Pressure Ulcer Prevention Strategies Research Articles

Nurses’ Knowledge of Pressure Ulcer Risk Assessment and Prevention Strategies: A Cross-Sectional Study in Nigeria

The development of PUs consequently results in significant physical, financial, and emotional burdens on the affected patients and their relatives including healthcare providers. This study aimed to assess knowledge of pressure ulcer risk assessment (PURA) and prevention strategies among nurses at University College Hospital (UCH), Ibadan, Nigeria. A cross-sectional descriptive design among 264 nurses was selected through a simple random sampling technique using a structured pre-tested questionnaire for data collection. Data were analyzed using descriptive and inferential statistics. The level of significance is set at a p-value <0.05. The mean age of participants was 40.59 ± 9.88 years. Findings revealed that an average of 51.1% of respondents had adequate knowledge of PURA. However, adequate knowledge of pressure ulcer prevention strategies was recorded among just a little above average 67.8%. Analysis of Variance (ANOVA) showed no significant relationship between respondents’ level of education and their knowledge of pressure ulcer risk assessment as well as their knowledge of pressure ulcer prevention strategies (p>0.05). Knowledge of pressure ulcer and prevention strategies was inadequate. Nurses need regular training programs to improve their knowledge and skills in PURA and the prevention of pressure ulcers among at-risk patients according to international best practices in order to bridge the previously identified gaps.

Effect of Intervention Training on Nurses’ Knowledge of Pressure Ulcer Risk Assessment and Prevention at a Tertiary Hospital, Nigeria

Background: Despite advances in healthcare, inadequate knowledge of pressure ulcer risk assessment (PURA) and prevention strategies among nurses as a major contributory factor to development of pressure ulcers among “at risk” patients has been identified by previous studies. Aim: This study evaluated effect of intervention training on nurses’ knowledge of pressure ulcer risk assessment and prevention strategies at University College Hospital, (UCH) Nigeria. Methods: A randomized controlled trials research design. Sample size was 268 (134 participants each in intervention and control groups) nurses selected through simple random and systematic sampling techniques. A structured pre-tested questionnaire was used for data collection. Data were analyzed using descriptive and inferential statistics. Level of significance set at p-value <0.05. Results: Mean ages of participants were 42.45±8.89 and 38.81±10.56 years for intervention and control groups respectively. Almost all participants in intervention group during pre-test had adequate knowledge of pressure ulcer risk assessment, and pressure ulcers prevention strategies compared to during pre-test in which poor knowledge of those areas was recorded among majority of them. Also, adequate knowledge of pressure ulcers prevention strategies was observed among intervention group after the training as compared to control group in which poor knowledge was recorded. Furthermore, intervention training was highly statistically significant with all studied domains at p<0.001. Conclusion: The intervention training on nurses’ knowledge regarding PURA and prevention strategies was positive at a high rate. Regular training programs on the subject matter for all nurse clinicians to promote quality nursing care according to international best practices is crucial.

Measuring subepidermal moisture to detect early pressure ulcer development: a systematic review.

The aim was to assess evidence related to the measuring of subepidermal moisture (SEM) to detect early, nonvisible development of pressure ulcers (PUs). Using systematic review methodology, all quantitative animal and human research studies written in English were considered. In January 2021, PubMed, CINAHL, SCOPUS, Cochrane and EMBASE databases were searched. The primary outcome of interest was the validity of SEM measurement to detect early PU development. The secondary outcome was time to PU detection, sensitivity and specificity of SEM measurement, and the impact of SEM measurements on PU prevention. Data analysis was undertaken using RevMan and narrative synthesis. A total of 17 articles met the inclusion criteria. In all studies, a consistent abnormal deviation in SEM measurements corresponded with evidence of visual PU development. Time to PU development, explored in four studies, showed earlier detection of PU development using SEM measurement. RevMan analysis identified the mean difference in time to PU development (SEM measurement versus visual skin assessment, VSA) was 4.61 days (95% confidence interval: 3.94-5.28; p=0.0001) in favour of SEM measurements. The sensitivity of SEM measurements was reported in four studies, and scores varied from 48.3% to 100.0%. Specificity was also reported in four studies and scores ranged from 24.4% to 83.0%. The impact of the detection of abnormal SEM measurements on PU prevention was explored by one study. Results showed a 93% decrease in PU rates when staff acted on the results of the SEM readings. The findings of this review identified that SEM measurement detects PU development earlier than VSA. Furthermore, when staff responded to abnormal SEM measurements, prevention strategies were enhanced, with a subsequent reduction in visible PU development. SEM measurement may therefore be a useful addition to PU prevention strategies. The School of Nursing & Midwifery, RCSI has a research agreement with Bruin Biometrics. Funding for the study was through an Irish Research Council PhD Enterprise Partnership Scheme with Bruin Biometrics. The authors have no other conflicts of interest.

