Heel Protector Research Articles

The effects of using heel protectors on the prevention of heel pressure injuries and plantar flexion contractures.

Immobilization in the intensive care unit can lead to pressure injuries and plantar flexion contractures. This study was conducted to evaluate the effectiveness of heel protectors applied for the prevention of heel pressure injuries and plantar flexion contractures in intensive care units. This study was conducted as a randomized controlled trial in two adult intensive care units of a teaching and research hospital. The study sample consisted of 84 patients admitted to intensive care units between January 2022 and December 2022. Patients who had been in the intensive care unit for at least 5 days, scored 16 or less on the Braden Pressure Ulcer Risk Assessment Scale and scored 4 or more on the Ramsey Sedation Scale, were included in the study. Heel protector boots were applied to the heels of the patients in the intervention group, while standard positioning with a pillow and ROM exercises were continued in the control group. A sociodemographic data form, the Ramsey Sedation Scale and the Braden Pressure Ulcer Risk Assessment Scale were used to collect data. While pressure injuries were evaluated with the International NPUAP-EPUAP Pressure Ulcer Classification System, goniometric measurements were made to evaluate joint ROM. In the intervention group, heel pressure injuries did not develop during the study, whereas five patients in the control group developed heel pressure injuries. The risk of pressure injury development that was seen in the control group was 1.7 times higher compared with the risk for the intervention group (log 95% CI: 0.91-2.59). There were significant differences between the right foot (99%; F = 99.229; p = .000) and left foot (99%; F = 100.519; p = .000) in range of motion measurement values of the patients in the intervention group according to the measurement times. According to the results of the multiple comparison test (Bonferroni) performed to determine the range of motion measurement periods showing significant differences, it was observed that each measurement for both feet yielded lower results than the previous measurement (seven measurements from day 1 to day 13). The use of heel protector boots was found to be effective in preventing the development of heel pressure injuries and plantar flexion contractures in intensive care unit patients. This study provides evidence that intensive care nurses can use heel protector boots to prevent the development of heel pressure injuries and plantar flexion contractures.

Heel pressure ulceration: the perennial clinical and financial problem?

The heel of the foot is particularly susceptible to pressure, friction and shear forces. In consequence, heel pressure ulcers account for approximately 18% of all hospital-acquired pressure ulcers in England. To ameliorate the effects of friction and shear forces, the use of heel protectors made from silk-like fabric is recommended. This article outlines how one such product, the Parafricta bootee (APA Parafricta), has facilitated a reduction in heel pressure ulcer development, resulting in both time and cost savings in an acute NHS trust over the course of 8 years and thousands of patients. A cost-analysis will also be detailed to show that if the products and processes pioneered by this trust were used throughout NHS England, over £300 million in resource savings could be achieved each year.

The role of using a special support surface in heel pressure ulcers appearance in intensive care unit patients

Introduction: Intensive Care Unit (ICU) patients suffer complications such as the development of pressure ulcers. Aim: The purpose of this study was to investigate the relationship between the use of special designed heel protector and the frequency and severity of heel pressure ulcers occurrence in ICU patients. Material and Method: The studied sample consisted of 40 patients hospitalized in ICU of a general hospital in Attica. Hospital Acquired Skin Injury (HASI) and Cubin Jackson (Score Cubin-Jackson) were used and data analysis was performed by the statistical package SPSS 19. Results: 62,5% of the studied sample were men, with mean age 59±17.7 years and length of hospital stay 21.4±18 days. The preventive intervention applied in the present study was effective, as no patient develop pressure ulcers. However, the incidence of tissue lesions at the unstressed edge did not appear to be influenced by factors such as patient age (p = 0.586), gender (p = 0.674 F = 0.180), total blood protein levels (p = 0.732 ), albumin levels (0.185) and hematocrit (p = 0.669). Conclusions: In those patients that the pressure ulcers heel protectors were applied no one develops pressure ulcers during their stay in ICU. On the contrary, in those patients

Assessment of knowledge and practice & identification of barriers towards pressure ulcer care and prevention among nursing professional

