Association of a structured prevention algorithm with nurse knowledge and device-related pressure injury severity in critical care: A pre‑post study
Yarkaram Zamani Shiva, Fateme Hasandoost, Malihe Nasiri, Tayebeh MahvarBackground
Medical Device-Related Pressure Injuries (MDRPI) are a serious complication in intensive care units (ICUs), yet structured prevention algorithms are lacking.
Methods
This single-group, pre-test/post-test quasi-experimental study was conducted in the General Intensive Care Unit from February 2025 to April 2025. The sample comprised 38 nurses and 77 patients (39 pre-intervention, 38 post-intervention). Nurses’ knowledge was assessed using the MDRPUKQ questionnaire, and patient outcomes were monitored using baseline and post-intervention data on pressure injury prevalence and severity. Data were analyzed using SPSS version 26, employing descriptive and inferential statistics including paired t-tests, independent t-tests, chi-square tests, Fisher’s exact tests, and multivariable logistic regression.
Results
The mean knowledge score increased significantly from 57.74 (SD = 11.15) before training to 89.55 (SD = 5.17) afterward (mean difference: 31.81, 95% CI: 28.35–35.27, P < 0.001, Cohen’s d = 3.02). Overall, MDRPI prevalence decreased from 38.5% (95% CI: 24.9–54.1%) pre-intervention to 28.9% (95% CI: 17−44%). However, this difference was not statistically significant using Pearson’s chi-square test (χ 2 = 0.82, P = 0.365). The distribution of pressure injury stages before implementation was: Stage 1 (28.2%), Stage 2 (7.7%), and Stage 3 (2.6%). Following the intervention, prevalence dropped to Stage 1 (21.1%) and Stage 2 (5.3%), with no new Stage 3 injuries reported. After adjusting for potential confounders (age, Braden score, ICU length of stay, and device exposure duration), implementation of the algorithm was associated with reduced MDRPI occurrence (adjusted OR = 0.42, 95% CI: 0.19–0.91, P = 0.026).
Conclusion
Implementation of the MDRPI prevention algorithm was associated with significant improvement in nurses’ knowledge. A numerically lower prevalence was observed. This suggests that injuries caused by medical equipment are largely absent from current mandatory continuing education or postgraduate nursing curricula, reinforcing the need for a thorough review and the integration of this topic into standard educational programs.