INTRODUCTION:

"A localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear" is the definition of pressure ulcers, which are also referred to as bedsores, decubitus ulcers, pressure injuries, or pressure sores. Long-term pressure or compression exposure can harm cells, stop local blood flow (i.e., lower perfusion), and set off a series of biochemical reactions that can cause tissue damage and ulceration. When humans are dragged into positions in chairs and beds, for instance, immobility can result in increased damage from shear and friction.¹

The incidence rate of pressure ulcers was 12% (95% CI: 10–14), as per A systematic review and meta-analysis on Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital. The incidence rates of pressure ulcers in the first, second, third, and fourth stages were 45% (95% CI: 34–56), 45% (95% CI: 34–56), 4% (95% CI: 3–5), and 4% (95% CI: 2–6), respectively. The orthopaedic surgery ward had the highest incidence of pressure ulcers (18.5%) among inpatients (95% CI: 11.5–25). The final results indicate that improved conditions should be implemented to reduce the prevalence of pressure ulcers in various wards, particularly orthopaedics and patients with diabetes.²

Wounds are often treated with antiseptics, like iodine-based solutions, because they work very well. Most of the time, they are put on wounds that are locally infected and are generally used with systemic antibiotics. Cadexomer-iodine and povidone-iodine are the two main types of iodine. Iodine kills bacteria in the lab, and its strongest effect is seen at 0.1% to 1%. Povidone-iodine has been used to clean and heal skin for a long time. Iodine kills microbes by blocking important bacterial cell structures and mechanisms. It also oxidises nucleotides, fatty acids, and amino acids in bacterial cell membranes, as well as cytosolic enzymes that work in the respiratory chain, deactivating and changing their shape. Povidone-iodine preparations of 5% and 10% can be bought in clinical places. Povidone-iodine was first used in business in 1955. This medicine is on the list of essential medicines made by the World Health Organisation. Povidone-iodine can be bought at the counter. It is sold under many brand names, such as Betadine.³

In the prevention and treatment of pressure ulcers, nurses are essential. The Braden scale is used by nurses to evaluate pressure ulcer risk. Additionally, tend to the patient who has a pressure ulcer. Reducing pressure on the afflicted area, tending to wounds, managing discomfort, avoiding infection, and eating healthily are all part of treating pressure ulcers. I noticed that patients with musculoskeletal injuries had a higher prevalence of pressure ulcers during my stint in the orthopaedic department. Although nurses care for patients, there are still significant gaps in the field of treating pressure ulcers. This study will serve as a useful tool to help nurses learn more about how to dress pressure ulcers effectively.⁴

STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of povidone-iodine (5%) dressing versus normal saline (0.9%) dressing on pressure ulcer among the patient with musculoskeletal injury admitted in orthopaedic department of Pt B.D. Sharma, PGIMS Rohtak.

OBJECTIVES:

1. To evaluate the effectiveness of povidone-iodine (5%) dressing on pressure ulcer among patient with musculoskeletal injury admitted in orthopaedic department of Pt B.D. Sharma, PGIMS Rohtak.

2. To evaluate the effectiveness of normal saline (0.9%) dressing on pressure ulcer among patient with musculoskeletal injury admitted in orthopaedic department of Pt B.D. Sharma, PGIMS Rohtak.

3. To compare the healing of pressure ulcer with intervention using povidone-iodine (5%) dressing (Group-1) versus normal saline (0.9%) dressing (Group-2) with help of PUSH scale among the patient with musculoskeletal injury admitted in orthopaedic department of Pt B.D. Sharma, PGIMS Rohtak

4. To find the association of socio-demographic variable and clinical profile with pressure ulcer among Group-1 and Group-2 patient with musculoskeletal injury admitted in orthopaedic department of Pt B.D. Sharma, PGIMS Rohtak.

