Comparison of interface pressures in two dynamic pressure ulcer prevention supports (NIMBUS 3 and SUMMIT): A randomized controlled trial

BackgroundPressure ulcers are a risk for bedridden patients and various supports exist to prevent them. The Pressure Relief Index (PRI) evaluates pressure relief of dynamic mattresses over time. This study compared the PRI of the SUMMIT mattress (AKS-France) and the NIMBUS 3 (HNE Medical).MethodsIn this non-blinded, randomized, crossover, non-inferiority study, patients aged ≥60 with a BMI of 16–35 kg/m2, predominantly confined to bed, able to walk with aid and with pelvic symmetry were recruited from a hospital rehabilitation department from March–April 2012. Exclusion criteria included past or present pressure ulcers, inability to remain supine and deep vein thrombosis. Peak pressures of the sacrum were recorded at 0.1 Hz during a single complete 10-min inflating cycle on both mattresses, with the order determined via electronic randomization allocation.ResultsThirty-one subjects were included and randomized; with 14 finally analyzed in the SUMMIT-NIBMUS 3 order group and 16 in the NIMBUS 3-SUMMIT group. The difference in PRI <30 mmHg between the two mattresses was 13.2% [0.3–26.1] (p < 0.05), allowing a non-inferiority - superiority switch. The SUMMIT mattress demonstrated a significantly higher percentage of time <30 mmHg (p = 0.0454). No significant difference in mean minimal pressure was seen (p = 0.3231) and mean maximal pressure was in favor of SUMMIT mattress (p = 0.0096). BMI did not affect pressure profile. There were no adverse events.ConclusionsEvaluated by the PRI, the SUMMIT mattress had a better interface pressure profile than the NIMBUS 3 in older patients. The PRI is a promising tool for clinical decision-making and research, warranting validation.     

A quantitative study of hydration level of the skin surface and erythema on conventional and microclimate management capable mattresses and hospital beds

BackgroundIn addition to pressure itself, microclimate factors are gaining more attention in the understanding of the development of pressure ulcers. While there are already various products to reduce pressure on sore-prone areas to prevent pressure ulcers, there are only a few mattresses/hospital beds that actively influence skin microclimate. In this study, we investigated if microclimate management capable mattresses/hospital beds can influence skin hydration and skin redness/erythema.MethodsWe included 25 healthy subjects in our study. Measurements were made using Courage & Khazaka Multi Probe Adapter MPA with Corneometer CM825 and Mexameter MX18 to determine skin hydration of the stratum corneum and skin redness/erythema before and after the subjects were lying in conventional (Viskolastic® Plus, Wulff Med Tec GmbH, Fedderingen, Germany and Duo™ 2 mattress, Hill-Rom GmbH Essen, Germany) or microclimate management capable mattresses/hospital beds (ClinActiv + MCM™ and PEARLS AFT, Hill-Rom GmbH Essen, Germany).ResultsWhile there was no difference in skin redness/erythema on the different mattresses/hospital beds, skin hydration of the stratum corneum decreased significantly in an air fluidized bed compared to baseline values and values measured on standard mattress/Viskolastic® Plus.ConclusionAir-fluidized therapy reduces skin hydration and therefore could contribute to prevent moisture associated ulcers. Changes in skin hydration as one important factor of skin microclimate can be detected after a short time of incubation and even before an erythema appears.     

