Module 3

Pressure injury prevention in COVID-19 patients

Pressure injury prevention in COVID-19 patients with Acute Respiratory Distress Syndrome

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019 and became a pandemic in a short period of time. While most infected people might have mild symptoms, older people and people with chronic illnesses may develop acute respiratory distress syndrome (ARDS). Patients with ARDS with worsening hypoxemia require prone positioning to improve the respiratory mechanics and oxygenation. Intubated patients may stay in a prone position up to 12–16 h, increasing the risk of pressure injury (PI). Frequent skin inspections and PI risk assessment in COVID-19 patients are challenging due to hospital infection control measures aimed to reduce the risk for health professionals.

We summarize the best practice recommendations for prevention of PI in SARS-CoV-2-infected ARDS patients in prone positioning.1,2 Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed.

Once a patient is in prone position, it is recommended to (1) use the swimmer's position, (2) reposition the patient every 2 h, and (3) keep the skin clean. When the patient is repositioned to supine position, healthcare professionals are advised to (1) assess the pressure points and (2) promote early mobilisation.


This webinar captured recent research and evidence-based practices undertaken by leading clinicians and researchers from Monash Partners and Sydney Health Partners on pressure injury prevention in prone-positioned COVID-19 patients with Acute Respiratory Distress Syndrome.

Frontline clinicians from intensive care settings presented their experiences of working with COVID-19 patients.

This event was organised by Monash Partners to increase awareness of pressure injury; it coincides with the National Pressure Injury Advisory Panel World Wide Pressure Injury Prevention Day, celebrated on Thursday, November 19, 2020. 


Infographic. COVID-19. Pressure Injury prevention in ARDS patients in prone position1

Team, V., Team, L., Jones, A., Teede, H., & Weller, C. D. (2021). Pressure Injury Prevention in COVID-19 Patients with Acute Respiratory Distress Syndrome. Frontiers in Medicine, 7, 558696. 

2 Barakat-Johnson, M; Carey, R; Coleman, K; Counter, K; Hocking, K; Leong, T; Levido, A and Coyer, F. Pressure injury prevention for COVID-19 patients in a prone position. Wound Practice & Research. 2020: 28(2):50-57.