Evaluation of the implementation of a pressure injury prevention protocol for ARDS patients receiving prone ventilation (PIPP-ARDS): Nurse and patient outcomes.

OBJECTIVE

To implement the PIPP-ARDS protocol and evaluate its impact on the incidence and characteristics of pressure injuries, as well as its effect on nurses' perception of pressure injury prevention in patients receiving prone ventilation.

DESIGN

A prospective before-after implementation study conducted following TREND guidelines and registered with the Chinese Clinical Trial Registry (ChiCTR2500101498).

METHODS

Patients meeting predefined inclusion and exclusion criteria were consecutively enrolled and allocated to the pre-intervention or post-intervention period based on admission period. Patients admitted from February to July 2024 received routine nursing care (pre-intervention), whereas those admitted from August 2024 to January 2025 received the PIPP-ARDS prevention protocol (post-intervention). Data were collected on pressure injury incidence, anatomical location, and nurses' perception before and after protocol implementation.

RESULTS

A total of sixty-eight patients were included in the study. The incidence of pressure injuries was significantly lower in the post-intervention period compared to pre-intervention period (20.6% vs. 44.1%, P = 0.038). Multivariable logistic regression analysis demonstrated that the intervention was independently associated with a significantly reduced risk of pressure injury (adjusted OR = 0.224, P = 0.021), whereas total prone duration was identified as an independent risk factor. The most frequently affected anatomical sites included the face (cheeks, forehead, chin, and nose), anterior chest, and anterior superior iliac spine. One hundred twenty-one intensive care nurses participated before the protocol, and ninety-four participated after implementation. Nurses exposed to the protocol showed improved perception of pressure injury prevention. Knowledge scores increased across all content domains, and nurses' attitudes toward prevention became more constructive.

CONCLUSIONS

These findings reflect real-world ICU practice and provide actionable guidance for pressure injury prevention. The implementation of the PIPP-ARDS protocol was associated with a lower incidence of pressure injuries and positively correlated with improved nurses' perceptions of prevention during prone ventilation. However, given the before-after study design, further studies with larger sample sizes or randomized controlled designs are required to confirm these findings and establish causality.