| International Guidelines |
About the GuidelinesGoal: The goal of this international collaboration is to develop evidence-based recommendations for the prevention and treatment of pressure injuries that can be used by health professionals throughout the world.
Editions: The first edition of the guideline (2009) was developed as a four year collaboration between the National Pressure Ulcer Advisory Panel (NPUAP, now NPIAP) and the European Pressure Ulcer Advisory Panel (EPUAP). In the second edition of the guideline (2014), the Pan Pacific Pressure Injury Alliance (PPPIA) joined the NPUAP and EPUAP. The third edition of the guideline was released in November 2019. The fourth edition is being developed as a “living guideline” with ongoing additions and updates based on the latest research. The Online PI Guideline site was launched on February 27, 2025. To review current chapters (and monitor ongoing updates) see https://internationalguideline.com/the-international-guideline.
Methodology: For each edition of the guideline, an explicit scientific methodology was used to identify and critically appraise all available research. The methodology for each edition was published in advance. Drafts of the recommendations and supporting evidence were made available to invited stakeholders (individuals and organizations) around the world. The final guidelines were based on available research and the accumulated wisdom of the NPIAP, EPUAP, PPPIA, Associate Organizations, expert panels and international stakeholders. In the 2nd edition of the guideline, a consensus voting process (GRADE) was used to assign a strength to each recommendation. The strength of recommendation identifies the importance of the recommendation statement based on potential to improve patient outcomes. It provides an indication to the health professional of the confidence one can have that the recommendation will do more good than harm, after careful consideration of multiple factors (certainty of evidence, desirable and undesirable effects, balance of effects, resources required, cost effectiveness, equity, acceptability and feasibility). For the fourth edition, the full GRADE process was implemented, providing a more rigorous analysis of the research while still providing clinically relevant implementation considerations and good practice statements for a variety of populations.
Dissemination and Uptake: Each edition has been translated into multiple languages with over 200,000 copies distributed worldwide. Each edition has exceeded thresholds for “highly cited articles in clinical medicine” (El Genedy-Kalyoncu and Kottner, 2024).
Additional Information about the Four EditionsVisit the International Guideline Website (https://internationalguideline.com) for:
New and Ongoing Updates from the 4th edition - Living GuidelineLaunched on February 27, 2025. See https://internationalguideline.com/the-international-guideline for the online Living Guideline containing:
Moving Forward: How is NPIAP supporting guideline implementation?
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