Pressure-redistributing Mattresses Research Articles

Pressure Redistribution Crib Mattress

Selective use of pressure-redistributing support surfaces is considered an essential component of a pressure injury prevention bundle. Critically ill children who are too big for an isolette but too little for a bed are usually placed in critical care cribs that have unique features such as moveable side rails and a built-in scale for weighing the patient, but they do not have a mattress designed to redistribute pressure. The primary aim of this quality improvement project was to evaluate a pressure redistribution mattress designed for use in critical care cribs. We retrospectively reviewed 22 charts of critically ill pediatric patients who participated in a product trial completed over a 12-week period in a stand-alone children's hospital in the Western United States. We reviewed demographic data, skin assessments, Braden Q Scale score, and support surface use. Our review revealed no pressure injury occurrences over the 12-week data collection period. Findings from this quality improvement project suggest that the pressure-redistributing mattress, when used as part of an intervention bundle, prevents pressure injuries in critically ill pediatric patients.

Skin stiffness determined from occlusion of a horizontally running microvessel in response to skin surface pressure: a finite element study of sacral pressure ulcers.

Pressure ulcers occur following sustained occlusion of microvessels at bony prominences under skin surface pressure (SSP). However, the mechanical conditions of the surrounding soft tissue leading to microvascular occlusion are not fully understood. This study determined the stiffness of homogenized skin with microvasculature at the sacrum that occludes microvessels at an SSP of 10kPa (consistent with a standard mattress) and recovers from occlusion at 5kPa (consistent with a pressure-redistribution mattress). We conducted two-dimensional finite element analyses under plane stress and plane strain conditions to determine the stiffness of the skin. The results for plane stress conditions show that the microvessel was occluded with a Young's modulus of 23kPa in response to an SSP of 10kPa at the center of the sacrum and that the circulation recovered following a reduction in the SSP to 5kPa. The resulting Young's modulus is consistent with reported data. Our study indicates that the critical value of the SSP for microvascular occlusion is determined not only by the stiffness of homogenized skin with microvasculature but also by the intraluminal pressure, microvascular wall stiffness, and body support conditions.

A 6 month evaluation of a non-powered hybrid mattress replacement system.

In 2013, the Royal Cornwall Hospitals NHS Trust undertook a 6-week evaluation of the AtmosAir 4000 non-powered reactive pressure redistribution mattress replacement system to determine its suitability in supporting the prevention of pressure ulcers in high-risk patients (phase one). The results demonstrated that the AtmosAir 4000 mattress system, together with skin assessment and repositioning regimes, met the pressure ulcer preventative needs of patients at high and very high risk of developing pressure ulcers. It also resulted in a notable reduction in the use of dynamic air mattresses. Consequently, 50 AtmosAir 4000 mattresses were purchased for two acute medical wards in the evaluation site, where the majority of patients are elderly with an acute medical condition. This article discusses the second phase where an audit compares the number of hospital-acquired pressure ulcers reported over a 6-month period with the equivalent time period in 2014. Results show that the number of pressure ulcers reduced by 65% and 50% in the two wards. The number of dynamic mattresses used on the two wards reduced significantly from 28 to 7, which represents a 75% reduction in usage.

2G34 体圧分散マットレスの変形特性の測定とその効果に関する検討(GS9-3:人間支援(3))

2G34 体圧分散マットレスの変形特性の測定とその効果に関する検討(GS9-3:人間支援(3))

Evaluating a pressure-redistribution mattress replacement system.

Pressure ulcer prevention is high on the quality agenda and provision of pressure-relieving equipment to meet patients' needs is an essential part of this process. This can be challenging in today's NHS and this article explores the evaluation process that supported the procurement of the AtmosAir™ 4000 pressure-redistributing mattress replacement system. Outcomes suggest that, when combined with a robust repositioning and skin assessment regime, the AtmosAir 4000 performed well and dynamic mattress usage was reduced. Further evaluation over a longer period of time will be undertaken in future.

Practice question.

Nurses are often faced with the complex challenge of preventing pressure ulcers and patient falls. Risk assessment and providing the right pressure-redistributing mattresses combined with correct use of bed rails is essential.

