From the Guidelines
The best material available to prevent pressure injuries is advanced static mattresses or advanced static overlays, as recommended by the American College of Physicians 1. When it comes to preventing pressure injuries, the choice of material is crucial. The American College of Physicians recommends using advanced static mattresses or advanced static overlays in patients who are at an increased risk of developing pressure ulcers, based on a strong recommendation and moderate-quality evidence 1. Some key points to consider when selecting materials to prevent pressure injuries include:
- Advanced static mattresses or overlays can help redistribute pressure and reduce the risk of pressure ulcers
- Alternating-air mattresses or overlays are not recommended for patients at increased risk of pressure ulcers, according to a weak recommendation and moderate-quality evidence 1
- Other materials, such as breathable moisture-wicking fabrics, protective padding made of gel, foam, or air-filled materials, and silicone multi-layered foam dressings, can also be used to reduce skin moisture, friction, and shear forces However, it is essential to note that these materials should be used in conjunction with regular repositioning, proper skin hygiene, nutrition management, and ongoing skin assessment to effectively prevent pressure injuries. The use of advanced static mattresses or overlays can help reduce the morbidity, mortality, and improve the quality of life for patients at risk of pressure injuries, by reducing the incidence of pressure ulcers and their associated complications.
From the Research
Pressure Injury Prevention Materials
The best material available to prevent pressure injuries is a topic of ongoing research. Several studies have investigated the effectiveness of different support surfaces and dressings in preventing pressure ulcers.
- Foam alternatives to standard hospital foam mattresses can reduce the incidence of pressure ulcers in people at risk 2.
- Alternating pressure mattresses may be more cost-effective than alternating pressure overlays 2.
- Medical grade sheepskins are associated with a decrease in pressure ulcer development 2, 3.
- Reactive air surfaces, alternating pressure air surfaces, and reactive gel surfaces may reduce pressure ulcer incidence compared to foam surfaces 4, 5.
- Multi-layer foam dressings have been shown to be effective in preventing pressure injuries in long-term care settings, with one study reporting a reduction in incidence rate from 5.2% to 0% after implementation 6.
Comparison of Support Surfaces
The effectiveness of different support surfaces in preventing pressure ulcers is unclear, with most studies having very low-certainty evidence.
- Alternating pressure air surfaces may reduce pressure ulcer risk and are probably more cost-effective in preventing pressure ulcers compared to foam surfaces 4, 5.
- Reactive air surfaces may reduce pressure ulcer risk and may increase complete ulcer healing compared to foam surfaces 4.
- Reactive gel surfaces may reduce pressure ulcer risk, particularly for people in operating rooms and long-term care settings 4.
Future Research Directions
More high-quality research is required to determine the relative effectiveness of different support surfaces and dressings in preventing pressure ulcers.
- Future studies should consider time-to-event outcomes and be designed to minimise any risk of bias 4, 5.
- Trials should be designed to evaluate the most important support surfaces from the perspective of decision-makers, and should include careful assessment of adverse events and trial-level cost-effectiveness evaluation 5.