METHODOLOGY:

This quantitative study compared povidone-iodine (5%) and normal saline (0.9%) dressings for pressure ulcers in orthopaedic patients with musculoskeletal injuries admitted to Pt B.D. Sharma, PGIMS Rohtak. The study used quasi-experimental design. Musculoskeletal injury patients admitted to Pt B. D. Sharma PGIMS, Rohtak, Haryana's orthopaedic department provided the data. Patients were picked using non-probability sequential sampling. The study included 40 Pt. B.D.S PGIMS, Rohtak patients. A standardised questionnaire with closed-ended questions was created to analyse sample demographics and patient clinical profile. PUSH (pressure ulcer scale for healing) to track pressure ulcer progression. PUSH scale measures pressure ulcer progression. Ulcer length and width, exudate amount, and tissue type are used to calculate a total score (0-17, higher scores indicate severity). Pressure healing graphs are created by regularly assessing data. Scores vary from 0-17. Total score over time shows pressure ulcer healing improvement or worsening.

Maximum score	17	Serious pressure ulcer of considerable size, heavy exudates and narcotise tissue
Minimum score	0	Healed wound

Interrater reliability in patients with chronic leg ulcers demonstrated excellent consistency for sub-scores of the length × width variable (kappa = .97 to 1.0), sub-scores of tissue type (kappa = 1.0), and for the total score (kappa = .97 to 1.0; de Gouveia Santos et al., 2007). Interrater reliability in patients with pressure ulcers: Interrater reliability was excellent, with personnel agreement exceeding 95% (Stotts et al., 2001). A pilot study was conducted in December 2021, with permission obtained from the Head of the Department of Orthopaedics at PGIMS, Rohtak. The pilot study findings indicate that the mean pre-test value for group 1 was 9.33, while for group 2 it was 10.33. The standard deviation for group 1 was 0.46, and for group 2, it was 2.05. The mean value of the post-test for group 1 was 8.3, while for group 2 it was 9.3. The standard deviation for group 1 was 0.46, and for group 2, it was 1.7. The collected data were analysed using descriptive and inferential statistics. The findings of the pilot study indicated that the tool was feasible, practicable, and acceptable.

The legal administration procedure was acquired from the principal of the College of Nursing, Pt. B.D. Sharma, PGIMS Rohtak, and permission to conduct the study was obtained from the Head of the Department of Orthopaedics, Pt. B.D. Sharma PGIMS Rohtak. Data were collected from a patient with a pressure ulcer admitted to the orthopaedic department of PT. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak. The sample was selected using a non-probability consecutive sampling technique. The screening of orthopaedic patients with pressure ulcers was conducted based on established inclusion and exclusion criteria. Informed consent was secured prior to their enrolment in the current study. The study involved 40 subjects drawn from the target population using a non-probability consecutive sampling technique. Subjects were then allocated to experimental group-1 (n1=20) and experimental group-2 (n2=20). Data regarding socio-demographic and clinical profiles were collected through interviews, observations, bio-physiological parameters, and records and reports. In experimental group-1, pressure ulcer dressing with 5% povidone iodine was planned, while experimental group-2 was assigned pressure ulcer dressing with 0.9% normal saline. Evaluation of the baseline healing process (O1) utilising the standardised PUSH tool version 3.0, 1998. The exudate volume was assessed during morning dressing prior to ulcer cleaning, while the surface area and tissue type were evaluated post-cleaning and prior to dressing application.

INTERVENTIONS:

Povidone iodine (5%) dressing in experimental group-1: This involves cleaning the pressure ulcer with a normal saline solution and applying a povidone iodine (5%) dressing to the ulcer area once daily for a total of 7 consecutive days.

Normal saline (0.9%) in experimental group-2: This involves cleaning the pressure ulcer with a normal saline solution and applying a normal saline (0.9%) dressing to the ulcer area once daily for 7 consecutive days.

Post intervention:

In experimental group 1 and experimental group 2, the post-intervention assessment related to the healing process was conducted as follows:

Day Ⅲ (2^nd observation)	At the time of morning dressing exudate amount was checked before cleaning the ulcer and the surface area and tissue type were checked after cleaning the ulcer and before Applying the dressing
Day Ⅴ (3^rd observation)
Day Ⅶ (4^th observation

Comparison of baseline and post-intervention healing of pressure ulcers in both groups. Data was analyzed using descriptive and inferential statistics.

RESULTS:

The analysed data were tabulated and presented in the diagrammatic way in this section.

