Numerous interventions for pressure injury prevention have been developed, including care bundles. To systematically review the effectiveness of pressure injury prevention care bundles on pressure injury prevalence, incidence, and hospital-acquired pressure injury rate in hospitalised patients. The Medical Literature Analysis and Retrieval System Online (via PubMed), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus, the Cochrane Library and two registries were searched (from 2009 to September 2023). Randomised controlled trials and non-randomised studies with a comparison group published in English after 2008 were included. Studies reporting on the frequency of pressure injuries where the number of patients was not the numerator or denominator, or where the denominator was not reported, and single subgroups of hospitalised patients were excluded. Educational programmes targeting healthcare professionals and bundles targeting specific types of pressure injuries were excluded. Bundles with ≥3 components directed towards patients and implemented in ≥2 hospital services were included. Screening, data extraction and risk of bias assessments were undertaken independently by two researchers. Random effects meta-analyses were conducted. The certainty of the body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. Nine studies (seven non-randomised with historical controls; two randomised) conducted in eight countries were included. There were four to eight bundle components; most were core, and only a few were discretionary. Various strategies were used prior to (six studies), during (five studies) and after (two studies) implementation to embed the bundles. The pooled risk ratio for pressure injury prevalence (five non-randomised studies) was 0.55 (95 % confidence intervals 0.29–1.03), and for hospital-acquired pressure injury rate (five non-randomised studies) it was 0.31 (95 % confidence intervals 0.12–0.83). All non-randomised studies were at high risk of bias, with very low certainty of evidence. In the two randomised studies, the care bundles had non-significant effects on hospital-acquired pressure injury incidence density, but data could not be pooled. Whilst some studies showed decreases in pressure injuries, this evidence was very low certainty. The potential benefits of adding emerging evidence-based components to bundles should be considered. Future effectiveness studies should include contemporaneous controls and the development of a comprehensive, theory and evidence-informed implementation plan. PROSPERO CRD42023423058. Pressure injury prevention care bundles decrease hospital-acquired pressure injuries, but the certainty of this evidence is very low.

中文翻译：

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压力性损伤预防护理组合对住院患者压力性损伤的影响：复杂的干预系统评价和荟萃分析

已经开发了许多预防压力性损伤的干预措施，包括护理包。系统评价压力性损伤预防护理组合对住院患者压力性损伤患病率、发生率和医院获得性压力性损伤发生率的有效性。检索了在线医学文献分析和检索系统（通过 PubMed）、护理和联合健康文献累积索引、EMBASE、Scopus、Cochrane 图书馆和两个登记库（从 2009 年到 2023 年 9 月）。纳入了 2008 年之后以英文发表的随机对照试验和带对照组的非随机研究。在报告压力性损伤频率的研究中，患者数量不是分子或分母，或者未报告分母，并且排除了住院患者的单个亚组。针对医疗保健专业人员的教育计划和针对特定类型压力性损伤的捆绑包被排除在外。包含 ≥3 个针对患者且在 ≥2 个医院服务中实施的组件的捆绑包。筛选、数据提取和偏倚风险评估由两名研究人员独立进行。进行了随机效应荟萃分析。使用建议、评估、制定和评价的分级来评估证据主体的确定性。纳入了在八个国家进行的九项研究（七项非随机，有历史对照；两项随机）。有四到八个捆绑组件；大多数是核心的，只有少数是可自由支配的。在实施之前（六项研究）、实施期间（五项研究）和实施之后（两项研究）使用了各种策略来嵌入捆绑包。压力性损伤发生率（五项非随机研究）的汇总风险比为 0.55（95% 置信区间 0.29-1.03），医院获得性压力性损伤发生率（五项非随机研究）的汇总风险比为 0.31（95% 置信区间） 0.12–0.83）。所有非随机研究都存在很高的偏倚风险，证据质量非常低。在这两项随机研究中，护理捆绑对医院获得性压力性损伤发生密度没有显着影响，但无法汇总数据。虽然一些研究表明压力性损伤有所减少，但这一证据的质量非常低。应考虑将新兴的基于证据的组件添加到捆绑包中的潜在好处。未来的有效性研究应包括同期控制以及制定全面的、基于理论和证据的实施计划。普洛斯彼罗 CRD42023423058。压力性损伤预防护理组合可减少医院获得性压力性损伤，但这一证据的质量很低。