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Skin care strategies to prevent pressure ulcer for patients in acute care settings: a systematic review.

Objective 
The objective of this systematic review is to identify the best available evidence for the effectiveness of skin care interventions in preventing pressure ulcer amongst patients in acute care settings. 
Review Question 
How effective are skin care interventions to prevent pressure ulcer in adults (18 years old) when compared with standard practice or no intervention? 
 
Criteria for Considering Studies for this Review 
Population 
The review will consider all studies that involved adult patients (more than or equal to 18 years old) in acute care hospitals. Since the prevalence of pressure ulcer is considerably high in acute care, the patients admitted to acute care settings will be included in this review. Patients in long-term care, rehabilitation centre and nursing homes will be excluded in the review. Moreover, this review will exclude patients who have pre-existing pressure ulcer. 
 
Intervention 
This review will identify the skin care in preventing pressure ulcers. The skin care is usually performed by nurses in hospitals. Types of the interventions are massage, skin inspection, skin dressing and providing skin topical (moisturizer, powder and solutions).23 Other types of prevention such as risk assessment, repositioning, using support surface, risk assessment, educational program and supplementation of nutrition will be excluded in the interventions. 
 
Comparison 
The comparison of the review will be standard care or no intervention. 
 
Outcome 
Patients do not develop grade one pressure ulcer will be consider as a primary outcome in this review. The stage is based on grading scale from National Pressure Ulcer Advisory Panel NPUAP.2 In addition, the outcome is measured by skin assessment using any scale such as Norton scale, Waterlow Scale, Braden Scale or nurse clinical judgement.21 The secondary outcome will be the length of stay in hospital.