National Pressure Injury Advisory Panel (NPIAP) releases position paper regarding pressure injuries during COVID-19 pandemic

On June 22, 2020, the National Pressure Injury Advisory Panel (NPIAP) released a position paper regarding pressure injuries during the COVID-19 pandemic.

According to the NPIAP, the mere diagnosis of COVID-19 does not make a pressure injury inevitable or unavoidable. However, the NPIAP took the following positions on the development of pressure injury during COVID-19 crisis situations:

  1. Before any decision is made about the avoidability or unavoidability of a pressure injury that developed during the COVID-19 crisis, all factors should be considered on a case-by-case basis, including both the intrinsic issues in the critically ill patient and the extrinsic issues in the health care facility at the time of the injury.
  1. Before labeling purpuric skin manifestations in COVID-19 patients, consider that the skin manifestations of COVID-19 may mimic the appearance of pressure injuries and should be considered in the differential diagnosis.
  1. Areas of skin discoloration or tissue injury on non-loaded anatomic locations (i.e. no history of pressure and/or shear stress, no use of a medical device) are most likely not pressure injuries.
  1. When pressure injuries occur on anatomical locations likely subjected to pressure and/or shear stress in patients with COVID-19, the pressure injury may be unavoidable IF:
    1. Microvascular occlusions from COVID-19 increased the magnitude and severity of non-modifiable risk to a level that preventive interventions were not able to be overcome despite reasonable efforts at prevention;
    2. Multiorgan dysfunction issues from critical illness ultimately affected the skin’s normal abilities to protect the body and remain resilient to injuries and trauma including pressure injuries; and,
    3. All reasonable efforts to provide evidence-based preventive care were attempted within the context of a health care system determined to be at crisis capacity.

NPAIP stated that “It is imperative that we prepare for future pandemics with adequate supplies of functioning equipment, supply chain management to ensure timely and appropriate distribution of supplies and pressure injury prevention protocols designed to be effective in crisis situations.”