An exploration of the key determinants of medical device-related pressure injury (MDRPI) among adult patients in intensive care units (ICUs) in the Kingdom of Saudi Arabia (KSA).

Abstract

Background
Pressure injuries continue to be a common complication of healthcare in intensive care units (ICUs). When these injuries are caused by medical devices, they are referred to as medical device-related pressure injuries (MDRPIs) (Kayser et al., 2018; Tyrer, 2020). MDRPIs are defined as localised injuries to the skin or underlying tissues, including mucous membranes, resulting from sustained pressure exerted by medical devices used for diagnostic or therapeutic purposes (Mehta et al., 2019). Such injuries can cause severe damage to the epidermis, dermis, subcutaneous tissue, and muscle (Kottner et al., 2020). MDRPIs are an increasing concern for healthcare systems due to their impact on patients, family members, and health services’ resources, therefore addressing MDRPIs is a major challenge within the ICU setting (Mehta et al., 2019; Tyrer, 2020). Patients who develop MDRPIs may experience significant pain, discomfort, emotional distress, and increases in mortality and morbidity (Edsberg et al., 2016).

Aim
To explore the key determinants relating to MDRPIs among adult patients receiving care in ICUs in the KSA.

Study Design
The study was conducted in four inter-related sequential phases. Phase 1, a systematic review was conducted to critically explore the available evidence to provide an overview regarding the key determinants of MDRPIs among adult patients receiving care in two ICUs in Kingdom of Saudi Arabia (KSA). Informed by the findings of the systematic review (Phase 1) and the Theoretical Domains Framework (TDF), the study adopted a qualitative exploratory design that was conducted in three sequential phases. Phase 2 involved focus group discussions with frontline ICU healthcare professionals. Phase 3 involved one-to-one interviews with ICU clinical leaders. Phase 4 involved integration of the findings from Phase 2 (focus group discussions), and Phase 3 (one-to-one interviews) to provide a comprehensive and cohesive understanding of the determinants of MDRPIs in the ICU setting.


Findings
The findings from the focus group discussions highlighted the significant impact of MDRPIs on patients, family members, and frontline healthcare professionals. Participants described the extent of concern experienced by frontline healthcare professionals when MDRPIs occur, including situations in which patients who are conscious may refuse treatment or support due to pain or discomfort caused by medical devices. They also observed the negative effects of MDRPIs on patients’ self-esteem and reported that family members often experience worry and concern when such injuries develop. Alongside these impacts, participants described a perceived inevitability of MDRPIs, rooted in the interaction between device-related factors (e.g., device size and securement method) and patient-related factors (e.g., clinical condition such as oedema), with downstream consequences including increased morbidity, prolonged ICU and/or hospital length of stay.

Findings from the one-to-one interviews with clinical leaders complemented these insights. Clinical leaders described their roles within ICU settings and acknowledged the multifaceted burden of MDRPIs for patients, family members, frontline healthcare professionals, and organisations. They emphasised the complexity of MDRPIs arising from the interaction between device- and patient-related factors. The emerging recommendations agreed multidisciplinary collaboration is a central organising principle for improvement and priority actions included: sustained educational courses and continued promotion of awareness among practitioners to maintain clinical vigilance; the introduction of targeted preventative practices, such as routine fit-checks for devices and prompt removal of devices when clinically appropriate; and the enablement of family members in MDRPIs care.

The data were then integrated using a joint display technique, narrative synthesis, and the Theoretical Domains Framework (TDF). This integration highlighted areas of convergence and divergence across three central themes: shared concerns about MDRPIs, understanding their determinants, and the recognised need for change in ICU practice. The integrated findings illustrated how professional roles and interrelated patient- and device-related factors shape the assessment, prevention, and reduction of MDRPIs among patients receiving care in ICU. By mapping the findings within the TDF, the chapter provides a theoretical understanding of how environmental, professional, and contextual factors influence MDRPIs prevention.

Conclusion
This study demonstrates that MDRPIs among adult patients receiving care in ICU are complex patient safety issues, arising from the interaction of patient and device-related factors, as well as organisational conditions. The findings indicate that MDRPIs require system-level approaches that support continuous education, structured multidisciplinary collaboration, and shared accountability, proactive assessment, and monitoring of the needs of patients, and the importance of the family and patient involvement. By highlighting the experiences and perspectives of frontline healthcare professionals and ICU clinical leaders, this study provides novel insight into the determinants shaping MDRPIs prevention and highlights implications for practice, education, and policy aimed at reducing the burden of MDRPIs within ICU settings.

Thesis is embargoed until 31 July 2028.

Date of Award	Jul 2026
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Saudi Arabia Government
Supervisor	Barry Quinn (Supervisor), Iseult Wilson (Supervisor) & Kevin Gormley (Supervisor)