Increasing heel skin perfusion by elevation

OBJECTIVE: To determine the efficacy of elevation in the primary prevention and treatment of pressure ulcers by studying the blood flow in tissue at risk of ulceration. DESIGN: A prospective study was used to compare different preventative devices with an elevating prosthesis. SETTING:: Wollongong Hospital Wollongong, New South Wales, Australia. PARTICIPANTS: Normal subjects and subjects with vasculopathy were tested with their heel resting on a hospital bed, medical-grade lamb's wool, or a viscoelastic gel overlay, with or without the test prosthesis. Skin perfusion was measured throughout using a laser Doppler monitor. INTERVENTION: A device designed to elevate the heel off the bed and distribute the weight of the leg and foot on the calf. MAIN OUTCOME MEASURE: Heel capillary blood perfusion. MAIN RESULTS: Perfusion in the heel was significantly greater when elevated than when using the other devices tested. The differences in mean red blood cell flux were significant, with P < .0001 for bed-normals, ie, subjects with no peripheral vascular disease on an alpha Xcell mattress overlay as the control with flux increasing from 7.6 to 163.1 arbitrary units (AU); P < .005 bed-vasculopathy, ie, subjects with peripheral vascular disease on an alpha Xcell mattress overlay as the control with flux increasing from 31.6 to 224.7 AU; P < .0001 viscoelastic overlay subjects where the viscoelastic overlay was the control with flux increasing from 26.6 to 291.4 AU; and P < .01 lamb's wool subjects where the lamb's wool was the control with flux increasing from 27.7 AU to 169.2 AU. CONCLUSION: In this study, when the heels were elevated, tissue perfusion to that area was substantially increased. When the heel was transferred to the elevating splint, the heel capillary bed underwent reactive hyperemia, indicating the alleviation of tissue hypoxia. Elevation is therefore an important technique in pressure ulcer prevention and treatment and should be incorporated into health care practice.     

Associations between skin structural and functional changes after loading in healthy aged females at sacral and heel skin: A secondary data analysis

Aim of the studyMechanical loading causes skin occlusion and deformation, which influences structural and functional skin properties. Aims of the study were to measure structural and functional skin parameters after loading at the sacral and heel skin and to describe possible associations.Material and methodsA secondary data analysis based on a clinical trial with n = 15 aged women was conducted. Changes of transepidermal water loss, stratum corneum hydration, epidermal hydration, erythema, temperature, structural stiffness, elastic recovery, elastic function, and mean roughness after 120 min loading were described and compared. Spearman's rho (r_s) was used to estimate possible associations.ResultsLoading caused an increase of transepidermal water loss, stratum corneum and epidermal hydration, erythema and temperature at sacral and heel skin. There was a decrease of median roughness at the heel skin surface (-8.5 (IQR -10.5 to 5.5) μm). Strongest positive associations were observed between changes of elastic function and elastic recovery (r_s = 0.9 at heel and sacral skin) and between changes of epidermal and stratum corneum hydration at both skin areas (r_s = 0.7 at sacral skin and r_s = 0.5 at the heel).ConclusionTwo hours loading on a standard foam mattress leads to skin occlusion at the skin surface and mechanical deformation. Skin occlusion seems primarily to increase temperature, stratum corneum and epidermal hydration that may affect mechanical skin properties. Mechanical deformation seems to be responsible for the erythematous response of the dermal skin layer.     

The effect of head of bed elevation on sacral and heel subepidermal moisture in healthy adults: A randomised crossover study

BackgroundSubepidermal moisture (SEM) changes may detect early tissue injury and enhance pressure injury risk assessments. However, little is known how modifiable factors, like head of bed elevation (HOBE), affect SEM.AimThis study investigated the influence of HOBE on sacral and heel SEM, using the Provizio ® SEM Scanner.MethodA 2 × 2 randomised crossover study compared the effects of 30-min of 30? versus 60? HOBE on sacral and heel SEM in healthy adults.Results48 participants were randomly allocated to 30? or 60? HOBE and crossed over after a 60-min washout period. The mean age was 40.6 years (SD = 18.3). The study found the sacral and heel SEM values were not statistically different at 30? versus 60? HOBE. No clinically relevant association between SEM and characteristics of age, sex, body mass index and skin type were found. Baseline sacral and heel SEM values recovered after a 60-min washout period. Notably, half of the initial baseline measures suggested pressure injury risk.ConclusionThe HOBE may not influence SEM at the sacrum and heels, in healthy adults after 30 min of loading. Standard operating procedures for measuring SEM for pressure injury risk assessment require a stronger body of evidence in varied populations and timeframes before this technology is widely adopted.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12622001456741.     

