The authors reply

We thank Labeau et al (1) for their interest and thoughtful letter about our systematic review of the incidence and prevalence of pressure injuries (PIs) in adult ICU patients (2), recently published article in Critical Care Medicine. We agree heterogeneity was the major threat to validity in pooling the ICU incidence and prevalence and we also agree on the potential sources of heterogeneity. As Labeau et al (1) note, it was not possible to assess most potential causes of heterogeneity in ICU PI events due to paucity of data, which we too identified. The influence of nurses’ workload on PI occurrence is an inconclusive area. One study cited in a review noted that increased ICU nurse staffing in was associated with decreased PI development (3). Internationally, the intensive care environment remains a comparatively well-resourced clinical area. Although we argue adequate staffing levels are important for the prevention of PI, timely regular skin assessment and implementation of prevention strategies based on patient need also strongly influence the outcome of PI development. Because of ICU patients’ disease acuity and complexity, emerging evidence to suggest multicomponent PI prevention programs, especially those with multidisciplinary involvements, are needed (4–6). We too believe PI prevention requires a multidisciplinary approach.