Effectiveness of Multilayered Polyurethane Foam Dressings to Prevent Hospital-Acquired Sacral Pressure Injuries in Patients With Hip Fracture

Abstract

PURPOSE: The purpose of this study was to determine the effectiveness of a multilayered polyurethane foam dressing applied within 24 hours of hospital admission compared with standard preventive pressure injury (PI) care in reducing sacral PI occurrence in older patients with hip fractures. DESIGN: Open-label, parallel-group, 2-arm, superiority trial. SUBJECTS AND SETTING: The sample comprised older patients aged 69 to 97 years admitted to a 1500-bed university hospital in Bologna, Italy, for hip fracture surgery. METHODS: Patients were randomly allocated to an intervention or control group. Both groups received standard evidence-based PI preventive care in accordance with National Pressure Ulcer Advisory Panel guidelines. In addition, patients in the intervention group received a single 12.9 × 12.9-cm2 multilayered polyurethane foam dressing shaped for the sacrum area applied within 24 hours of hospital admission. Bivariate analysis on primary and secondary outcomes and baseline characteristics was performed to compare group differences, and a survival analysis was used to determine the difference in PI incidence rates per group. RESULTS: Sixty-eight patients completed the trial; 34 patients were allocated to the intervention group and 34 patients to the control group. A trend toward significance was observed for sacral PI occurrence in the intervention group (intervention: 20.6%; control: 2.9%; P = .054). The foam dressing allowed significantly longer time (days) to PI occurrence (intervention: 5.9 ± 1.60; control: 2.7 ± 0.96; P = .003). CONCLUSIONS: These findings suggest that multilayered polyurethane foam dressings are not superior to the standard preventive PI care alone and should be used with caution, especially when multiple dressing changes may occur. Further exploration of the role of multilayered polyurethane foam dressings in preventing PI development is warranted.

Use of a Sacral Foam Dressing to Prevent Pressure Injury in At-Risk Subacute Hospitalized Older Adults

“…However, it is important to note that replacement of the dressing was often required before a routine change was due, most commonly due to the dressing lifting or rolling, or soiling from incontinence. Other trials have also reported similar issues 18,21. Our results suggest that routine dressing changes in an elderly population may be required more often than weekly, and dressings may need to be removed temporarily for some activities such as showering.…”

“…Our results suggest that routine dressing changes in an elderly population may be required more often than weekly, and dressings may need to be removed temporarily for some activities such as showering. Indeed, while trials of the study dressing in different populations have reported following the same routine of dressing changes on a weekly basis unless required earlier13,21 and dressing changes as per manufacturer instructions,18 other trials with different dressings have performed changes more frequently (eg, every 3 days) 15,17,19…”

“…Similarly, a hospital-based RCT of 359 patients with a hip fracture (mean age >80 years) found that prophylactic multilayer polyurethane foam sacral dressings plus standard preventive care significantly reduced PI incidence compared to standard preventive care only (n = 8/177, 4.5%, vs n = 28/182, 15.4%; P = .001) 13. In contrast, a smaller study of 68 patients with a hip fracture and a similar age demographic found that the incidence of sacral PIs at 8 days was greatest in the intervention group that received a multilayered polyurethane foam dressing plus standard preventive care compared to controls that received standard preventive care only (n = 7/34, 20.6%, vs n = 1/34, 2.9%; P = .054) 21. However, the time to the occurrence of a PI was significantly longer in the intervention group compared to the control group (6 vs 3 days, P = .003) 21.…”

“…21 Within the context of these studies, it is important to note that differences in the dressings evaluated must be considered when interpreting results, given that different dressings may not be clinically equivalent. 22 In terms of sacral dressings for older persons, Santamaria and colleagues 17 trialed a 5-layer foam dressing (Mepilex® Border Sacrum, Mölnlycke Health Care AB, Gothenburg, Sweden), while the latter 2 studies 13,21 trialed a multilayered hydrocellular foam dressing (ALLEVYN Life® Sacrum, Smith and Nephew, Watford, United Kingdom). Further consideration must also be given to variations in, and compliance with, standard PI preventive care between studies.…”

Prophylactic sacral protective dressings' effect on preventing pressure injury: A meta‐analysis

“…A total of 967 unique studies were identified, of which 11 studies (between 2015 and 2021) fulfilled the inclusion criteria and were included in this meta-analysis. [25][26][27][28][29][30][31][32][33][34][35] The 11 studies included 5150 community-or hospital-based adult subjects requiring care at the start of the study; 2832 of them were using sacral protective dressings and 2318 were given standard care with no sacral protective dressings. All studies evaluated the effects of prophylactic sacral protective dressings on preventing pressure injury.…”