Hypochlorous acid (HOCl) is endogenously produced by neutrophils, macrophages, and other cells of the innate immune system and acts as a natural antiseptic. The active components are chlorine and reactive oxygen species in the form of a weak acid. It can be manufactured by electrolysis or chemical acidification of sodium or calcium hypochlorite, producing a mixed solution of HOCl and hypochlorite ions (OCl - ) in equilibrium. The ratios of HOCl to OCl - within the solutions vary depending upon the manufacturing process and method used for stabilization. These ratios can change over time, and maintaining pH and storage conditions is essential to ensure a long shelf life. Hypochlorous acid solution has become favorable as an alternative skin preparation and skin care in aesthetics and dermatology. This review will examine the manufacture, toxicity, and efficacy of HOCl used in skin preparation and other areas of use in health care.
OBJECTIVE:Hard-to-heal wounds affect 1% to 2% of the population in resource-rich countries, with increasing incidence due to aging and comorbidities such as diabetes. Copper oxide-impregnated wound dressings promote wound healing, including among hard-to-heal, noninfected, stagnated wounds. This study sought to assess the effects of copper oxide-impregnated dressings on oxygen saturation levels in wounds and surrounding skin using hyperspectral imaging. METHODS:A prospective case series involving 15 patients with chronic wounds was conducted across 2 hospitals. Hyperspectral imaging measured superficial (stO2) and deep (near-infrared) tissue oxygenation pre- and postapplication of copper dressings. RESULTS:Superficial oxygen saturation increased significantly in 75% of wounds (stO2 mean change: 53.0% to 56.9%; P<.05). In the focal center of the wounds, the increase of stO2 was even higher (stO2 mean change: 51.6% to 60.0%; P<.05). Deep tissue oxygenation improved in 50% of cases. CONCLUSIONS:Copper oxide-impregnated dressings significantly increased wound oxygenation, suggesting a potential mechanism for enhanced healing in hard-to-heal wounds. Further research is warranted to optimize protocols and confirm findings.
OBJECTIVE:This study compared an innovative closed-incision negative pressure wound therapy (ciNPWT) system with the leading control system in healthy volunteers simulating recovery from total knee arthroplasty. The new system combines a single-use NPWT device with an incisional dressing designed to reduce skin irritation and blistering. Outcomes included dressing survivability, skin irritation, discomfort, and nuisance. METHODS:Healthy volunteers aged 40 to 80 were recruited. After surgical skin preparation, each participant had one knee randomized to the evaluated system and the other to the control system. Participants wore both systems for up to 7 days unless an adverse event occurred. Discomfort and tolerance were rated daily on a 10cm Visual Analog Scale, and a blinded clinician assessed skin irritation at dressing removal using a standardized scale. RESULTS:Sixteen healthy volunteers participated. Dressing survivability did not differ significantly between systems (P = .081). The evaluated system produced lower skin irritation scores than the control system (P = .015; 95% CI, -5 to -1). Continuous ordinal regression showed lower discomfort with the evaluated system on days 5 to 7 and lower nuisance on day 7. CONCLUSIONS:The ciNPWT system provided similar dressing survivability while reducing adverse skin reactions.
OBJECTIVE:This quality improvement (QI) project evaluated the effectiveness of a structured, nurse-driven incontinence-associated dermatitis (IAD) prevention system in reducing IAD incidence and severity and improving nursing staff knowledge and caregiver adherence in a general surgery ward. METHODS:A pre-post QI project was conducted in the general surgery ward of a tertiary hospital. The intervention included systematic identification of high-risk patients, standardized preventive nursing protocols, nurse training, and caregiver education. Outcomes assessed before and after implementation included IAD incidence and severity among high-risk patients, nursing staff knowledge, caregiver compliance with preventive measures, and incontinence-related pressure injuries. RESULTS:At baseline, 110 patients were assessed, including 11 high-risk patients, of whom 3 developed IAD (27.3%). After implementation, 122 patients were assessed, including 16 high-risk patients, with 1 case of IAD (6.3%), an absolute reduction of 21.0%. Grade 2 IAD decreased from 9.1% to 0%. Nursing staff knowledge increased from 66.7% to 94.1%, and caregiver compliance improved from 46.7% to 87.5%. No incontinence-related pressure injuries occurred during the intervention period (baseline incidence: 1.34%). All outcomes met or exceeded predefined QI targets. CONCLUSIONS:A structured, nurse-driven QI system implemented in a general surgery ward was associated with reduced IAD incidence and severity and improved nursing practice and caregiver adherence, supporting the value of risk-based, standardized prevention strategies in general surgery settings.
