Support surfaces for pressure ulcer prevention

Department of Health Sciences, University of York, Area 2 Seebohm Rowntree Building, Heslington, York, North Yorkshire, UK, YO10 5DD.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2004; 3(3):CD001735. DOI: 10.1002/14651858.CD001735.pub2
Source: PubMed


Pressure ulcers (also known as bedsores, pressure sores, decubitus ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings.
This systematic review seeks to answer the following questions: to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the incidence of pressure ulcers compared with standard support surfaces? how effective are different pressure-relieving surfaces in preventing pressure ulcers, compared to one another?
The Specialised Trials Register of the Cochrane Wounds Group (compiled from regular searches of many electronic databases including MEDLINE, CINAHL and EMBASE plus handsearching of specialist journals and conference proceedings) was searched up to January 2004, Issue 3, 2004 of the Cochrane Central Register of Controlled Trials was also searched. The reference sections of included studies were searched for further trials.
Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure ulcers, in any patient group, in any setting. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as incidence and severity of new of pressure ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded.
Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis.
41 RCTs were included in the review. Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure ulcers in people at risk. The relative merits of alternating and constant low pressure devices, and of the different alternating pressure devices for pressure ulcer prevention are unclear.Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure ulcer incidence, although one study indicated that an overlay resulted in adverse skin changes. One trial indicated that Australian standard medical sheepskins prevented pressure ulcers. There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure ulcer incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and an operating theatre overlay are harmful.
In people at high risk of pressure ulcer development, consideration should be given to the use of higher specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. Organisations might consider the use of pressure relief for high risk patients in the operating theatre, as this is associated with a reduction in post-operative incidence of pressure ulcers. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated.

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Available from: Nicky A Cullum
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    • "Main databanks (PubMed, BMJ, Joanna Brings, Cochrane Library, JAMA, Age & Aging, MedScape) were consulted to perform the review using the following keywords: pressure ulcer or cost-effectiveness or HTA or advanced dressing or simple dressing. Sixteen articles were identified as being of interest and coherent with the topic of the study for further in depth analysis; five articles concerning budget impact or costeffectiveness analysis of ulcer prevention [10-14]; three articles on the benchmarking concerning costs of different advanced dressing typologies [15-17], one article reporting on a cost of illness study [18], one article suggesting clinical and economic modelling in order to develop guideline for pressure ulcers [19] and two articles with a focus on clinical aspects [20] [21]. In addition , four articles [22-25] were identified for analysis of the economic evaluation, patient sample, and treatment administered. "
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    ABSTRACT: Pressure ulcer management represents a growing problem for medical and social health care systems all over the world, particularly in European Union countries where the incidence of pressure ulcers in older persons (> 60 years of age) is predicted to rise. The aim of this study was to provide evidence for the lower impact on economic resources of using advanced dressings for the treatment of pressure ulcers with respect to conventional simple dressings. Two different models of analysis, derived from Activity Based Costing and Health Technology Assessment, were used to measure, over a 30-day period, the direct costs incurred by pressure ulcer treatment for community-residing patients receiving integrated home care. Although the mean cost per home care visit was higher in the advanced dressings patient group than in the simple dressings patient one (E 22.31 versus E 16.03), analysis of the data revealed that the cost of using advanced dressings was lower due to fewer home care visits (22 versus 11). The results underline the fact that decision-makers need to improve their understanding of the advantages of taking a long-term view with regards to the purchase and use of materials. This could produce considerable savings of resources in addition to improving treatment efficacy for the benefit of patients and the health care system.
    Full-text · Article · Mar 2012 · Journal of preventive medicine and hygiene
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    • "Several other technologies were studied such as alternating pressure mattresses, air fluidized beds, and mechanically assistive beds. A review of these passive technologies mentioned shows that their actual benefits were unclear and inconclusive [14]. The one clinically proven method for preventing pressure ulcers is to turn the patient frequently, which none of these mattresses can do [15]. "
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    ABSTRACT: The focus of this paper is to develop a software-hardware platform that addresses one of the most costly, acute health conditions, pressure ulcers — or bed sores. Caring for pressure ulcers is extremely costly, increases the length of hospital stays and is very labor intensive. The proposed platform collects information from various sensors incorporated into the bed, analyzes the data to create a time-stamped, whole-body pressure distribution map, and commands the bed's actuators to periodically adjust its surface profile to redistribute pressure over the entire body. These capabilities are combined to form a cognitive support system, that augments the ability of a care giver, allowing them to provide better care to more patients in less time. For proof of concept, we have implemented algorithms and architectures that cover four key aspects of this platform: 1) data collection, 2) modeling & profiling, 3) machine learning, and 4) acting.
    Full-text · Conference Paper · Oct 2011
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    • "An estimated one billion dollars is spent annually to manage pressure ulcers in the United States [1]. A pressure ulcer is defined as localized damage to the skin and the underlying tissues in response to moderate but sustained mechanical compression [2]. The exact cause and pathogenesis of pressure ulcers are largely unknown. "
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    ABSTRACT: The molecular mechanism initiating deep pressure ulcer remains to be elucidated. The present study tested the hypothesis that the ubiquitin proteasome system is involved in the signalling mechanism in pressure-induced deep tissue injury. Adult Sprague Dawley rats were subjected to an experimental compression model to induce deep tissue injury. The tibialis region of the right hind limb was subjected to 100 mmHg of static pressure for six hours on each of two consecutive days. The compression pressure was continuously monitored by a three-axial force transducer within the compression indentor. The left hind limb served as the intra-animal control. Muscle tissues underneath the compressed region were collected and used for analyses. Our results demonstrated that the activity of 20S proteasome and the protein abundance of ubiquitin and MAFbx/atrogin-1 were elevated in conjunction with pathohistological changes in the compressed muscle, as compared to control muscle. The administration of the proteasome inhibitor MG132 was found to be effective in ameliorating the development of pathological histology in compressed muscle. Furthermore, 20S proteasome activity and protein content of ubiquitin and MAFbx/atrogin-1 showed no apparent increase in the MG132-treated muscle following compression. Our data suggest that the ubiquitin proteasome system may play a role in the pathogenesis of pressure-induced deep tissue injury.
    Full-text · Article · Mar 2011 · BMC Musculoskeletal Disorders
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