Keywords
Quality Improvement
Pressure Injuries
Incontinence-Associated Dermatitis
Neonatal Intensive Care Units
How to Cite
Abstract
Introduction. Neonatal and pediatric patients present an increased risk of skin injuries due to their immature skin barrier and frequent exposure to medical devices. To improve prevention, monitoring, and standardization of care, the Azienda USL Toscana Centro (AUTC), one of the largest healthcare organizations in Italy, implemented a corporate pediatric wound care model supported by a multidisciplinary working group.
Methods. This descriptive retrospective observational study was conducted within an institutional Quality Improvement framework. Aggregated anonymized data were collected annually from 2021 to 2024 across Neonatal Intensive Care Units (NICUs), Neonatology units, and Pediatric wards. Nurse representatives, coordinated by a pediatric wound care specialist from the corporate Wound Care Team, reviewed medical records to identify pressure injuries (PIs), medical device-related pressure injuries (MDRPIs), and incontinence-associated dermatitis (IAD). Total admissions and injury frequencies were reported for each setting.
Results. Over the four-year period, 12,818 admissions were recorded (mean 3,204.5 per year). The mean incidence of PIs was 0.47%, while IAD incidence averaged 5.13%, with higher rates observed in NICUs. Between 2021 and 2024, 149 healthcare professionals (nurses, physicians, and midwives) completed seven editions of a dedicated pediatric wound care training program. The pediatric wound care working group expanded from 6 to 9 nurses and 1 physician, meeting quarterly to review surveillance data, discuss clinical challenges, and update procedures. In 2024, the corporate procedure for the prevention and treatment of neonatal and pediatric skin injuries was revised, and an inter-organizational pathway for the management of minor pediatric burns was jointly developed with Meyer IRCCS Children’s Hospital.
Discussion and conclusions. The corporate wound care model supported consistent monitoring, widespread training, and standardized preventive practices across AUTC. The very low incidence of PIs and the stable burden of IAD indicate positive organizational impact, highlighting the value of sustained multidisciplinary engagement in pediatric skin injury prevention.
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