Pressure Ulcer Prevention: Optimizing a Temporally Redistributing Support Interface

Joshua M Peterson,Cameron Crombie,Eric H Ledet,G Jacobus Visser,Colleen P Healey

doi:10.3844/ajeassp.2016.1222.1231

Joshua M Peterson, Cameron Crombie + Show 3 more

Open Access

https://doi.org/10.3844/ajeassp.2016.1222.1231

Copy DOI

Abstract

One of the most common complications from long-term wheelchair use or bed rest is pressure ulcers. Pressure ulcers have significant morbidity and are associated with high mortality. Prolonged sitting can cause high pressures in the skin and subcutaneous tissue which can lead to local ischemia and breakdown of skin. Rapid relief of pressure prevents ulcer formation. One prevention strategy is to change the temporal distribution of pressure at the interface between user and surface so that no one area is subjected to high pressures for long periods of time. While there are several dynamic interfaces in use currently, there is no definitive evidence of enhanced pressure ulcer prevention with their use. The purpose of this research was to parametrically evaluate interface array sizes, shapes and patterns for dynamic support surfaces to optimize pressure redistribution to prevent pressure ulcers. Finite element analyses, anatomical phantom deep tissue pressure measurements and interface pressure mapping were used to test various support geometries and sizes and different array spacing and patterns. Results indicate that modulating pressure in an array of supports that are equally spaced is not effective. Only interrupted pattern arrays resulted in sufficient pressure reduction. These data suggest that dynamic surface supports can be optimized based on the geometry and size of the individual supports and the pattern of the array to further reduce the likelihood of pressure ulcer formation.

Highlights

According to the World Health Organization, there are more than 70 million wheelchair users worldwide
Pressure ulcer incidence is as high as 38% depending on nature of injury while in long term care settings, the incidence is reported at 24% (Xakellis, 1992; Cuddigan et al, 2001)
While there are several dynamic interfaces in use currently, there is no definitive evidence of enhanced pressure ulcer prevention with their use (Reddy et al, 2006; McInnes et al, 2011; Qaseem et al, 2015)

Summary

Introduction

According to the World Health Organization, there are more than 70 million wheelchair users worldwide. For users with impaired ability to reposition themselves, one of the most common complications from long-term wheelchair use or bed rest is pressure ulcers (Coleman et al, 2013). In 2008, the World Health Organization identified pressure ulcers as one of the top 20 patient safety issues worldwide (WHO, 2008) and in that same year, pressure ulcers were recognized as the most common medical error in the United States (Van Den Bos et al, 2011). Pressure ulcer incidence is as high as 38% depending on nature of injury while in long term care settings, the incidence is reported at 24% (Xakellis, 1992; Cuddigan et al, 2001). Up to 66% of paraplegics will develop pressure ulcers (Richardson and Meyer, 1981)

Objectives

Methods

Results

Conclusion