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.     

Preventing pressure ulcers: choosing a mattress

The standard hospital mattress is not suitable for patients at risk of developing pressure ulcers. The type of mattress or overlay system they require will depend on their pressure ulcer risk, medical history and local practice. This article provides a guide to pressure-relieving mattresses.     

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.     

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.     

The QUATTRO ACUTE mattress and pressure ulcer prevention

There are a plethora of mattresses on the market and nurses are not always sure which mattress to select for each individual patient. This article outlines the issues in preventing and understanding pressure ulcers and the performance of the QUATTRO ACUTE trade mark mattress, manufactured by Talley Medical.     

The role of alternating air and Silicore overlays in preventing decubitus ulcers

Patients with chronic neurological diseases who were at high risk of decubitus ulcers were randomly assigned to alternating air on silicore mattress overlays for a period of 3 months. Of 148 subjects who completed the trial, more than 50% in each group developed one or more ulcers. No statistically significant differences between groups were found in the incidence, severity, healing duration or the location of the ulcers; with the exception of a significant difference (p less than 0.001) in the categorical location of the trochanters.     

Associations between back pain,quality of sleep and quality of mattresses. Double-blind pilot study with hotel guests

BACKGROUND: Associations between back pain, the quality of sleep and the quality of mattress have not yet been investigated systematically. METHODS: At check-out we asked 265 consecutive guests of a trade fair hotel about the subjective quality of sleep in the previous night. Nine rooms had been equipped with new mattresses of three different qualities and prices, but this was kept blind to the hotel staff and the guests. Sleep quality was assessed on an analog scale between 1 (very good) and 5 (very bad) and was analyzed in comparison to the remaining 8-year old mattresses of the hotel, but also with respect to social (e.g. private vs. professional reason for the stay) as well as personal (e.g. previous experience with low back and sleep complaints) characteristics of the guests. RESULTS: The three qualities of the mattresses correlated significantly and positively with the perceived quality of sleep, but the difference to the "old" mattresses was most pronounced for those guests who were staying overnight for professional reasons, or who frequently were suffering from low back pain or sleep disturbances. CONCLUSION: At least for chronic sufferers from back pain and sleep problems, the association between sleep quality and quality of the mattress is significant.     

Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients

OBJECTIVE: To describe the short-term and long-term effects of a hospital-wide pressure ulcer prevention and treatment guideline on both the incidence and the time to the onset of pressure ulcers in critically ill patients. DESIGN: Prospective cohort study. SETTING: Adult intensive care department of a university medical center. PATIENTS: Critically ill patients (n = 399). INTERVENTIONS: A guideline for pressure ulcer care was implemented on all intensive care units. The attention of nurses for timely transfer to a specific pressure-reducing device was an important part of this guideline. MEASUREMENTS AND MAIN RESULTS: Patient characteristics, demographics, pressure ulcer risk profile at admission, daily pressure ulcer grading, and type of mattress were determined to describe the short-term and long-term effects 3 and 12 months after the implementation. The incidence density of pressure ulcers grade II-IV decreased from 54 per 1000 patient days at baseline to 32 per 1000 days (p = .001) 12 months after the implementation. The median pressure ulcer-free time increased from 12 days to 19 days (hazard rate ratio, 0.58; p = .02). After adjustment for differences in risk factors in a Cox proportional hazard model, the number of preventive transfers to special mattresses was the strongest indicator for the decreased risk of pressure ulcers (hazard rate ratio, 0.22; p < .001). The number needed to treat to prevent one pressure ulcer during the first 9 days was six. CONCLUSIONS: The implementation of a guideline for pressure ulcer care resulted in a significant and sustained decrease in the development of grade II-IV pressure ulcers in critically ill patients. Timely transfer to a specific mattress (i.e., transfer before the occurrence of a pressure ulcer) was the main indicator for a decrease in pressure ulcer development.     

Efficacy and cost-effectiveness of the Thermo contour mattress

Use of air mattresses in reduction of pressure sore incidence is an important part of quality patient care. However, there will never be enough air mattresses to match the demand as increased education and an increase in the general provision of air mattresses can lead to an unrealistic expectation of obtaining air mattresses when required for patients. This raises the demand for air mattresses and increases costs within hospital trusts. This study examined a way to redress the balance through use of an alternative, cost-effective type of mattress (thermoelastic polymer) in the prevention of pressure sores. Prime consideration was given to the comfort of the patient. The claims of the manufacturers, Barrington Healthcare, that 'patients with Waterlow scores of 23 can be nursed safely on this product' were explored as part of the study. A total of 407 patients took part over a 6-month period. Twenty-four Thermo contour mattresses were loaned to one ward for the study and patients were allocated to the mattress through admission to the experimental ward. Patients were then split into two groups on two wards. Group B were allocated to a Thermo contour mattress and group A were nursed on air mattresses and foam mattresses generally used throughout the trust. Results showed that more patients were comfortable on the Thermo contour mattresses than on all other mattresses. Patients with Waterlow scores under 25 did not develop pressure sores on the Thermo contour mattress. However, the sample of patients with a Waterlow score of between 20 and 25 was small and therefore further research is required.     

