What Is the Impact of Care Bundles on the Prevalence or Incidence of Pressure Ulcers Among At-Risk Adults in the Acute Care Setting? A Systematic Review

Abstract

A pressure ulcer is an injury to the skin and underlying tissues caused by pressure, shear or a combination of the two. In Europe, the mean prevalence rate of pressure ulcers is 10.8%, in Ireland, it is less than 12%. Using systematic review methodology, original research studies written in English were included, employing pre- and post-studies, quality improvement initiatives or projects, randomised controlled trials and experimental studies. Data was extracted using a pre-designed data extraction tool and quality appraisal was undertaken using the Evidence-Based Librarianship (EBL) tool. Where appropriate, a meta-analysis was undertaken using RevMan. The study protocol was pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42023442711). Following the search, 628 records were returned, of which 25 met the inclusion criteria. The studies were conducted in a variety of acute healthcare settings. Of the included studies, 16 presented data on incidence and 12 presented data on prevalence of pressure ulcers post-implementation of a care bundle. A meta-analysis of 10 studies discussing incidence indicates the RR of PU is 0.40 (95% CI: 0.21–0.78; p = 0.007), supporting the use of a care bundle. A meta-analysis of seven studies discussing prevalence indicates the RR of PU is 0.34 (95% CI: 0.21–0.56; p = 0.0001), demonstrating the reduction in the RR of PU development in favour of the care bundle group. A variety of care bundle elements were found in the studies. Although results indicated the use of a care bundle was advantageous in preventing a pressure ulcer in the acute care setting, it was unclear which of these elements were most effective.