Original Article

The effect of rosemary ointment on the grade I pressure ulcers in ICU patients: A randomized clinical trial


Background & Aim: Pressure ulcers have been identified as one of the most important and challenging issues in patients well-being. Based on the evidence, rosemary extract compounds can affect wound healing. The aim of this study was to determine the effect of rosemary ointment on pressure ulcer healing in patients admitted to the Intensive Care Unit.
Methods & Materials: In this single-blind randomized parallel clinical trial, 70 patients who met the inclusion criteria were selected purposefully and assigned to the groups by stratified randomization method. In the intervention group, rosemary ointment was applied once a day for seven days. The control group received routine care. Data were collected using the Pressure Ulcer Scale for Healing (PUSH) before the intervention and on the third and seventh days after the intervention. Data were analyzed using independent t-test, chi-square test, and two-way repeated measurements ANOVA with SPSS 18 software.
Results: The mean scores of PUSH decreased significantly in the intervention group while remained unchanged in the control group (P=0.001) one week after the intervention. The effect of time and interaction effect was also significant (P=0.001). Comparison of the ratio of complete ulcer healing in the two groups showed a significant difference between the two groups (p=0.004).
Conclusion: Rosemary ointment facilitated healing and prevented the progression of grade І pressure ulcers in the Intensive Care Unit. Therefore, the use of this ointment, as a low-risk, uncomplicated, available, and inexpensive intervention, is recommended in such patients.