Effects of cycle periods and pressure amplitudes of alternating pressure on sacral skin blood flow responses

BackgroundThere are no guidelines on selecting alternating pressure (AP) configurations on increasing sacral skin blood flow (SBF).AimThe specific aims were to compare different cycle periods and pressure amplitudes of AP on sacral SBF responses in healthy people to establish the efficacy and safety of the protocols.MethodsTwo studies were tested, including the cycle period study (8 2.5-min vs 4 5-min protocols) and the pressure amplitude study (75/5 vs 65/15 mmHg protocols). Sacral SBF was measured using laser Doppler flowmetry (LDF) in 20 participants. AP loads were randomly applied using an indenter through the rigid LDF probe. Each protocol included a 10-min baseline, 20-min AP and 10-min recovery periods. A 30-min washout period was provided. The SBF response was normalized to the baseline SBF of each condition of each participant.ResultsFor the cycle period study, the 4 5-min cycle protocol partially restored more SBF than the 8 2.5-min cycle protocol at the low-pressure phase (0.87 ± 0.04 vs 0.71 ± 0.03, p < 0.05) and at the high-pressure phase (0.25 ± 0.03 vs 0.19 ± 0.03, p < 0.05). For the pressure amplitude study, the 75/5 mmHg protocol partially restored more sacral SBF than the 65/15 mmHg protocol at the low-pressure phase (0.87 ± 0.1 vs 0.25 ± 0.03, p < 0.05) but not at the high-pressure phase (0.23 ± 0.02 vs 0.21 ± 0.02, non-significant).ConclusionThis study demonstrated that 1) a cycle period of 5 min was better than 2.5 min and 2) a pressure amplitude of 75/5 mmHg was better than 65/15 mmHg. The finding provides insights for selecting the AP configurations for increasing SBF.     

Sacral skin blood flow response to alternating pressure operating room overlay

Pressure injuries resulting from long surgeries may be caused by prolonged ischemia. Operating table surfaces with alternating pressure (AP) features may reduce the risk of ischemia-induced pressure injuries by providing periodic relief of blood flow occlusions. Prior research investigated alternating loading applied with a single isolated rigid indenter and demonstrated increased perfusion. This study quantified effects of an overlay with AP on sacral skin perfusion for individuals lying supine for 60-min while blood flow was monitored. The mean normalized sacral skin blood flow was found to be greater with the AP overlay over an operating table pad compared to the operating pad alone (pad with AP mean SBF?=?1.45?±?1.16, pad without AP mean SBF?=?1.03?±?0.46, p?=?0.10). Peak and average interface pressure at the sacrum was significantly lower during the deflation cycle of the AP surface compared to the operating pad alone (P?<?0.001), suggesting this periodic reduction resulted in higher mean blood flow. Post-hoc regression analysis showed participant body mass index was a significant predictor of the effectiveness of the AP overlay (p?=?0.012). The results suggest risk for pressure injuries due to prolonged ischemia might be mitigated by the addition of an alternating pressure feature on operating table pads for lower BMI patients.     

An instrument for in-service testing of mattresses

It is widely recognised that mattresses have a finite life-span. In particular, hospital mattresses, typically made from polymer foam materials, are known to degrade over a period of years. Fatigue of a mattress in this way leads to a phenomenon known as 'bottoming'. This refers to the yielding of the mattress to such an extent that the occupant comes into close contact with the hard base of the bed: an important condition to avoid as it is thought to represent an aggravated risk factor for pressure ulcers. The authors have developed a portable, easy--to use, interactive device that quickly gives accurate information as to the condition of a mattress in a clinical setting. The device is validated against accelerated fatigue, pressure mapping of bottoming with healthy volunteers, and service life of 150 mattresses. The QUINCE SUPPORT SCORE provides an objective and valid basis for a mattress replacement programme.     

