Clinical evaluation of an electronic pressure-relieving mattress

A 12-month clinical evaluation of the Talley Quattro Deep Cell 2000 mattress manufactured by Talley Medical was undertaken on both a trauma and surgical ward at the Royal Devon and Exeter Hospital. An identified registered nurse coordinated the evaluation with support from tissue viability clinical nurse specialists. Data on patients, including diagnosis, Waterlow score, pressure area condition and general comments by nurses and patients, were collected. The evaluation involved 35 patients who were at high- to very-high risk of pressure sore formation. The results showed that 16 out of 40 sores healed during the evaluation period and 16 sores remained unchanged. Only one patient developed broken skin while nursed on the mattress. Seventeen patients maintained tissue integrity. Although the study was limited the results suggest that the Talley Quattro Deep Cell 2000 mattress is useful in preventing and managing pressure sores in high- to very high-risk patients.     

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.     

Evaluation of patient outcomes: pressure ulcer prevention mattresses

This article reports the findings of a small evaluation audit which compares the Dyna-Form Mercury Advance Mattress to that of the Softform Premier Active Mattress (a foam mattress with dynamic underlay). A small group of patients with similar co-morbidities who were an emergency admission were recruited to an evaluation audit. Their median age and Waterlow score indicated that these patients were at high risk of pressure ulcer development. All patients were given the same nursing care on the two mattresses and all were moved, handled and repositioned 2-4 hourly. Of the patients nursed on the Dyna-Form Mercury Advance mattress, three did not develop pressure ulcers. The two who already had pressure ulcers when they were recruited appeared to have healed within four days. Of the patients nursed on the Softform Premier Active mattress, three patients did not develop ulcers and two did. Although the sample size was small, the comprehensive assessment gave interesting results, particularly on the Dyna-Form Mercury Advance. A larger study may be of benefit to demonstrate efficacy of these products further.     

A review of the Medical Agency Services Confor-Med range

Medical Agency Services Ltd (MAS) has, since 1994, been involved in the design and development of mattresses and overlays manufactured from visco-elastic polymer foam, which is currently utilized in the manufacture of domestic, automative and specialist bedding and seating products. The foam is fire retardant and satisfies the BS 5852 (Part 2) ignition source 5. The foam is a heat and weight sensitive, visco-elastic polymer, giving a high performance, pressure redistributing surface that 'moulds' to the patient giving simultaneous muscular/skeletal support and allowing the patient to feel comfortable. The Confor-Med mattress offers a sensible alternative for patients with high Waterlow scores who have no pressure sores, but require early intervention to prevent pressure sores developing. A case study is included in this review of the products.     

MEASUREMENTS OF INTERFACE PRESSURE BETWEEN BODY SITES AND THE SURFACES OF FOUR SPECIALISED AIR MATTRESSES

SUMMARY Four specialised air mattresses had interface pressure measured under six body sites prone to pressure sores in 10 subjects, supine and sitting. The mattresses were the Clinirest (SSI) and FirstStep (KCI) continuous airflow mattress overlays, and Airwave (Pegasus) and Nimbus (Huntleigh) alternating pressure air mattresses. On the mattress overlays, average supine interface pressures were 2.33 kPa (scapula), 4.15 kPa (elbow), 1.94 kPa (sacrum) and 2.79 kPa (buttock), although they were higher at the occiput (7.97 kPa) and heel (11.7 kPa). The alternating pressure air mattresses had an average minimum interface pressure close to zero for three sites, rising to 4.28 kPa under the heel. Average maximum interface pressures were 8.61 kPa (occiput), 5.21 kPa (scapula), 4.90 (elbow), 4.85 kPa (sacrum), 4.61 kPa (buttock) and 13.2 kPa (heel). No accepted scientific method exists for comparing the two types of mattress. Our data suggest a clinical benefit at the occiput and heel (supine) in using an alternating pressure air mattress and a benefit in using a continuous airflow mattress overlay at other sites.     

An investigation into the use of serum albumin in pressure sore prediction

OBJECTIVES: To ascertain the relevance of serum albumin and serum sodium as predictors of pressure sores in addition to the Waterlow score. DESIGN: Observational study of patients at risk of developing decubitus ulcers. SETTING: Staffordshire, in the midlands of the United Kingdom. PARTICIPANTS: 773 elderly hospital in-patients of a district general hospital. MEASUREMENTS: Waterlow scores and serum albumin and sodium. Development of a pressure sore. RESULTS: Logistic regression analysis of serum albumin, serum sodium and the Waterlow score showed the Waterlow score and serum albumin were significant predictors of pressure sores. CONCLUSIONS: Serum albumin may, in this patient group (in-patients over 64 years of age), be a useful predictor of pressure sore occurrence, though further work is needed to establish whether this is the case. Risk assessment of pressure sores can possibly be improved by adding serum albumin to one of the pre-existing tools such as the Waterlow score.     

