Use Of Support Surfaces Research Articles

Prevention of pressure injuries using a non-motorised decompression air mattress: a non-interventional study.

Prevention of pressure injuries (PI) is a public health issue. Among the preventive measures, the use of support surfaces adapted to the risk of PI occurrence is recommended. This study aimed to report the incidence of PIs in patients at medium-to-high risk of occurrence of PIs and using a new non-motorised automated decompression air mattress combined with other recommended PI prevention measures. An observational, national, multicentre, prospective, non-comparative study, with a follow-up period of 35 days was conducted. Patients at medium-to-high risk of PIs and without PIs at baseline were included if they were lying on a specific non-powered automated decompression air mattress. The primary outcome was the percentage of patients who developed at least one category 2 or more severe PI of the sacrum, backbone or heel between day 0 and day 35. In total, 81 patients were included from four participating centres. There was one report of a patient with a PI that fitted within the definition of the primary outcome, meaning an incidence of 1.2% (95% confidence interval (CI) 0-6.7%). More than 80% of patients rated the overall comfort and the stability of the non-motorised automated decompression air mattress as satisfactory or very satisfactory. In more than 80% of cases, the healthcare teams found the use of the mattress to be easy or very easy. This study has shown that in combination with other preventive measures, the use of a specific non-motorised air mattress with automated decompression is associated with a low incidence of PIs in patients with medium-to-high risk of occurrence of PIs.

Nursing interventions in preventing pressure injuries in acute inpatient care: a cross-sectional national study

BackgroundSeveral nursing interventions for pressure injury prevention have been identified, including risk and skin status assessment. The aim of this study was to explore prevention of pressure injuries in Finnish acute inpatient care. The data were collected on pressure injury risk and skin status assessments, repositioning, the use of support surfaces, preventive skin care, malnutrition risk assessment, and nutritional care.MethodsThis multicentre, cross-sectional study was conducted in 16 acute care hospitals, excluding psychiatric care. Adult patients from inpatient care were recruited on the annual international Stop Pressure Ulcers Day in 2018 and 2019. Enrolment covered 6,160 participants in 503 units. Descriptive statistics were used to describe pressure injuries, risk assessments, and preventive nursing interventions. Cross tabulation, Pearson’s chi-square and Fisher’s exact tests were also used. Reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.ResultsIn all, 30% of the participants had their pressure injury risk assessed during the care, and for 19% within 8 h after admission. The same time limit in risk assessment was fulfilled for 16% of the participants with a pressure injury, and 22% of the participants using a wheelchair or being bedridden. A skin status assessment within 8 h after admission was conducted for 30% of all participants, and for 29% of the participants with a pre-existing pressure injury, and for 38% of the participants using a wheelchair or being bedridden. The risk of malnutrition was screened in 20% of the participants. Preventive interventions were targeted to participants with a pressure injury instead of patients with a high-pressure injury risk.ConclusionThis study adds evidence about pressure injury risk assessments and the implementation of preventive nursing interventions in Finnish acute care. Skin status and pressure injury risk assessments were irregularly conducted, and the outcome was not used by nurses to guide the implementation of preventive interventions. The results reveal the gaps in evidence-based nursing practice, which require further efforts to prevent pressure injuries. Improving the national focus on pressure injury prevention practice is critical for improving healthcare for our patients.

Reducing the Incidence and Prevalence of Pressure Injury in Adult ICU Patients with Support Surface Use: A Systematic Review.

To provide information on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injuries (PIs) in adult ICU patients. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant will: 1. Distinguish features of active and reactive support surfaces used in the ICU.2. Compare the PI incidence in patients using a variety of support surfaces.3. Synthesize recommendations for the use of support surfaces to reduce the risk of PI in adult ICU patients.

Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey.

PURPOSE:The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey.DESIGN:Observational, cohort study with cross-sectional data collection and retrospective data analysis.SUBJECTS AND SETTING:The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years.METHODS:Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units.RESULTS:Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups.CONCLUSION:Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.

Reducing the Incidence and Prevalence of Pressure Injury in Adult ICU Patients with Support Surface Use: A Systematic Review

Reducing the Incidence and Prevalence of Pressure Injury in Adult ICU Patients with Support Surface Use: A Systematic Review

Pressure injury prevention practices among medical surgical nurses in a tertiary hospital: An observational and chart audit study.

