Pressure ulcers are injuries to the skin and underlying tissue that form due to prolonged pressure. Bedridden patients are the most susceptible to these wounds, so hospital nurses need to turn them every few hours to alleviate the built-up pressure. In public hospitals like San Juan de Dios in Guatemala City, there is a high incidence of these wounds due to understaffing.
Currently, hospitals in Guatemala have egg carton foam mattresses intended to reduce the incidences of bedsores. However, even with these mattresses, patients who are not turned would still develop preliminary pressure ulcers in as little as six hours. Additionally, it is difficult for nurses in this hospital to prioritize and communicate which patients need to be turned because they use paper and pencil to track the patients. Thus, current prevention methods would benefit from engineering solutions that reduce the physical and mental demand on nurses to turn patients.
Project Alivio is a project team within M-HEAL (Michigan Health Engineered for All Lives), a student organization that fosters interdisciplinary global health education, engineering design, and social entrepreneurship. We are designing mechanical and software engineering solutions: the mechanical device lowers the physical demand of turning patients, and the software application lowers the mental demand of tracking patient statuses.
Our partnership with SAIMER (Student Association of International Medical Research), a team of medical students in Guatemala, has been essential in the advancement of our project. We review design implementations and learn about their hospital workflow in order to build sustainable designs for the community.
Mechanical Device
The mechanical subteam is prototyping a pressure-modulating mattress topper that would allow for a less frequent need for patient turning, relieving the strain on nurses in understaffed hospitals.
This mattress topper is a system of airbags, valves, and a pump controlled by an Arduino. The airbags inflate and deflate at different time intervals to redistribute the patient’s weight. The airbag placements target high-risk areas for pressure ulcers (head, shoulders, hips, feet) and account for the 5 to 95 percentile population height in Guatemala. The airbags are held in pouches, which allow for easy replacement and removal.
A dial allows the nurses to adjust modulation frequency to tailor the needs of each patient. A CPR release valve deflates the whole system in the case of an emergency when CPR is required. The whole system is contained within the mattress topper, and can be easily placed on a hospital bed and under a bedsheet. This allows for simple set-up and clean-up between patients. The pump operates in a noise range of 27.5-28.5 decibels, so it is quiet enough for the hospital floor.
We made these design decisions based on our needs assessment and required criteria from SAIMER. The main design criteria are effectiveness, ease of use, adaptability, sanitation, privacy, and patient comfort. Some constraints include the cost, power supply of the pump, CPR release inclusion, and pump output noise level. We are able to price our prototype at $400 by making cost-effective decisions.
The mechanical subteam has been successful in building the mattress, airbags, and tubing. Future steps include implementing the valve and pump system and the Arduino system. We will continue to communicate with our community partners, finalize the prototype, and eventually travel to Guatemala for on-site testing.
Software Application
The software subteam is building an intuitive progressive web app to streamline nurse workflow by visualizing the statuses and priorities of patients in real-time. Throughout the week, different nurses are responsible for different shifts, and patients will come and go. Thus, it is mentally taxing to track and communicate every patients’ statuses. Our app conveniently puts all turning-related information in one spot that can be accessed anywhere. This prevents any misinformation errors that can occur from losing physical papers. Additionally, when one nurse turns a patient, all nurses with the application can be notified immediately, providing real-time insights to boost communication and efficiency within the workplace.
The main feature of our application are patient “cards.” Each card uniquely identifies a patient by their bed number and has the most relevant information for the Braden Scale. The Braden Scale identifies a patient’s risk level for developing pressure ulcers and ranges from 6 (higher risk) to 23 (lower risk). Each patient card features a Braden Scale calculator that automatically calculates a respective value according to the patient’s age, weight, gender, and length of stay.
The card features a clock that displays how long it has been since a patient was last turned. The clock is highlighted in green, yellow, or red depending on how urgently a patient needs to be turned, and fills up at a rate dependent on the Braden Value. When a patient is turned, the user can double-click the clock to restart it.
Additionally, each card has a pressure ulcer body map where nurses can digitally input the location of the pressure ulcers on the body. This allows nurses to monitor and communicate with other nurses on the development of the pressure ulcers. Other features include the ability to login and logout; add, delete, and move patients to another bed; provide user feedback; and to sort, search, and filter patient cards based on Braden Value or the time they were last turned. These features allow for streamlined task analysis and eased navigation of information.
Lastly, the app provides summary level statistics to give the staff an overview of the pressure ulcer trends in the unit. This includes displaying median values of key metrics such as Braden Values and turn times, and trends within risk groups, i.e. (correlations between high risk and ICU stay durations or weight.
Our design decisions center around the characteristics of public Guatemalan hospitals and security regarding patient data. This progressive web app uses Python and Flask for backend APIs, React.js for the UI, and PostgreSQL for data storage. Since many of these hospitals can have unstable internet, certain aspects of the technology stack help guarantee data consistency (SQL) and some amount of data availability at all times (offline caching and periodic background data sync). To maintain stability of the application we deployed the application’s relational database on AWS and employed an elastic load balancer to ensure that the application can handle a large amount of traffic and remains stable at all times.
The security of our app is paramount. We utilize token authentication through Auth0’s services to authenticate and further authorize users, as well as AWS services such as a virtual private cloud and a web application firewall for deployment and security. We ensure that the schema of the data would be entirely de-identified and compliant with U.S. HIPAA standards.
The web application is currently deployed with all functional features. In the future, we will focus on optimizing the performance and stability of the app, conduct usability testing locally and in Guatemala, and make amendments based on feedback.
How the Library Mini Grant Fund helped us
We are extremely grateful for the financial support that allowed us to purchase building materials. We also utilized the library for our meeting spaces. The Library Mini Grant Fund is directly supporting our team in using socially-engaged and interdisciplinary design techniques for a global health solution with real social impact.