Table I shows the Frequency and percentage distribution of demographic characteristics of sample

In the study, the demographics of the subjects in the two experimental groups revealed notable differences. In Experimental Group 1, 45% of the 20 subjects were aged 41-55 years, while 30% were above 55 years and 25% were aged 25-40 years. Conversely, **Experimental Group 2** had 45% of subjects above 55 years, followed by 35% aged 41-55 years and 20% aged 25-40 years. Gender distribution showed that Group 1 comprised 70% males and 30% females, while Group 2 had 65% males and 35% females. Regarding religion, Group 1 had 90% Hindu and 10% Sikh participants, whereas Group 2 included 85% Hindu, 10% Muslim, and 5% Sikh subjects. In terms of education, 35% of Group 1 had secondary education, 30% had primary education, 25% had no formal education, and 10% were postgraduate; in contrast, 50% of Group 2 had no formal education, 30% had secondary education, 15% had primary education, and 5% had graduated. Family income analysis indicated that 70% of Group 1 subjects earned below 20,000, while 85% of Group 2 fell into that category. The area of residence revealed that 75% of Group 1 lived in rural areas compared to 65% in Group 2. Dietary habits showed that 60% of Group 1 participants were vegetarian, while Group 2 was evenly split with 50% vegetarian and 50% non-vegetarian. Supplementary diet intake indicated that 60% of Group 1 were not taking a supplementary diet, whereas 85% of Group 2 reported the same. With regard to lifestyle habits, 70% of Group 1 were alcoholic non-smokers, compared to 60% in Group 2. Finally, the site of pressure ulcers showed that in Group 1, 40% had ulcers on the sacrum and 30% on both the trochanter and ischial tuberosities, while Group 2 also had 40% on the sacrum and trochanter, with 20% on ischial tuberosities.

Table I: Frequency and percentage distribution of demographic characteristics of sample (N-40)

Sr. No.	Sample characteristics	Experimental group-1 (Povidone-iodine)		Experimental group 2 (Normal saline)
Sr. No.	Sample characteristics	Frequency	Percentage	Frequency	Percentage
1	Age
	Below 25 25-40 41-55 Above 55	0 5 9 6	0 25% 45% 30%	0 4 7 9	0 20% 35% 45%
2	Gender
	Male Female Other	14 6 0	70% 30% 0	13 7 0	65% 35% 0
3	Religion
	Hindu Muslim Christian Sikh	18 0 0 2	90% 0 0 10%	17 2 0 1	85% 10% 0 5%
4	Education
	No formal education Primary education Secondary education Graduate Postgraduate	5 6 7 2 0	25% 30% 35% 10% 0	10 3 6 1 0	50% 15% 30% 5% 0
5	Family monthly income
	Below 20,000 20,000-40,000 40,000-60,000 More than 60,000	14 5 1 0	70% 25% 5% 0	17 3 0 0	85% 15% 0 0
6	Area of residence
	Rural Urban	15 5	75% 25%	13 7	65% 35%
7	Dietary habit
	Vegetarian Non-vegetarian	12 4	60% 40%	10 10	50% 50%
8	Supplementary diet
	Yes No	5 15	25% 75%	3 17	15% 85%
9	Habits
	Alcoholic &smoker Alcoholic &nonsmoker Non-alcoholic &nonsmoker Non-alcoholic & smoker Other	0 14 2 4 0	0 70% 10% 20% 0	4 12 1 3 0	20% 60% 5% 15% 0
10	Site of pressure ulcer
	Sacrum Trochanter Ischial tuberosities Scapula Other	8 6 6 0 0	40% 30% 30% 0 0	8 8 4 0 0	40% 40% 20% 0 0

Table – 1I - Frequency and percentage distribution of sample as per their clinical profile N=40

Sr. No.

