NOTE: Due to the COVID-19 pandemic, and concerns for the health and safety of our attendees, sponsors and instructors, the 2020 Wipeout Wounds Tour is being rescheduled for 2021, with our first sessions scheduled for the spring. To view current dates and information on the 2021 Wipeout Wounds National Conference Tour, please click here.

Are you aware of the new pressure injury guidelines?

The National Pressure Injury Advisory Panel (NPIAP) and its partner organizations released the 2019 Clinical Practice Guideline for the prevention and treatment of pressure injuries.

The new NPIAP Guideline consists of a 409-page document. As a wound care clinician, you’ll be expected to integrate these current standards of care and pressure injury guidelines into your practice.

Donna Sardina, MHA, RN, WCC, CWCMS, DWC, OMS, co-founder of the Wound Care Education Institute (WCEI) and the Wild on Wounds (WOW) Conference, shared some highlights of the new guideline that you should know.

“The guideline includes 114 evidence-based recommendations,” she said. “These evidence-based recommendations are supported by various strengths of evidence ranging from Level A to Level C. Many areas of pressure injury prevention and treatment don’t have extensive quality research available to support them. However, they are still important in clinical practice.”

Here is an overview of some key points:

62 good practice statements

To address the existing gaps in research, the guideline groups created 62 good practice statements.

“Good practice statements in the guideline are not supported by a strong body of evidence,” Sardina said. “However, (they) are significant for clinical practice.”

Implementation and quality indicators

Sardina said there is an extended section on implementation in the NPIAP Guideline, and 20 quality indicators to assist healthcare organizations to implement and monitor strategies recommended in the document.

“The guideline has been relaxed a bit with broader, open recommendations instead of specific ‘you must do’ type of items,” she said. “The guideline is truly a tool that can be used all over the world, not just in the U.S. and U.K. Now there are recommendations for what to do in remote geographical regions that have limited access to modern wound care supplies.”

Input from patients, informal caregivers

Overall, the previous standards of care have not changed, according to Sardina.

“However, this time there is one difference — for the first time, the guidelines were developed with input from patients and informal caregivers,” she said. “Over 1,000 individuals from around the world completed online surveys to identify care goals, priorities and education needs. Their responses were used throughout the guideline to help develop recommendations.”

NPIAP Guideline on products

Product recommendations are more generalized, said Sardina, yet there are a couple of new categories to consider:

  • Sub-epidermal moisture/edema measurement device as an adjunct to routine clinical assessment: Sardina described sub-epidermal moisture as tissue trauma triggers an inflammatory response. The inflammatory response produces erythema, edema and serous exudate. As the level of tissue damage increases, so does the inflammatory response. Accordingly, the resulting level of localized tissue edema termed sub-epidermal moisture increases. Studies by Bates-Jensen concluded that abnormal sub-epidermal moisture readings may precede positive visual skin inspection findings (skin breakdown) within three to 10 days.
  • Polymer dressings: Sardina said the guideline now advises to “use a polymeric membrane dressing for non-infected Stage 2 pressure injuries as indicated by clinical condition of the pressure injury.”

Evaluation tools

A new risk screening was included for identifying at-risk individuals.

“The purpose of the new screening tool is to rapidly identify pressure injury risk with a minimum amount of diagnostic effort,” Sardina said. “The screening should be conducted at first contact with a health professional upon admission. If the screening indicates an at-risk status, then a full pressure injury risk assessment should be completed.”

Some individuals may not require a screening if major pressure injury risk factors are present and associated with their reason for admission.

“These individuals would automatically be considered at-risk on admission and the clinician should proceed directly to a full pressure injury risk assessment,” Sardina said.

The pressure injury risk tools such as the Braden and Norton scales are not all-inclusive. Their use requires additional investigation and clinical judgement to be used along with these tools, according to Sardina.

Change in nomenclature

Another change Sardina pointed out is that the term pressure injury is used throughout the NPIAP Guideline instead of pressure ulcer.

Wipe Out Wounds Tour

If you’re caring for patients with pressure injuries and wounds, our Wipe Out Wounds Tour will provide a review of the 2019 Clinical Practice Guideline.

“While there aren’t a lot of new recommendations, it’s important to make sure healthcare systems and their staff are following what is included,” Sardina said.

Another reason to attend the Wipe Out Wounds Tour is the content of the guideline is conveyed to attendees in easy-to-understand terms.

Sardina explained “the program handouts include extensive resources to support organizations and clinicians with implementation of the guidelines, product names are discussed, and web links to tools and forms are also provided.”

After attending the Wipe Out Wounds Tour, you will likely find you don’t have to go back and dive into research regarding what you need to do to implement the new guidelines, according to Sardina.

If you want to learn more about the new NPIAP Guideline, consider attending the Wipe Out Wounds Tour to hear engaging lectures and experience hands-on opportunities at our skills stations with industry experts at various locations throughout the U.S.

Attend our Wipe out Wounds Tour in spring 2021.


Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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