OBJECTIVE:This study prospectively aimed to evaluate the validity and reliability of the Turkish language version of the Intensive Care Unit-Specific Pressure Injury Risk Assessment Scale (RAPS-ICU), designed to assess pressure injury (PI) risk among critically ill patients in intensive care units (ICU). METHODS:This methodological study was conducted with 39 patients hospitalized in ICUs in a university hospital in Turkey. The original scale was translated into the Turkish language using a standardized forward-backward translation process. Subsequently, its content and construct validity were assessed. Construct validity was assessed using confirmatory factor analysis (CFA) and further supported by correlations with the Norton and Braden Risk Assessment Scales. Internal consistency was evaluated with Cronbach α. RESULTS:The content validity index of the RAPS-ICU was found to be between 0.9 and 1.0. The analysis showed that the scale comprised 6 items. According to the confirmatory factor analysis (CFA) results [χ2/degrees of freedom ratio (χ2/df) = 1.904, Non-Normed Fit Index (NNFI) = 0.96, root mean square error of approximation (RMSEA) = 0.050, root mean square residual (RMR) = 0.057, Comparative Fit Index (CFI) = 0.99, Goodness-of-Fit Index (GFI) = 0.92], the model demonstrated a good fit. The scale's Cronbach α coefficient was calculated as 0.85, indicating high internal consistency. In addition, based on the parallel-forms reliability method, a significant positive correlation (P <.01) was found between the RAPS-ICU and the other risk assessment scales, supporting its reliability. CONCLUSIONS:The Turkish language version of the RAPS-ICU is a valid and reliable measurement tool that can be used to assess the risk of PIs among patients in the ICU.
OBJECTIVE: To investigate the incidence of community-acquired pressure injuries (PIs) and factors influencing their frequent occurrence (ie, 2 or more PIs after discharge) among community-dwelling individuals with spinal cord injury in China. METHODS: This retrospective study included a convenience sample of 302 community-dwelling individuals with either traumatic or nontraumatic spinal cord injury. Univariate analysis and logistic regression analysis were performed to identify factors influencing the frequent occurrence of community-acquired PI (CAPI). RESULTS: Of the sample, 34.11% had a CAPI. Independent risk factors for CAPI included complete spinal cord injury, >2 years duration since injury, low serum albumin or total protein levels before discharge, high fasting blood glucose before discharge, and the occurrence of PI during hospitalization. Independent protective factors for CAPI included having at least a senior middle school education, reporting often or always alleviating local skin pressure when sitting, and average duration of each skin pressure relief exceeding 15 seconds when sitting. CONCLUSIONS: The incidence of CAPI among individuals with spinal cord injury in China was high. It is vital that health care professionals evaluate CAPI risk for CAPI community-dwelling individuals, determine patients’ skin self-management level, and provide long-term follow-up and care after discharge.
OBJECTIVE: Surgical site infection (SSI) after cranial surgery is a serious complication with high morbidity and mortality. This study sought to evaluate the relationship between an alternative scalp closure technique for craniotomy after tumor resection and SSIs. METHODS: The authors retrospectively reviewed patients who underwent craniotomy for tumor resection between January 1, 2020, and June 10, 2023. After clinical and demographic data were collected, patients were dichotomized by suture closure technique, and SSI and wound dehiscence incidence were evaluated. RESULTS: A total of 285 patients were identified for study inclusion, with 58 in the experimental cohort. The experimental cohort had higher rates of preoperative chemotherapy, current smoking, low albumin, and revision procedures. There were no significant differences in treatment outcomes (wound washout, SSI, dehiscence, or oversewing) individually or collectively. Multivariate models did not demonstrate any differences. CONCLUSIONS: Although the present study did not statistically demonstrate an advantage to this novel closure technique, patients within the experimental group had a greater number of risk factors for infection, with no significant differences between groups for wound dehiscence, washout, or SSI. This is likely due to low adverse events, nonrandomization, and group heterogeneity. Future studies are needed to fully determine the significance of suture technique on cranial SSI.