Developing Algorithm Based on Activity and Mobility for Pressure Ulcer Risk Among Older Adult Residents: Implications for Evidence-Based Practice.

A pressure ulcer (PU) is a localized injury to the skin or underlying tissue usually over a bony prominence. The prevention PU per patient per day is costly; therefore, the detection of a PU at its earliest stage is imperative to afford timely interventions. Currently, there are very few clinically useful tools to assist with early PU detection and prevention. There were two primary aims of this study: (1) to investigate the relationship between activity, mobility, and PU development; and (2) to ascertain the next steps for delineating an algorithm based on activity and mobility for detecting PU risk among older adult residents in long-term care. This quantitative, prospective, descriptive, non-experimental study was conducted between July 2019 and March 2020 among 53 older adult residents who were followed for 4 consecutive days. Participants' Braden score, Elderly Mobility Scale (EMS) score, Movement Level, and 6-item Cognitive Impairment Test score were assessed. Further, the sacrum and heels were assessed daily using a non-invasive subepidermal moisture (SEM) scanner and visual skin assessment (VSA). SEM values > 0.5 were considered as indicative of the presence of an SEM-PU. The incidence rate of VSA-PU was 15.1% (N=8). There was an incidence of 87.5% (N=42) of SEM-PU damage. According to the Braden subscale, Mobility Braden, most of the participants (62.2%, N=33) were assessed as having no limitations/slightly limited mobility, while the EMS indicated that most of the participants (67.9%, N=36) were classed in an independent category. From the 42 SEM-PUs observed, 62% (N=26) occurred among the low movers, and 38% (N=16) occurred among the high movers. Using traditional methods for the assessment of movement does not provide insight into the protective nature of the movement. Given that both low- and high-moving patients can develop tissue damage, it is important to focus on the assessment of movement using more objective measures and algorithms, which enable real-time assessment of the protective nature of the movement. This would enable development of person-centered PU prevention strategies to reduce the burden of this significant healthcare problem.

Evidence-based review of the effects of nutritional supplementation for pressure ulcer prevention.

The objective of this evidence‐based review was to explore whether the evidence supports the use of nutritional supplements in pressure ulcer (PU) prevention strategies. Several electronic databases, including Ovid MEDLINE (1946 to May week 32 019), Ovid EMBASE (1947 to May 28, 2019), EBSCO CINAHL (until June 13, 2019), Scopus (until July 9, 2019), and the Web of Science (until June 13, 2019) were searched. No limitation was placed on the year of publication. Studies considered for inclusion were those with adult populations, and only English language texts with available full text were reviewed. AMSTAR (a measurement tool to assess systematic reviews) was used to evaluate the quality of the studies included in the systematic review. The Oxford Centre for Evidence‐Based Medicine (OCEBM) 2011 Levels of Evidence was used to assess the level of evidence. Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) was used to assess guideline article, and Appraisal tool for Cross‐Sectional Studies (AXIS) was also used for cross‐sectional studies. The search identified 1761 studies. After the application of inclusion and exclusion criteria, 24 studies were retained of various designs, including 10 systematic reviews, five clinical reviews, three randomised controlled trials, two observational studies, one quasi‐experimental study, one cross‐sectional study, one cohort study, and one Clinical Guideline. Two were rated as high‐quality reviews, 14 were rated as moderate‐quality reviews, five were rated as low‐quality reviews, and three were rated as critically low‐quality reviews. The majority of the reviewed studies were of low‐to‐moderate quality because of biases in the study design and incomplete data reporting, which did not fulfil the reporting criteria of the appraisal tools. However, the majority of the studies showed a reduction in PU incidence after nutritional supplement though not significant. Whether the use of pharmacological appraisal tools to assess non‐pharmacological studies is appropriate is unclear. Regardless of the low‐to‐moderate quality of the studies in this review, nutritional supplements appear to play a role in PU prevention.

Power and sample size for multistate model analysis of longitudinal discrete outcomes in disease prevention trials.