Clinical and cost effectiveness evaluation of low friction and shear garments

To determine the effectiveness of Parafricta low-friction garments in reducing the incidence and prevalence of pressure ulceration and to evaluate the curative aspects of these products on pre-existing skin breakdown within a hospital setting. Patients with a Waterlow score of >15 and who were unable to reposition independently were offered the low-friction undergarments and bootees. A total of 650 patient cases were initially reviewed. Of these, 204 met the criteria for use of the products in the 3 months prior to the start of the evaluation (cohort 1) and 165 patients met the criteria during the period when the garments were used (cohort 2). Data collected included pressure ulcer incidence, location, grading, and outcome of ulcer on discharge. Locally derived costs for length of stay, wound dressings, pressure-redistributing mattresses and additional cost of the low-friction garments were applied to build a cost-effectiveness model. In patients at risk of skin breakdown there was a statistically significant reduction in the number of patients who developed pressure ulcers following use of the low-friction garments in cohort 2 when compared with cohort 1 (16% reduction; p = 0.0286). In addition, the number of patients who were ulcer free on admission but who developed ulcers and then improved or completely healed before discharge was also statistically significant (41% increase; p = 0.0065) when cohort 2 was compared with cohort 1. Fewer patients admitted with ulcers deteriorated when using the low-friction garments (21% reduction; p = 0.0012). The costs, which were calculated by comparing patient throughput for these patients, suggest that the savings associated with preventing skin breakdown outweighed the cost of the products used (base case model indicated a saving of over £63,000 per 100 at risk patients). The results support the conclusion that low-friction garment products have a role to play in the prevention of skin breakdown, and appear to be both clinically effective and cost effective. The authors have no conflicts of interest to declare. APA Parafricta provided the products, as well as financial support for training of the ward staff who participated in the evaluation and for the data collection and analysis (which was performed by Xcelerate Health Outcomes Unit, NHS Innovations London).

The value of systematic evaluation in determining the effectiveness and practical utility of a pressure-redistributing support surface

Introduction Up to 20% of hospital patients will have pressure ulcers; more than half will be nosocomial and are associated with high treatment cost, increased morbidity, complaints and litigation. Consequently, patient safety programmes may include the provision of pressure-redistributing mattress replacements (PRM). However, despite the different functionality of PRMs, there is often little information to support clinical prescription; with some mattresses potentially unsuitable for a busy acute care environment: this is particularly true for mattresses which require manual adjustment each time the patient changes position. Methods A systematic prospective investigation of a new PRM was conducted over a 5-month period; following a convenience sample of high-risk hospital patients. The device automatically detects the angle of back rest, optimises cell inflation and reduces the risk of user error and sub-optimal support. Outcomes reported: ulcer prevention, healing, usability. Results A convenience sample of 60 patients were included; 39 (65%) had existing wounds. A single patient developed erythema to the sacrum (1.6%) while the majority of existing wounds (69%), including full thickness injury, improved or healed. The utility of the device was well received by staff and patients. Conclusion Although ideal, effectiveness studies (such as RCTs) are difficult to control in wound care and seldom reflect the natural challenges encountered in a busy hospital. By contrast the data arising from this pragmatic evaluation showed the mattress to be compatible with the care setting and also suitable for the vulnerability of the population and so provided the necessary information to inform subsequent clinical practice.

Clinical effectiveness of a low-tech versus high-tech pressure-redistributing mattress

To compare the effectiveness of a high-specification foam mattress (control) with a high-tech (Duo2, Hill Rom) alternating/continuous low-pressure mattress (treatment) in the prevention of pressure ulceration. The study also evaluated if there is a difference in performance between the two working modalities (alternating and continuous low pressure) of the high-tech mattress in a comparable sample of patients. Thirty-three patients were observed for two weeks in the control group. In the treatment group, 86 patients were randomised to receive alternating low pressure and 84 continuous low pressure. Incidence of pressure ulcers in both arms was recorded. Student's t-test was used to compare all Braden scores, and the chi-square test and Fisher's exact test to evaluate differences between groups. There was a high difference in the number of new pressure ulcers in the control group when compared with the treatment group. There was no difference in performance between the alternating and continuous low-pressure modes. However, the sample size is too small to prove or disprove a statistically significant difference between the two modalities. The high-tech mattress was markedly more effective than the high-specification foam mattress in preventing the onset of pressure ulcers. Initial data suggest that the use of alternating or continuous low pressure made little or no difference to the results.

The role of pressure-redistributing equipment in the prevention and management of pressure ulcers

In response to a focus on education and research in pressure ulcer prevention, this paper reviews the evolution of pressure-redistributing mattresses and explores the effectiveness of interface pressure measurement in mattress development.

Changing pressure-redistributing mattress stocks: costs and outcomes

There remains considerable confusion regarding the selection of appropriate pressure-redistributing support surfaces, although it is accepted that use of low-pressure foam mattresses is likely to reduce the incidence of pressure ulcers compared with standard hospital mattresses. In this study, a 650- hospital replaced its mattress stock with low-pressure foam mattresses with over pounds sterling 100 000 cost savings in the first year after implementation. Incidence and prevalence data were recorded but given the challenges of interpreting apparent trends in the data (due to the lack of robust data collection methodologies and no case-mix adjustment) these data were not included.

Collecting pressure ulcer prevention and management outcomes: 2.

