Support Surfaces To Prevent Pressure Ulcers
- Mon, 8/17/09 - 9:40am
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Dear Readers:
One of the best ways to manage pressure ulcers (PU) across the continuum of care is to prevent them. Interventions that work include repositioning at least every 4 hours, when combined with an appropriate pressure redistribution surface,1 optimizing support surfaces and nutritional status, and moisturizing at-risk skin sites.2 Pressure redistribution is integral to any approach for preventing PU development. In an effort to clarify which support surfaces are effective, Cochrane reviews3,4 have reported “high-specification foam” as more effective than a standard hospital mattress in preventing PU. Comparative benefits of individual support surfaces remain to be clarified, as does the operational definition of “high specification foam” so that professionals can recognize and use effective support surfaces to prevent PU. Gradually, randomized controlled trial (RCT) evidence is adding to our knowledge of what does and does not work. Below are reviews of two studies that may help you to better navigate the maze of PU prevention.
Laura Bolton, PhD, FAPWCA
Adjunct Associate Professor
Department of Surgery, UMDNJ
WOUNDS Editorial Advisory Board Member and Department Editor
Heel PU Prevention
Reference: Nicosia G, Gliatta AE, Woodbury MG, Houghton PE. The effect of pressure-relieving surfaces on the prevention of heel ulcers in a variety of settings: a meta-analysis. Int Wound J. 2007;4(3):197–207.
Rationale: The heel is the second most common site for a PU and the incidence of heel PU may be increasing. Heel PU are especially prevalent post-operatively or in recumbent patients.
Objective: A meta-analysis investigated effectiveness of preventative interventions in reducing the incidence of heel PU in various settings.
Methods: MEDLINE, CINAHL, PubMed, EMBASE, and Cochrane databases were searched for English language controlled studies of heel PU preventative interventions published from January 1980 through May 2005. Two reviewers reviewed each abstract independently and the entire research team made the final decision for inclusion in the meta-analysis. Included prospective studies were critically reviewed and rated for quality on the Jadad 0–5-point scale for methodology and the PEDro 10-point scale, which includes integrity of randomization, blinding, analysis, and validity of outcome measures. Intervention type, population, study design, and measurement of heel PU prevention outcome(s) were included in the meta-analysis.
Results: Fourteen studies qualified for the meta-analysis of the 105 unique studies selected for full review. Combined analysis indicated that specialty air or foam mattresses or overlays reduced the relative risk of developing a heel ulcer by 50% compared to using a standard hospital mattress (P = 0.03). When interventions were analyzed singly, only the foam mattresses had sufficient evidence of efficacy in preventing heel PU development. Variability in the air mattress study results in addition to the fact that most overlays were compared with other overlays instead of a standard hospital mattress control obscured these results.
Authors’ Conclusions: Evidence supports use of “certain air or foam mattresses/overlays” in preventing heel PU compared to standard hospital mattresses. There is insufficient evidence to support similar efficacy of heel protective devices at this time. Low methodologic study quality and sample sizes as well as difficulties with blinding dictate caution when interpreting these results.
Preventing PU With a Specialized Mattress
Reference: Berthe JV, Bustillo A, Mélot C, de Fontaine S. Does a foamy-block mattress system prevent pressure sores?
1. Krapfl LA, Gray M. Does regular repositioning prevent pressure ulcers? J Wound Ostomy Continence Nurs. 2008;35(6):571–577.
2. Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA. 2006;296(8):974–984.
3. Cullum N, Deeks J, Sheldon TA, Song F, Fletcher AW. Beds, mattresses and cushions for pressure sore prevention and treatment. Cochrane Database Syst Rev. 2003;(3):Oxford Update.
4. Cullum N, McInnes E, Bell-Syer SE, Legood R. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2004;(3):CD001735.
5. Comfort EH. Reducing pressure ulcer incidence through Braden Scale risk assessment and support surface use. Adv Skin Wound Care. 2008;21(7):330–334.
6. Aronovitch SA. Intraoperatively acquired pressure ulcers: are there common risk factors? Ostomy Wound Manage. 2007;53(2):57–69.
7. Feuchtinger J, de Bie R, Dassen T, Halfens R. A 4-cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery. J Clin Nurs. 2006;15(2):162–167.
8. Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JA; Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil. 2009;90(2):213–231.
9. Bots TC, Apotheker BF. The prevention of heel pressure ulcers using a hydropolymer dressing in surgical patients. J Wound Care. 2004;13(9):375–378.
10. Weng MH. The effect of protective treatment in reducing pressure ulcers for non-invasive ventilation patients. Intensive Crit Care Nurs. 2008;24(5):295–299.