Pressure injuries are frequently occurring adverse events in hospitals, negatively impacting patient safety and quality of care. Most pressure injuries are avoidable if effective prevention strategies are used. However, the extent to which various settings influence their use of prevention strategies is unknown. The aim of this study was to describe and compare pressure injury prevention strategies used by medical and surgical nurses in the Chinese context. In this observational study, we used semi‐structured observations with chart audits to collect data in two medical and two surgical wards in a tertiary hospital from June to December 2020. Observations were patient‐focused; any prevention practices the patient received were recorded, and a chart audit was used to identify documented prevention strategies. The frequency of each prevention strategy was reported, and differences between medical and surgical wards were analysed using independent t‐test or χ2 test. A total of 577 patients (n = 294, 50.9% medical; n = 283, 49.1% surgical) were observed and their charts audited. Risk assessment was completed on admission for all patients. Repositioning was the most frequently used strategy, with about 84% (n = 486) patients being repositioned regularly. However, skin care, nutritional risk screening and the use of support surfaces were suboptimal. Patient education was not commonly observed but was documented in 75% (n = 433) of audited charts. More medical patients' skin was kept clean and hydrated, but more surgical patients received barrier creams, had a support surface and received more nutrition support and if a prone position was used, they were more likely to be turned after 2 hr and to be repositioned after sitting in a chair for an hour. Prevention strategies were more likely to be documented in surgical patients' charts. Despite pressure injury prevention guideline recommendations provided various prevention strategies for nurses to apply, the observed use of some strategies such as nutrition, skin care and support surfaces was not ideal. Nurses relied heavily on repositioning for pressure injury prevention. Most pressure injury prevention practices need improvement although surgical patients generally received better preventative care. These findings can facilitate clinicians and nurse managers when tailoring future pressure injury prevention work.

RISK FACTORS AND PREVENTIVE INTERVENTIONS FOR PRESSURE INJURIES IN CANCER PATIENTS

Objective: identify and describe the risk factors for the development of pressure injuries in adult cancer patients and interdisciplinary preventive interventions. Method: integrative literature review. Data collection was carried out between March and April 2019 and December 2020, using the databases: BDENF; PubMed/Medline; Embase; Scopus; Cinahal and Web of Science. Results: the sample consisted of 16 articles published from 2008 to 2019. Among the risk factors identified, the following stand out: nutritional status, advanced age, incontinence and immobility; the interdisciplinary preventive interventions identified were: decubitus change, nutritional assessment and monitoring, skin care and use of support surfaces. Conclusion: further studies are needed to take a careful and assertive look at cancer patients.

Use of Air-Fluidized or Fluid Immersion Redistribution Support Surfaces for the Treatment of Stage 4 Pressure Injuries: A Case Series

Healing of severe pressure injuries (PIs) in patients with multiple comorbidities requires a multifaceted and interdisciplinary approach and includes the use of support surfaces. Published clinical data guiding support surface selection are very limited. Long-term acute care hospitals frequently treat medically complex patients, many with severe PIs. To compare healing rates in patients with severe PIs on air-fluidized therapy (AFT) or fluid immersion system (FIS) support surfaces. After obtaining informed consent, patients with a stage 3 or 4 PI were randomized to receive either AFT or FIS in addition to the standard protocol of care. Baseline and weekly wound measurements were obatined using a 3-dimensional camera measurement tool. The required sample size was calculated to be 60. After the study had started, the long-term acute care hospital admission criteria changed, severely limiting the number of patients who met the study inclusion criteria. Only 4 patients with a stage 4 PI completed the study. Of those, 2 were on an AFT and 2 were on an FIS surface. All wounds reduced in size; 0.12 and 0.57 cm²/day for patients on AFT and 0.68 and 1.34 cm²/day for patients on FIS. All but 1 wound had a reduction in wound volume ranging from -0.2 and 0.97 cm³ to 1.78 and 4.18 cm³/day for patients on AFT and FIS, respectively. Obtaining much-needed evidence to guide support surface selections for patients with severe PIs is challenging and requires multicenter studies.