For clinical trials where participants pass through a number of discrete health states resulting in longitudinal measures over time, there are several potential primary estimands for the treatment effect. Incidence or time to a particular health state are commonly used outcomes but the choice of health state may not be obvious and these estimands do not make full use of the longitudinal assessments. Multistate models have been developed for some diseases and conditions with the purpose of understanding their natural history and have been used for secondary analysis to understand mechanisms of action of treatments. There is little published on the use of multistate models as the primary analysis method and potential implications on design features, such as assessment schedules. We illustrate methods via analysis of data from a motivating example; a Phase III clinical trial of pressure ulcer prevention strategies. We clarify some of the possible estimands that might be considered and we show, via a simulation study, that under some circumstances the sample size could be reduced by half using a multistate model based analysis, without adversely affecting the power of the trial.

Biomechanical monitoring and machine learning for the detection of lying postures

BackgroundPressure mapping technology has been adapted to monitor over prolonged periods to evaluate pressure ulcer risk in individuals during extended lying postures. However, temporal pressure distribution signals are not currently used to identify posture or mobility. The present study was designed to examine the potential of an automated approach for the detection of a range of static lying postures and corresponding transitions between postures. MethodsHealthy subjects (n = 19) adopted a range of sagittal and lateral lying postures. Parameters reflecting both the interactions at the support surface and body movements were continuously monitored. Subsequently, the derivative of each signal was examined to identify transitions between postures. Three machine learning algorithms, namely Naïve-Bayes, k-Nearest Neighbors and Support Vector Machine classifiers, were assessed to predict a range of static postures, established with a training model (n = 9) and validated with new input from test data (n = 10). FindingsResults showed that the derivative signals provided a means to detect transitions between postures, with actimetry providing the most distinct signal perturbations. The accuracy in predicting the range of postures from new test data ranged between 82%–100%, 70%–98% and 69%–100% for Naïve-Bayes, k-Nearest Neighbors and Support Vector Machine classifiers, respectively. InterpretationThe present study demonstrated that detection of both static postures and their corresponding transitions was achieved by combining machine learning algorithms with robust parameters from two monitoring systems. This approach has the potential to provide reliable indicators of posture and mobility, to support personalised pressure ulcer prevention strategies.

The microclimate under dressings applied to intact weight-bearing skin: Infrared thermography studies

BackgroundWhen a patient is lying in a hospital bed (e.g. supine or prone), bodyweight forces distort soft tissues by compression, tension and shear, and may lead to the onset of pressure ulcers in those who are stationary and insensate, especially at their pelvic region. Altered localized microclimate conditions, particularly elevated skin temperatures leading to perspiration and resulting in skin moisture or wetness, are known to further increase the risk for pressure ulcers, which is already high in immobile patients. MethodsWe have used infrared thermography to measure local skin temperatures at the buttocks of supine healthy subjects, to quantitatively determine, for the first time in the literature, how skin microclimate conditions associated with a weight-bearing Fowler's position are affected by application of dressings. Our present methodology has been applied to compare a polymeric membrane dressing versus placebo foam, with a no-dressing case used as reference. FindingsOne hour of lying in a Fowler's position was already enough to cause considerable heat trapping (~3 °C rise) between the weight-bearing body and the support surface. Analyses of normalized local skin temperatures and entropy of the temperature distributions indicated that the polymeric membrane dressing material allowed better and more homogenous clearance of locally accumulated body-heat with respect to simple foam. InterpretationInfrared thermography is suitable for characterizing skin microclimate conditions under different dressings, and, accordingly, is effective in developing and evaluating pressure ulcer prevention and treatment strategies - both of which require adequate skin microclimate.

Do we still need to assess nurses' attitudes towards pressure ulcer prevention? A systematic review.

To critically appraise and synthesise existing research literature pertaining to nurses' attitudes towards pressure ulcer (PU) prevention. Using systematic review methodology, published quantitative studies focusing on nurses' attitudes towards PU prevention measured by psychometric tests were included. The search was conducted in May 2019 using PubMed, CINAHL, Scopus, Cochrane and EMBASE databases, and returned 442 records, of which 21 met the inclusion criteria. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the checklist. Of the included studies, 20 employed a cross-sectional design and one author employed a validation study. In measuring nurses' attitudes toward PU prevention two distinct instruments were used: the 'Moore and Price Attitude Scale' and the 'Attitude towards Pressure Ulcer Prevention Instrument'. The mean attitude score within the studies was 73% (standard deviation=9.2%). The lowest attitude score was 51%, while the highest score was 89%. The results obtained from the studies indicated that 86% (n=18) yielded positive attitude results. The findings suggest that, overall, nurses are positively disposed towards PU prevention. However, it is important to highlight that the nurses have difficulties translating this positive attitude into actual PU prevention strategies.

