Incidence of pressure injury and nursing care time in intensive care HOW TO CITE

Objectives: To correlate the incidence of pressure injury (PI) with the average time of nursing care in an intensive care unit (ICU). Method: Epidemiological, observational, retrospective study, carried out in the ICU of a university hospital. Data were collected by consulting the PI incidence and the average nursing care time from ICU databases between 2010 and 2014. Measures of central tendency and variability, and Pearson’s correlation coefficient were used for data analysis. Results : The average incidence of PI between 2010 and 2014 was 10.83% (SD = 2.87) and the average time spent in nursing care for patients admitted to the ICU was 15 hours (SD = 0.94). There was no statistically significant correlation between the incidence of PI and the nursing care time (r = -0.17; p = 0.199), however, the results suggested an overload on the nursing team. Conclusion: This study confirms the importance of implementing and reassessing the effectiveness of preventive care protocols for PI, in addition to warning about the work overload of nursing in assisting critically ill patients.


INTRODUCTION
Patient safety is discussed worldwide. Studies on this topic highlight that one of the adverse events that most affect hospitalized patients is the pressure injury (PI) 1  There are several risk factors related to the patient, the care process and the institution itself that contribute to the development of PIs. Critical patients admitted to intensive care units (ICU) are considered more vulnerable and present even higher risks for the development of these lesions due to immobility in bed, sedation, clinical instability with the need for vasoactive drugs and invasive interventions 6 .
Pressure injuries are one of the most prevalent adverse events and incidents in the ICU, with incidence rates ranging from 8.8 to 25.1% worldwide 3,6,7. . National studies show incidence rates between 13.6 and 59.5% 2,8 .
The incidence of PI indirectly reflects the quality of care provided, as well as it is used as a parameter in the evaluation of strategies and preparation of protocols for prevention. Thus, the incidence of PI has been adopted as an indicator of quality in service and nursing care by several health institutions 3 .
Considering the risk factors related to care and organizational issues, such as health care management, that contribute to adverse events, including PI, the workload and human resources in nursing are highlighted.
Although there are disputes about how much the nursing workload increases the risk of PI, it is worth noting that little has been discussed about this topic in the literature 3,9 . Studies show the importance of considering the nurse-patient coefficient and the management of nursing workload to integrate a set of PI prevention actions, providing quality of care and cost reduction of the actions provided 3 . Thus, the training of the health care team in the early identification of intrinsic and extrinsic factors is of paramount importance in the care of critically ill patients 10,11 .
Considering PI as an adverse event that puts at risk the patient's safety, quantifying and analyzing the incidence of PI in the ICU, as well as evaluating the correlation between the incidence of PI and the time of nursing care spent with these patients, it is relevant as it collaborates in the evaluation of the dimension of the RESUMEN Objetivos: Correlacione la incidencia de úlceras por presión (UP) con el tiempo promedio de atención de enfermería en la Unidad de Cuidados Intensivos (UCI). Método: Estudio epidemiológico, observacional, retrospectivo, realizado en la UCI de un hospital universitario. Los datos se recopilaron consultando las bases de datos de incidencia de UP y el tiempo promedio de atención de enfermería entre 2010-2014. Se utilizaron medidas de tendencia central y variabilidad, y el coeficiente de correlación de Pearson para el análisis de datos. Resultados: La incidencia promedio de LP entre 2010-2014 fue de 10.83% (DE = 2,87) y el tiempo promedio dedicado a la atención de enfermería para pacientes ingresados en la UCI fue de 15 horas (DE = 0,94). No hubo correlación estadísticamente significativa entre la incidencia de UP y el tiempo de atención de enfermería (r = -0.17; p = 0.199), sin embargo, los resultados sugirieron una sobrecarga del equipo. Conclusión: Este estudio confirma la importancia de implementar y reevaluar la efectividad de los protocolos de atención preventiva para UP, además de advertir sobre la sobrecarga del trabajo de enfermería en la atención de pacientes críticos.   Tables 1 and 2   The average incidence of PI considering the period

DISCUSSION
Scientific evidence points to high rates of PI incidence in hospitalized patients, especially in the ICU, due to the numerous risk factors to which they are exposed 3,10 .
In the world scenario, a systematic review and metaanalysis study identified a cumulative incidence of 10.0 to 25.9% (CI 95%). In the studies of this review in which skin inspection was performed to identify PI, the accumulated incidence was from 9.4 to 27.5% (CI 95%) and in the studies that excluded stage 1, the incidence was from 0.0 to 23.8% (CI 95%) 15 .
In a study developed with 335 patients admitted  13 . In addition, the incidence of PI is now considered an indicator of quality in the institution 12 .
In 2012, the second study evaluated the incidence of PI after the implementation of the prevention protocol, and the incidence identified in the ICU was 23.1%, highlighting an important reduction in its incidence, which showed that the protocol implemented had a positive impact on the prevention of new cases 14 . In the present study, it was found that the incidence of PI gradually decreased over the years, the maximum value being 26.3%, observed punctually in January 2012.
Therefore, the need for greater attention to prevent new cases is evident, so that the incidence continues to decrease through the support of the institution's administration, in the provision of material and human resources, and in the active involvement of professionals 3,19-21 .

ACKNOWLEDGMENTS
To the Intensive Care Unit of the University Hospital of São Paulo.