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.     

Forensic analysis of crib mattress properties on pediatric CPR quality—Can we balance pressure reduction with CPR effectiveness?

Introduction

Single mode, pressure reduction (PR) crib mattresses are increasingly employed in hospitals to prevent skin injury and infection. However, single mode PR mattresses risk large mattress deflection during CPR chest compressions, potentially leading to inadequate chest compressions.

Hypothesis

New, dual mode PR crib mattress technology provides less mattress deflection during chest compressions (CCs) with similar PR characteristics for prevention of skin injury.

Methods

Epochs of 50 high-quality CCs (target sternum–spine compression depth ≥38 mm) guided by real-time force/deflection sensor (FDS) feedback were delivered to CPR manikin with realistic CC characteristics on two PR crib mattresses for four conditions: (1) single mode + backboard; (2) dual mode + backboard; (3) single mode − no backboard; and (4) dual mode − no backboard. Mattress displacement was measured using surface reference accelerometers. Mattress displacement ≥5 mm was prospectively defined as minimal clinically important difference. PR qualities of both mattresses were assessed by tissue interface pressure mapping.

Results

During simulated high quality CC, single mode had significantly more mattress displacement compared to dual mode (mean difference 16.5 ± 1.4 mm, p < 0.0001) with backboard. This difference was greater when no backboard was used (mean difference 31.7 ± 1.5 mm, p < 0.0001). Both single mode and dual mode met PR industry guidelines (mean surface pressure <50 mmHg).

Conclusions

Chest compressions delivered on dual mode pressure reduction crib mattresses resulted in substantially smaller mattress deflection compared to single mode pressure reduction mattresses. Skin pressure reduction qualities of dual mode pressure reduction crib mattress were maintained. We recommend that backboards continue to be used in order to mitigate mattress deflection during CPR on soft mattresses.     

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.     

Esprit HR mattress cover in pressure ulcer prevention

Modern mattresses provide soft dense foam, which permits the redistribution of pressure on the patient over a wider area - away from bony prominences where pressure ulcers usually occur. The material used in producing multistretch covers for the new mattresses had a tendency to delaminate as a result of a combination of heat, moisture and inappropriate cleansing techniques causing the water barriers to fall. In partnership with York Health NHS Trust and the material manufacturer, STM Healthcare produced a mattress cover (Esprit HR) which was able to withstand higher pressure from heat and moisture and greatly extended the life expectancy of the Esprit HR mattress.     

A Phantom-Based Method to Assess X-Ray Table Mattress Interface Pressures

BackgroundPressure redistribution performance of x-ray table mattresses can influence the development of pressure ulcers in at-risk populations. Interface pressure analysis, with human participants, is a common method to assess mattresses. This approach has limitations that relate to the lack of standardisation between and within humans.AimThis study aimed to develop and validate an anthropomorphic phantom-based method to assess x-ray table mattress interface pressures as an index of mattress performance.MethodsA three dimensional phantom simulating an adult’s head, pelvis, and heels was printed from x-ray computed tomography image data and attached to a metal frame 175 cm in length. Dry sand was added to the phantom head, pelvis, and heels to represent a range of human weights. Pressure distribution was assessed using XSensor. Phantom validation was achieved by comparing phantom mattress interface pressure characteristics, for five human equivalent weights, against 27 sets of human mattress interface pressure data.ResultsUsing the correlation coefficient R, phantom and human pressure data showed good correlation for the five phantom weights (R values: head = 0.993, pelvis = 0.997, and heels = 0.996).ConclusionA novel method to test x-ray mattresses for interface pressure was developed and validated. The method could have utility in the testing of x-ray mattresses that are in routine use and for new mattress development. Phantom interface pressure data could be provided by manufacturers to help inform procurement decisions when matching mattress characteristics to medical imaging demands and the underlying patient populations.     

