More than three-fourths of pressure injuries among a large cohort of Italian nursing home residents were categorized as “unavoidable.”It is a finding that strengthens arguments that some skin breakdown is impossible to prevent despite stringent PI prevention protocols.

A study published in the May/June issue of the Journal of Wound, Ostomy and Continence Nursing looked at more than 8,000 nursing home patients, 11.6% of whom had at least one pressure injury. Just over 700 of those wounds — 76.1% — were classified as being unavoidable, meaning they occurred even when residents received “the best preventative practices provided by healthcare professionals or lay carers as recommended by up-to-date evidence-based guidelines.”

The researchers reviewed patient charts as well as accreditation evaluations and annual surveys that demonstrated the homes’ use of PI-prevention measures including repositioning, moisture management and nutrition.

Residents who developed unavoidable pressure injuries had lower functional and cognitive scores, as well as more pain, sleep disorders, wandering, and verbal or physical aggressiveness. Patients included in the study also had irregular blood pressure, terminal conditions, used medical devices such as oxygen cannulas, or were uncooperative during repositioning or other interventions.