Effectiveness on hospital-acquired pressure ulcers prevention: a systematic review

Int Wound J. 2019 Oct;16(5):1087-1102. doi: 10.1111/iwj.13147. Epub 2019 Jul 1.


The effective approach on pressure ulcer (PU) prevention regarding patient safety in the hospital context was evaluated. Studies were identified from searches in EBSCO host, PubMed, and WebofScience databases from 2009 up to December 2018. Studies were selected if they were published in English, French, Portuguese, or Spanish; incidence of PUs was the primary outcome; participants were adults (≥18 years) admitted in hospital wards and/or units. The review included 26 studies. Studies related to prophylactic dressings applied in the sacrum, trochanters, and/or heels, education for health care professionals, and preventive skin care and system reminders on-screen inpatient care plan were effective in decreasing PUs. Most of the studies related to multiple intervention programmes were effective in decreasing PU occurrence. Single interventions, namely support surfaces and repositioning, were not always effective in preventing PUs. Repositioning only was effective when supported by technological pressure-mapping feedback or by a patient positioning system. Risk-assessment tools are not effective in preventing PUs. PUs in the hospital context are still a worldwide issue related to patient safety. Multiple intervention programmes were more effective in decreasing PU occurrence than single interventions in isolation. Single interventions (prophylactic dressings, support surfaces, repositioning, preventive skin care, system reminders, and education for health care professionals) were effective in decreasing PUs, which was always in compliance with other preventive measures. These results provide an overview of effective approaches that should be considered when establishing evidence-based guidelines to hospital health care professionals and administrators for clinical practice effective in preventing PUs.

Keywords: effectiveness; hospital-acquired pressure ulcers; patient safety; pressure injury; prevention.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Administration, Topical
  • Bandages
  • Case-Control Studies
  • Dermatologic Agents / therapeutic use
  • Female
  • Follow-Up Studies
  • Hospitalization / statistics & numerical data*
  • Humans
  • Inpatients / statistics & numerical data
  • Male
  • Patient Positioning
  • Practice Guidelines as Topic*
  • Pressure Ulcer / prevention & control*
  • Primary Prevention / methods*
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Skin Care / methods*
  • Time Factors
  • Wound Healing / physiology


  • Dermatologic Agents