OBJECTIVE: To explore the lived experiences of patients with chronic wounds from a remote Indigenous community in Northern Manitoba, Canada, focusing on challenges in wound management, the impact on quality of life, barriers to wound care access, and the role of traditional healing practices. METHODS: A qualitative descriptive study was co-created with members of the Nisichawayasihk Cree Nation (NCN) and conducted in alignment with OCAP (Ownership, Control, Access, and Possession) principles. Fifteen participants with current or past chronic wounds participated in semi-structured, in-person interviews at the NCN Family and Community Wellness Centre in June 2024. Interviews were audio-recorded, transcribed verbatim, and analyzed inductively using NVivo to identify key thematic domains. RESULTS: Five thematic domains emerged: (1) access to health care—limited local services, long wait times, and substantial travel and financial burden to obtain specialty care; (2) inadequate wound care—inconsistent follow-up and reliance on self-management at home; (3) patient education—focused largely on diabetes control with little wound-specific guidance; (4) living with pain—persistent pain limiting mobility, sleep, and emotional well-being; and (5) traditional Indigenous medicine—frequent use of culturally rooted treatments, though often not acknowledged or integrated by Western providers. CONCLUSIONS: Indigenous patients experience major barriers to timely, effective wound care, driven by geographic isolation, fragmented services, and gaps in patient education. Integrating traditional healing with Western practice, strengthening community-based care pathways, and improving specialist access may support limb preservation, reduce preventable amputation, and enhance quality of life.
GENERAL PURPOSE:To present the latest evidence published in 2025 regarding pressure injury (PI) risk factors, classification strategies, social consequences, and evidence-based management. TARGET AUDIENCE:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES:After participating in this educational activity, the participant will: Identify patient-specific risk factors associated with the development of PIs and the associated consequences of PI occurrence.Differentiate between hospital-acquired PIs and community-acquired PIs based on current expert recommendations and classification criteria.Apply current evidence-based management strategies for the treatment of PIs.
OBJECTIVE: To determine the prevalence of pressure injuries (PIs) in intensive care units (ICUs). METHODS: This descriptive point prevalence study was conducted in 43 adult ICUs of the General Hospital, Cardiovascular Hospital, Orthopedics and Neurology Hospital, and Oncology Hospital of the City Hospital in Turkey. The study population consisted of 705 patients who were hospitalized in the adult ICUs of the City Hospital on May 2, 2024; of those, 632 patients agreed to participate. Data were collected using a patient information form and the Braden Risk Assessment Scale. RESULTS: Overall, 45.1% of the patients were at high risk for PI, 28.8% had a PI, and 12.9% had a PI originating from an external center. The prevalence of PI in this population was 12.8%. Pressure injuries occurred most frequently in the sacral region (38.8%) and the most frequent staging was stage 2 (34.5%). The Braden Risk Assessment Scale was used in 100% of patients. CONCLUSIONS: Pressure injuries represent system-level issues. Sustainable prevention requires strengthened education, improved nurse-to-patient ratios, reduced workload, and enhanced holistic care practices alongside ongoing training efforts within intensive care settings.
OBJECTIVE: To evaluate the usability of RemindMe, a tablet-based application designed to assist informal caregivers in repositioning patients with or at risk of pressure injuries during hospitalization. METHODS: This cross-sectional study was conducted in a single acute-tertiary care hospital. Informal caregivers, including family members or foreign domestic helpers of patients with limited mobility, were recruited. Caregivers received a tablet equipped with the RemindMe application, which provided 2-hourly repositioning reminders from 8:00 am to 8:00 pm for up to 4 days. The app featured an audible alarm to signal repositioning times and a pictorial guide highlighting high-risk pressure areas. Utilization information was collected from the app’s log report. Caregivers’ feedback on the app’s usefulness and ease of use on a Likert scale, and suggestions for improvements were gathered via an open-ended survey and analyzed using content analysis. RESULTS: A total of 40 informal caregivers were recruited, with 1 dropout. Of the 39 remaining, 37 (93%) were foreign domestic helpers. The mean age was 38 years (SD=9.3). The app utilization rate was 16.7% to 61.1%. Twelve caregivers (30%) found the RemindMe app extremely useful, and 14 (35%) found it easy to use. All caregivers found the pictorial guide clear and easy to follow. Suggestions included adding educational content on bed exercises, oral suctioning, tracheostomy, and catheter care. Two caregivers recommended a larger screen and multilingual support. CONCLUSIONS: The RemindMe app was well received by caregivers of patients with limited mobility, who found it useful and easy to use. Adding educational content, multilingual support, and larger screen options may enhance usability and engagement.
