Medical Device-Related Pressure Injuries: A Systematic Review for Prevalence, Causes, and Risk Factors Since the COVID-19 Pandemic.

Incidence, characteristics and risk factors of medical device-related pressure injuries: An observational cohort study

The Medical Device Related Pressure Injuries (MDRPIs) are a wound type that has been extensively tracked and recorded within observational studies, with a global patient prevalence of 19.3% [Zhang N et al. in Eur J Med Res 1:425, 2024]and 28.1% in acute care patients [Brophy S et al. inJ Tissue Viability 4:489-498, 2021]. Yet, despite being an injury caused directly by medical intervention, to the author's knowledge, no in-depth proteomic analysis in this wound type has been published previously. This study represents a novel proteomic analysis of clinical MDRPI samples providing initial characterization of a protein pathway significant to wound healing in the context of MDRPIs developed in an ICU setting (Fig.1). To investigate the proteomic changes associated with the healing outcomes of medical device related pressure injuries through comprehensive proteome characterisation. Clinical wound fluid samples were collected from Intensive Care Unit (ICU) patients with MDRPIs. These samples underwent analysis using Sequential Window Acquisition of all Theoretical Mass Spectra (SWATH-MS) mass spectrometry. The severity and healing trajectories of the injuries were assessed using the Pressure Ulcer Scale for Healing (PUSH) scores, facilitating the comparison of protein abundances to identify key pathways involved in healing and non-healing MDRPIs. The study identified a significant inverse correlation between the severity of non-healing MDRPIs and the levels of alpha-1 antitrypsin (A1AT) (R = -0.43; P = 0.035). A1AT functions as an inhibitor of neutrophil elastase (NE), which targets kininogen-1 (KNG-1). This relationship was further substantiated by a strong positive correlation between A1AT and KNG-1 levels (R = 0.76; Q < 6.8 × 10- 10), indicating a protective function of A1AT over KNG-1 from NE. Given that KNG-1 contributes to early wound healing through its derivative, bradykinin, the misregulation of A1AT may disrupt the healing process of MDRPIs. The findings suggest that decreased levels of A1AT are associated with increased severity in non-healing MDRPIs, potentially due to the disruption of KNG-1 activity. These insights offer a foundation for further research into targeted therapeutic strategies aimed at enhancing the healing of MDRPIs.

Medical device-related pressure injuries: Knowledge levels of nurses and factors affecting these

Multiple medical devices are often required for the monitoring and treatment of trauma patients in intensive care units (ICUs), which increases the risk of medical device-related pressure injuries (MDRPIs). Despite the increasing incidence of MDRPIs in critically ill patients, there has been insufficient research focusing specifically on trauma ICU populations in South Korea. This study aimed to identify the characteristics of and risk factors for MDRPIs in trauma ICU patients. This retrospective case-control study analyzed 755 trauma ICU patients, comprising 151 who developed MDRPI and 604 who did not develop MDRPI. Data including general, clinical, and trauma-related characteristics as well as details on medical device use were extracted from electronic medical records. A multivariate logistic regression analysis was performed to identify risk factors for MDRPIs. The incidence of MDRPIs was 4.3%. Deep tissue pressure injuries (60.1%) and stage 2 (24.0%) were the most common, while the most common MDRPI locations were the heel (24.0%) and nose (17.5%). Significant risk factors identified included the use of a nasogastric tubes (odds ratio (OR) = 16.48), continuous renal replacement therapy (OR = 13.92), and the use of splints or casts (OR = 12.73). This study has identified unique characteristics of and risk factors for MDRPIs in trauma ICU patients, for whom the use of immobilization devices and nasogastric tubes is a major contributor to such injuries. This research study has provided important insights for developing targeted prevention strategies for MDRPIs in trauma ICU settings in South Korea.

The aim of this cross-sectional study was to determine the point prevalence and associated risk factors of medical device-related pressure injuries (MDRPI) in intensive care patients in Turkey. MDRPI remain a clinical problem that has garnered the attention of healthcare professionals. This study used a cross-sectional design and was conducted over a single day in all intensive care units. Data were collected through face-to-face interviews, observation, skin examination and detailed diagnosis of MDRPI development and influencing factors. Presence of pressure injuries on the skin in the areas where the patient's medical device was placed was defined. The study was reported according to the STROBE declaration. MDRPI developed in 65 out of 200 patients included in the study (32.5%). The most frequent locations were on the face (71%). The MDRPIs were commonly associated with nasogastric tube (29.2%), endotracheal tube (18.5%) and CPAP mask (15.4%). A significant proportion of these injuries were mucosal (53.8%, n = 35). The majority of the skin pressure injuries were classified as Stage II (18.5%, n = 12). The risk increased 14 times in patients who were hospitalised for 9-16 days and 13 times in those who received mechanical ventilator support. The study findings suggest that MDRPI developed in approximately one of three patients hospitalised in the intensive care unit, and the length of hospital stay and mechanical ventilator support were important determining risk factors. The high prevalence of MDRPI may indicate inadequate nursing care quality. Therefore, it is recommended that nurses be aware of risk factors and evaluate the suitability and safety of medical devices. No patient or public contribution was involved in this study.