Patient involvement in pressure ulcer prevention and adherence to prevention strategies: An integrative review

BackgroundChronic wounds including pressure ulcers represent a significant burden to patients and healthcare providers. Increasingly patients are required to self-manage their care but patient adherence to prevention strategies is a significant clinical challenge. It is important to increase understanding of the factors affecting patients’ ability and willingness to follow pressure ulcer prevention interventions. ObjectivesTo investigate from a patient perspective the factors affecting adherence to pressure ulcer prevention strategies. DesignIntegrative literature review. Data sourcesA systematic search of electronic databases (Athens, Pub Med, Web of Science, Science Direct, AMED, CINAHL, Cochrane Library, PsychInfo, Google Scholar, Delphis) was initially conducted in May 2017 (repeated August 2018). Review methodsThe methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) principles. The Noticing, Collecting, Thinking (NCT) model of qualitative data analysis was used to identify key themes. ResultsA total of twelve studies met the inclusion criteria and were included in the review. The majority of studies were qualitative and three key themes were identified: (i) individual/daily lifestyle considerations, (ii) patient involvement in the decision-making process, and (iii) pain and/or discomfort. ConclusionThere is limited research that focuses on the patient view of factors affecting adherence to prevention measures, particularly in community settings. Individual and daily lifestyle considerations and involvement in decision-making around pressure ulcer care are important aspects from the patient perspective. Further research is necessary to explore which factors affect patient adherence in order to improve clinical practice and support patient involvement in preventative strategies.

Effectiveness of pressure ulcer prevention strategies on pressure ulcer formation among bed ridden patients at NIMS hospital, Jaipur

Effectiveness of pressure ulcer prevention strategies on pressure ulcer formation among bed ridden patients at NIMS hospital, Jaipur

Use of dermal gel pads in preventing and managing pressure ulcers in ICU: an audit.

Most of the pressure ulcers (PUs) that developed in the intensive care unit (ICU) of an acute trust were medical-device related. While use of a dermal pad was recommended as part of its pressure ulcer prevention strategy, staff were concerned that it tended to tear or split while in use. An alternative gel pad (Dermisplus® Prevent, Frontier Medical), that was cost-effective and appeared to be more robust, was identified. A 4-week non-comparative audit involving 37 patients was therefore undertaken to investigate the effect of this alternative gel pad on PU incidence in the ICU. With the exception of the change in the gel pad used, there was no difference to the overall PU prevention strategy. No new PUs developed during the audit period with the new gel pad, although there was also no reduction in incidence compared with the previous 3 months. None of the four patients (11%) with blanching erythema developed category 1 PUs. There were also no reports of tearing or splitting with the new gel pad. The ICU staff commented that they found the new gel pad simpler to use, easier to clean and more robust than the previous product used. Following the audit, the ICU incorporated the new gel pad into its PU prevention strategy.

Mobilising the team and the patient to prevent pressure ulcers

The occurrence of a pressure ulcer can be considered as an avoidable adverse event. Its consequences are not only very harmful for the patient, but also in terms of the costs induced and for the nursing teams faced with the failure of the prevention treatment. For these reasons, nurses, nurse assistants and the multidisciplinary team must work together around a pressure ulcer prevention strategy.

Why is the heel particularly vulnerable to pressure ulcers?

In this article, the vulnerability of the soft tissues of the heel to pressure ulcers (injuries) is explained from a biomechanical engineering perspective, and emerging technologies for protecting the heel, particularly low-friction garments, are reviewed. Sustained deformations in the soft tissue of the weight-bearing posterior heel cause progressive cell and tissue damage due to loss of homeostasis in the cells, as the cytoskeleton and plasma membranes of the affected cells lose integrity and functionality. This deformation damage onsets and evolves rapidly when there is no relief of the tissue distortion (e.g. in supine motionless lying). Hence, prevention should be timely and be applied across all patient populations that are at risk. In particular there is a need to protect tissues from the action of frictional forces that are shearing not only the skin but also the deep tissue structures of the heel. The internal anatomy and physiology of the posterior heel, the common hospital conditions (lying supine, head of the bed elevated) and medical conditions involving neuropathy and perfusion impairments may impose specific risk for heel (pressure) ulcers. There is growing evidence that low-friction-fabric garments may provide added benefits in preventing heel ulcers when used in addition to standard clinical and technology-supported pressure ulcer prevention strategies, as the low-friction fabric structures absorb frictional forces before these are able to considerably distort the susceptible heel tissues.

