Intrinsic and Extrinsic Risk Factors for Nosocomial Pressure Injury among Hospitalized Adults at a Tertiary Hospital in Western Kenya




Braden Scale, Nosocomial, Odds Ratio, Pressure Injury, Risk Factors


The high incidence and prevalence of nosocomial pressure injuries pose a threat to safe hospitalization and additional strain on the healthcare system. Analysis of pressure injury risk factors is necessary for efficient prevention and management as part of the program to ensure that no patient experiences any preventable harm while receiving care, as per the international patient safety goals. This study evaluated the intrinsic and extrinsic risk factors for pressure injury among cohorts of hospitalized adults using a prospective approach. The Braden Scale was used to assess the participants’ level of risk and classify low (score 15 to 23) and high (score 6 to 14) cohorts prior to follow-up. Binary regression analysis was used to establish an association between the risk factors and the development of stage 2 and above pressure injuries and the odds reported. The intrinsic factors—nutrition, sex, age, and primary diagnosis—influenced the occurrence of pressure injuries. Similarly, the extrinsic factors—sensory perception, moisture, mobility and activity, presence of a medical device, friction, and shear—showed an association with the development of pressure injuries. Poor nutrition, impaired mobility, and persistent moisture, however, were statistically the most significantly associated risk factors, at OR 18.20, CI 2.18–151.69, p =.01; OR 20.93, CI 1.13–387.92, p =.04; OR 16.11, CI 2.02–128.52, p =.01, respectively, confirming a significant association between intrinsic and extrinsic risk factors and the development of hospital-acquired pressure injury. These identified risk factors can be used to tailor intervention earlier on admission and avert these preventable injuries. Standardized, timely risk assessment and proactive addressing of the identified risk factor among hospitalized patients are therefore recommended.


Ahmad, T., Panos, P., Denis, A., & Laila, H. (2018, July). Pressure Ulcers Prevalence in the Acute Care Settings: A System Review, 2000-2015. Journal of Clinical Nursing Research, 27(6), 643-659. DOI:

Bergstrom, N., & Braden, B. (1987). The Braden Scale for Predicting Pressure Sore Risk. Journal of Nursing Research, 36(4), 205-210. DOI:

Black, J. M., Cuddigan, J. E., Walko, M. A., Didier, L. A., Lander, M. J., & Kelpe, M. R. (2010). Medical Device Related Pressure Ulcers in Hospitalized Patients. International Wound Journal, 311-350. DOI:

Borsting, T., Tvedt, C., Skogestad, I., Granheim, T., Gay, C., & Lerdal, A. (2018). Prevelance of Pressure Ulcer and Associated Risk Factors in Midle- and Old-aged Medical Inpatients in Norway. Journal of Clinical Nursing, 27(3-4), 530-540. DOI:

Brem, H., Maggi, J., Nierman, D., Rolnitzky, L., Bell, D., Rennert, R., . . . Vladeck, B. (2010). High Cost of Stage IV Pressure Ulcers. The America Journal of Surgery, 200(4), 473-477. DOI:

Brienza, D., Antokal, S., Herbe, L., Logan, S., Maguire, J., Van Ranst, J., & Siddiqui, A. (2015). Friction Induced Skin Injuries - are they pressure ulcers? An updated NPUAP white paper. Journal of Wound Ostomy and Continence Nursing, 42(1), 62-64. DOI:

Bryant, R. A., & Nix, D. P. (2012). Acute and Chronic Wounds: Current Management Concepts. St Louis: Elsevier.

Chan, W., Pang, S., & Kwong, E. (2009). Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting. Journal of Clinical Nursing, 18(11), 1560-1570. DOI:

Coleman, S., Nixon, J., Keen, J., Wilson, L., McGinnis, E., Dealey, C., . . . others. (2014). A New Pressure Ulcer Conseptual Framework. Journal of Advanced Nursing, 70(10), 2222-2234. DOI:

Cox, J. (2012). Predictive Power of The Braden Scale for Pressure Sore Risk in Adult Critical Care Patients: A Comprehensive Review. Journal of Wound Ostomy and Continence Nursing, 39(6), 613-621. DOI:

De Souza, D., Santos, V., Iri, H., & Sadasue, O. M. (2010). Predictive validity of the Braden Scale for pressure ulcer risk in elderly residents of long-term care facilities. Geriatric Nursing, 31(2), 93-105. DOI:

Drake, D., Swanson, M., Baker, G., & al., e. (2010). The Association of BMI and Braden total score on the occurence of pressure ulcers. Journal of Wound Ostomy Continence Nursing, 37(4), 368-370. DOI:

Edwine, B., Peter, N., & Di, M. (2019). Towards Universal Health Coverage in Kenya: Are We on the Right Path. Nairobi, Kenya: Health Economics Research Unit, KEMRI Welcome Trust Research Program.

