Reducing the incidence of stage II or higher pressure injuries in patients undergoing prone positioning in the intensive care unit: A pre- post-intervention study

Prone positioning (PP) is widely used in intensive care units (ICUs) to improve oxygenation in patients with respiratory distress. However, prolonged maintenance in this non-physiological position, especially in patients with underlying comorbidities, increases the risk of pressure injuries (PIs).

This study aimed to evaluate the effectiveness of a nursing quality improvement (QI) project in reducing the incidence of stage II or higher PIs in ICU patients undergoing prone positioning.

This was a single-centre, pre- and post-intervention QI study conducted in an ICU setting. The intervention included the development of the nursing care protocol for prone-positioned patients and the foam dressing application protocol for prone-positioned patients, along with instructional videos, structured nurse training and enhanced supervision mechanisms. Given that stage II PIs signify damage to both the epidermis and dermis, representing a critical phase in their progression, this study focused primarily on the incidence of stage II or higher pressure injuries.

A total of 70 patients were included, with 31 in the pre-intervention group and 39 in the post-intervention group. Before the intervention, 58.06% (18/31) of patients developed stage II or higher PIs across 47 sites, most commonly on the cheeks (n = 9, 19.15%). Post-intervention, 25.64% (10/39) of patients developed PIs, affecting a total of 10 sites, all classified as stage II, with the chin being the most frequently affected area (n = 4, 40.00%). The intervention significantly reduced PI incidence by 55.83% (p = .006, odds ratio = 0.24, 95% CI: 0.08-0.69), with no stage III or higher injuries reported.

The implementation of the nursing QI project significantly reduced the incidence of stage II or higher PIs in ICU patients undergoing prone positioning. However, PIs continued to occur predominantly in the head and facial regions, such as the chin and ears, highlighting the need for targeted protective strategies for these high-risk areas.

This study demonstrates the effectiveness of a structured QI approach in reducing stage II or higher PIs in ICU patients undergoing prone positioning. Standardized protocols, structured training and quality monitoring enhanced adherence to preventive measures, providing practical guidance for ICU nurses in mitigating PI risk.