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Evaluation of a Pressure Injury Prevention Bundle in an Australian Intensive Care Unit: A Before and After Study

Year: 2025

Type: article

Abstract: BACKGROUND: Recent studies indicate that the incidence of pressure injury (PI) in intensive care is significant. Multiple intensive care-specific PI risk assessment tools are available, but only the COMHON Index has been bundled with preventative interventions based on assessed risk level. AIMS: Evaluate the effectiveness of the COMHON Index intervention bundle to reduce PI in an Australian intensive care unit (ICU) and to assess compliance with bundle implementation. STUDY DESIGN: Before and after study including all patients admitted to a general ICU during the study period (3-month before/after-phases, 2-month wash-out). Standard care in the before-phase comprised the Braden Scale and interventions selected with clinical judgement. In the after-phase, the COMHON Index and its risk-stratified intervention bundle were implemented. The primary outcome was PI incidence. RESULTS: PI incidence reduced from 4.9% in the before-phase (sample n = 296) to 3.9% in the after-phase (sample n = 295), resulting in a 21% relative risk reduction. Three significant factors associated with PI development were identified using logistic regression: intensive care length of stay (odds ratio [OR] 1.2), high-risk cases (OR 4.5) and male gender (OR 3.9). In the after-phase, overall bundle compliance was good (81%) but all-or-nothing compliance was poor (30%) although individual intervention compliance varied (range 53%-100%). CONCLUSIONS: Implementation of the COMHON index risk-stratified bundle resulted in a small reduction in PI incidence. However, compliance with some interventions was poor, especially repositioning frequency. The relationship between intervention and bundle compliance and PI outcomes requires further research. RELEVANCE FOR CLINICAL PRACTICE: The results suggest that the use of the COMHON Index intervention bundle may be beneficial to prevent PI in ICU patients. Further research is needed to examine its effectiveness, while controlling for bundle compliance. Future efforts of translation into clinical practice should be underpinned by a relevant implementation framework to enhance local contextualisation and bundle adherence.

Source: Nursing in Critical Care

DOI: 10.1111/nicc.70242

Authors: Paul Fulbrook, Richard McAllister, Cindy Weatherburn, Ellen Burke, Josephine Lovegrove