apply forces on their body.

"These environments create high risks," Dr. Gefen comments, "especially for patients who can't feel the problem, such as those under anesthesia, those who are unconscious, or for those who are unable to report the problem because they have trouble communicating."

In addition, many of the devices used in the hospital setting are so routine, it is easy for personnel to forget about them or not consider the mechanical forces that they deliver to tissues, causing extended exposure and increased risk. Devices, wrappers, cups or tubes and other small pieces of equipment related to packaging or use of consumables can end up accidently left behind after a procedure while still in contact with the patient, sometimes forgotten under a patient’s body.

According to Dr. Gefen, the time is ripe for bioengineering solutions to help make devices more suitable for those at high risk of pressure injury as well as minimize the likelihood for such accidents.

Bioengineering to the Rescue

Dr. Gefen very recently presented his ideas on how engineering can help reduce the problem at 15th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering (CMBBE) and the 3rd Conference on Imaging and Visualization, Instituto Superior Técnico Lisbon in Lisbon, Portugal in March of 2018.

He presented two primary ways bioengineering can help lower the rate of pressure injuries that result in medical devices.

1. Design

The brilliance of bioengineering empowers us to revisit the engineering and design of the medical devices which often cause pressure injuries. Materials used in many ICUs could potentially be made of substances and textiles that are less likely to cause friction and shear. Better engineering concepts and design can minimize mechanical loads on and within tissues.

There are also opportunities to add nearly imperceptible ‘smart sensors’ that will alert and remind medical personnel that devices are in contact with skin, and for how long.

2. Education

Engineers need hard data in order to better design medical devices that will significantly reduce the risk of pressure injuries. That data can be obtained through computer simulations which allow the scientific community to examine the interaction between the tissue and the device, both objectively and quantitatively.

The simulations serve a dual purpose: they allow researchers to try out different (virtual) designs to see which work best without the need for extensive, costly clinical trials, and they also provide a visual model for how the devices biomechanically interact with the skin and deeper tissues.

These visualizations can also be utilized as high-quality educational tools which help clinicians understand how devices transfer mechanical loads such as pressure and shear to the body, which is the beginning of the process that results in a pressure injury. The ability to visualize precisely how a mechanical load is transferred to and within the tissue structures informs clinicians of the potential consequences of use of a medical device or of accidentally leaving a piece of equipment under the body in a clinical setting. Illustration is much more powerful than simply issuing procedure or instruction; it’s critical to demonstrate the “why” behind the instructions, which motivates the medical staff to act upon the recommendations and increases their awareness to the problem and risks.

Investing in Change Can Save Big Money

Pressure injuries impose life-endangering conditions, can be extremely painful for patients and deeply undercut their quality of life. They are also expensive to treat, requiring many hours of hands-on medical service over periods that can extend for months, or even longer.

Facility-acquired pressure injuries can also cause significant losses in litigation; when the courts believe that medical equipment applied by a facility was directly responsible for causing a pressure injury, lawsuits can prevail, costing the medical establishment multi-millions that could have been spent on medical care, research and education for prevention.

An oxygen mask which caused a pressure injury to the bridge of the nose, cheeks or chin, for example, can leave a lifelong facial scar, and a hospital can be held accountable, Dr. Gefen stated.

He noted that direct damages (not including legal fees) that are awarded by courts in the event of a PI average approximately $200K per case in cases of settlements, according to US data. "At any given time, there are 17,000 open lawsuits in connection with facility-acquired pressure injuries," he commented. "You multiply 17,000 by $200K and you're looking at an unbelievable number of billions in just pressure injury related legal damages, and just in the US.”

Accordingly, preventing device-based PIs not only saves vast amounts of money on treatment but also protects the hospital or other care facility from litigation.

The Future Will Be Engineered

Dr. Gefen has long advocated technology as a key tool to winning the war on pressure injuries. And when the enemy is so dangerous and pernicious, there is no reason to avoid using every method available in minimize and ultimately eliminate it.

Increasingly, that means applying the strength of the emerging field of bioengineering. The process, Dr. Gefen explains, begins with the acknowledgment that medical devices have not been designed to avoid or prevent pressure injuries.

"Bioengineering can come up with much better engineering concepts that minimize mechanical loads to tissues," he said, adding that any equipment that comes in contact with human skin has to be reconsidered from this perspective.

These are important opportunities created by the abundance of new technology today, and it would be tragic and neglectful not to take full advantage of them.