Words on Wounds

A forum to discuss the latest news and ideas in skin and wound care.

Thursday, February 21, 2013

Using Foam Dressings to Prevent Pressure Ulcers: Too Good to be True?

Pressure ulcers (PrUs) are a significant problem across the continuum of healthcare settings. In 2009, the overall prevalence was 12.3% (N = 92,408) in the United States, according to a national survey. The burden of PrUs is significant; the average cost associated with the treatment of deep PrUs and related complications is $129,248 in acute care. In a number of reviews, support surfaces (eg, medical-grade sheepskin, high-specification foam mattresses) have been recognized as reducing the incidence of PrUs. The majority of specialty surfaces are expensive and evidence to support PrU prevention is scarce.

     Increasing attention has been drawn to the role of using silicone foam dressings to prevent PrUs. It is hypothesized that the multilayer material inside the foam dressing will help minimize shear as the dressing materials slide against each other, reduce friction at the interface between the skin and the support surface, and protect the skin from mechanical damage. The other potential advantage is the ability of breathable foam dressings to minimize heat and moisture accumulation that tends to render the skin more vulnerable to pressure damage. So, can foam dressings prevent PrUs? In the current Quick Poll found on this website, 40% of the respondents to date answered “yes.” A number of new studies indicate that the incidence of PrUs is reduced by the introduction of silicone foam dressings in critical care settings. However, more evidence is needed to confirm the efficacy of using a dressing to prevent PrUs.

     It is important to remember that the extent and severity of tissue injury is dependent on a number of intrinsic factors that predispose individuals to the development of PrUs. Some of these key factors are poor nutritional intake, low body mass index (<18.5), hypoproteinemia, low systolic blood pressure, anemia, contractures and prominent bony prominences, vascular disease, neuropathy, and uncontrolled diabetes. Selection of support surfaces, dressings, or any interventions should be individualized, taking into consideration the risk of tissue tolerance to injury. Clinicians must not forget the primacy of frequent repositioning and meticulous nursing care.