1. Kumar A, Sinha V. Comparative study of EUSOL and Silverstream in healing of pressure sore in traumatic spinal cord injury patients. International Journal of Orthopaedics. 2018;4(1):228-34.
2. Asghar M, Naseem S. Risk factors of pressure ulcer in elderly non-operative femur fracture patients. international journal of Recent scientific Research. 2018;9(7):28088-90.
3. de Almeida Medeiros AB, Fernandes MIdCD, de Sá Tinôco JD, Cossi MS, de Oliveira Lopes MV, de Carvalho Lira ALB. Predictors of pressure ulcer risk in adult intensive care patients: A retrospective case-control study. Intensive and Critical Care Nursing. 2018;45:6-10.
4. Farzi S, Saba F, Hojatollah Y, Azam M, Mhin M. Knowledge, Attitue and Practice of Nurses Concerning Pressure Ulcer Prevention and Its Relationship with Some Demographic Characteristics. Iranian journal of nursing research. 2016;11(4):66-70 (Persian).
5. Paymard A, Salehian T, Shahnavazi A, Bakhshi F, Allahyari E, Ghaffarian Shirazi HR. The effect of local olive oil on prevention of pressure ulcers in patients hospitalized in the intensive care unit of Shahid Beheshti Hospital, Yasuj: A double-blind randomized clinical trial. Anesthesiology and Pain. 2016;6(3):54-61.
6. Afkar A, Mahboubi M, Mehrabian F, Farmanbar R, Ghahramani F, Nezhad EK, Khodadadi A. Predictive factors of ICU bedsores using Braden scale. J Kermanshah Univ Med Sci. 2014 Jul 30;18(4):220-5.
7. Saghalein S, Dehghan K, Shadvar K, Mahmoodpoor A, Sanaie S, Ostadi Z. Bedsore: Epidemiology; Risk Factors; Classification; Assessment Scales and Management. Archives of Anesthesiology and Critical Care. 2016;2(3):226-30.
8. Coleman S, Smith IL, McGinnis E, Keen J, Muir D, Wilson L, Stubbs N, Dealey C, Brown S, Nelson EA, Nixon J. Clinical evaluation of a new pressure ulcer risk assessment instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T). Journal of Advanced Nursing. 2018 Feb;74(2):407-24.
9. Yap TL, Kennerly SM, Horn SD, Bergstrom N, Datta S, Colon-Emeric C. TEAM-UP for quality: a cluster randomized controlled trial protocol focused on preventing pressure ulcers through repositioning frequency and precipitating factors. BMC geriatrics. 2018;18(1):54.
10. Bhattacharya S, Mishra R. Pressure ulcers: current understanding and newer modalities of treatment. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India. 2015;48(1):4.
11. Šáteková L, Žiaková K, Zeleníková R. Predictive validity of the Braden scale, Norton scale and Waterlow scale in Slovak Republic. Cent Eur J Nurs Midw. 2015;6(3):283-90.
12. Elahi N, Mojdeh S, Poordad A. The effect of fish oil on improvement of first stage bed sore. Iranian journal of nursing and midwifery research. 2012;17(4):313-7.
13. Esmaili R, Khalilian A, Nasiri E, Jafari H, Dehghani O, Alipour S. Study regarding the effect of calendula officinalis cream in healing of pressure sores. Journal of Mazandaran University of Medical Sciences. 2008;18(66):19-25.
14. Avijgan M, Avijgan M, Hakamifard A, Razavi N. An innovation for retarded healing process of a chronic ulcer by Aloe vera gel treatment. Journal of natural remedies. 2016;16(2):45-51.
15. Solhi H, Salehi B, Alimoradian A, Pazouki S, Taghizadeh M, Saleh AM, Kazemifar AM. Beneficial effects of Rosmarinus officinalis for treatment of opium withdrawal syndrome during addiction treatment programs: a clinical trial. Addiction & health. 2013;5(3-4):90.
16. Harris C, Bates-Jensen B, Parslow N, Raizman R, Singh M, Ketchen R. Bates-Jensen wound assessment tool: pictorial guide validation project. Journal of Wound Ostomy & Continence Nursing. 2010;37(3):253-9.
17. Van Lis M, Van Asbeck F, Post M. Monitoring healing of pressure ulcers: a review of assessment instruments for use in the spinal cord unit. Spinal cord. 2010;48(2):92-9.
18. Bodavula P, Liang SY, Wu J, VanTassell P, Marschall J, editors. Pressure ulcer-related pelvic osteomyelitis: a neglected disease? Open forum infectious diseases; 2015: Oxford University Press.
19. Smith DM. Pressure ulcers in the nursing home. Annals of internal medicine. 1995;123(6):433-8.
20. Dehghani A, Anvari HM. Effects of Rosemary extract on sore throat after intratracheal intubation; A double-blind clinical trial. J Biochem Tech. 2019; (2): 183-7.
21. Umasankar K, Nambikkairaj B, Backyavathy DM. Effect of topical treatment of rosmarinus officinalis essential oil on wound healing in streptozotocin induced diabetic rats. Nature Environment and Pollution Technology. 2012;11(4):607.
22. Sharifabad MM, Salehi E. The effect of rosemary on the healing of oral mucosal wounds in goats affected by PPR (small ruminant plague),. Fifth National Conference on Agriculture and Sustainable Natural Resources, Tehran, https://civilicacom/doc/521491. 2016.
23. Nejati H, Ferahpoor M, Criticism M. Experimental study of topical antifungal activity of rosemary essential oil on skin ulcers
Infected with Candida albicans in rats: A pathological study Cellular. Comparative Pathobiology, Scientific-Research. 2015;11(3):1397-405 (Persian).
24. Ince B, Yildirim AM, Okur MI, Dadaci M, Yoruk E. Effects of Rosmarinus officinalis on the survivability of random-patterned skin flaps: an experimental study. Journal of plastic surgery and hand surgery. 2015;49(2):83-7.
25. Boyko TV, Longaker MT, Yang GP. Review of the Current Management of Pressure Ulcers. Adv Wound Care (New Rochelle). 2018;7(2):57-67.
26. Stotts NA, Rodeheaver GT, Thomas DR, Frantz RA, Bartolucci AA, Sussman C, et al. An instrument to measure healing in pressure ulcers: development and validation of the pressure ulcer scale for healing (PUSH). The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56(12):795-9.
27. Keshavarzian S, Shahgholian N. Comparison of the effect of topical application of rosemary and menthol for musculoskeletal pain in hemodialysis patients. Iranian journal of nursing and midwifery research. 2017;22(6):436.
28. Dehghani A, Anvari HM. Effects of Rosemary Extract on Sore Throat after Intratracheal Intubation; A Double-Blind Clinical Trial. 2019.
29. Li W, Ma Y, Yang Q, Pan Y, Meng Q. Moist exposed burn ointment for treating pressure ulcers: A multicenter randomized controlled trial. Medicine. 2017;96(29).
30. Hosseinrezaei H, Ahmadinejad M, Jahani Y, Noradini Z. Effect of topical oxygen on the healing of bedsore in trauma ICU patient at Bahonar Hospital Anesthesiology meeting magazine and special care of Iran. 2017;38(99):21-35 (Persian).
31. Farsaei S, Khalili H, Sadat Farboud E, Iman K, Beigmohammadi MT. Efficacy of topical atorvastatin for the treatment of pressure ulcers: A randomized clinical trial. 2014;34(1):19-27.
IssueVol 9 No 1 (2022): Winter QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v9i1.7321
intensive care unit; patient safety; pressure ulcer; wound healing

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How to Cite
Khoshoei Parizi F, Sadeghi T, Heidari S. The effect of rosemary ointment on the grade I pressure ulcers in ICU patients: A randomized clinical trial. NPT. 2021;9(1):15-23.