The Knowledge, Attitudes and Practices of ICU Nurses in Preventing Oral Mucosal Pressure Injuries Among Orotracheally Intubated Patients: A Multicentre Cross‐Sectional Study From Western China

ABSTRACT

Background

Patients undergoing orotracheal intubation (OTI) are prone to oral mucosal pressure injuries (OMPI), yet clinical recognition and prevention remain insufficient. The knowledge, attitudes and practices (KAP) of ICU nurses regarding OMPI prevention are unclear, particularly in multicentre settings.

Objective

To assess ICU nurses' KAP on OMPI prevention in Western China, identify gaps, and inform targeted training and practices.

Design

Cross-sectional survey.

Methods

A multicentre cross-sectional survey used convenience sampling. ICU nurses completed a 36-item KAP-OMPI questionnaire online. Data were analysed using R 4.3.3 and Zstats 1.0. Cronbach's α assessed internal consistency. Group comparisons used chi-square, Mann–Whitney U or Kruskal–Wallis tests (α = 0.05). Multivariate linear regression and mediation analysis (1000 bootstraps) tested the KAP pathway.

Results

A total of 667 questionnaires were returned from ICU nurses in 48 hospitals. Median total KAP-OMPI score was 136. Knowledge scored 30, attitude 40 and practice 64. Univariate analysis showed that education, professional title, age, years of experience, prior OMPI care, training and active literature learning were significantly associated with all scores (all p < 0.05). Multivariate regression identified lack of training, no prior OMPI care and no active literature learning as independent predictors of lower total, knowledge and practice scores (all p < 0.05). Mediation analysis showed attitude partially mediated the knowledge–practice relationship (indirect effect 0.294), accounting for 31.35% of the total effect.

Conclusion

ICU nurses showed positive attitudes and moderate-to-high practices, but knowledge, assessment and evidence-based learning gaps persist. We recommend targeted training on staging and standardized protocols to improve OMPI prevention and reduce OTI-related complications.

Impact

Leveraging these findings, OMPI staging training and standardized protocols should be implemented to bridge the KAP gap and reduce intubation-related OMPI.

Patient or Public Contribution

No patient or public involvement; data from anonymous nurse surveys only.

Trial Registration

Chinese Clinical Trial Registry: ChiCTR2500112798 (Date: November 19, 2025)