Downloaded from http://journals.lww.com/jwocnonline by BhDMf5ePHKbH4TTImqenVLTWxlDBt+9AXWizrqggQ6Gtr1V0HuGiQKnTdwyRxXXZ on 07/10/2020 Copyright © 2020 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited. Copyright © 2020 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited. Wound Care 336 JWOCN ¿ July/August 2020 Copyright © 2020 by the Wound, Ostomy and Continence Nurses Society™ J Wound Ostomy Continence Nurs. 2020;47(4):336-342. Published by Lippincott Williams & Wilkins Wound Care (ICU). 1 Pressure injury is defned as a local injury to the skin and underlying soft tissues, caused by prolonged pressure and shear. 2 Severity ranges from a nonblanchable reddish area to an open and deep ulcer that extends to the muscle and bone. 3 Worldwide, prevalence rates of pressure injury range from 4.7% to 32.1% in hospitalized patients, with incidence rates in the ICU between 8.8% and 25.1%. 2,5,6 Te incidence of pressure injuries in the ICU is estimated to be approximately 44% in Iran. 7 Risk factors for pressure injuries include older age, altered level of consciousness, physical disability, prolonged admis- sion, immobility, moisture-associated skin damage, urinary incontinence, edema, reduced microcirculation, hypoalbu- minemia, malnutrition, and use of sedatives. 8-10 Pressure inju- ries increase care needs of patients and result in poorer health, decreased quality of life, and higher morbidity. 11,12 Studies have confrmed the efectiveness of fatty acids in protecting skin against pressure injuries. 7,11,13,14 Specifcally, lipids play a vital role in maintaining skin structure, moisture, and protect it against dryness by maintaining moisture content. 15 Lipids such as vegetable oils made from olives and almonds are ex- amples of fatty acids (nonhyperoxygenated) that have been used to prevent and treat pressure injuries. 7,13,16,17 For example, Perez and colleagues 12 conducted a comparative study of the efect of nonhyperoxygenated olive oil and a hyperoxygenated fatty acid product on the prevention of pressure injuries in ABSTRACT PURPOSE: The aim of our study was to determine the effect of topical almond oil for prevention of pressure injuries. DESIGN: Single-blind randomized clinical trial. SAMPLE AND SETTING: Patients admitted to an intensive care unit in Besat Hospital, Hamadan, Iran, were invited to participate in the trial. Data were collected over an 8-month period. METHODS: A convenience sample of 108 patients, using a permuted block randomization method was assigned to 3 equal groups that received the intervention almond oil, placebo (liquid paraffn), or control (standard of care). Data included demographic information, Braden Scale score, and National Pressure Ulcer Advisory Panel—European Pressure Ulcer Advisory Panel (NPUAP—EPUAP) pressure injury staging system classifcation score. The intervention and placebo groups received daily application of 6.5 cc of topical almond oil or paraffn to the sacrum, heels, and shoulders for 7 consecutive days. The skin was evaluated for pressure injuries by an expert nurse who was blinded to groups. Chi-square test, analysis of variance, and regression analyses were used to evaluate relationships within and between groups for study variables, incidence of pressure injuries, and duration of time of onset of pressure injuries. P values less than .05 were deemed statistically signifcant. RESULTS: The incidence of pressure injury in the almond oil group (n = 2; 5.6%) was lower than that in the placebo (n = 5; 13.9%, P = .189) or control groups (n = 9; 25.1%, P = .024). The incidence of pressure injuries in the control group was 6.8 and 2.12 ( P = .227) times higher than that in the almond and placebo groups, respectively. The onset day of a pressure injury occurred 5.4 days after initiation of the protocol in the almond oil group compared to 4.22 days in the control group ( P = .023) and 5 days in the placebo group ( P = .196). CONCLUSION: The topical application of almond oil was associated with a lower incidence of pressure injuries and that developed later during the study compared to participants who received paraffn or standard of care only. Further study is recommended to advance this work in populations at risk for pressure injury. KEY WORDS: Almond oil, Braden Scale, Intensive care unit, Mini Nutritional Assessment, Pressure injury, Prevention. Topical Almond Oil for Prevention of Pressure Injuries A Single-Blinded Comparison Study Seyed Reza Borzou ¿ Sheller Amiri ¿ Azim Azizi ¿ Leili Tapak ¿ Farshid Rahimi Bashar ¿ Shirin Moradkhani DOI: 10.1097/WON.0000000000000648 Seyed Reza Borzou, Department of Nursing, Chronic Diseases (Home Care) Research Center, School of Nursing & Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran. Sheller Amiri, MSc, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran. Azim Azizi, PhD, Chronic Diseases (Home Care) Research Center, Malayer Nursing School, Hamadan University of Medical Sciences, Hamadan, Iran. Leili Tapak, PhD, Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. Farshid Rahimi Bashar, Anesthesiology Fellowship of Critical Care, Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Shirin Moradkhani, Department of Pharmacognosy, School of Pharmacy, Medicinal Plants and Natural Product Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. The authors declare no conflicts of interest. Correspondence: Azim Azizi, PhD, Chronic Diseases (Home Care) Research Center, Malayer Nursing School, Hamadan University of Medical Sciences, Shahid Fahmideh St, 98 8138380535, Hamadan, Iran (Azimazizi1360@gmail. com) or Sheller Amiri, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Shahid Fahmideh St, 98 8138380535, Hamadan, Iran (sheller.amiri5115@gmail.com). INTRODUCTION Pressure injury is one of the most common hospital-acquired conditions experienced by patients in the intensive care unit