Thermographic Imaging to Detect and Prevent Deep Tissue Injuries

Abstract

Background: At Sarah Bush Lincoln Health Center (SBLHC), respiratory Medical Device Related Pressure Injuries (MDRPI) accounted for 27% of all hospital acquired pressure injuries in FY19. As a result, a multidisciplinary team was created to develop a pressure injury prevention protocol. As part of the protocol, SBLHC utilizes thermographic imaging with WoundVision’s “Scout” camera for detection of suspected deep tissue injury (DTI) present at the time of admission. This study was initiated following review of a thermographic image taken of a home NIV dependent patient that indicated temperature abnormalities on the bridge of the nose consistent with signs/symptoms of suspected DTI present at the time of admission.

Methods: At admission, all patients are scored with the STOP BANG Questionnaire. A positive score triggers an OSA Assessment by RT. During the OSA screening, if it is determined the patient wears a NIV device at home and the patient was placed on NIV while in the ED, Wound Ostomy Care Nurses and other trained RNs take a thermographic image of the patients face. The area was imaged with a FDA-approved thermographic imaging device, clinically reliable for capturing thermal anomalies on localized pressure sites. Preventative measures including a skin barrier wipe and bordered foam dressing are also applied when NIV is initiated.

Results: During the course of the evaluation a total of twenty-two thermal images were obtained. Six thermal images were excluded from interpretation due to poor image quality and laser position. Of the remaining sixteen thermal images, twelve demonstrated temperature anomalies representing signs/symptoms of suspected DTI over the bridge of the nose and/or cheek, which were likely present on admission. Four thermal images demonstrated a minimal temperature differential not indicative of signs/symptoms of suspected DTI. There have been no hospital acquired pressure injuries related to medical devices at Sarah Bush Lincoln in FY20 involving nasal cannulas, ET tube holders, or NIV devices.

Conclusions: Early detection and visual documentation of signs/symptoms of suspected DTI present at admission can trigger early intervention and prevent reimbursement loss. The implementation of a protocol including preventive measures and RT/RN education has significantly reduced MDRPI at SBLHC. Barriers to this data include inappropriate documentation, staff buy-in, and poor picture quality. This study was approved by the institutional IRB.

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