Clinical effectiveness of a multidisciplinary quality improvement initiative to prevent nasal pressure injuries associated with nasotracheal tube: a historical controlled study

Purpose This study aimed to evaluate the impact of a multidisciplinary quality improvement initiative on reducing nasal pressure injuries related to nasotracheal tube (NTT) in patients undergoing prolonged oral, head and neck surgery. Methods Transnasal intubation is frequently employed in these procedures to optimize surgical field exposure. With the growing complexity and duration of surgeries, particularly for malignant tumors, the risk of nasal pressure injuries has increased. These injuries contribute to greater pain, extended hospital stays, higher treatment costs, and delayed recovery, underscoring the need for effective preventive measures. Under the Hospital Patient Safety Initiative, a multidisciplinary team was established to implement a comprehensive prevention strategy. This involved structured risk assessment, dynamic and graded nursing interventions, and systematic postoperative follow-up. A historical control study was conducted, comparing nasal pressure injury incidence over two 12-month periods: pre- and post-intervention. Results A total of 515 patients were included—221 in the historical control (HC) group and 294 in the intervention group (IG). Baseline characteristics were well-balanced between the two groups, with all standardized mean differences (SMD) below 0.1. The incidence of nasal pressure injuries (PI) significantly decreased from 7.24% in the HC group to 2.38% in the IG group ( p = 0.008, two-sided). The absolute risk reduction (ARR) was 4.86% (95% CI: 1.19–9.23%), corresponding to a relative risk (RR) of 0.33 (95% CI: 0.14–0.79) and a number needed to treat (NNT) of 21 (95% CI: 11–85). Notably, stage 2 injuries were eliminated in the intervention group (3 vs. 0 cases), and no injuries of stage 3 or higher were observed in either cohort. Conclusion The multidisciplinary bundle, featuring a modified CORN scale and graded interventions, effectively reduces the risk of device-related nasal pressure injuries. This approach is scalable for perioperative nursing management in prolonged head and neck surgeries.