This study is a cluster randomized controlled trial to examine the effectiveness of multiple intervention strategy in reducing the number of patient pressure ulcer and pressure ulcer related injuries for 38 week at a general hospital in IRAN. The units (clusters) are determined by random allocation before the start of the trial for entrancing to the intervention phase at specific period of times (2 weeks). All clusters start the trial in a control phase with no intervention being delivered in any of them and then sequentially cross over from the control group to the intervention group, until all units are receiving the intervention. A pressure ulcer was defined as localized areas of tissue damage to skin and underlying soft tissue caused by sustained mechanical loading and shearing forces. Inclusion criteria: patient at risk of pressure ulcer with Braden (pressure ulcer risk assessment) scale less than 9, length of stay more than 48 hours in the intensive care unit, ventilator-dependent patients more than 3 days, no medical condition that would preclude the use of re-positioning, consent to participate in the study and exclusion criteria: length of stay less than 48 hours, medical condition that would preclude the use of repositioning. Sample size is accounted base on Woertman’s study. It is estimated that a total of 1280 participants will require intervention. Intervention’s study are assessment of patient with Braden scale, alarm to identify patients prone, patient education, employee education, massage local skin, wound wash regulatory, change position frequently, using wavy mattress, dressing, Daily visit wound care nurse. The primary outcomes are rate of reduction in pressure ulcer surface area and incidence of pressure ulcers in wards and Secondary outcomes are time to healing, percentage of wounds healed, incidence of new pressure ulcers, pressure ulcer prevalence, Grades of new pressure ulcers and length of stay.