title: A two-arm cluster randomized control trial to determine the effectiveness of a pressure ulcer prevention bundle for critically ill patients.
abstract: OBJECTIVE
  This study tested the effectiveness of a pressure ulcer (PU) prevention bundle in reducing the incidence of PUs in critically ill patients in two Saudi intensive care units (ICUs).
  
  
  METHODS
  A two-arm cluster randomized experimental control trial.
  
  
  METHODS
  Participants in the intervention group received the PU prevention bundle, while the control group received standard skin care as per the local ICU policies. Data collected included demographic variables (age, diagnosis, comorbidities, admission trajectory, length of stay) and clinical variables (Braden Scale score, severity of organ function score, mechanical ventilation, PU presence, and staging). All patients were followed every two days from admission through to discharge, death, or up to a maximum of 28 days. Data were analyzed with descriptive correlation statistics, Kaplan-Meier survival analysis, and Poisson regression.
  
  
  RESULTS
  The total number of participants recruited was 140: 70 control participants (with a total of 728 days of observation) and 70 intervention participants (784 days of observation). PU cumulative incidence was significantly lower in the intervention group (7.14%) compared to the control group (32.86%). Poisson regression revealed the likelihood of PU development was 70% lower in the intervention group. The intervention group had significantly less Stage I (p = .002) and Stage II PU development (p = .026).
  
  
  CONCLUSIONS
  Significant improvements were observed in PU-related outcomes with the implementation of the PU prevention bundle in the ICU; PU incidence, severity, and total number of PUs per patient were reduced.
  
  
  CONCLUSIONS
  Utilizing a bundle approach and standardized nursing language through skin assessment and translation of the knowledge to practice has the potential to impact positively on the quality of care and patient outcome.
authors: Doctoral Candidate, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia and Lecturer. School of Nursing, Umm Al-Qura University, Mecca, Saudi Arabia.
authors: Nahla
authors: N
authors: Tayyib
authors: Fiona
authors: F
authors: Coyer
authors: Peter A
authors: PA
authors: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D064648:Critical Care Nursing / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
keywords: Bundle care; incidence; intensive care; pressure ulcer