The first part of this article (Vol 11(4): 230-8) outlined the argument that a combination of efficacy and effectiveness is required to assess fully the impact of interventions such as pressure-redistributing (PR) beds and mattresses. In addition, it described the methodology of this multinational, multicentre, prospective, non-randomized cohort study designed to record the occurrence and characteristics of patients vulnerable to, or with, established pressure ulcers. This article reports further details of the characteristics of the 2507 UK adult hospital patients recruited to the study. Over 40% (42% n = 1046) of all subjects were considered to be at an elevated risk of developing ulcers (Waterlow score of 15 or greater) (Waterlow, 1985). Many were inactive with 332 (13%) confined to bed alone with a further 262 (10%) confined to bed and their chair. Most (74% n = 1868) were nursed upon PR beds and mattresses, while fewer subjects were provided with a PR seat cushion (n = 547; 27%). Two hundred and fifty-seven subjects (10%) experienced at least one change of bed mattress during their stay in hospital, with two subjects being nursed on five different mattresses during their hospital stay.

A Randomised Stratified Survey of the Current use of an Alternating Pressure Air Mattress Within the National Health Service

Summary Little is known about the range and variability of pressure area care within the UK. While pressure-redistributing (PR) mattress use has become widespread during the past ten years, there is little information on how such devices are used. This paper describes a randomised stratified survey of the current use of one PR support surface. 412 mattresses were included in the survey, of which 329 were in use at the time of the visit of the data collector to the provider unit. 74.2% of mattresses in use were found in hospitals. Of the 329 mattresses, 80.2% were being used to prevent the development of sores. The majority of subjects had been assessed using the Waterlow Scale, with 73.6% judged to be at high or very high risk of developing sores. Seventeen (5.2%) subjects developed sores post allocation of the mattress. At the time of mattress allocation, 98 subjects had 130 established sores, of these sores 57 (43.8%) were reported to be full-thickness (severe). The majority of sores (76.5%) were reported to be improving following allocation of the PR mattress. Five key implications for nursing practice were identified through the data collected during this survey - a new indication for use of the APAM, the confusion over relative effectiveness of PR surfaces, the loss of PR mattresses to the NHS, the manual repositioning of mobile patients and the shortage of PR cushions within the NHS.

The Contribution of the Commercial Sector to Tissue Viability

Tissue viability is typically presented as an area of health care which best achieves successful results through multi professional collaboration. The contributions of the different academic and clinical professional groups, and of their constituent specialities, to tissue viability, are beginning to be stated explicitly 1 • 2 • 3 • This article presents a strictly personal view of the contribution of the commercial sector to tissue viability. Clearly I cannot claim to represent each of the thousands of individuals who work to develop and offer new technologies to assist wound healing. Perhaps, for many, the contribution of the commercial sector begins, and ends, with the availability of products. The past decade has witnessed the rapid growth of new products with each promoted as an effective solution to differing tissue viability problems. While the increased range of interventions is an obvious contribution of the commercial sector to the field of tissue viability, the value of many of these new technologies is open to question. For example, while at least 200 different forms of pressure-redistributing mattress are commercially available, only 30 randomised controlled trials comparing the efficacy of such devices are available in the literature 4 with the majority of these investigations reported to exhibit significant methodological flaws. The provision of data to support claims of efficacy is a key responsibility of the commercial sector. Given this responsibility manufacturers, through their funding of investigations, can make a strong contribution to the development of the evidence base which underpins tissue viability. However, for such a contribution to be fully achieved, the credibility of commercially funded research must be enhanced. Bero and Rennie 5 recently reviewed the quality of published studies which had been funded by the pharmaceutical industry. This review highlighted that these publications were often seriously flawed, with three key weaknesses noted; negative results were frequently not published, the funder controlled the content of the publication with articles published without peer-review. Research into wound prevention and healing, which frequently derives its funding from product manufacturers, will continue to be viewed with caution unless the tissue viability community works together to enhance the credibility of studies funded by industry. Bero and Rennie 5 offered a number of initiatives which would improve the credibility of industry funded research. Fundamental to this process was the recommendation that 'companies commit themselves to submitting for publication every study that is undertaken, regardless of the findings'. This commitment to publication could, according to Bero and Rennie, be monitored through the implementation of a register of new studies. Perhaps the development and maintenance of such a register could be one future activity for the Tissue Viability Society? The commercial sector has a major role to play in the generation of new evidence but this contribution will flower best when industry, researchers, and journal editors take responsibility for the quality of studies that are published 5 •

Matching patient need for pressure sore prevention with the supply of pressure redistributing mattresses.

The authors have conducted a series of pressure sore prevalence surveys within one health district over a 4-year period. Additional surveys of the availability and deployment of pressure redistributing (PR) bed mattresses have also been made within the same district. The prevalence of pressure sores increased from 6.8% (1986) to 14.2% (1989) while the available stocks of PR mattresses increased from 69 (1987) to 186 (1989). Our results appear to question the common assumption that successful pressure sore prevention can be achieved through expanding the stocks of PR mattresses. Five possible reasons why the increase in mattress provision was matched with an increased prevalence of pressure sores are forwarded. The use of measures of prevalence rather than incidence rates to monitor the effects of clinical initiatives is discussed.