Context: Medical device-related pressure injuries (MDRPI) are a common complication that can occur in critically ill patients and require medical devices in the intensive care unit. MDRPI can occur when pressure from a medical device, such as a ventilator, catheter, or feeding tube, is exerted on the patient's skin for prolonged periods, causing tissue damage and leading to pressure injuries. MDRPI can result in pain, discomfort, prolonged hospital stays, and increased healthcare costs. Therefore, preventing and managing MDRPI in ICU patients is crucial to improving patient outcomes. Aim: The study aimed to assess factors affecting medical devices related to pressure injury in intensive care units. Methods: A descriptive and exploratory research design was employed to fulfill the objectives of this study. The study included two distinct samples: a purposive sample of 157 adult patients admitted to the intensive care unit and connected to various medical devices such as NGT, EET, CVC, UC, and CPAP masks, as well as a convenience sample of 50 nurses working in the intensive care unit who provided care to the same group of patients. Data were collected through a self-administered questionnaire, nurses' practice observational checklists, patient assessment records, and medical device assessment records. Results: The findings from this study reveal that 40% of the nurses under investigation demonstrated a moderate level of knowledge concerning Medical Device-Related Pressure Injuries (MDRPI). In comparison, 68.8% exhibited unsatisfactory practice in this area. Moreover, 56% of the nurses displayed a negative attitude towards factors associated with pressure injuries caused by medical devices in intensive care units. Concurrently, 58% of the patients in the study were found to have pressure injuries linked to medical devices, with 48% of these cases being attributed to CPAP masks. Furthermore, a highly significant statistical correlation was identified between the total knowledge scores of the nurses and their overall practice. Conclusion: The current study's conclusions indicate that the highest percentage of the participating nurses possessed an average level of knowledge, displayed inadequate practice, and harbored negative attitudes regarding factors contributing to medical device-related pressure injuries in intensive care units. Consequently, it is recommended that an educational training program be implemented to enhance nurses' competence in preventing medical device-related pressure injuries in intensive care units.

Introduction: Medical device-related pressure injuries (MDRPIs) tend to occur in hospital settings, negatively impacting patients' quality of life and increasing health care costs. This systematic review aimed to identify the incidence, prevalence, and associated risk factors of MDRPIs in Türkiye based on observational studies. Methods: From the beginning until October 31, 2024, an extensive electronic literature search was conducted across the Web of Science, PubMed, CINAHL, ScienceDirect, TR Index databases, and Google Scholar. Studies published in Turkish and English that report the incidence or prevalence of MDRPI in Türkiye were incorporated into the review. Two authors independently evaluated the eligibility of studies and extracted the data. Results: A total of twelve studies, four reporting prevalence and eight reporting incidence, were included in this review, comprising data from 7,067 patients. The estimated pooled incidence and prevalence of MDRPIs were demonstrated at 31.23% (95% CI = 21.96–42.29%) and 26.12% (11.40 – 49.28%), respectively. The predominant classifications of MDRPIs were stage 1 and stage 2 injuries. The occurrence of MDRPI was predominantly observed in the head and facial regions. Respiratory devices, nasogastric tubes, urinary catheters, arterial and venous catheters, thromboembolism stockings, and physical restraint equipment were the most common causative devices for MDRPIs. Risk factors for MDRPIs included length of stay in intensive care or hospital, age, gender, Braden risk score, mechanical ventilation, enteral or parenteral nutrition, skin type, number of medical devices used, fecal incontinence, diet, low albumin and hemoglobin levels. Conclusion: Despite the significant heterogeneity observed among the included studies, MDRPIs are common among patients receiving critical care and in hospital environments. Additional investigation is required regarding the reporting incidence, prevalence, and risk evaluation of MDRPIs. Future research should include data on MDRPIs stratified by age, gender, devices, and total device days.