Why is the use of support surfaces not more evidence based? - Draft paper or article for publication

• This article explores some reasons for the dearth of evidence for therapeutic support surfaces in relation to pressure ulcer (PU) prevention and provides some insight into why more support surfaces are in use and highlights newer evidenced based technology now being adopted in the NHS and elsewhere. • The ‘Pressure 2’ study (2019) identified some difficulties with producing evidence for the use of support surfaces including defining the primary purpose for their use, product selection, and intervention and raised concerns that the burden posed by the need for clinical studies to prove preference of one surface against another in preventing pressure ulcers may delay or terminate innovation in this key area, at least in England. • Product identification and selection and important determinates: The NICE Guidance (cg179) and EPUAP/NPIAP/PPPIA Pressure Ulcer Guidance insistence upon using the term ‘High Specification Foam Mattresses’ is to perpetuate the myth that there is a material that is High Specification Foam. • Manufacturers are reluctant to sponsor research because of the difficulty of obtaining evidence that meets MDR requirements and the historical slow adoption of innovation in the NHS. Indeed it appears that NICE are sceptical of ‘evidence funded by industry’.

Design and development of an embedded sensors matrix for pressure mapping and monitoring applications

Despite improvements in medical industry and the consequent healthcare modernization, pressure ulcers prevalence remains high, particularly in hospitalized patients. This kind of skin injury affects the patients’ quality of life and their caregivers, being an important cause of morbidity and, in some cases, contribute to the increase of the mortality rate. The use of support surfaces is an important consideration in pressure redistribution and consequent prevention, although its can never remove all of the body's pressure, which is one of the factors with the greatest impact on the development of pressure ulcers. This work aims to demonstrate a new concept of pressure sensing/monitoring system, from which the caregiver will have the perception of the body parts exposed to excessive pressure. This system consists of a resistive sensor array made from Force Sensing Resistors (FSR) embedded in a textile substrate. The developed system is a demonstrator that can be used as support for the construction of a more robust pressure mapping system, able to measure pressure distribution of a lying person. In addition, this system can also be used for the creation of an actuation system, which responds to pressure relief needs based on the sensing system feedback.

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.

Support surfaces for the treatment and prevention of pressure ulcers: a systematic literature review.

Changes in technology have resulted in a lack of clarity regarding the comparative effectiveness between active and reactive support surfaces in the prevention and treatment of pressure ulcers (PUs). The purpose of this literature review was to evaluate the comparative effectiveness of active and reactive mattresses for prevention and treatment of PUs. A literature search was completed using CINAHL, Medline Plus, Scopus, Cochrane Library and PubMed databases, as well as reference lists. A temporal limiter was placed excluding studies published before 2000 due to changes in care standards and support surface technology. Of the 33 articles included, nine were systematic/literature reviews and 24 were randomised controlled trials (RCTs). There was a consensus that pressure mattresses are an effective prevention and treatment strategy, however comparisons of the two types were often inconclusive or conflicting. Studies were conducted in acute, sub-acute or residential facilities, with no studies in a domiciliary setting. The majority of studies were rated as moderate quality with significant methodological limitations. Further research is needed to investigate the use of support surfaces in a domiciliary setting with an appropriate methodology aimed at minimising the limitations described in the existing literature.

Support surfaces in the prevention of pressure ulcers in surgical patients: An integrative review

To assess the scientific evidence about the types of support surfaces used in intraoperative surgical practice in the prevention of pressure ulcers due to surgical positioning. This is an integrative literature review. The electronic databases Cochrane, PubMed, Web of Science, Scopus, Lilacs, and CINAHL were used. The descriptors surgical patients, support surfaces, perioperative care, patient positioning, and pressure ulcer were used in the search strategy. Articles that addressed the use of support surfaces intraoperatively, published between 1990 and 2016, were selected. The PRISMA guidelines were used to structure the review. Of 18 evaluated studies, most were in English, followed by Portuguese and Spanish; most were performed by nurses. The most commonly cited support surfaces were viscoelastic polymer, micropulse mattresses, gel based mattresses, and foam devices. There are gaps in knowledge regarding the most efficient support surfaces and the specifications of the products used to prevent pressure ulcers due to surgical positioning.

Wound Healing Society 2015 update on guidelines for pressure ulcers.

Wound Healing Society 2015 update on guidelines for pressure ulcers.

Identifying the right surface for the right patient at the right time: generation and content validation of an algorithm for support surface selection.