A quantitative study of transepidermal water loss (TEWL) on conventional and microclimate management capable mattresses and hospital beds

BackgroundTransepidermal water loss (TEWL) is regarded as one of the most important parameters characterizing skin barrier integrity and has found to be higher in impaired skin barrier function. Reduced or low TEWL instead indicates skin barrier integrity or improvement. We evaluated if different mattresses/hospital beds can influence this skin barrier function by measuring TEWL before and after subjects lying in conventional and microclimate management capable mattresses/hospital beds.MethodsWe included 25 healthy subjects in our study. Measurements were made using Courage & Khazaka Multi Probe Adapter MPA with Tewameter TM300 to determine TEWL before and after the subjects were lying in conventional (Viskolastic® Plus, Wulff Med Tec GmbH, Fedderingen, Germany and Duo? 2 mattress, Hill-Rom GmbH Essen, Germany) or microclimate management capable mattresses/hospital beds (ClinActiv + MCM? and PEARLS AFT, Hill-Rom GmbH Essen, Germany).ResultsWhile there was no statistically significant difference in standard mattresses/hospital beds (22.19 ± 12.99 and 19.80 ± 11.48 g/hm²), the decrease of TEWL was statistically significant in both microclimate management capable mattresses/hospital beds we investigated (16.89 ± 8.586 g/hm² and 17.41 ± 7.203 g/hm²) compared to baseline values (35.85 ± 24.51 g/hm²).ConclusionAs higher TEWL announces impaired skin barrier function these findings indicate that the choice of the mattress/hospital bed is important for skin barrier function and microclimate management systems improve skin barrier function of the skin.     

Pressure distribution and flow characteristics during negative pressure wound therapy

Aim of the studyNegative pressure wound therapy is thought to improve wound healing by altering capillary perfusion. However, despite many theories, the underlying mechanism of action remains controversial. Recent evidence suggests an increased tissue pressure and a temporary decreased microvascular blood flow as the main reasons for the good clinical results [1]. In an attempt to further explain the mechanism of action, we investigated the pressure distribution on the foam interface, and the influence on perfusion in a pre-experimental design.Materials and methodsPressure distribution was measured using a sensor based on a capacitive dielectric elastomer with flexible electrodes. In vitro flow measurements were done with vessel imitations in a block of 300 bloom ballistic gel to simulate soft tissue.ResultsA peak pressure of up to 187 mmHg (255 g/cm2) within the foam interface, as well as decreased perfusion, were found using a standard negative pressure wound therapy setup. In conclusion, negative pressure wound therapy applies positive pressure to adjacent tissue and decreases local flow. The amount of suction applied is proportional to the pressure on the foam interface and reduction in flow.ConclusionIn line with previous studies investigating the underlying mechanism of action, these findings may contribute to possible alterations in the use of negative pressure wound therapy, e.g. lowering suction pressure in patients with diminished peripheral blood flow.     

Evaluation of pressure ulcer risk and development in operating rooms

AimThis study aimed to determine the risk and development of pressure ulcers in operating rooms.Materials and methodsThe sample of the study included a total of 250 patients. In the study, the risk of pressure ulcers was assessed before the operation, and the development of pressure ulcers was evaluated within 24 h after the operation.ResultsThe risk of pressure ulcers was low before the operation, and Stage I pressure ulcer developed in 12.8% of the patients within 24 h after the operation. The patients had pressure ulcers mostly in their sacrum. Their mean 3S Intraoperative Risk Assessment Scale of Pressure Sore score was 15.68 ± 4.84, suggesting that they were not at risk of developing pressure ulcers. Having a chronic disease (OR = 8.986; 95% CI = 3.697–21.845), undergoing general anesthesia (OR = 3.084; 95% CI = 1.323–7.194), and orthopedic surgery (OR = 10.172; 95% CI = 3.121–33.155) were statistically significant risk factors for pressure ulcers (p < 0.001). Additionally, moderately edematous skin (OR = 3.838; 95% CI = 1.024–14.386), overweight/underweight (OR = 16.333; 95% CI = 3.779–70.602), intraoperative bleeding greater than 800 ml (OR = 13.000; 95% CI = 3.451–48.969), operation time longer than 5 h (OR = 21.667; 95% CI = 2.122–221.223), moderate intraoperative stress (OR = 4.917; 95% CI = 0.425–56.916), body temperature higher than 38.3 °C or lower than 36.1 °C (OR = 5.462; 95% CI = 2.161–13.805), and intraoperative prone position (OR = 3.354; 95% CI = 1.386–8.115) were statistically significant risk factors for the development of pressure ulcers.ConclusionAccording to our preoperative pressure ulcer risk assessment, it is very important to take additional protective measures both during and after surgical operations to prevent pressure ulcers.     