The incidence of medical device-related pressure injuries (MDR-PI) related to nasogastric tubes (NGT) is under-investigated. This is particularly significant in the intensive care unit (ICU), as patients here are highly susceptible to MDR-PI development. This study aimed to undertake continuous surveillance of patients in the ICU to detect NGT-MDR-PI in order to determine its incidence. A prospective cohort study of adult ICU patients with NGT inserted during an ICU stay or shortly before ICU admission, with daily monitoring for NGT-MDR-PI, including documenting the location and stage of any PI detected and excluding patients with facial injuries, wounds or ulcers on admission. One-year data were collected, beginning in July 2022, in the 18-bed general ICU of the Shamir Medical Center (Assaf Harofeh) in Israel (60 patients). NGT-MDR-PI incidence was 5% (3/60). No relationship was found between NGT-MDR-PI development and patients' albumin at admission, age or comorbidities. To the best of the authors' knowledge, this is the first prospective long-term study dedicated solely to NGT-MDR-PI incidence in the ICU. The incidence rate of NGT-MDR-PI was lower than that of endotracheal tube (ETT)-MDR-PI. The difference between NGT-MDR-PI and ETT-MDR-PI incidence rates may lie in the need for strong fixation of the ETT, as accidental ETT removal can be life-threatening. Another reason for the lower NGT-MDR-PI incidence might be the dedicated care of the ICU nursing team, which is responsible for various aspects of PI and wound detection, surveillance and treatment.

Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence

Medical device-related pressure injuries (MDRPIs) are common in intensive care units (ICUs) and can cause patient harm when prevention, detection or management is inadequate. Device-specific education for ICU nurses is essential to support evidence-based MDRPI prevention and management. To identify ICU nurses' perceived educational needs related to MDRPIs by years of clinical experience and to examine domain- and content-specific needs by medical device type. A cross-sectional survey was conducted among nurses working in eight adult ICUs at a 1200-bed tertiary hospital in South Korea. The questionnaire assessed demographics, prior MDRPI education and perceived learning needs across eight domains. Data were analysed using descriptive statistics and the Kruskal-Wallis test with Bonferroni-adjusted post hoc comparisons. Open-ended responses were analysed using supplementary qualitative content analysis to complement the quantitative results and to categorise educational needs by device type and care domain. Of the 94 participants, 77 (81.9%) were female, with a mean age of 30.2 years. Although 64 (68.1%) had received general pressure-injury education, only 38 (59.4%) reported MDRPI-specific training. Nurses with ≥ 10 years of experience reported higher educational needs in assessment and documentation (median 5.0, range 3.0-5.0) compared with those with < 5 years (median 4.0, range 3.0-5.0) and 5-10 years of experience (median 4.0, range 3.0-5.0; H = 7.99, p = 0.018). Device-specific gaps were most frequent for nasogastric tubes, respiratory devices and endotracheal tubes. Overall, 76 domain-specific educational needs were identified. ICU nurses reported unmet educational needs, particularly in device-specific assessment, prevention and management. Higher learning needs among experienced nurses suggest that current education does not fully address MDRPI prevention in critical care. Integrating device-focused, scenario-based MDRPI education into professional development may enhance clinical judgment, reduce preventable injuries and improve patient safety in ICU environments.

The ability of knowledge, attitude, and practice of intensive care unit (ICU) nurses to perform medical device-related pressure injuries (MDRPIs) can affect the incidence of MDRPI in ICU patients. Therefore, in order to improve ICU nurses' understanding and nursing ability of MDRPIs, we investigated the non-linear relationship (synergistic and superimposed relationships) between the factors influencing ICU nurses' ability of knowledge, attitude, and practice. A Clinical Nurses' Knowledge, Attitude, and Practice Questionnaire for the Prevention of MDRPI in Critically Ill Patients was administered to 322 ICU nurses from tertiary hospitals in China from January 1, 2022 to June 31, 2022. After the questionnaire was distributed, the data were collected and sorted out, and the corresponding statistical analysis and modelling software was used to analyse the data. IBM SPSS 25.0 software was used to conduct Single factor analysis and Logistic regression analysis on the data, so as to screen the statistically significant influencing factors. IBM SPSS Modeler18.0 software was used to construct a decision tree model of the factors influencing MDRPI knowledge, attitude, and practice of ICU nurses, and ROC curves were plotted to analyse the accuracy of the model. The results showed that the overall passing rate of ICU nurses' knowledge, attitude, and practice score was 72%. The statistically significant predictor variables ranked in importance were education background (0.35), training (0.31), years of working (0.24), and professional title (0.10). AUC=0.718, model prediction performance is good. There is a synergistic and superimposed relationship between high education background, attended training, high years of working and high professional title. Nurses with the above factors have strong MDRPI knowledge, attitude, and practice ability. Therefore, nursing managers can develop a reasonable and effective scheduling system and MDRPI training program based on the study results. The ultimate goal is to improve the ability of ICU nurses to know and act on MDRPI and to reduce the incidence of MDRPI in ICU patients.