POTENTIAL FOR BED SORES DUE TO HIGH PRESSURES : INFLUENCE OF BODY SITES,BODY POSITION,AND MATTRESS DESIGN

SUMMARY Pressures were measured on 10 subjects, supine and sitting, under six anatomical sites prone to bed sores on three different mattresses. Studied were the Clinifloat and Therarest specialist replacement mattresses, and a standard hospital mattress. Mean supine pressures were less than 5 kPa under four sites. Average supine buttock pressure was 2.93 kPa. Occiput and heel pressures were much higher than under other sites, being on average 2.6 and 4.5 times greater respectively than the mean buttock pressure. On sitting up, buttock pressure increased by a factor of 1.7 on average, to a level higher than the accepted capillary closing pressure. Measurements were consistent with mattress design, specific features of which can significantly affect pressure under certain sites.     

A clinical evaluation of the Transfoam mattress after 4 years

It is recognized that pressure-reducing foam mattresses can be of benefit in the prevention of pressure sores but it is also recognized that more information is required to demonstrate their long-term efficacy (Cullum et al, 1995). It is therefore necessary to evaluate the pressure-reducing capabilities of this type of mattress some years after purchase to evaluate if in fact it can maintain its initial level of performance. This article presents the results of one such study carried out 4 years after the purchase of Transfoam mattresses.     

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.     

Pressure sores in intensive care: defining their incidence and associated factors and assessing the utility of two pressure sore risk assessment tools.

Patients in intensive care units (ICU) are at high risk of developing pressure sores and the use of pressure sore risk tools has been advocated as a means of identifying patients at risk. A prospective multi-site observational study was conducted to define the incidence of pressure sores, assess two pressure sore risk scales and to define risk factors relevant to intensive care. Patients (n = 534) were assessed for the presence of pressure sores. The Waterlow and Jackson/Cubbin risk scales were completed each day for 314 and 188 of these patients respectively. A total of 75 pressure sores were recorded. Of these, 34 were present on admission. Of the remaining 41, 16 were classified as Grade 1 and 24 as Grade 2 sores. The pressure sore (PS) incidence was 5.2 per cent. Expressed as PS/1000 patient days there were 18.48 pressure sores per 1000 patient days. The ability of the risk scores to predict pressure sores was tested using a Receiver Operating Characteristic (ROC) analysis. The association of risk score with pressure sores was analysed using a survival function (Kaplan Meier) and variables compared using a logrank test (Mantel-Cox). Factors associated with pressure sore occurrence were developed and tested using a survival regression model. Both risk scales were poor predictors of pressure sores (ROC curve area approximately 70 per cent for both). The factors, coma/unresponsiveness/paralysed & sedated and cardiovascular instability were significantly associated with pressure sores with relative risks of 4.2 and 2.5 respectively. Risk increased as a function of time such that the cumulative risk was 50 per cent at 20 days.     

The clinical relevance of the waterlow pressure sore risk scale in the ICU

Objective: To evaluate whether the Waterlow pressure sore risk (PSR) scale has prognostic significance for intensive care patients. Design: A prospective study. Setting: The surgical intensive care unit (ICU) of the University Hospital Rotterdam. Patients: Data were evaluated from 594 patients who had been admitted to the ICU during the year 1994. Methods and results: Each patient was assessed daily with respect to their Waterlow PSR score and the development of pressure sores in the sacral region. Actuarial statistical methods were used to analyse the predictive value of the risk score. When a patient had a Waterlow PSR score > 25 on admission, the risk of developing a pressure sore was significantly increased compared to patients with a PSR score < 25. After admission, the daily Waterlow PSR scores obtained were significantly associated with the risk of developing a pressure sore. For each additional point this risk increased by 23 % (95 % confidence interval 17 to 28 %). Conclusions: The Waterlow PSR scale provides the medical and nursing staff at an early stage with reliable information about the risk patients have in developing a pressure sore. Received: 8 August 1997 Accepted: 24 April 1998     

Randomized comparison trial of the RIK and the Nimbus 3 mattresses

A randomized comparison trial was carried out at Queen's Hospital, Burton-on-Trent, to compare patient outcomes on the RIK mattress (KCI) and the Nimbus 3 mattress (Huntleigh Healthcare). One hundred and fifty-eight patients, who were assessed to be at particular risk of development of pressure ulcers using the Waterlow score (85 on RIK mattress, 83 on Nimbus), completed the trial. There were no statistically significant differences in baseline parameters at recruitment or pressure ulcer progress. Lack of difference can be as useful as evidence of superiority. Other factors such as nursing interventions required accessible equipment, and costs are important when making equipment choices. For a significant proportion of patients, a static (RIK) mattress can be as effective as an active (Nimbus 3) mattress for management of pressure ulcers.     

