Effects and Interventions of Pressure Injury Prevention Bundles of Care in Critically Ill Patients: A Systematic Review

Abstract

Background: Many studies on pressure injury prevention bundles have been conducted outside the Intensive Care Unit (ICU). The bundles, which include multi interventions, have proven effective in reducing pressure ulcer incidents compared to a single intervention. However, the existing review studies on pressure injury prevention in ICUs still only investigate a single intervention rather than multi interventions. Only few reviews, to our knowledge, involves prevention bundle strategies in the ICU.Purpose: This study aims to review the effects of the pressure injury prevention bundles of care on the incidents of pressure injury in critically ill patients and the intervention measures of the care bundles.Methods: This review searched published articles from several databases, namely EBSCO, ScienceDirect, PubMed, ProQuest, Google Scholar, and Scopus from 2009 up to 2020. PRISMA flowchart was used to select relevant articles using several inclusion and exclusion criteria, resulting in 17 article from 50 eligible full-text articles for assessment. The included studies were assessed for their quality using Joanna Briggs Institute (JBI) critical appraisal tools. The synthesis was then conducted narratively.Results: As many as 17 studies, which mostly had good quality yet evidence level of II, were included in the analysis. The findings showed that the pressure injury prevention bundles of care decreased pressure injury incidents as many as 4.3%-36.2% in developed countries and 4.16%-21% in developing countries. Moreover, the bundles of care which significantly reduced the incidents of pressure injury consisted of 7 intervention measures, which were pressure injury risk assessment using Cubbin Jackson scale, skin assessment and care, repositioning, nutrition, education, support surface, and medical device care.Conclusion:The review concluded that the pressure injury prevention bundles of care in critically ill patients significantly reduced the incidents of pressure injury. The study recommends more studies with stronger evidence levels to carry out and utilize 7 intervention measures as a preventive standard of care in critically ill patients.

Effleurage Massage With Virgin Coconut Oil (Vco) to Prevent Decubitus Ulcers in Immobilized Patients: A Case Study

“…Several other studies that also used VCO as a topical agent for the prevention of pressure sores explained that there was an effect of changing position and VCO massage on the prevention of decubitus ulcers in bedridden patients at Tangerang District General Hospital. The risk of decubitus ulcers after changing position and VCO massage decreased compared to before changing position and VCO massage (Demir & Kasapoğlu, 2008;Trisnaningtyas et al, 2021).…”

“…Massage is a therapy that has various benefits for the body's organ systems, including improving the function of the skin, muscle tissue, bone growth, joint motion, and nerve tissue. If massage is done for a certain time, it will have a relaxing effect thereby reducing pressure on the body, one of which is using the effleurage technique (Darmareja et al, 2020;Trisnaningtyas et al, 2021). The effleurage technique is performed by wiping the body once or twice a day which is believed to minimize the occurrence of decubitus ulcers (Phasar, Imran.…”

What is the evidence on skin care for maintaining skin integrity and prevention of wounds? An integrative review

“…A systematic review of 17 studies exploring pressure injury prevention bundles for critically ill patients mostly found decreased incidence of pressure injuries, however a metaanalysis could not be taken due to the variation in methods. 58 The pre/post studies evaluated implementation of local guidelines and education, multi-component 'bundles' or programs, or structured skin care protocols. Studies on guideline and/or education interventions found improved nurses' or care staff knowledge, 59,60 in addition to improvement of dry skin and decreased TEWL.…”