Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit

Abstract

Background In critically ill patients, prevention of pressure ulcers is a challenge because of the high risk for multiple comorbid conditions, immobility, hemodynamic instability, and increased use of medical devices. Objectives To compare the difference in incidence rates of hospital-acquired pressure ulcers (HAPUs) in critically ill patients between those treated with usual preventive care and a 5-layered soft silicone foam dressing versus a control group receiving usual care. Secondary goals were to examine risk factors for HAPUs in critically ill patients and to explicate cost savings related to prevention of pressure ulcers. Methods A prospective, randomized controlled trial in the intensive care units at a 569-bed, level II trauma hospital. All 366 participants received standard pressure ulcer prevention; 184 were randomized to have a 5-layered soft silicone foam dressing applied to the sacrum (intervention group) and 182 to receive usual care (control group). Results The incidence rate of HAPUs was significantly less in patients treated with the foam dressing than in the control group (0.7% vs 5.9%, P = .01). Time to injury survival analysis (Cox proportional hazard models) revealed the intervention group had 88% reduced risk of HAPU development (hazard ratio, 0.12 [95% CI, 0.02-0.98], P = .048). Conclusion Use of a soft silicone foam dressing combined with preventive care yielded a statistically and clinically significant benefit in reducing the incidence rate and severity of HAPUs in intensive care patients. This novel, cost-effective method can reduce HAPU incidence in critically ill patients.

Dressings cut to shape alleviate facial tissue loads while using an oxygen mask

“…In agreement with our previous computational modelling work with regard to the biomechanical function of dressings in PUP, here, we found that application of the dressing cuts considerably reduced peak stresses in facial soft tissues for both model variants BCS1 and BCS2, in comparison with the respective no‐dressing cases. Furthermore, use of the dressing cuts substantially reduced the volumetric exposure of facial soft tissues to elevated effective stresses and SED values, for BCS1 at the bridge of the nose and for BCS2 at the chin.…”

“…26 It is noteworthy that, in the same context of PUP, the Mepilex Border prophylactic dressing designs (Mölnlycke Health Care) have been shown to successfully protect vulnerable tissue sites subjected to sustained bodyweight forces, for example, near the sacrum and calcaneal (heel) bones; their effectiveness in alleviating localised tissue loads has been demonstrated in multiple biomechanical computational studies, as well as in large-scale randomised clinical trials. [27][28][29][30][31][32][33][34][35] The ability to non-invasively monitor changes in skin microcirculation improves both the diagnosis and treatment of certain diseases. It was already observed that cutaneous haemodynamic variables could reflect local and systemic changes and even predict the development of ischemic stress conditions.…”

The biomechanical protective effects of a treatment dressing on the soft tissues surrounding a non‐offloaded sacral pressure ulcer

“…In this latter study, which included 77 adults hospitalised at the Mayo Clinic in the United States, it has been demonstrated that the normal trajectory of tissue destruction associated with DTIs was changed, and DTIs healed, through early intervention with the MBS dressing. This provides strong clinical support for the present computational modelling results, demonstrating that the MBS either prevents DTIs or helps DTIs not to deteriorate…”

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

“…Santamaria et al and Cubit et al demonstrated that the use of the multi‐layer silicone foam Mepilex Border Sacrum and Mepilex Heel dressings (Molnlycke Health Care AB, Gothenburg, Sweden) significantly decreased PI incidence in critically ill patients when applied in the ED . The prophylactic use of these dressings has also been shown to decrease overall wound care costs when applied in the ED for critically ill patients …”

“…45 The prophylactic use of these dressings has also been shown to decrease overall wound care costs when applied in the ED for critically ill patients. [46][47][48] 6 | LEADERSHIP, LOCAL CULTURE, AND MANAGEMENT All levels of senior and unit-based clinical and hospital management have a vital role in the prevention of PIs in the ED. It is the role of senior-level executives to set expectations and support staff to accomplish PI prevention goals, remove barriers, encourage collaboration, and provide the required human and financial resources.…”