Support surfaces are an integral component of pressure ulcer prevention and treatment, but there is insufficient evidence to guide clinical decision making in this area. In an effort to provide clinical guidance for selecting support surfaces based on individual patient needs, the Wound, Ostomy and Continence Nurses Society (WOCN®) set out to develop an evidence- and consensus-based algorithm. A Task Force of clinical experts was identified who: 1) reviewed the literature and identified evidence for support surface use in the prevention and treatment of pressure ulcers; 2) developed supporting statements for essential components for the algorithm, 3) developed a draft algorithm for support surface selection; and 4) determined its face validity. A consensus panel of 20 key opinion leaders was then convened that: 1.) reviewed the draft algorithm and supporting statements, 2.) reached consensus on statements lacking robust supporting evidence, 3.) modified the draft algorithm and evaluated its content validity. The Content Validity Index (CVI) for the algorithm was strong (0.95 out of 1.0) with an overall mean score of 3.72 (out of 1 to 4), suggesting that the steps were appropriate to the purpose of the algorithm. To our knowledge, this is the first evidence and consensus based algorithm for support surface selection that has undergone content validation.

What is the best support surface in prevention and treatment, as of 2012, for a patient at risk and/or suffering from pressure ulcer sore? Developing French guidelines for clinical practice

The use of support surfaces in the prevention and treatment of pressure ulcers prevention is an important part of care for a patient at risk and/or suffering from sore(s). Define which support surfaces to use in prevention and treatment of at-risk and/or pressure sore patients. A systematic review of the literature querying the several Pascal Biomed, PubMed and Cochrane Library databases from 2000 through 2010. RESULTS (GRADE A): In prevention, a structured foam mattress is more efficient than a standard hospital mattress. An alternating pressure mattress is more effective than a visco-elastic mattress limiting the occurrence heel pressure ulcers, but those that do occur are more serious. A low-air-loss bed is more efficient than a mixed pulsating air mattress in prevention of heel pressure ulcers. Some types of sheepskin can reduce sacral pressure ulcer incidence in orthopedic patients. Use of an overlay on an operating table limits the occurrence of peroperative and postoperative pressure ulcers. An air-fluidized bed improves pressure ulcer healing. The data in the literature are not always relevant and do not suffice to dictate a clinician's choices. We are compelled to recognize the methodological limitations of many studies, the lack of corporate interest in conducting such studies and the relatively small number of available trials. However, the effectiveness of some support surfaces reaches a sufficient level of evidence, especially when they are associated with postural, hydration and nutritional measures. Support surfaces are recommended in prevention and treatment of patients at risk and/or already suffering from pressure ulcer, and their use should constitute part of an overall preventive or curative strategy.

Pressure-redistributing support surface use and pressure ulcer incidence in elderly hip fracture patients.

To evaluate the association between pressure-redistributing support surface (PRSS) use and incident pressure ulcers in older adults with hip fracture. Secondary analysis of data from prospective cohort with assessments performed as soon as possible after hospital admission and on alternating days for 21 days. Nine hospitals in the Baltimore Hip Studies network and 105 postacute facilities to which participants were discharged. Six hundred fifty-eight people aged 65 and older who underwent surgery for hip fracture. Full-body examination for pressure ulcers; bedbound status; and PRSS use, recorded as none, powered (alternating pressure mattresses, low-air-loss mattresses, and alternating pressure overlays), or nonpowered (high-density foam, static air, or gel-filled mattresses or pressure-redistributing overlays except for alternating pressure overlays). Incident pressure ulcers (IPUs), Stage 2 or higher, were observed at 4.2% (195/4,638) of visits after no PRSS use, 4.5% (28/623) of visits after powered PRSS use, and 3.6% (54/1,496) of visits after nonpowered PRSS use. The rate of IPU per person-day of follow-up did not differ significantly between participants using powered PRSSs and those not using PRSSs. The rate also did not differ significantly between participants using nonpowered PRSSs and those not using PRSSs, except in the subset of bedbound participants (incidence rate ratio=0.3, 95% confidence interval=0.1-0.7). PRSS use was not associated with a lower IPU rate. Clinical guidelines may need revision for the limited effect of PRSS use, and it may be appropriate to target PRSS use to bedbound patients at risk of pressure ulcers.