Reducing pressure ulcer incidence in a long-term setting

Selection of appropriate pressure prevention equipment relies on risk assessment and clinical assessment of the resident/patient. Decisions are then made in combination with manufacturer's recommendations, such as interface pressure testing. However, risk assessments can over-predict and laboratory investigations do not necessarily provide an accurate picture of how individual patients will react to pressures from support services. There are few studies on visco-elastic mattresses and their benefits in reducing pressure ulcer incidence. Therefore, a small study was undertaken to review the efficacy of a pressure-reducing visco-elastic foam mattress. For the benefit of the study, a 20-bedded nursing home was provided with 20 visco-elastic mattresses (Pressurease) and 20 pressure-reducing cushions (Mediform Visco). The study aimed to demonstrate a reduction in pressure ulcer prevalence. The study involved 21 residents over a 6-month period. There was a 58.3% prevalence (of Stirling grade 1-2 pressure damage) at trial initiation. The results showed an 85.7% decrease of pressure ulcers within 4 weeks, and an overall decrease of 82.5% over the 6-month period. Comfort levels, scored by residents on a visual analogue scale, demonstrated the Pressurease mattress to be superior to the nursing home standard mattress.     

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.     

Respiratory effects of spinal immobillzatlon

Objective. To evaluate the effect of whole-body spinal immobilization on respiration. Methods. This was a randomized, crossover laboratory study with 39 human volunteer subjects (20 males; 19 females) ranging in age from 7 to 85 years. Respiratory function was measured three times: at baseline (seated or lying), immobilized with a Philadelphia collar on a hard wooden backboard, and on a Scandinavian vacuum mattress with a vacuum collar. The comfort levels of each of the two methods were assessed on a forced Likert scale. Results. Both immobilization methods restricted respiration, 15% on the average. The effects were similar under the two immobilization conditions, although the FEV, was lower on the vacuum mattress. Respiratory restriction was more pronounced at the extremes of age. The vacuum mattress was significantly more comfortable. Conclusion. This study confirmed the previously reported respiratory restriction caused by spinal immobilization. Vacuum mattresses are more comfortable than wooden backboards.     

Introducing the pressure support surfaces from Kaymed

The range of support surfaces available is quite varied. It is important that both the purchaser and the users are satisfied with the quality, comfort and the pressure-reducing properties of the mattress. The mattress needs to be versatile, in that it can be used both in a patient's home or in a hospital or nursing home and also on profiling beds. The Kaymed range of mattresses offers increased comfort with low interface pressures for patients up to and including high risk. This product focus examines the Kaymed mattress and looks at the design and results of tests performed on the visco-elastic foam used in the manufacturing of the mattresses.     

Pressure ulcer prevention and treatment. A synopsis of the current evidence from research.

Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure ulcers in people at risk. The relative merits of AP and CLP devices and of the different AP devices for pressure ulcer prevention are unclear. There is some evidence from one study to suggest that LAL beds may reduce the incidence of pressure ulcers compared with standard intensive care beds. There is insufficient evidence to make conclusions on the value of various CLP devices and sheepskins as pressure ulcer prevention strategies, although Australian Medical Sheepskin was an effective preventive strategy in a recent study. There is evidence from two trials that air-fluidized therapy may improve pressure ulcer healing rates. There is insufficient evidence to make conclusions on the value of other beds and mattresses as pressure ulcer treatments. There is insufficient evidence to recommend any particular wound dressing or debridement technique. Research about pressure ulcer prevention and treatment is generally conducted on a small scale and is of poor quality; few economic evaluations have been undertaken of pressure area care strategies. Only when a clinically relevant research agenda has been developed and appropriate research methods have been used in sufficiently large studies can evidence-based pressure ulcer prevention and treatment be a possibility. Until then, nurses and other health care professionals can only rely on what little research evidence exists together with their professional judgment to make decisions in this field.     

The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers

BACKGROUND: Turning is considered to be an effective way of preventing pressure ulcers, however almost no research has been undertaken on this method. AIM: The aim of the study was to investigate the effect of four different preventative regimes involving either frequent turning (2, 3 hourly) or the use of a pressure-reducing mattress in combination with less frequent turning (4, 6 hourly). SUBJECTS: 838 geriatric nursing home patients participated in the study. METHODS: During 28 days, four different turning schemes were used: turning every 2 h on a standard institutional (SI) mattress (n = 65), turning every 3 h on a SI mattress (n = 65), turning every 4 h on a viscoelastic foam (VE) mattress (n = 67), and turning every 6h on a VE mattress (n = 65). The remaining patients (n = 576) received standard preventive care. MAIN RESULTS: The incidence of non-blanchable erythema (34.8-38.1%) was not different between the groups. The incidence of grade II and higher pressure ulcers in the 4h interval group was 3.0%, compared with incidence figures in the other groups varying between 14.3% and 24.1%. CONCLUSIONS: Turning every 4 h on a VE mattress resulted in a significant reduction in the number of pressure ulcer lesions and makes turning a feasible preventive method in terms of effort and cost.