Clinical profile of sample

Experimental group-1 (Povidone-iodine)

Experimental group-2 (Normal saline)

Frequency

Percentage

Frequency

Percentage

1. Stage of pressure ulcer

Stage -Ⅰ

Stage-Ⅱ

Stage-Ⅲ

Stage-Ⅳ

65%

30%

45%

25%

30%

2. History/chief complaint of patient

Fracture

Yes

85%

15%

80%

20%

Infection

Yes

100%

90%

10%

Any other

Yes

15%

85%%

95%

3. Duration of pressure ulcer

Less than 10 days

10-20 days

20-30days

Above 30 days

40%

25%

20%

15%

30%

25%

40%

4. Duration of hospital stay

Less than 1 week

1-2 week

2-3 week

More than 3 weeks

30%

25%

40%

30%

35%

5. Antibiotic

Yes

100%

6. Hemoglobin level

Below 12g/dl

12-17g/dl

Above 17g/dl

65%

35%

90%

10%

7. Serum protein level(albumin)

Below 3.4g/dl

3.4-5.4g/dl

Above 5.4g/dl

20%

80%

45%

50%

8. Diabetic status

Non- diabetic

Diabetic

70%

30%

70%

30%

Table III: Frequency and percentage distribution of sample as per their clinical profile N=40

Sr. No.	Clinical profile of sample	Experimental group-1 (Povidone-iodine)		Experimental group-2 (Normal saline)
Sr. No.	Clinical profile of sample	Frequency	Percentage	Frequency	Percentage
1	Stage of pressure ulcer
	Stage -Ⅰ Stage-Ⅱ Stage-Ⅲ Stage-Ⅳ	0 13 6 1	0 65% 30% 5%	0 9 5 6	0 45% 25% 30%
2	History/chief complaint of patient
	Fracture Yes No Infection Yes No Any other Yes No	17 3 20 0 3 17	85% 15% 100% 0 15% 85%%	16 4 18 2 1 19	80% 20% 90% 10% 5% 95%
3	Duration of pressure ulcer
	Less than 10 days 10-20 days 20-30days Above 30 days	8 5 4 3	40% 25% 20% 15%	6 5 1 8	30% 25% 5% 40%
4	Duration of hospital stay
	Less than 1 week 1-2 week 2-3 week More than 3 weeks	6 5 8 1	30% 25% 40% 5%	1 6 6 7	5% 30% 30% 35%
5	Antibiotic
	Yes No	20 0	100% 0	20 0	100% 0
6	Hemoglobin level
	Below 12g/dl 12-17g/dl Above 17g/dl	13 7 0	65% 35% 0	18 2 0	90% 10% 0
7	Serum protein level(albumin)
	Below 3.4g/dl 3.4-5.4g/dl Above 5.4g/dl	4 16 0	20% 80% 0	9 10 1	45% 50% 5%
8	Diabetic status
	Non- diabetic Diabetic	14 6	70% 30%	14 6	70% 30%

Table VI illustrates the comparison of study subjects between Experimental Group 1 and Experimental Group 2, based on their mean total scores for pressure healing on Days 1 and 7. On Day 1, the observed difference was statistically significant (p = 0.017), and similarly, on Day 7, the difference also reached statistical significance (p = 0.036).

DISCUSSION:

The study conducted at Pt B.D. Sharma, PGIMS Rohtak, aimed to evaluate the effectiveness of 5% povidone-iodine versus 0.9% saline dressings in treating pressure ulcers among orthopaedic patients with musculoskeletal injuries. The demographic profile of the participants revealed a predominantly male population (70%) aged between 41-55 years (45%), with a significant portion living in rural areas (75%) and earning below ₹20,000 monthly. The clinical findings indicated that a majority of the participants had sacral pressure ulcers (40%) and stage 2 ulcers (65%), with all individuals presenting infections and a notable prevalence of fractures (85%).
The results of the study demonstrated that the group treated with povidone-iodine showed a statistically significant improvement in pressure ulcer scores from day 1 to day 7, with scores decreasing from 9.55±2.665 to 7.35±3.249 (p<0.05). In contrast, the saline group exhibited less improvement, with scores reducing from 11.60±2.563 to 10.00±3.162 (p<0.05). The unpaired t-test confirmed significant differences between the two treatment groups, supporting the hypothesis that povidone-iodine is more effective than saline in promoting healing of pressure ulcers.^5,6

The study also explored the relationship between various socio-demographic factors and pressure ulcer development. Notably, no significant correlations were found between hospital stay duration, haemoglobin levels, serum albumin levels, diabetes, age, gender, education, family income, or residence and pressure ulcer scores in the first group. However, dietary habits and lifestyle choices, such as alcohol consumption, showed a significant association with pressure ulcer scores, indicating that non-alcoholic and non-smoking individuals had better outcomes.