Development and validity of a new model for assessing pressure redistribution properties of support surfaces

Pressure ulcers are a common problem, especially in older patients. In Japan, most institutionalized older people are malnourished and show extreme bony prominence (EBP). EBP is a significant factor in the development of pressure ulcers due to increased interface pressure concentrated at the skin surface over the EBP. The use of support surfaces is recommended for the prophylaxis of pressure ulcers. However, the present equivocal criteria for evaluating the pressure redistribution of support surfaces are inadequate. Since pressure redistribution is influenced by physique and posture, evaluations using human subjects are limited. For this reason, models that can substitute for humans are necessary. We developed a new EBP model based on the anthropometric measurements, including pelvic inclination, of 100 bedridden elderly people. A comparison between the pressure distribution charts of our model and bedridden elderly subjects demonstrated that maximum contact pressure values, buttock contact pressure values, and bone prominence rates corresponded closely. This indicates that the model provides a good approximation of the features of elderly people with EBP. We subsequently examined the validity of the model through quantitative assessment of pressure redistribution functions consisting of immersion, envelopment, and contact area change. The model was able to detect differences in the hardness of urethane foam, differences in the internal pressure of an air mattress, and sequential changes during the pressure switching mode. These results demonstrate the validity of our new buttock model in evaluating pressure redistribution for a variety of surfaces.

Reducing Pressure Ulcer Incidence through Braden Scale Risk Assessment and Support Surface Use

To collect available evidence showing that some hospitals have been able to markedly reduce pressure ulcer incidence despite broad surveys in previous recent years that demonstrated little or no progress and to provide guidance to hospitals through analysis of the evidence showing incidence reduction to be expected by taking the measures indicated. At the time of the article's writing, a review of the literature was conducted using PubMed. References were sought that cited hospitals using the Braden Scale to identify at-risk patients and providing pressure-reducing surfaces to those found to be at risk. Nine hospitals were so identified. Each hospital had reduced pressure ulcer incidence through risk assessment followed by intervention that included support surface provision. Statistical measures were used to establish confidence limits for the noted improvements. Each of the hospitals reviewed had implemented a policy of risk assessment of all admitted patients using the Braden Scale followed by implementation of best practices, generally including assignment of patients judged to be at risk to a pressure-reducing support surface. Each hospital reported in the literature a rate of nosocomial prevalence, both before and after program implementation. All hospitals demonstrated improvement, although the amount of improvement varied widely. Realizing that each of the hospitals reviewed started from different baselines, used different at-risk criteria, did not utilize the same support surface, and may have implemented a variety of additional interventions, it is perhaps not surprising that the 95% confidence interval for incidence odds ratio is broad, from 0.220 to 0.508 (meta-analysis), yet clearly significant. Cost savings due to reduced need for rental of expensive low-air-loss- or fluidized-bed therapy were reported. Risk assessment of all admitted patients followed by provision of specialized support surfaces to all deemed to be at risk offers real hope of reducing the present very high rate of hospital-caused pressure ulcers. With the growing understanding that some pressure ulcers have their origin in deep tissue, it no longer makes sense to wait for the appearance of Stage I or II ulcers before taking action.

Preventing Pressure Ulcers: A Systematic Review

Pressure ulcers are common in a variety of patient settings and are associated with adverse health outcomes and high treatment costs. To systematically review the evidence examining interventions to prevent pressure ulcers. MEDLINE, EMBASE, and CINAHL (from inception through June 2006) and Cochrane databases (through issue 1, 2006) were searched to identify relevant randomized controlled trials (RCTs). UMI Proquest Digital Dissertations, ISI Web of Science, and Cambridge Scientific Abstracts were also searched. All searches used the terms pressure ulcer, pressure sore, decubitus, bedsore, prevention, prophylactic, reduction, randomized, and clinical trials. Bibliographies of identified articles were further reviewed. Fifty-nine RCTs were selected. Interventions assessed in these studies were grouped into 3 categories, ie, those addressing impairments in mobility, nutrition, or skin health. Methodological quality for the RCTs was variable and generally suboptimal. Effective strategies that addressed impaired mobility included the use of support surfaces, mattress overlays on operating tables, and specialized foam and specialized sheepskin overlays. While repositioning is a mainstay in most pressure ulcer prevention protocols, there is insufficient evidence to recommend specific turning regimens for patients with impaired mobility. In patients with nutritional impairments, dietary supplements may be beneficial. The incremental benefit of specific topical agents over simple moisturizers for patients with impaired skin health is unclear. Given current evidence, using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers. Although a number of RCTs have evaluated preventive strategies for pressure ulcers, many of them had important methodological limitations. There is a need for well-designed RCTs that follow standard criteria for reporting nonpharmacological interventions and that provide data on cost-effectiveness for these interventions.