The effectiveness of Iranian sheep-felt mattresses on pressure injuries prevention in moderate to high-risk hospitalized patients: a randomized controlled trial

Managing chronic wounds, particularly pressure injuries, poses a challenge for healthcare professionals. This study aimed to evaluate the effectiveness of Iranian sheep-felt mattresses in preventing pressure injuries among hospitalized patients. In this parallel, open-label randomized controlled trial, 55 patients at moderate to high risk of pressure injuries, admitted to the intensive care unit or the internal ward of Bohlol Hospital (Gonabad, Iran; 2022–2024), were randomly assigned to an experimental group (n = 28) or a control group (n = 27). Participants had no existing pressure injuries or uncontrolled diabetes upon admission. The control group received routine care with a standard wavy mattress, while the experimental group additionally received an Iranian sheep-felt mattress. Eligible patients were enrolled within 48 h of admission and followed for up to 30 days. Primary outcome was pressure injuries occurrence within 30 days; secondary outcomes included pressure injury-free days, pressure injury severity, and patient satisfaction. Data were collected via demographic/clinical questionnaires, the Braden Risk Scale, National Pressure Injury Advisory Panel classification, and the mattress satisfaction questionnaire, and analyzed using Chi-square, Mann–Whitney, exact tests, and survival analysis. Relative risk, absolute risk reduction, and number needed to treat were calculated. Data from 50 patients (25 in each group) were analyzed. The incidence of pressure injuries was significantly lower in the experimental group compared to the control group (12.0% vs. 56.0%; p < 0.001), corresponding to a relative risk of 0.21, an absolute risk reduction of 44%, and a number needed to treat of 3, highlighting the clinical significance of using the Iranian sheep-felt mattress. A significant difference was also noted in the stage of pressure injuries (p = 0.002), with lower stages in the experimental group. The median survival time free of pressure injuries was 20.0 days (Interquartile range: 18.0–30.0) in the control group and 30.0 days (Interquartile range: 30.0–30.0) in the experimental group, with a significant difference between the groups (p = 0.015). This study indicated that Iranian sheep-felt mattresses can reduce the incidence and severity of pressure injuries. Multi-center trials with larger sample sizes are necessary to confirm these results and evaluate long-term effects. This research was registered (11/05/2022) at https://irct.behdasht.gov.ir/ with registration number: IRCT20190622043968N3.