{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:54:35Z","timestamp":1777661675986,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T00:00:00Z","timestamp":1665446400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prone positioning has been widely used to improve oxygenation and reduce ventilator\u2010induced lung injury in patients with severe COVID\u201019 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID\u201019 ARDS undergoing prone positioning in the intensive care unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>This was a single\u2010centre pre and post\u2010test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the pre\u2010intervention study, 20 patients were included and 80% (<jats:italic>n<\/jats:italic>\u00a0=\u200916) of these patients developed PUs, comprising 34 ulcers in total. In the post\u2010intervention study, a further 20 patients were included and 60% (<jats:italic>n<\/jats:italic>\u00a0=\u200912) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, <jats:italic>n<\/jats:italic>\u00a0=\u200922; 88%, <jats:italic>n<\/jats:italic>\u00a0=\u200928, respectively). In the post\u2010intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre\u2010intervention 6%, <jats:italic>n<\/jats:italic>\u00a0=\u20092 grade III, 6% <jats:italic>n<\/jats:italic>\u00a0=\u20092 deep tissue injuries; post\u2010intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post\u2010intervention group with 6% (<jats:italic>n<\/jats:italic>\u00a0=\u20092) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre\u2010intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The use of a new evidence\u2010based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to Clinical Practice<\/jats:title><jats:p>The use of a new, evidence\u2010based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nicc.12842","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T06:37:56Z","timestamp":1665556676000},"page":"1115-1123","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Pressure ulcers in patients with <scp>COVID<\/scp>\u201019 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre\u2010 and post\u2010intervention study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7533-166X","authenticated-orcid":false,"given":"Natalie L.","family":"McEvoy","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"},{"name":"School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oisin","family":"Friel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmet","family":"Browne","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierce","family":"Geoghegan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aglecia","family":"Budri","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pinar","family":"Avsar","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinead","family":"Connolly","sequence":"additional","affiliation":[{"name":"Beaumont Hospital  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Declan","family":"Patton","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"},{"name":"Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences  Dublin Ireland"},{"name":"Fakeeh College of Health Sciences  Jeddah Saudi Arabia"},{"name":"Faculty of Science, Medicine and Health University of Wollongong  Wollongong Australia"},{"name":"School of Nursing and Midwifery Griffith University  Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerard F.","family":"Curley","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"},{"name":"Beaumont Hospital  Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zena","family":"Moore","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Sciences  Dublin Ireland"},{"name":"Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences  Dublin Ireland"},{"name":"Fakeeh College of Health Sciences  Jeddah Saudi Arabia"},{"name":"School of Nursing and Midwifery 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