Abstract
This systematic review considers the evidence supporting the use of prophylactic dressings for the prevention of pressure ulcer. Electronic database searches were conducted on 25 July 2013. The searches found 3026 titles and after removal of duplicate records 2819 titles were scanned against the inclusion and exclusion criteria. Of these, 2777 were excluded based on their title and abstract primarily because they discussed pressure ulcer healing, the prevention and treatment of other chronic and acute wounds or where the intervention was not a prophylactic dressing (e.g. underpads, heel protectors and cushions). Finally, the full text of 42 papers were retrieved. When these 42 papers were reviewed, 21 were excluded and 21 were included in the review. The single high-quality randomised controlled trial (RCT) and the growing number of cohort, weak RCT and case series all suggest that the introduction of a dressing as part of pressure ulcer prevention may help reduce pressure ulcer incidence associated with medical devices especially in immobile intensive care unit patients. There is no firm clinical evidence at this time to suggest that one dressing type is more effective than other dressings.
Highlights
Management of both the duration and magnitude of the mechanical loads applied to skin and soft tissues has long been seen as the essential element of pressure ulcer prevention and management (1)
Three randomised controlled trials (RCTs) were identified; of these two were small and failed to describe how random allocation to treatment was achieved; the final RCT was appropriately powered with adequate description of the elements of pressure ulcer prevention that were provided in addition to the placement of a soft silicone foam dressing over the sacrum
This RCT indicated that use of the soft silicone foam dressing significantly reduced the incidence of pressure ulcers compared to similar patients who received preventive care but no dressing
Summary
Management of both the duration and magnitude of the mechanical loads applied to skin and soft tissues has long been seen as the essential element of pressure ulcer prevention and management (1). Three randomised controlled trials (RCTs) were identified; of these two were small and failed to describe how random allocation to treatment was achieved; the final RCT was appropriately powered with adequate description of the elements of pressure ulcer prevention that were provided in addition to the placement of a soft silicone foam dressing over the sacrum This RCT indicated that use of the soft silicone foam dressing significantly reduced the incidence of pressure ulcers compared to similar patients who received preventive care but no dressing all the 18 non-RCT studies reported low pressure ulcer incidence where dressings were applied to the sacrum, heels, nose and trochanter; these studies were methodologically weak and Hawthorne effects cannot be discounted when considering their data there were only three methodologically weak comparisons between the effect of different dressing materials upon reductions in pressure ulcer incidence. The purpose of this systematic review was to consider whether the introduction of prophylactic dressings for pressure ulcer prevention can lead to reductions in the occurrence of superficial (category I and II) pressure ulcers (5)
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