Intensive Care Training Cuts Device Pressure Wounds

Intensive care unit patients relying on breathing tubes and intravenous lines face a high risk of developing painful skin damage known as medical device-related pressure injuries, or MDRPIs, which affect roughly 20 percent of critical care admissions worldwide. These painful wounds form when diagnostic or therapeutic equipment presses against vulnerable tissue, often matching the exact shape of the device, yet structured prevention guidelines remain scarce in many clinical settings.

How a Structured Prevention Protocol Changed Critical Care

To address this clinical gap, researchers designed a quasi-experimental study in an adult general intensive care unit to evaluate whether a standardized prevention algorithm combined with targeted staff training could improve care. The study, published in PLOS One, examined 38 intensive care nurses and 77 patients, dividing the patient group into 39 individuals monitored before the intervention and 38 evaluated afterward between February and April 2025. The educational intervention consisted of a 90-minute multimedia presentation and a 30-minute question-and-answer session delivered by a certified wound care nurse with a decade of intensive care experience. The curriculum covered six common medical device types, including endotracheal tubes, nasogastric tubes, central venous lines, arterial lines, standard oxygen masks, and non-invasive ventilation masks. Participating nurses completed the Medical Device-Related Pressure Injury Knowledge Questionnaire immediately before the training and one week later to measure immediate knowledge acquisition.

Dramatic Gains in Staff Knowledge and Wound Outcomes

Before the educational sessions, participating nurses achieved an average knowledge score of 57.74 out of 100, reflecting a moderate baseline understanding of device-related skin risks. Following the training program, the average score jumped significantly to 89.55, representing an average gain of 31.81 units. Independent audits conducted twice weekly by trained researchers revealed a high overall adherence rate of 87.3 percent among the nursing staff, with skin assessments showing the highest compliance at 91.5 percent and prophylactic dressing application recording 82.1 percent.

Patient outcomes tracked over the study period showed that the overall prevalence of device-related pressure injuries dropped from 38.5 percent pre-intervention to 28.9 percent post-intervention. Although this 9.6 percentage point decrease did not reach statistical significance in the unadjusted chi-square analysis, a multivariable logistic regression model adjusting for patient age, Braden skin risk scores, intensive care length of stay, and device exposure duration found that algorithm implementation was independently associated with a reduced occurrence of pressure injuries, yielding an adjusted odds ratio of 0.42.

Understanding the Limits and Future Directions

The authors noted several important limitations to keep in mind when interpreting these findings. Because the research employed a single-group pre-test and post-test design without a randomized control group, establishing direct causality remains challenging, and the observed improvements could be influenced by external factors or increased staff awareness driven by study participation. Furthermore, the patient sample size was relatively small and exploratory, and the one-week post-test measured short-term knowledge recall rather than long-term retention over months of clinical practice. Future investigations will need to incorporate randomized controlled trials with larger patient cohorts and extended follow-up windows to confirm these preliminary findings and evaluate whether structured prevention protocols can deliver sustained protection for critically ill patients.

The research was published in PLOS One on October 27, 2026.