The surveillance system of decubital lesions of the University Polyclinic in Udine: results of an incidence study

A retrospective study of the incidence of pressure sores was one of the principal component of the ad hoc program of surveillance, prevention and treatment of pressure sores started in 1996 at University Hospital of Udine. Data were collected from the nursing records of patients defined at risk according to the Waterlow scale and admitted during 1998-99. Aims of the study were to quantify the number of patients who developed a pressure sore while in hospital and their risk level; stage of the lesions; to qualify the main risk factors and the management strategies adopted (i.e. mattresses, medications). Overall, 151 subjects (20.7% of those recruited) developed a pressure sore the greatest majority (96%) were classified as transient and reactive redness or superficial sore, while 14 patients (4%) developed a severe sore. For 50.4% of the lesions a regression to a lower risk level or healing were documented.     

Special mattresses: effectiveness in preventing decubitus ulcers in chronic neurologic patients

Thirty-two chronic neurologic patients between 19 and 60 years of age were randomly assigned, for a period of three months, to either an alternating air mattress or a silicore mattress to test the preventive qualities of special mattresses in the occurrence of decubitus ulcers. The two groups were comparable on the variables of age, weight, diagnoses, history of disease process, history of being wheelchair bound, history of previous pressures, and mean scores on Norton's scale of risk, which is based on the subject's physical condition, mental alertness, ambulation, mobility and incontinence. No significant differences were observed in the preventive qualities of the two types of special mattresses in terms of the incidence, location, severity, or healing duration of the subjects' decubitus ulcers. Improved studies of common special mattresses are suggested.     

Preventing pressure ulcers: an evaluation of four operating-table mattresses.

Pressure is a major factor in the development of pressure ulcers. This research focused on assessing the pressure-reducing effects of operating-table mattresses. Five mattresses were tested: a standard operating-table mattress, a foam mattress, a gel mattress, a visco-elastic polyether mattress, and a visco-elastic polyurethane mattress. Four intraoperative postures were evaluated: supine, lateral, fossa, and the Miles-Pauchet position. Interface pressure measurements were performed on 36 healthy volunteers. The foam mattress and the gel mattress seem to have little or no pressure-reducing effect; the polyurethane mattress and the polyether mattress reduce interface pressure significantly better (p < .001); but none of the mattresses reduce pressure sufficiently to prevent the occurrence of pressure ulcers.     

Monitoring the pressure sore problem in a teaching hospital

During 1989 and 1990 a senes of three prevalence surveys were undertaken in a West Midlands teaching hospital to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure relieving equipment A further survey was undertaken in January 1993 to examine any improvement in pressure sore prevention strategies and in the care of those with established pressure sores All in-patients were assessed using the Waterlow score Full details of all pressure sores and any pressure relieving equipment in use was recorded The findings were compared with those of the first survey in 1989 The prevalence for 1989 was 8 77%, and this had reduced slightly to 7 9% in 1993 There was no significant difference in these figures However, in 1989 35 patients had 64 pressure sores and in 1993 32 patients had 46 pressure sores There was a significant reduction in the actual numbers of pressure sores There was no significant difference in the grades of sores and the sacrum was the most frequent position in both surveys The survey showed an improvement in the management of established pressure sores There was little change in the patient populations with respect to the degree of risk of pressure sore development Using the Waterlow score, the numbers of patients found to be in the no risk, at risk, high risk and very high risk categories remained remarkably stable These surveys will continue to provide a basis for selecting pressure relieving equipment Measurement of pressure sore incidence is needed in the future to monitor the efficacy of the prevention programme     

Use of Pressurease and Airform mattresses in pressure ulcer care

Large cell dynamic air mattresses are effective in the prevention of pressure ulcers but they still have inherent problems, e.g. the ability of the mattresses to move patients along the mattress through the inflation and deflation of the cells. Also, there have been reports that the inflation and deflation of cells can cause motion sickness. This article reviews two mattresses from Sareo Healthcare Ltd: a static system, Pressurease; and a unique dynamic system, Airform. These two systems offer a cost-effective and clinically effective method of pressure ulcer prevention and therapy.     

Pressure sore prevalence within a public health services area

Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure‐sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. The most frequently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures. There was no statistical difference in pressure‐sore prevalence when compared with a similar study from 1980. Patients were, however, older in 1995.     

Waterlow计分表在神经内科预防压疮中的应用

目的评价Waterlow计分表对神经内科卧床患者压疮的预测效果。方法应用Waterlow计分表作为评估工具,通过对新入神经内科患者进行评估,根据分值采用不同的预防措施。结果 2014年神经内科压疮高危患者上报率显著增加(P0.01),高危患者院内压疮发生率显著下降(P0.01)。结论 Waterlow计分表应用于神经内科临床预防压疮具有可靠性、有效性。     

ProfiCare: an alternating pressure-relieving mattress

Risk assessment tools should only act as a guide to patient status rather than definitive diagnosis. Emphasis must be placed on not using the Waterlow score in isolation but in conjunction with clinical judgement. We must therefore attempt to minimize opportunities for disagreement over pressure ulcer risk scores through the selection of appropriate support surfaces based on a thorough consideration of costs of pressure ulcers for the patients, institutions and healthcare professionals. This product focus advocates that ProfiCare replacement mattresses are an option as they are designed for use on a hospital bed frame and provide alternating and static patient support surfaces.