In the second group, pressure ulcer stage was significantly correlated with scores, suggesting that more severe ulcers corresponded with higher scores. Interestingly, the duration of pressure ulcers did not significantly correlate with scores, nor did the presence of infections or other comorbidities. The findings indicate that while certain socio-demographic factors did not influence pressure ulcer outcomes, the severity of the ulcer and lifestyle choices played a more critical role.

The literature review included a comparison with previous studies, such as the work by K. Prem Belwin, which also highlighted the superior healing effects of povidone-iodine over saline in diabetic foot ulcer patients. This reinforces the current study's findings and suggests a 7broader applicability of povidone-iodine in wound care management.⁷

This study provides valuable insights into the effectiveness of povidone-iodine dressings for pressure ulcer treatment in a specific demographic. The results underscore the importance of considering both clinical and socio-demographic factors in managing pressure ulcers, as well as the potential benefits of povidone-iodine in enhancing healing outcomes.^8,9,10 Future research should continue to explore these relationships and the efficacy of various treatment modalities in diverse patient populations to optimize care strategies for pressure ulcer management.

CONCLUSION:

The study concluded that there is a significant difference in the healing of pressure ulcers between the two interventions in the experimental groups: Group 1 (povidone iodine 5%) and Group 2 (normal saline 0.9%). It was observed that the povidone iodine (5%) dressing demonstrates a slightly more effective healing outcome for pressure ulcers compared to the normal saline (0.9%) dressing. Additionally, the results indicated a significant association between the stage of the pressure ulcer and the pressure ulcer score in Group 1, as well as a correlation between the stage of the pressure ulcer and its duration in the same group.

REFERENCES:

1. Zaidi SR, Sharma S. Decubitus Ulcer. 2020 Jan

2. Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised national pressure ulcer advisory panel pressure injury staging system: revised pressure injury staging system. Journal of Wound, Ostomy, and Continence Nursing. 2016 Nov; 43(6): 585.

3. Borojeny LA, Albatineh AN, Dehkordi AH, Gheshlagh RG. The incidence of pressure ulcers and its associations in different wards of the hospital: A systematic review and meta-analysis. International Journal of Preventive Medicine. 2020; 11.

4. Lyder CH, Ayello EA. Pressure ulcers: a patient safety issue. Patient safety and quality: An Evidence-based Handbook for Nurses. 2008 Apr.

5. British National Formulary (BNF), 69th Edition. British Medical Association; Joint Formulary Committee. 6 March 2015. p. 840. Archived from the original on 22 February 2022.

6. Lawrence JC. Wound Irrigation. Journal of Wound Care. 1997 Jan 2; 6(1): 23-6.

7. Shiferaw WS, Akalu TY, Mulugeta H, Aynalem YA. The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2020 Dec; 21:1-1.

8. Van der Wielen H, Post MW, Lay V, Gläsche K, Scheel-Sailer A. Hospital-acquired pressure ulcers in spinal cord injured patients: time to occur, time until closure and risk factors. Spinal Cord. 2016 Sep; 54(9): 726-31.

9. Zakrasek EC, Creasey G, Crew JD. Pressure ulcers in people with spinal cord injury in developing nations. Spinal Cord. 2015 Jan; 53(1): 7-13.

10. Walker J. Pressure ulcers in cervical spine immobilisation: a retrospective analysis. Journal of Wound Care. 2012 Jul; 21(7): 323-6.

Received on 22.05.2025 Revised on 20.06.2025

Accepted on 11.07.2025 Published on 16.08.2025

Available online from August 25, 2025

Int. J. Nursing Education and Research. 2025;13(3):169-175.

DOI: 10.52711/2454-2660.2025.00036

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

	Experimental group-1 Mean±sd	Experimental group-2 Mean±SD
Day 1	9.55±2.665	11.60±2.563
Day 3	9.15±2.815	11.40±2.873
Day-5	8.05±3.137	10.85±2.961
Day-7	7.35±3.249	10.00±3.162