The HAPU Bundle: A Tool to Reduce the Incidence of Hospital-Acquired Pressure Ulcers in the Intensive Care Unit

Hospital-acquired pressure ulcers remain a large problem in hospitalized patients, most often developing in critically-ill patients in intensive care units. Extensive guidelines exist to assist in the prevention and care of pressure ulcers, however the individual recommendations are numerous and it is very unclear as to their relative importance. We reviewed these recommendations and developed a short list of 6 that we rigorously implemented and audited in our mixed surgical and medical ICU using an interdisciplinary team of physicians, nurses and dieticians. We termed these 6 indicators the hospital acquired pressure ulcer bundle, or HAPU Bundle. With one year of broad utilization of these bundles, we were able to reduce the incidence of hospital-acquired pressure ulcers in our ICU from 12.4% to 6.1%. The HAPU bundle may prove to be an easy to use and practical tool to help apply evidence-based guidelines and reduce pressure ulcers in the highest risk patients.