The Mölnlycke Health Care blog
Proven pressure ulcer prevention in practice
Professor Nick Santamaria, University of Melbourne & Royal Melbourne Hospital.
The clinical and scientific evidence about pressure ulcer prevention continues to show that the risk of developing pressure ulcers can be mitigated using prophylactic interface dressing treatment as an effective prevention strategy. Knowing what we know about the costs of avoiding hospital-acquired conditions like pressure ulcers and the imperative to do more with fewer resources, about which I wrote last year, coupled with the evidence from both clinical and scientific studies, it is difficult to argue against pressure ulcer prevention protocols and strategy adoption.
Evidence has demonstrated that pressure alone is not the sole reliable measure for risk of tissue breakdown, and looking at interface pressure alone is not adequate. Additionally, the risk for stresses and strains near bony prominences within deep tissue is higher, which means unseen damage is happening under the surface. In fact these findings are a part of the international guideline, Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline1, because we know, with clinical, scientific and financial proof that we can implement proven prevention strategies that will save unnecessary pain and suffering, alleviate longer hospital stays, require less staff time and use resources more wisely and ultimately make inroads toward making pressure ulcers a thing of the past.
Each piece of new evidence supports this effort.
In conducting our latest cohort study2, we used multilayer heel dressings on trauma and critically ill patients admitted to the ICU from the emergency department at Royal Melbourne Hospital between April 2013 and May 2014. Patients were monitored every 24 hours during their stay, or until they were mobile, to determine whether a hospital-acquired pressure ulcer had developed.
We found that there was a zero incidence rate when the Mepilex Border Heel® multilayer dressing was applied prophylactically. In the control cohort, the total number of heel pressure ulcers developed was 19.
The results demonstrated proven pressure ulcer prevention and were consistent with the finite element modelling research that demonstrates the effectiveness of multilayer foam dressings in reducing mechanical loading in soft tissue.
Has the emergence of new evidence changed your approach to pressure ulcer prevention?
Join me and my colleagues for Stop Pressure Ulcer Day, 19 November 2015, to learn more about clinically and scientifically proven pressure ulcer risk reduction. Register for the "Proof into practice" webinar at www.stop-pressureulcers.com (external link, opens in a new window).
- National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice guideline. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014.
- Santamaria, N., Gerdtz, M., Liu, W., Rakis, S., Sage, S., Ng, AW., Tudor, H., McCann, J., Vassiliou, T., Morrow, F., Smith, K., Knott, J., Liew, D. Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial. Journal of Wound Care 2015; 24(8).
- Levy A., Frank M.B., Gefen A. The biomechanical efficacy of dressings in preventing heel ulcers. Journal of Tissue Viability 2015.