Develop a method to reduce the incidence of pressure ulcers that form in the San Juan de Dios Hospital by lowering the physical demand of patient turning and prioritizing the turning of patients with a higher risk of developing pressure ulcers.
Pressure ulcers are caused by sustained pressure against the skin resulting in impaired blood flow and damage to surrounding tissue. They are commonly found in bedridden patients, and the current protocol for prevention is to turn the patient every two hours. In hospitals in Guatemala City, nurses are understaffed and thus, patients are turned infrequently. Project Alivio’s goal is to design a device that reduces instances of pressure ulcers in the San Juan de Dios hospital. To ensure the device is built to consumer-driven needs, students are conducting research on user requirements and design specifications. A comprehensive list is being created based on the insights from pressure ulcer experts such as Dr. VanEpps, a doctor at the University of Michigan hospital, and Andy Reyes, a medical student resident at the Universidad de San Carlos in Guatemala City. Students have also begun generating device concepts based on the main factors that contribute to pressure ulcers: high pressure, shear forces, and moisture. Concepts were developed using functional decomposition: concepts addressing each factor separately were created, and now, students are combining these ideas to create concepts that satisfy the user requirements and will reduce instances of pressure ulcers.
Immobile patients in hospitals in Guatemala are at an increased risk of developing pressure ulcers due to issues prioritizing at risk patients and the difficult process in preventing the ulcers. Pressure ulcers, also known as bedsores, are injuries to the skin and underlying tissue that are caused by prolonged pressure on bony prominences of skin. Currently, hospitals in Guatemala have air and gel mattresses intended to reduce the incidences of bedsores. However, even with these mattresses, patients who aren’t turned develop preliminary pressure ulcers in six hours. Project Alivio ’s goal is to improve upon the current prevention devices present in hospitals by codesigning a solution that reduces the amount of effort it takes the nurses to turn a patient and that prioritizes patients based on risk factors.
Project Alivio resulted from M-HEAL’s first Service Abroad and Needs Assessment (SANA) trip to Antigua, Guatemala in the spring of 2015. Travelers observed clinics and interviewed doctors and patients, and using this data, they compiled a list of needs statements. Project Alivio then investigated into these needs statements, prioritizing and researching them further once returning to the University of Michigan. In the following year, the team formed a partnership with medical students from La Universidad de San Carlos (USAC) in Guatemala. However, they determined that the information collected in the previous trip was inadequate and decided to conduct another needs assessment trip. In the summer of 2016, they collected information on three predetermined focus areas: respiratory health, gastrointestinal diseases, and pressure ulcers. After spending a week in Antigua with various clinics gathering data,the U-M and USAC students jointly decided to pursue prevention of pressure ulcers in hospital environments.
During the 2016-2017 school year, this was finalized into M-HEAL’s first codesign team with members of U-M (Project Alivio) and USAC (Students Association of International Medical Research, SAIMER) both participating in the design process. The year following this collaboration of students and faculty was announced, Project Alivio and SAIMER worked to redefine the need of the stakeholders in Guatemalan public hospitals. This redefinition process was concluded with a trip to Guatemala by Project Alivio in the summer of 2018 to observe hospital settings and interview nurses and doctors.
Our team is currently in the process of generating concepts for potential prototypes that focus on lowering the physical demand of patient turning and prioritization of patients with higher risk. Later in the fall, we will downselect to 1-3 concepts and develop low-fidelity prototypes for those concepts. In the winter, we will be able to downselect further and build one high-fidelity prototype. We hope to travel back to Guatemala next spring to gather more data and feedback on our downselected solution.
Mentors and Advisors
Dr. J. Scott VanEpps, University of Michigan Clinical Advisor
Patrick Lafleche, Stryker MDP Mentor
Dr. Aileen Huang-Saad, University of Michigan, M-HEAL Advisor
Dr. Michael Deininger, University of Michigan, C-SED Consultant
Dr. Miriam Scheel, San Juan de Dios Hospital (Guatemala City, Guatemala), Clinical Advisor
Dr. Erwin Calgua, Universidad de San Carlos/San Juan de Dios Hospital (Guatemala City, Guatemala), Advisor