Effectiveness of using a new polyurethane foam multi‐layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial

Abstract

Hip fractures in the elderly are a serious problem for the health service due to the high rate of complications. One of these complications is pressure ulcers that, according to the literature, occur in 8.8% to 55% of patients and mainly arise in the sacral area. The present randomised controlled trial tests whether applying a new innovative multi-layer polyurethane foam dressing (ALLEVYN LIFE™), reduces the onset of pressure ulcers in the sacral area. From March to December 2016, 359 fragility hip fracture patients were randomly divided into 2 groups: 182 in the control group and 177 in the experimental group. Pressure ulcers occurred overall in 36 patients (10%): 8 patients (4.5%) in the experimental group compared to 28 (15.4%) in the control group: P = 0.001, relative risk 0.29 (95% CI 0.14-0.61) with NNT of 9 (95% CI 6-21). In the experimental group the onset of pressure ulcers occurred on average on the 6th day compared to the 4th day in the control group (HR 4.4). Using polyurethane foam is effective at reducing the rate of pressure ulcers in the sacrum in elderly patients with hip fracture. The adhesiveness of this device also enables costs to be kept down.

Effectiveness on hospital‐acquired pressure ulcers prevention: a systematic review

“…The most common study design was RCTs ( n = 6). Regarding the PU preventive interventions, most of the featured studies focused on support surfaces, health professional's education, multiple intervention programmes, repositioning and early mobilisation, preventive skincare, prophylactic dressings, remind systems on patient care plan, and risk‐assessment tools . According to the care setting where the studies were carried out, most of them ( n = 17) were developed in intensive care units (ICU) followed by medicine ( n = 6), geriatrics ( n = 2), surgical ( n = 2), orthopaedics ( n = 2), oncology ( n = 1), rehabilitative ( n = 1), community hospital ( n = 1), and other specific units ( n = 4).…”

“…The study conducted by Dutra et al showed that polyurethane film dressings were more effective than hydrocolloid dressings in decreasing PU incidence in the trochanteric and sacral areas for patients cared for in the ICU, coronary unit, and in one general medicine unit . Other studies found that a multilayered silicone foam dressing was effective in reducing PUs on heels and sacrum in orthopaedics patients and patients in ICU when previously applied in emergency department or within 24 hours of admission to the ICU . Multilayered silicone foam dressing applied on sacrum in a special population like patients with spinal cord injury did not show a higher effectiveness in terms of PU prevention when compared with a gel mattress .…”

“…Multilayered silicone foam dressing applied on sacrum in a special population like patients with spinal cord injury did not show a higher effectiveness in terms of PU prevention when compared with a gel mattress . Forni et al found that a polyurethane foam dressing applied on the sacral area is effective in decreasing the incidence of PUs in orthopaedics patients …”

“…The role of dressings in PU prevention, regarding the capacity of reducing pressure, friction, and shear, as well as effectively managing skin moisture, has been explored by many investigators . Multilayered foam dressings are effective in preventing PUs on heels and sacrum in patients admitted to ICUs when they were in the emergency department or in the first 24 hours of ICU admission . Many PUs may have their beginning in the period of pre‐hospital wards admission .…”

The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: a randomized controlled parallel‐group trial

“…The principle underlying mode of action of the investigated dressings is lower friction between the outer dressing and the support surfaces, thus reducing shear within the skin and underlying soft tissues . Other types of dressings are used for PU prevention and study results are mixed . Therefore, compared with many other areas in PU prevention research, direct head‐to‐head comparisons are urgently needed to support clinical decision making …”