OBJECTIVE:This study aimed to determine the incidence of and risk factors for device-related pressure injuries (PIs) in prolonged surgeries. METHODS:A descriptive, prospective, single-center study was conducted in a hospital in Istanbul, Turkey, between June and September 2023. The study included 367 adults who underwent elective surgery with an operative time of 3 hours or longer. Data were collected via a patient information form, the Braden Scale, and the 3S Intraoperative Risk Assessment Scale (3S Intraoperative RAS). RESULTS:The patients in the study had a mean age of 47 years, 64% were women, and 28.9% underwent plastic surgery. The median operative time was 250 minutes, and the median number of intraoperative medical devices used was 13. Device-related PIs were observed in 30% of the patients (n=110), and 98.8% of the PIs were classified as stage 1. The factors associated with a significantly greater incidence of device-related PI were age older than 48 years ( P =.001), body mass index ≥25 kg/m 2 ( P =.036), position change after anesthesia induction ( P <.001), skin abnormalities ( P =.033), operative time ≥250 minutes ( P =.012), intraoperative bleeding ≥150 mL ( P =.012), and ≥13 intraoperative medical devices ( P <.001). CONCLUSIONS:Patient and surgical factors are important in the development of device-related PIs during long surgeries. The use of risk assessment tools that include surgical risk factors and evidence-based PI prevention interventions for the medical devices used in surgery is recommended.
OBJECTIVE:Premature infants are understudied in relation to pressure injury (PI) development. Prevention of PIs relies on understanding PI risk factors. Research was conducted to determine PI risk factors for premature infants aged 24 to 37 weeks' gestation. METHODS:A retrospective, observational, correlational study was conducted that included 799 PIs that developed in hospitalized pediatric patients between April 2017 and February 2020. This study included 108 premature infants who developed 130 PIs. Adult and pediatric PI risk factors were utilized for a stepwise multivariate logistic regression model. RESULTS:Analysis revealed that 30 (23%) full-thickness and 100 (77%) partial-thickness PIs were present. Nine (7%) immobility-related PIs and 121 (93%) medical device-related PIs (MDRPI) were noted. Two logistic regression models were performed: full-thickness versus partial-thickness and immobility-related PI versus MDRPIs. The results of the full-thickness versus partial-thickness PIs analysis noted that generalized edema was statistically significant (P = .033; 95% CI, 1.793 to 10.097). The analysis for immobility-related PI versus MDRPI noted significance for low hemoglobin (P = .006; 95% CI, 2.346 to 167.585) and generalized edema (P < .001; 95% CI, 3.542 to 68.320). Length of stay (LOS) was significant for the development of MDRPI: LOS [F = 3.183; t = -.2.669 (df = 128); P = .009; mean difference, -.390; SE, .146; 95% CI, -0.679 to 0.101]. CONCLUSIONS:Pressure injury risk factors for premature infants differ from adult risk factors. Prevention measures should be tailored to risk factors while understanding that 93% of PIs in premature infants are medical device-related. Pressure injury prevention measures should focus on medical devices. GENERAL PURPOSE:To understand risk factors of pressure injury (PI) development in premature infants. TARGET AUDIENCE:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES:After participating in this educational activity, the participant will: Evaluate limitations and evidence gaps in the current literature on PI risk factors and prevention strategies in premature infants.Analyze the research methods and study findings used to identify risk factors associated with the development of PIs in premature infants.Apply study findings related to PI incidence and associated risk factors to inform PI prevention strategies in premature infants.