The mechanism of persistent undermining of a sacral pressure ulcer: Experimental analyses using a deformable model and examination of skin mobility over different anatomical locations

Undermining is an important issue in the treatment and care of deep pressure ulcers. The frequency of the undermining over different bony prominences varies. In particular, deep pressure ulcers over the sacrum exhibit undermining more frequently than those occurring over the heel. Although shear force has been suggested as a critical factor in undermining, the exact mechanism remains unclear due to ethical and technical reasons in clinical practice. To clarify this issue, a deformable model was constructed to recreate the physical and morphological properties of a pressure ulcer with persistent undermining. The model was constructed using urethane to recreate the physical properties of a pressure ulcer. To examine the clinical relevance of the model, mechanical properties of the skin and the model were measured using a durometer. The model was further mounted onto a phantom that was laid on a bed. Backrest elevation of the bed induced deformities in the urethane model, suggesting a mechanism of persistent undermining of the sacral pressure ulcer. Moreover, a simple palpation examination in elderly volunteers revealed that the skin over the sacrum was more mobile than the skin over the heel. Therefore, persistent undermining is likely caused by specific external forces and the characteristic skin mobility of the sacral region. These two different factors explain the frequent undermining that occurs in sacral pressure ulcers.     

Pressure relief, cold foam or static air? A single center, prospective, controlled randomized clinical trial in a Dutch nursing home

Objective

At present, the evidence regarding the type of mattress that is the best for preventing pressure ulcers is not convincing. In a single center, prospective, controlled trial we compared a static air overlay mattress (no electric pump needed) on top of a cold foam mattress with a cold foam mattress alone on pressure ulcer incidence in nursing home residents.

Methods

83 Patients were included in the study with a score lower than 12 points on the Norton scale and no pressure ulcer at the start of the study. 42 Patients received a cold foam mattress and 41 patients received a static air overlay on top of that cold foam mattress. Out of bed we standardized the pressure reduction in sitting position by using a static air cushion in both groups. Patients were checked weekly in both groups for pressure ulcers.Only when there were signs of developing a pressure ulcer grade 2 or higher, repositioning by our nursing home pressure ulcer protocol (PU protocol) was put into practice.

Results

Seven patients (17.1%) on a cold foam mattress and two (4.8%) on a static air mattress developed a pressure ulcer grade 2 or more. There was no difference regarding pressure ulcer incidence between patients with a high risk (Norton 5-8) and patients with a medium risk (Norton 9-12). In 5 out of 7 patients who developed a pressure ulcer on a foam mattress the ulcers showed no healing using our PU protocol. In the static air group all pressure ulcers healed by regular treatment according to our PU protocol.

Conclusions

In this study, static air overlay mattresses provided a better prevention than cold foam mattresses alone (4.8% versus 17.1%). The Norton scores of the patients in both groups did not change during the 6 month trial period. Our decision to use repositioning only when there were signs of a pressure ulcer seems to be acceptable when a static air overlay is in position. However, the score of 17.1% development (incidence) of pressure ulcers in the foam group may stress the need of repositioning when using only this type of mattress.     

Skin temperature and vascular attributes as early warning signs of pressure injury

ObjectivesThis study aimed to validate the skin temperature on sacral region and vascular attributes as early warning signs of pressure injury.MethodsTotally 415 patients admitted to the adult intensive care unit from August 2018 to April 2019 were prospectively screened. Daily blood pressure and blood glucose affecting vascular attributes and the relative skin temperature of sacral region were measured for 10 consecutive days. Collect the changes of these indicators during the occurrence of pressure injury. The optimal cut-off values of indicators were determined by X-tile analysis. The risk ratios of indicators associated with pressure injury were compared using the Cox proportional hazards regression model.ResultsThere were no obvious interactions among blood pressure, blood glucose and relative skin temperature (P > 0.05). The optimal cutoff value for above indicators was 63.5 mmHg, 9.9 mmol/L and −0.1 °C, respectively. The incidence of pressure injury peaked on the 4th and 5th day after hospitalization when categorizing the patients into low- and high-risk groups according to the cutoff values (P < 0.05). Based on relative skin temperature, patients in the high-risk group were more likely to develop pressure injury (hazard ratio = 6.36, 95% confidence interval = 3.91, 10.36), when compared to the other two indicators of blood pressure and blood glucose.ConclusionStringent skin temperature and vascular attributes measurements were necessary for preventing pressure injury. Nursing measures should be taken according to warning sings to reduce the incidence of pressure injury.     

