A Care Bundle to Prevent the Pressure Ulcer in the Intensive Care Units; A Systematic Review

Background: Pressure ulcer (also known as PU) or pressure sore is a localized injury of the skin or its underlying tissue which usually develops over bony prominences of body as a result of a long period of pressure. Pu s are combined with pain, risk of infection and sepsis, longer time of hospitalization and higher costs and mortality, and they also have effect on health_related quality of life. Although they can be life-threatening, yet they are preventable. Today s challenge is to implement evidance_based pressure ulcer prevention in clinical practice. A care bundle or prevention bundle is a small set of evdance_based interventions for a defined patient with the goal of promoting cooperation among health care members, and translation of guidelines. The existing one, which has been revised upon the EPUAP( European Pressure Ulcer Advisory Panel 2014) and RNAO (the guidelines of Registered Nurses Association of Ontario 2009) includes 5 important elements of PU: 1. Risk assessment 2.Skin assessment 3.Support surface 4.Nutrition 5.Repositioning Which runs in the different departments of a hospital, especially Intensive Care Units because of its high prevalence rate. Objectives: To evaluate the effects of implementing a care bundle to prevent the increasing the prevalence rate of pressure ulcers in the Intensive Care Units. Methods: To find related articles, search was conducted on Web of science, PubMed and Scopus databases for the articles which were published between 2007 and 2017 with these keywords: pressure ulcer, pressure ulcer prevention, prevention bundle, care bundle to prevent pressure ulcers. Results: After a final selection, a number of 22 Randomized Control Trials that assessed implementing the prevention bundle method in the ICU s, were included. Conclusion: 21 out of 22 studies which were included, reported success and decreasing prevalence rate. Just one of them did not report an obvious difference between the control and intervention group. This may be because of the prevention bundle did not provide an adequate training for nurses. Although, due to the novelty of this method, it is believed that success in interventional groups is due to the nurses s thoughts about being wathched, but it cannot be denied the significant effect of this intervention on reducing the prevalence of pressure ulcers.