Implementing Nurse-Led Prevention of Medical Device–Related Pressure Injuries in Adult Critical Care. A Focused Integrative Review and Saudi Practice Algorithm

Vollständiger Abstract

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Background: Medical device–related pressure injuries (MDRPIs) are a preventable source of harm in adult intensive care units (ICUs), where life- sustaining devices, vasopressor therapy, edema, immobility, and impaired sensation converge. Nurses are positioned to identify early tissue change and coordinate pressure redistribution, yet implementation is inconsistent. Aim: To synthesize current evidence on nurse-led MDRPI prevention in adult acute and critical care and translate the findings into a pragmatic implementation algorithm for Saudi hospitals. Methods: A focused integrative review was conducted using PubMed/MEDLINE, publisher platforms, professional guidance, and backward/forward citation searching. English-language evidence published from January 2017 to 28 July 2026 was prioritized. Eligible sources addressed adult acute or critical care, prevention protocols, care bundles, education, device-interface protection, implementation, or Saudi practice. Findings were narratively synthesized because interventions and outcome definitions were heterogeneous. Results: Recent meta-analysis estimates an overall MDRPI incidence of 19.3%, with adult critical care estimates near 19%. Across systematic reviews, useful components consistently included device necessity review, correct selection and fit, baseline and repeated skin assessment, pressure redistribution, moisture control, preventive dressings when device function is preserved, documentation, education, and multidisciplinary escalation. Saudi pre–post evidence reported a fall in MDRPI prevalence from 23.0% to 8.5% after a tailored prevention initiative. A 2026 Saudi study of 311 registered nurses found that a structured educational intervention improved prevention scores from 14.17 to 16.25 (Cohen’s d=0.67). However, much of the outcome evidence remains quasi-experimental or quality-improvement based. Conclusion: A standardized nurse-led bundle is clinically defensible, but it should be implemented as a measured safety program rather than as an assumed solution. The proposed SAFE–DEVICE algorithm links bedside actions to competency assessment, documentation, and audit indicators suitable for local validation in Saudi adult ICUs.