Effect of mattress bedding layer structure on pressure relief performance and subjective lying comfort

Mattresses' pressure relief performance and comfort largely affect sleep quality. Mattress filling materials have been proven to affect the interface pressure distribution and comfort, but the effect of mattress structure is unclear. In this paper, the interface pressure distribution and subjective comfort of 10 subjects were assessed in the different bedding layer structures of mattresses, after mattress support performance was tested. The results show that the mattresses with bedding material hardness gradually increasing from the top layer to the bottom layer (BMH-ITTB) structure have a softer surface layer, a better support core layer, and higher fitness. This enables the mattress to achieve a better decompression effect. The low-pressure area (PAI_≤0.67kPa) increased, while the high-pressure area (PAI_≥2.67kPa and PAI_≥4.00kPa), maximum pressure (P₉₅), average pressure (P₅₀), and pressure index (PI) decreased. This also enables the mattress to achieve higher subjective comfort scores.     

The knowledge and attitudes regarding pressure ulcer prevention among healthcare support workers in the UK: A cross-sectional study

BackgroundPressure ulcers cause significant, detrimental effects on personal wellbeing. They represent a serious health and social care burden. Nurses and those working in support roles are primarily accountable for preventing pressure ulcers. Healthcare support workers are an expanding group of key workers in the UK.ObjectiveTo examine healthcare support workers’ knowledge and attitudes regarding pressure ulcer prevention.MethodsA cross-sectional study was conducted from December 2020 to June 2021, using Knowledge and Attitudes toward Pressure Ulcer Prevention Assessment Tool.ResultsA total of 164 participants completed the questionnaire fully. A low mean knowledge score of 0.42 ± 0.14, but a positive attitude score of 0.76 ± 0.10 per item were reported. The weakest areas of knowledge include aetiology, risk assessment and addressing pressure-reducing interventions for patients at risk. Higher mean scores per item in knowledge of pressure ulcer prevention were reported in participants working in acute hospital wards and nursing homes (0.468 ± 0.15, 0.47 ± 0.08 respectively) than those in other settings (p < 0.05). Participants working in primary care scored lowest (0.33 ± 0.12). The scores of participants with more positive attitudes towards pressure ulcer prevention significantly correlated with higher score of knowledge (p < 0.005).ConclusionWhile positive attitudes towards pressure ulcer prevention exist among healthcare support workers, this is overshadowed by significant knowledge deficits. Findings highlight the importance of continuing structured education for support workers across both acute and community settings. A future national survey and interventional study are needed to examine support workers’ pressure ulcer knowledge and to inform a national continuous education strategy.     

Sacral interface pressure can be alleviated by repositioning with a small-angle change using an automated bed in patients with spinal cord injury

Aim of the studyThis study aimed to compare interface pressure and total contact area of the sacral region in different positions, including small-angle changes, in patients with spinal cord injury (SCI). Furthermore, we analyzed the clinical factors influencing pressure to identify the pressure injury (PI) high-risk group.Materials and methodsAn intervention was conducted for patients with paraplegia (n = 30) with SCI. In the first and second trials, interface pressure and total contact area of the sacral region were recorded from large- and small-angled positions using the automatic repositioning bed, which can change the angle of the back, lateral tilt, and knee.ResultsPositions with back raised ≥45° showed significantly higher pressure on the sacrum than most other positions. The pressure and contact area differences were statistically insignificant for combinations of small-angled changes <30°.Additionally, the duration of injury (β = 0.51, p = 0.010) and neurological level of injury (NLI) (β = −0.47, p = 0.020) were significant independent predictors of average pressure. Similarly, the duration of injury (β = 0.64, p = 0.001), the Korean version of the spinal cord independence measure-III (β = −0.52, p = 0.017), and body mass index (BMI; β = −0.34, p = 0.041) were significant independent predictors of peak pressure.ConclusionsFor repositioning, combinations of small-angle changes <30° effectively reduce pressure on the sacral region in patients with SCI. Lower BMI, longer duration of injury, lower functioning score, and NLI ≥ T7 are predictors of high sacral pressures, which increase the risk for PI. Therefore, patients with these predictors require strict management.     