The Relationship Between Patient-Controlled Analgesia and Postcesarean Section Pressure Ulcers: Analysis of Medical Record Data

In this study, we aim to investigate the relationship between patient-controlled analgesia (PCA) and the incidence of pressure ulcer in postcesarean section mothers. A retrospective analysis was performed among consecutive cesarean section mothers in2016. Univariate and multivariate logistic regression was used to analyze the relationship between PCA and postcesarean section pressure ulcers. One thousand nine hundred eighteen cesarean section mothers were included in the study. Forty-five mothers (2.3%; 95% confidence interval [CI], 1.7%-3.1%) developed stage I pressure ulcer. The pressure ulcers were cured in 2 to 5days. Eighty percent (1,535) of mothers received PCA after cesarean section surgery. Pressure ulcer incidence was significantly higher in the PCA group compared with non-PCA groups (2.9% vs 0.0%, Fisher's exact P<.0001). Patient-controlled intravenous analgesia and patient-controlled epidural analgesia showed the same pressure ulcer risk (3.2% vs 2.6%, χ2=0.581, P=.446). After multivariate analysis by logistic regression, the adjusted odds ratio of PCA for pressure ulcer risk was 33.632, with a 95% CI of 25.061 to 45.134. Our results showed PCA was an independent risk factor for pressure ulcer in postcesarean section mothers. Although the pressure ulcers were all rated as stage I and can be cured in 2 to 5days, we still recommended some pressure ulcer prevention strategy should be used for these mothers.

Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice.

In 2013, an observational survey was conducted among 242 in-patients in a community hospital with a pressure ulcer (PU) prevalence of 34.3%. An evidence-based pressure ulcer prevention program (PUPP) was then implemented including a staff awareness campaign entitled "Healthy Skin Wins" with an online tutorial about PU prevention. To determine the effectiveness of the PUPP in reducing the prevalence of PUs, to determine the effectiveness of the online tutorial in increasing hospital staff's knowledge level about PU prevention, and to explore frontline staff's perspectives of the PUPP. This was a mixed methods study. A repeat observational survey discerned if the PUPP reduced PU prevalence. A pre-test post-test design was used to determine whether hospital staff's knowledge of PU prevention was enhanced by the online tutorial. Qualitative interviews were conducted with nurses, allied health professionals, and health care aides to explore staff's perspectives of the PUPP. A comparison of initial and repeat observational surveys (n = 239) identified a statistically significant reduction in the prevalence of PU to 7.53% (p < .001). The online tutorial enhanced staff knowledge level with a statistically significantly higher mean post-test score (n = 80). Thirty-five frontline staff shared their perspectives of the PUPP with "it's definitely a combination of everything" and "there's a disconnect between what's needed and what's available" as the main themes. Incorporating evidence-based PU prevention into clinical practice greatly reduced the prevalence of PUs among hospital in-patients. Due to the small sample size for the pre-test post-test component, the effectiveness of the online tutorial in improving the knowledge level of PU prevention among hospital staff requires further research. Evidence-based PU prevention strategies are facilitated by using a multidisciplinary approach. Educational tools about PU prevention must target all members of the healthcare team including healthcare aides, patients and families.

Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients

BackgroundHospital acquired pressure ulcers have a detrimental effect on patient quality of life, morbidity, mortality, and cost to the healthcare industry. Little is known about pressure ulcer prevention in perioperative services. ObjectivesThe objectives of this study were to describe perioperative registered nurses (RNs) knowledge, attitudes, behaviors, and barriers about pressure ulcer prevention and to determine if knowledge and the availability of a pressure ulcer staging tool are predictors of pressure ulcer prevention behavior. MethodsA cross-sectional descriptive pilot study was conducted. Sixty-two perioperative RNs from 10 acute care hospitals participated. ResultsPerioperative nurses believed carrying out pressure ulcer prevention strategies is essential to nursing practice but only two-thirds reported conducting pressure ulcer risk assessment on all patients and daily assessment on at risk patients. Results indicated a knowledge deficit regarding assessment and prevention of pressure ulcers as performance on the PUKT (72%) fell below the recommended score of 90%. Results of binary logistic regression indicated that knowledge as measured by the PUKT and availability of a pressure ulcer staging tool were statistically significant (p=0.03) predictors of pressure ulcer prevention behavior. The initial model without the predictor variables, indicated an overall success rate of correct predictions of 64% which increase to 73% when the predictor variables were added to the initial model. ConclusionsAlthough perioperative nurses believe that pressure ulcer prevention is important, a knowledge deficit exists and there is a need for pressure ulcer prevention education.

Improving the quality of nurse-influenced patient care in the intensive care unit.

Quality of care is a major focus in the intensive care unit (ICU). To describe a nurse-initiated quality improvement (QI) project that improved the care of critically ill patients in a New Zealand tertiary ICU. A framework for QI was developed and implemented as part of a practice change initiative. Audit data were collected, analysed and reported across seven nurse-influenced patient care standards. The seven standards were enteral nutrition delivered within 24 h of admission, timely administration of antibiotics, sedation holds for eligible patients, early mobilization and three pressure ulcer prevention strategies. Comparison of audit data collected in 2014 and 2015 demonstrated improvements in five of the seven standards. Those standards with the largest practice improvements were related to the following standards: all eligible patients have enteral nutrition commenced within the first 24 h of ICU admission (3% increase); all eligible patients receive antibiotics within 30 min of prescription time (6% increase); all eligible patients have a daily sedation interruption (DSI; 24% increase); and all eligible patients are mobilized daily in their ICU stay (11% increase in percentage of patients mobilized daily). The nursing-initiated QI project demonstrated improved ICU patient care in relation to early enteral nutrition commencement, DSIs and early and daily mobilizing. The use of a nursing QI framework incorporating audit and feedback is one method of evaluating and enhancing the quality of care and improving patient outcomes. This initiative demonstrated the improved quality of nursing care for ICU patients, particularly in relation to early enteral nutrition commencement, timely antibiotics, DSIs and daily mobilizing. It is thus highly relevant to critical care nursing teams, particularly those working to create a culture where change is safe, achievable and valued.

Effectiveness of Pressure Ulcer Prevention Strategies for Adult Patients in Intensive Care Units: A Systematic Review.

Pressure ulcers are associated with substantial health burden, but could be preventable. Hospital-acquired pressure ulcers (HAPUs) prevention has become a priority for all healthcare settings, as it is considered a sign of quality of care providing. Intensive care unit (ICU) patients are at higher risk for HAPUs development. Despite the availability of published prevention strategies, there is a little evidence about which strategies can be safely integrated into routine standard care and have an impact on HAPUs prevention. The aim was to synthesize the best available evidence regarding the effectiveness of single strategies designed to reduce the incidence and prevalence of HAPUs development in ICUs. The search strategy was designed to retrieve studies published in English across CINAHL, Medline, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Mednar between 2000 and 2015. All adult ICU participants were aged 18 years or over. This review included randomized controlled trials, quasi-experimental and comparative studies. The studies that were selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical-appraisal instruments. The review included 25 studies, and the meta-analysis revealed a statistically significant effect of a silicon foam dressing strategy in reducing HAPUs incidence (effect size = 4.62; 95% CI: 0.05-0.29; p < .00001, effect size = 4.50; 95% CI: 0.05-0.31; p = .00001, respectively) in critically ill patients. Evidence of the effectiveness of nutrition, skin-care regimen, positioning and repositioning schedule, support surfaces, and the role of education in prevention of HAPUs development in the ICU was limited, which precludes strong conclusions. The review provides an evidence-based guide to future priorities for clinical practice. In particular, a silicone foam dressing has positive impact in reducing sacrum and heel HAPUs incidence in the ICU.

Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: a systematic review protocol.

The objective of this review is to identify the effectiveness of pressure ulcer (PU) prevention strategies on the incidence of hospital-acquired PUs in the intensive care unit (ICU).More specifically, the objectives are to identify the effectiveness of utilizing PU prevention strategies such as risk assessment, skin assessment, skin care, nutrition, position and repositioning, education and training, medical devices care or other strategies designed to manage the risk factors for PU development and reduce the incidence of PUs in ICUs.