Association of a structured prevention algorithm with nurse knowledge and device-related pressure injury severity in critical care: A pre‑post study
4 affiliations
- 1Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- 2Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- 3Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- 4Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract
Background: 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 (χ2 = 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.
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BibTeX
@article{shiva2026association,
title = {{Association of a structured prevention algorithm with nurse knowledge and device-related pressure injury severity in critical care: A pre‑post study}},
author = {Yarkaram Zamani Shiva and Fateme Hasandoost and Malihe Nasiri and Tayebeh Mahvar},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359842},
url = {https://doi.org/10.1371/journal.pone.0359842},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of a structured prevention algorithm with nurse knowledge and device-related pressure injury severity in critical care: A pre‑post study
AU - Yarkaram Zamani Shiva
AU - Fateme Hasandoost
AU - Malihe Nasiri
AU - Tayebeh Mahvar
PY - 2026
DA - 2026/10/27
JO - PLOS One
DO - 10.1371/journal.pone.0359842
UR - https://doi.org/10.1371/journal.pone.0359842
AB - Background: 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 (χ2 = 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.
SN - 1932-6203
ER -