Device-related pressure ulcers from a biomechanical perspective

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Sustained pressure, shear forces, and friction, as well as elevated humidity/moisture, are decisive physical factors in the development of pressure injuries (PIs). To date, further research is needed in order to understand the influence of humidity and moisture on the coefficient of friction (COF) of skin against different types of medical textiles. The aim of this work was to investigate the effects of moisture caused by sweat, urine, or saline on the resulting COF of skin against different textiles used in the medical setting in the context of PI prevention. For that purpose, we performed physical measurements of static COFs of porcine skin followed by finite element (FE) computational modelling in order to illustrate the effect of increased COF at the skin on the resulting strains and stresses deep within the soft tissues of the buttocks. The COF of dry skin obtained for the 3 textiles varied between 0.59 (adult diaper) and 0.91 (polyurethane dressing). In addition, the COF increased with the added moisture in all of the tested cases. The results of the FE simulations further showed that increased COF results in elevated strain energy density and shear strain values in the skin and deeper tissues and, hence, in an increased risk for PI development. We conclude that moisture may accelerate PI formation by increasing the COF between the skin and the medical textile, regardless of the type of the liquid that is present. Hence, reduction of the wetness/moisture between the skin and fabrics in patients at a high risk of developing PIs is a key measure in PI prevention.

Section: Introductionmentioning

confidence: 99%

Effects of humidity on skin friction against medical textiles as related to prevention of pressure injuries

Schwartz

Magen

Levy

et al. 2018

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“…The few studies undertaken have included air pads, gel pads, or foam rings . Some occipital devices, particularly ring‐shaped or donut‐shaped devices that off‐load the centre of the occiput, have been found to cause more shear at the surface and internally, and in fact increase the risk for the development of PIs . A recent study, conducted by Katzengold and Gefen used finite element modelling to compare a foam pad with a shape‐memory head positioner (Z‐Flo, Molnlycke), demonstrated that this specific positioner alleviated shear, reduced tissue distortion, and minimised focal contact pressures at the occiput region.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study

Barakat‐Johnson

Lai

Gefen

et al. 2018

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This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post‐test design with a historical control group was used in a 54‐bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty‐four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger‐scale study.

“…In addition, potentially, there could also be small objects, including plastics (eg, needle covers), consumables, or pieces of packaging of sterile equipment, that may have fallen or have been forgotten on the bed and may come into contact with the patient. Rigid equipment, devices, and any objects that are misplaced between the body and support surface act like an “external bony prominence” and can inflict localised, aggressive soft tissue distortions in addition to those caused near the bony prominences because of bodyweight . Procedures to thoroughly check the correct placement of catheter tubing and wiring, as well as careful collection of all packaging and plastics/consumables so that they do not become trapped under the weight‐bearing body, is critically important for the prevention of PIs in the ED.…”

Section: The Role Of Tissue Deformation In the Pathogenesis Of Pressumentioning

confidence: 99%

“…The above‐described cell‐scale destructive processes are strongly affected by the mechanical state of tissues, one important factor being tissue stiffness. Connective tissues and specifically skin tend to stiffen with old age, and likewise in individuals with type‐2 diabetes, because of localised fusion of collagen fibres and pathologically increased fibre thickness, which reinforces the skin and makes it less able to relieve mechanical stress . These age‐related and/or diabetes‐related changes exacerbate the mechanical state in tissues subjected to bodyweight forces, particularly around the sacrum, and may contribute to the susceptibility to sacral PIs in older individuals compared with younger (and non‐diabetic) individuals …”

Section: The Role Of Tissue Deformation In the Pathogenesis Of Pressumentioning

confidence: 99%

Preventing pressure injuries in the emergency department: Current evidence and practice considerations

Santamaria

Creehan

Fletcher³

et al. 2019

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The emergency department (ED) is at the front line of hospital pressure injury (PI) prevention, yet ED clinicians must balance many competing clinical priorities in the care of seriously ill patients. This paper presents the current biomechanical and clinical evidence and management considerations to assist EDs to continue to develop and implement evidence‐based PI prevention protocols for the high‐risk emergency/trauma patient. The prevention of hospital‐acquired pressure injuries has received significant focus internationally over many years because of the additional burden that these injuries place on the patient, the additional costs and impact to the efficiency of the hospital, and the potential for litigation. The development of a PI is the result of a complex number of biomechanical, physiological, and environmental interactions. Our understanding of the interaction of these factors has improved significantly over the past 10 years. We have demonstrated that large reductions in PI incidence rates can be achieved in critical care and general hospital wards through the application of advanced evidence‐based prevention protocols and believe that further improvement can be achieved through the application of these approaches in the ED.