Prone positioning is a method used to manage ventilator-associated lung injury and promote oxygenation in severe acute respiratory distress syndrome (ARDS). With the COVID-19 pandemic and ever-increasing numbers of patients presenting with clinical pictures of ARDS, critical care practice guidelines and governing bodies are recommending prone positioning for adult patients with ARDS related to severe COVID-19 infection. Complications associated with prone positioning in critical care have the potential to cause patient morbidity. Common complications with prone positioning include the development of pressure injuries (PIs) on the forehead, chest, pelvis, chin, shoulders, genitalia, iliac crest and knees. Ocular damage and musculoskeletal issues may also occur. These complications are largely avoidable by implementing appropriate interventions. This article summarises current best practice and literature on interventions to reduce skin injury and other complications associated with prone positioning of COVID-19 patients with ARDS.

This paper first provides an overview of the contemporary research findings and latest aetiological discoveries concerning the prevention of pressure injuries (PIs) as reported in the 2019 version of the Prevention and treatment of pressure ulcers/injuries: clinical practice guideline (known as the International guideline), including, where relevant, through the new prism of the coronavirus disease 2019 (COVID-19) pandemic. Second, the biomechanical principles of PI prevention (PIP) through minimisation of tissue deformation levels are explained from a support surface design perspective. Third, and related to the second, the association between alleviation of sustained tissue deformations and mitigation of PI-risk-related or PI-related pain are reviewed with a focus on the role of the support surface. Fourth, and last, a discussion of the current PI aetiology theory is presented from a clinical practical perspective, using one documented patient testimony and two additional patient case stories, which are used here to analyse the complex interlinks between the known aetiological factors in PIs – discomfort and pain.

Pressure injuries remain a focus for patient safety and quality initiatives, particularly in acute care settings. This focus has been facilitated by the generation of data on pressure injury point prevalence which began publication in Australia in 2003. Since then, many healthcare organisations have undertaken serial pressure injury point prevalence audits (PIPPA) as part of a comprehensive program to measure and address pressure injuries. In our local health district, there has been a commitment to an annual PIPPA, but recently we sought to determine if we had reached a tipping point where the relative benefits of collecting this snapshot data may no longer justify the costs, particularly given the economic environment in the Australian healthcare system. The annual cost of conducting a district-wide PIPPA was calculated, and this is discussed alongside both non-financial costs and organisational and auditor benefits.

Patient skin injuries associated with medical or therapeutic devices are increasingly reported in the literature. With the coronavirus (COVID-19) pandemic, healthcare staff are wearing personal protective equipment (PPE) for prolonged periods. Anecdotally, cases of healthcare workers’ self report of injuries to their face, particularly the bridge of the nose, upper cheek, forehead and above the ears, as a result of extended use of eye protection and masks is increasing. Protecting the skin of frontline healthcare staff is as important as protecting patients’ skin. The tip sheet presented in this paper provides staff with a guide in the form of written and visual assistance in order to reduce the risk of device-related pressure injuries (DRPIs) in healthcare staff caused by PPE.

Paediatric patients are at risk of developing pressure injuries; however, there is a paucity of literature addressing the specific considerations related to pressure injury prevention for this patient cohort. Pressure injuries are generally linked to the adult patient population, hence most of the literature available to date is related to prevention and management of pressure injuries in older people or adult patients considered to be at high risk. The aim of this paper is to outline recommended pressure injury risk assessments for the neonatal/paediatric patient and to highlight some specific pressure injury prevention considerations when caring for this often-overlooked patient population.

In November 2019, the third edition of the International guideline was published. Dissemination of clinical guidelines and translation into practice is shown to be facilitated by resources to support the guideline and address of barriers to implementation. To identify the barriers, facilitators and challenges that influence translation of the recommendations in the International guideline into practice, and resources that might be useful to health professionals, two consultation forums were undertaken. This paper outlines the outcomes from these consultation forums and identifies resources that are considered important for translating recommendation into practice.