Background: Reduced payments from Medicare related to high rates of hospital-acquired pressure injuries has prompted hospitals to invest in new technologies and strategies to improve wound care and prevention. While many hospitals have increased the purchase of skin care products such as prophylactic dressings, little is known about the association between these products and reductions in pressure injuries. The aim of this study was to measure longitudinal changes in pressure injury rates pre- and post-adoption of prophylactic dressings.

Methods: This was an observational cohort at U.S. academic medical centers of the University Health System Consortium (UHC). Patients included in the study were adults 18 years or older hospitalized for 5+ days. Pressure injury cases were flagged by Patient-Safety Indicator #3 (PSI-03). We characterized adoption patterns of prophylactic dressings by hospital-quarter for 38 academic hospitals between 2010-2015. Mixed-effects negative-binomial regression tested the longitudinal association of prophylactic dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. 

Results: Significant pressure injury rate reductions in U.S. academic hospitals between 2010-2015 were associated with the adoption of prophylactic dressings within a prevention protocol, (-1.0 cases/quarter; p=0.002) and changes to Medicare payment rules in 2014 (-1.13 cases/quarter; p=0.035). 

Conclusions: Prophylactic dressings may be an effective component of a pressure injury prevention bundle by relieving pressure, friction and shear on the skin to reduce incidence and slowing progression of full-thickness wounds.