Implementing the SSKIN Bundle in Home Healthcare: A Tool Tutorial for Reducing Pressure Injuries.

BACKGROUND

Pressure injuries remain a significant source of preventable harm in home healthcare settings where standardized prevention approaches are often inconsistent, and caregiver support varies substantially. The object of this study was to provide a comprehensive, replicable toolkit for implementing the SSKIN bundle (Support surfaces, Skin inspection, Keep moving, Incontinence management, Nutrition) in home healthcare to reduce pressure injury incidence.

METHODS

The authors implemented the SSKIN bundle across Qatar's Home Healthcare Services, serving approximately 2,650 patients monthly. The intervention comprised structured training for 110 nursing staff (January-March 2023), culturally adapted Arabic and English educational materials for caregivers, standardized risk assessment protocols using the Braden Scale, and enhanced referral pathways. Implementation began in April 2023 across all four geographic districts simultaneously. The study measured monthly pressure injury incidence rates from January 2023 through December 2025.

RESULTS

Monthly pressure injury incidence declined from a baseline of 0.48% (January-April 2023, n = 47 injuries over 4 months) to 0.36% in 2024 (n = 115 injuries over 12 months) and 0.34% in 2025 (n = 111 injuries over 12 months), representing a sustained 29% relative reduction. Nursing staff compliance with SSKIN documentation protocols exceeded 97% by 18 months postimplementation. The median monthly incidence shifted from 0.50% preintervention to 0.34% postintervention, indicating statistically significant improvement.

CONCLUSION

Systematic implementation of the SSKIN bundle in home healthcare effectively reduces pressure injury incidence when combined with comprehensive staff education, cultural adaptation of materials, and standardized documentation. This toolkit provides replicable resources for organizations seeking to implement evidence-based pressure injury prevention in community settings.