Background: Medical device–related pressure injuries (MDRPIs) represent a critical yet often underrecognized source of patient morbidity in intensive care settings. Critically ill patients are frequently exposed to multiple invasive and non-invasive medical devices, increasing their vulnerability to pressure-induced skin damage. Objective: This study aimed to identify the risk factors associated with the development of MDRPIs among adult patients admitted to the Intensive Care Unit (ICU) at Nishtar Hospital, Multan. Methods: A case-control observational study was conducted over six months, involving 44 ICU patients, including 22 cases with MDRPI and 22 controls without MDRPI. Data were collected using a structured checklist assessing demographic information, clinical parameters, device type, Braden scale scores, and physiological characteristics. Logistic regression analysis was performed to determine significant predictors of MDRPIs. Results: MDRPIs most frequently occurred in the oral cavity (36.36%), followed by the neck, arms, hands, and femoral region. Stage II pressure injuries were predominant (59.09%). Significant predictors included sedation administration (p &lt; 0.05), mechanical ventilation (p &lt; 0.05), edema (p = 0.05), GCS score (p &lt; 0.05), Braden risk score (p = 0.05), and prolonged ICU stay (p = 0.05). Patients with extended hospitalization and multiple medical devices were at higher risk of developing MDRPIs. Conclusion: MDRPIs are influenced by both device-related and patient-specific risk factors. Early risk screening using standardized assessment tools, vigilant skin monitoring, minimizing device pressure, and timely repositioning are essential to reduce MDRPI incidence. The study underscores the need for structured prevention protocols and continuous staff education to enhance ICU patient safety.

Intensive care unit (ICU) patients are at high risk for pressure injuries (PIs), medical device-related pressure injuries (MDRPIs), and skin tears (STs). Although nurses play a key role in preventing all three conditions, existing research has mainly focused on PIs, with limited evidence addressing nurses' combined knowledge related to MDRPIs and STs. In particular, shared deficiencies across these conditions remain unclear. This study aimed to assess ICU nurses' knowledge of PIs, MDRPIs, and STs together to identify overlapping knowledge gaps that may affect skin integrity management in ICU settings. A cross-sectional online survey was conducted with 283 ICU nurses. Data were collected using three validated tools: the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0), the Medical Device-Related Pressure Injury Knowledge Assessment Tool (MDRPI-KAT), and the Skin Tear Knowledge Assessment Instrument (OASES), enabling construct-specific measurement across related conditions. Knowledge levels varied across domains, with mean total scores of 14.44 ± 3.43 (PUKAT 2.0), 8.73 ± 1.83 (MDRPI-KAT), and 10.17 ± 2.44 (OASES). Across all three tools, prevention consistently emerged as the lowest-scoring domain. Higher knowledge scores were observed among nurses with greater professional experience, postgraduate education, and prior care experience related to STs. The findings provide a comprehensive overview of ICU nurses' knowledge regarding PIs, MDRPIs, and STs, highlighting variability across domains and consistently lower scores in prevention-related areas. These results underscore the need for targeted educational strategies to strengthen knowledge across key aspects of skin integrity management in intensive care settings. However, findings should be interpreted with caution due to potential sampling bias related to social media-based recruitment and the absence of multivariable analysis. Not applicable.

Although securing an endotracheal tube with medical adhesive tape has been shown to be associated with medical adhesive-related skin injury (MARSI) and medical device-related pressure injuries (MDRPIs), their incidence has been studied separately. To compare the incidence of MARSI and MDRPI after endotracheal tube fixation using medical adhesive tape. In addition, the risk factors for occurrence were identified. Data collection started when the endotracheal tube was secured with medical adhesive tape and was followed until extubation or change to another fixation method. The incidence of MARSI and MDRPI was calculated, and the risk factors were examined using a generalized estimating equation. During the study period, 20 of 153 patients had MARSI or MDRPI, with an incidence of 13%. Eleven patients had MARSI with an incidence rate of 7.2%, and 9 patients had MDRPI with an incidence rate of 5.9%. The factors associated with the occurrence of MARSI were fixation time with medical adhesive tape (P=0.003), analgesics (P=0.015), and fraction of inspired oxygen (P=0.038). The factors associated with the occurrence of MDRPI were fixation time with medical adhesive tape (P<0.001) and analgesics (P=0.017). The incidence of MDRPI was higher than that of MARSI when the endotracheal tube was secured with medical adhesive tape. The results showed that there are common factors in the association between MARSI and MDRPI, suggesting the importance of a prevention strategy that considers both factors as a single entity.

To review risk factors for the development of medical device-related and immobility-related pressure injuries in hospitalized pediatric patients. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will be better able to:1. Describe trends in pressure injuries (PIs) for hospitalized pediatric patients as summarized in current literature.2. Identify risk factors predictive of medical device-related and immobility-related PIs in hospitalized pediatric patients.3. Summarize the methodology used to understand risk factors for developing PIs in the hospitalized pediatric patient population.