Investigation of the prevalence of pressure ulcers and patient-related risk factors in hospitals in the province of Erzurum: A cross-sectional study

BackgroundPressure ulcers are a significant health care problem all across the world due to their associated high mortality and morbidity rates and high health care costs. The prevalence of pressure ulcers serves as one of the most important indicators of the quality of nursing care.Study aimThis study aims to determine the prevalence of pressure ulcers and patient-related risk factors in inpatients receiving treatment in the province of Erzurum, located in the eastern part of Turkey.DesignThis is a cross-sectional study.Participantswhich included 832 inpatients hospitalized for at least 24 h after admission in five hospitals in the province of Erzurum. All of the study patients were 18 years of age or older and agreed to participate in the research. Patients hospitalized in the obstetric, emergency, and pediatric clinics were excluded from the study (due to the low probability of pressure ulcers in these clinics).InstrumentsFor the collection of data, the “Introductory Information Form” was used to learn the socio-demographic and clinical characteristics of the patients, and the “Braden Risk Assessment Scale” was used to determine the risk of pressure ulcers. The stage of the pressure ulcers of the patients was determined according to the classification of the National Pressure Ulcer Advisory Panel (NPUAP).MethodsSince the study was planned as a point prevalence study, research data were gathered by the researchers and interviewers on a single day designated for each hospital during the first week of October 2016.ResultsAmong the patients included in the study, 53.1% were male, mean age was 56.62 ± 17.95, 57.2% were treated in internal clinics, and the mean hospital stay was 9.02 ± 13.36 days. In terms of the patients' risk of pressure ulcers, it was determined that 28% were at risk. The overall prevalence of pressure ulcers was calculated to be 12.7% (for stages I-IV), with the overall prevalence decreasing by 6.7% when the patients with stage-I were excluded. Furthermore, it was found that 48.3% of the pressure ulcers were stage-I, and that the sacral region (37.3%) was the most affected region. According to the logistic regression analysis conducted to determine the factors, along with their weights, that affect the development of pressure ulcers, the age of the patient, the duration of the hospital stay, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to have an impact (p < 0.05).ConclusionIn this study, the prevalence of pressure ulcers was calculated to be 12.7%, with the highest prevalence found in intensive care clinics (35.3%). The age of the patient, the duration of the hospital stays, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to be effective in the development of pressure ulcers.     

Evaluation of comfort associated with the use of a robotic mattress with an interface pressure mapping system and automatic inner air-cell pressure adjustment function in healthy volunteers

Aim of the studyA robotic mattress equipped with an interface pressure mapping system and an automatic inner air-cell pressure adjustment function had been developed to aid in the management of pressure ulcers, but its effects on comfort remained unclear. The present study aimed to investigate whether use of the mattress with continuous, automatic, interface pressure mapping-based regulation of inner air-cell pressure (i.e., robotic mattress) improves comfort over that provided by body weight-based pressure regulation (traditional approach) in healthy volunteers.Materials and methodsA robotic mattress was used with two settings (i.e., interface pressure-vs. body weight-based regulation). First, 20 healthy volunteers were recruited, and the level of comfort, interface pressure distribution, body immersion, and tissue oxygenation were measured and compared between the two settings.ResultsThe level of comfort (20.5 vs 47.5, p = 0.014), contact area (2263.9 vs 2145.2 cm², p = 0.002), and body immersion for healthy participants were significantly larger when using the interface pressure-based setting.ConclusionThe robotic mattress provided improved comfort, which might be caused by increased contact area, and improved body immersion. The robotic mattress is expected to be effective both for managing pressure ulcers and increasing comfort.