Despite advances in health care, pressure ulcers (PrU) remain one of the most common and serious complications of spinal cord injury (SCI). Prevention of hospital-acquired PrU is an essential prerequisite for early reintegration of SCI patients into the society. Therein, lays the importance of awareness and knowledge about the prevention and management of PrU amongst nurses. The aim of this study was to assess nurses's knowledge of PU management to identify lacunas in implementation of PrU prevention strategies. It was a cross-sectional study. The participants completed a structured performa and Pressure Ulcer Knowledge Test (PUKT), which comprised of 47-items to examine the knowledge on PrU prevention, staging and wound description. A cutoff score of 90% of participants answering an item correctly was used to gauge “adequate” knowledge. Total 240 nurses participated in this study, out of which 87% were female, mean age 42.5 ± 10.49(yrs), more than 50% subjects had work experience of > 20 years. Mean total correct response was 59.01 ± 17.75 and to questions related to ulcer, wound and prevention was 56.19 ± 23.54, 52.98 ± 22.13, and 61.09 ± 18.09, respectively. A satisfactory percentage had adequate knowledge of prevention of PrU. However very poor response was observed to certain questions with only 7(2.92%) answering correctly about the use of Heel protectors and only 37(16.25%) aware about the role of eschar in ulcer healing. The mean PUKT score was < 60% for 41% of the participants. Nursing professionals involved in active care of patients performed significantly better in all the aspects of knowledge test. University training followed by In-service training was the source of education on PrU. Lack of resources and training (25%) & shortage of staff (23%) were the frequently cited barriers to carrying out PrU risk assessment, documentation and prevention. Our study identified deficits in PrU knowledge and areas where nurses would benefit from focused education strategies.

The impact of care practices and health demographics on the prevalence of skin tears and pressure injuries in aged care.

To determine whether differences in care practices and demographics between two long-term aged care facilities affected the incidence of residents' skin wounds. A retrospective analysis of care plans and clinical outcomes was conducted for a 6-month period in 2016 at two aged care facilities, N=39 Home 1 and N=45 Home 2. Skin tears, pressure injuries and usual care practices and associated health demographics were recorded. Over the 6-month period, 84 residents were found to have a total of 206 aged care acquired skin wounds (skin tears, pressure injuries, haematomas, rashes, infections). The frequency of skin tears or total wounds did not differ between the homes. Several factors were identified that influenced the skin wounds. A reduction in skin tears was associated with the use of heel protectors and antiembolic stockings, whilst a diagnosis of vascular dementia was associated with increased prevalence of skin wounds. Pressure injuries were significantly higher at Home 2. Increased use of strategies to moderate-risk activities, such as tray tables and bed rails, and impaired cognitive function were associated with higher pressure injury prevalence. A number of care factors and health demographics influenced the rate of skin wounds. A holistic approach to skin management is needed. Practices, such as repositioning and skin hygiene, are well known to reduce the incidence of pressure injuries and skin tears; however, there are other care practices that take place in homes as part of usual care that also impact skin wounds that have been largely ignored. This study highlights those care practices, as well as resident characteristics and comorbidities that may increase the risk of skin wounds, requiring further monitoring/mitigating strategies.

Prevention of Heel Pressure Injuries and Plantar Flexion Contractures With Use of a Heel Protector in High-Risk Neurotrauma, Medical, and Surgical Intensive Care Units: A Randomized Controlled Trial.

The purpose of this study was to compare the use of a heel protector to standard of care (pillows) in the prevention of hospital-acquired pressure injuries (HAPI) of the heels and prevention of plantar flexion contractures. Randomized controlled trial. The study took place on a surgical intensive care unit, medical intensive care unit, and neurotrauma intensive care unit. Inclusion criteria were a minimum of 5 days of sedation related to care for a critical illness, immobility for 6 to 8 hours before study initiation, a Braden Scale for Pressure Sore Risk score 18 or less, and a mobility subscale score 2 or less. Patients were included if they had preexisting heel pressure injury or plantar flexion contracture. The sample comprised 54 subjects; 37 were randomly allocated to the intervention group and 17 to the control group. Their average age-mean (standard deviation)-was 40.7 (14.96) years in the control group and 44.6 (17.15) years in the intervention group. Data were collected from patients' electronic medical records. We recorded subject demographics, presence of diabetes mellitus or peripheral vascular disease, Glasgow Coma Scale scores (every shift), Braden Scale for Pressure Sore Risk scores (every shift), heel skin assessments (every shift), goniometric measurements (every other day), and adverse events (every shift). Assessments and measurements were continued until the patient was discharged from the study. None of the patients in the intervention group developed HAPI of the heels, as compared to 7 in the control group (0% vs 41%, P < .001). Patients in the intervention group had a significantly greater decrease in goniometric scores (mean decrease = 1.4 ± 2.25) compared to the control group by day 3 (mean decrease = 0.1 ± 0.52 P = .004) and the last study day (mean decrease = 2.0 ± 3.02 for the intervention group vs 0.07 ± 0.96 for the control group; P < .001). Study findings indicate that a heel protector that ensures off-loading and maintains the foot in a neutral position is more effective for prevention of HAPI of the heel and contractures as compared to standard care using pillows to position the heel and redistribute pressure.

