The effectiveness of plant-based topical agents for the prevention of pressure injuries: Systematic review of randomised controlled trials

Background

Pressure injuries (PIs) are a major global health challenge. As PI-related healthcare costs continue to rise and patient safety is increasingly impacted, nurses are actively working to design and implement effective prevention strategies, particularly focusing on skin care, to prevent PIs in high-risk patients. Recent advances in incorporating plant-based topical agents into comprehensive care bundles for PI prevention have shown promising potential, though the results remain somewhat variable.

Objective

To evaluate effectiveness of plant-based topical agents in preventing PIs and their impact on PI incidence, time to PI formation and adverse events.

Methods

A systematic review was performed and reported according to the PRISMA guidelines. PubMed, Cochrane Library, EMBASE, PROQUEST Health Research Premium Collection, Clinical Key, MEDLINE, CINAHL, Google Scholar, and Airiti Library from database inception to May 2024.Two researchers independently screened randomised controlled trials published in Chinese and English. Screening, data extraction, and quality evaluation were independently performed by two reviewers using the Cochrane RoB 2.0 tool and GRADE to assess the strength of evidence. Disagreements were resolved by a third reviewer. Due to the heterogeneity of the intervention, a meta-analysis was not feasible; consequently, the findings were synthesised narratively.

Results

Ten randomised controlled trials were included, consisting of 2364 patients without PI and no sensitivity to plant-based topical agents. The plant-based topical agents used in the interventions included olive oil (n = 6), sweet almond oil (n = 1), aloe vera gel (n = 2), aloe vera gel–olive oil compound (n = 1), peppermint oil gel (n = 1), and henna paste (n = 1). PI incidence was lower in the intervention groups compared to control groups, but the time to PI formation was inconsistent. No or mild adverse events were reported. The overall risk of bias was categorised as ‘some concerns’ (n = 5) and ‘high risk’ (n = 5).

Conclusions

This review found that different plant-based topical agents can be effective in preventing PI and can be an option for PI prevention. Higher-quality studies are needed to validate effectiveness of plant-based topical agents in preventing PI and to clarify their mechanisms of action. We suggest incorporating plant-based topical agents into PI care protocols and in-service education to ensure consistent usage. Implementation can start with high-risk PI patients in critical/home care settings to prevent PI occurrence.

Registration

PROSPERO Registration Number CRD42024567522.

Tweetable abstract

Plant-based topical agents like olive oil and aloe vera show potential in preventing pressure injuries in high-risk patients, but more high-quality research is needed to validate their effectiveness and mechanisms.