EPUAP; NPIAP; PPPIA. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. (E. P. Panel, N. P. Panel, & P. P. Alliance, Eds.) International Guideline.

Huang, T.-T., Tseng, C.-E., Lee, T.-M., Yeh, J.-Y., & Lai, Y.-Y. (2009). Preventing Pressure Sores of the Nasal ala after Nasotracheal Tube Intubation. Journal of Oral and Maxillofacial Surgery, 67(3), 543-551. DOI:

Iranmanesh, S., Rafiei, H., & Sabzevari, S. (2012). Relationship between Braden Scale Score and Pressure Ulcer Development in Patients Admitted in Trauma Intensive Care Unit. International Wound Journal, 9(3), 248-252. DOI:

Jane, M. N., Priscillah, N. K., & James, O. (2021). Nurses' Management of Patients with Pressure Ulcers in Selected Health Facilities in Murang'a County, Kenya. East African Journal of Health and Science, 3(1). DOI:

Jan Noel, M., & Emmanuel, E. (2011). Pressure Ulcer Incidence and Risk Factors Among Hospitalized Orthopedic Patients: Results of a Prospective Cohort Study. Osteomy Wound Management, 57(10), 60-70.

JCI. (2019, September 17). International Patient Safety Goals (IPSG). World Patient Safety Day.

Kayser, S., VanGilder, C., & Lanchenbruch, C. (2019). Predictors of Superficial and Severe Hospital-Acquired Pressure Injuries: A Cross-sectional Study using the International Pressure Ulcer Prevelance Survey. International Journal of Nursing Studies, 89, 40-50. DOI:

Lyder, C. H., Shannon, R., Empleo-Frazier, O., McGeHee, D., && White, C. (2002). A comprehensive program to prevent pressure ulcers in long-term care: Exploring costs and outcomes. Journal of Ostomy Wound Management, 48(4), 52-62.

Matozinhos, F., Velasquez-Melendez, G., Tiensoli, S., Moreira, A., & Gomes, F. (2017). Factors Associated with the Incidence of Pressure Ulcer During Hospital Stay. Rev Esc Enferm USP, 2-9. DOI:

Molon, J. N., & Estrella, E. P. (2011). Pressure Ulcer Incidence and Risk Factors Among Hospitalized Orthopedic Patients: Results of a Prospective Cohort Study. Journal Of Ostomy- Wound Management, 57(10), 64.

Nangole, F. W., Khainga, S. O., & Kiboi, J. (2009, December). Pressure Ulcers Presentation and Management at Kenyatta National Hospital and Spinal Injury Hospital. East African Medical Journal, 86(12). DOI:

National Pressure Ulcer Advisory Panel. (2009). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Cambridge: Cambridge Media.

Sociedad Iberolatino America. (2011). Declaration of Rio De Janeiro on Pressure Ulcers Prevention as a Universal Human Right. Rio De Janeiro: Ibero-Latin-American Society on Wounds.

Sookyung, H., Xiaobai, L., Brenda, V., Cheryl, N., Monica, F., Pacharmon, K., . . . Elizabeth, L. (2014, November). Body Mass Index and Pressure Ulcers in Intensive Care Patients. American Journal of Criical Care, 23(6), 495-501. DOI:

VanGilder, C., LachenBruch, C., Algrim-Boyle, C., & Stephanie, M. (2017, February). The International Pressure Ulcer Prevalence Survey: 2005 - 2015: A 10-Year Pressure Injury Prevelance and Demographic Trend Analysis by Care Setting. Journal of Wound Ostomy and Continence Nursing, 44(1), 20-28. DOI:

Wangia, E. D., & Kandie, C. D. (2019). Refocusing on Quality of Care and Increasing Demand for Services; Essential Elements in attaining Universal Health Coverage in Kenya. Nairobi: The Health Sector Monitoring and EvaluationUnit, Ministry of Health.

WHO. (2005). Health Financing: Universal Health Coverage. Geneva: World Health Organisation.

World Health Organization. (2017). Patient Safety: Making health care safer. Geneva: WHO.

World Health Organization. (2021). World Health Statistics 2021: Monitoring Health for the SDGs, sustainable development goals. Geneva, Switzerland: WHO.

Zhaoyu, L., Frances, L., Lukman, T., & Wendy, C. (2020). Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. International Journal of Nursing Studies. Retrieved March 17, 2022, from 10.1016/j.ijnurstu.2020.103546. Epub 2020 Jan 31. PMID: 32113142.




How to Cite

Makori, O. L. S., Olayo, R., & Wamukoya, E. K. (2023). Intrinsic and Extrinsic Risk Factors for Nosocomial Pressure Injury among Hospitalized Adults at a Tertiary Hospital in Western Kenya. African Journal of Empirical Research, 4(2), 546–554.