Using heel protectors for the prevention of hospital-acquired pressure ulcers.

Pressure ulcers are a frequent, but often preventable, occurrence among patients in acute care facilities, and the heel is one of the anatomical locations most commonly affected. Multiple clinical guidelines recommend the use of robust assessments to identify at-risk patients and the application of heel protection devices to reduce the likelihood of developing heel pressure ulcers. A quality improvement initiative involving robust skin-assessment practices, staff education, and the use of heel protection devices was analysed retrospectively to evaluate the efficacy of current practice interventions. These analyses revealed that the incidence of heel pressure ulcers was inversely correlated with the number of heel protectors used at two large acute NHS teaching hospitals in inner London, and that the consistent and early use of heel protectors improved patient outcomes and reduced costs of care.

Systematic review of the use of prophylactic dressings in the prevention of pressure ulcers

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.

How to reduce hospital-acquired pressure ulcers on a neuroscience unit with a skin and wound assessment team

Background:In 2008, the incidence of hospital acquired pressure ulcers (HAPUs) continued to increase on a neuroscience unit that included both neurosurgical and neurological patients in a 14-bed intensive care unit, and in a 18-bed floor unit.Methods:To reduce HAPUs, several changes were instituted in 2008; (1) turning patients every 1–2 h/repositioning, (2) specialty beds, and (3) a “skin and wound assessment team (SWAT)” that included one (or two) “expert” nurses/nursing assistants who made rounds on all the patients in the unit at least once a week. They would examine patients from “head to toe”, document/measure all pressure ulcers, and educate primary nurses/nurse assistants on the plan/products needed for the patients wound care based on their assessments. In 2010, further measures included: (1) adding eight Stryker beds, (2) adding pressure relieving heel protector boots, and (3) requiring that all new hospital orientees work one shift (7.5 h) shadowing the SWAT team.Results:The SWAT team initially decreased HAPUs by 48% in 2009; this reduction was further increased in 2010 (57%), and 2011 (61%). Additionally, in 2010, the SWAT team was required to educate nurses in all other units. By 2011, all nurses had to complete the hospital acquired pressure ulcer prevention tutorial.Conclusions:Since instituting a specialized SWAT team for our neuroscience unit, the incidence of HAPUs (cost estimated for grade IV, US $129,248) was decreased by 48% in 2009, by 57% in 2010, and by 61% in 2011. The SWAT program is now hospital-wide.

Heel damage and epidural analgesia: is there a connection?

To determine heel pressure injury prevalence in surgical patients prescribed epidural analgesia and identify intrinsic and extrinsic factors associated with heel damage in this patient cohort. A descriptive study was used to investigate intrinsic and extrinsic variables associated with recorded heel observations at a private hospital in Victoria, Australia. We recruited a sample of 29 consecutive non-emergency participants undergoing general anaesthesia for major surgery, who were prescribed epidural analgesia postoperatively. A total of 58 heel observations were made. Heel damage prevalence in the study sample was 13.8% (n=8). Intrinsic factors associated with this complication included intra- and postoperative hypotension, vascular disease, smoking, chronic obstructive pulmonary disease, and multiple disease burdens. Extrinsic factors associated with heel damage included thromboembolic deterrent stockings and the postoperative ward use of heel protectors designed for use in operating theatres. It is hoped that the study findings will assist improvements in the assessment of heel damage risk and promote the pressure prevention strategies required by this patient cohort.

Preventing Heel Pressure Ulcers and Plantar Flexion Contractures in High‐Risk Sedated Patients

An intervention using heel pressure ulcer and plantar flexion contracture prevention protocols for high-risk patients was established to promote earlier recognition of heel skin issues and provide effective prevention of both conditions. Fifty-three patients who were sedated, managed in an intensive care unit for 5 days or more, and had a Braden Scale score of 16 or less were treated with heel protector devices that maintained the foot in a neutral position and floated the heel off the bed. On admission to the intensive care unit, heel skin assessment and the Braden Scale were administered to all patients. Initial ankle range of motion was measured with a goniometer on admission and before the application of the heel protector. Goniometric measurements were documented every other day. Heel assessments and the Braden Scale for Predicting Pressure Sore Prevention and Ramsay Sedation Scale scores were recorded in every shift and recorded as part of the study every other day. Measurements continued until the patient was transferred, the heel protector boot was discontinued by the physician, or the patient's Braden Scale score rose above 16. Application of the heel protectors led to a 50% reduction in prevalence of abnormal heel position. No patients developed plantar flexion contractures or new heel ulcers. Patients with normal heels had significantly higher Braden Scale scores compared to those with abnormal heels (P 5 .0136). Despite their high risk, no patients using the heel protector device developed a heel pressure ulcer or plantar flexion contracture.

Reduced heel pressure damage when using the Repose® Foot Protector

An evaluation of the Repose® heel pressure ulcer prevention system was conducted in an orthopaedic setting to establish its clinical efficacy in reducing the incidence of heel pressure damage, following a literature review of appropriate pressure-reducing devices. The study involved patients from a 24-bed orthopaedic ward over a six-month period. The results showed that the use of the heel protector led to a significant reduction in the incidence of heel pressure ulceration from more than 6% to 0%. A significant reduction in cost was also identified. The results indicate that the use of a heel protector alongside individualized pressure ulcer prevention has a significant impact on preventing heel pressure damage.

Research Comparing Three Heel Ulcer-Prevention Devices

To compare 3 pressure-reduction devices for effectiveness in prevention of heel ulcers in moderate-risk to high-risk patients. A prospective quasi-experimental 3-group design was used. A sample of 338 "moderate-risk to high-risk" adult inpatients, ages 18 to 97, at 2 medical centers in South Texas were studied. The Braden Scale for Pressure Ulcer Risk and investigator-developed history and skin assessment tools were used. Subjects were randomly assigned to the High-Cushion Kodel Heel Protector (bunny boot), Egg Crate Heel Lift Positioner (egg crate), or EHOB Foot Waffle Air Cushion (foot waffle). Data are demographics, Braden scores, comorbidities, skin assessments, lengths of stay, and costs of devices. Analyses were Chi-square, analysis of variance, and regression. Of 240 subjects with complete data, 77 (32%) were assigned to the bunny boot group, 87 (36.3%) to the egg crate, and 76 (31.7%) to the foot waffle. Twelve ulcers developed in 240 subjects (5% incidence). Six subjects had only 1 foot. Eleven ulcers were Stage I (nonblanchable erythema), and 1 was Stage II (partial thickness). Overall incidence was 3.9% for the bunny boot, 4.6% for the egg crate, and 6.6% for the foot waffle (not significantly different among groups). The bunny boot with pillows was most cost effective (F[3], N = 240) = 1.342, p <or= .001). In this study, the bunny boot was as effective as higher-tech devices. The results, however, were confounded by nurses adding pillows to the bunny boot group.

Dinah Christie: “Necessity Is A Mother”

If anyone has earned the accolade of a Canadian cabaret star, it’s Dinah Christie, who has been entertaining audiences, at home and abroad, for three decades. Although her theatrical work has embraced every aspect of production, including writing and directing, she is most familiar to Canadians as an eclectic trouper whose work covers all the performing media. Whether starring in cabaret (often with Tom Kneebone and Dean Regan), on television (including This Hour Has Seven Days, Party Game, and Check It Out), dramatic film (she won an ACTRA nomination for her role in One Night Stand), singing with symphony orchestras across the country or donating her talent for charity fund-raisers, Christie has maintained a special connection with Canadian audiences. Along with her theatrical career, she has also established herself as an inventor and businesswoman, creating practical, environmental-friendly accessories for her company, The BADD Sisters. Her creations include decorative heel protectors and insulated water bottle carriers (which were sent with Canadian troops to the Persian Gulf).

A pilot study of interface pressure with heel protectors used for pressure reduction

A pilot study of interface pressure with heel protectors used for pressure reduction

Heel Protector during Ambulation

Journal Article Heel Protector during Ambulation Get access Margaret L. McComas, M.S. Margaret L. McComas, M.S. Chief Physical Therapist George Morris Piersol Rehabilitation Center, Hospital of the University of Pennsylvania, Philadelphia. Search for other works by this author on: Oxford Academic Google Scholar Physical Therapy, Volume 48, Issue 2, February 1968, Page 138, https://doi.org/10.1093/ptj/48.2.138 Published: 01 February 1968

Heel Protector during Ambulation

Heel Protector during Ambulation