Support surfaces for pressure ulcer prevention
Elizabeth McInnes, Asmara Jammali-Blasi, Sally E M Bell-Syer, Jo C Dumville, Victoria Middleton, Nicky Cullum, Elizabeth McInnes, Asmara Jammali-Blasi, Sally E M Bell-Syer, Jo C Dumville, Victoria Middleton, Nicky Cullum
Abstract
Background: Pressure ulcers (i.e. bedsores, pressure sores, pressure injuries, decubitus ulcers) are areas of localised damage to the skin and underlying tissue. They are common in the elderly and immobile, and costly in financial and human terms. Pressure-relieving support surfaces (i.e. beds, mattresses, seat cushions etc) are used to help prevent ulcer development.
Objectives: This systematic review seeks to establish:(1) the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared with standard support surfaces, and,(2) their comparative effectiveness in ulcer prevention.
Search methods: In April 2015, for this fourth update we searched The Cochrane Wounds Group Specialised Register (searched 15 April 2015) which includes the results of regular searches of MEDLINE, EMBASE and CINAHL and The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 3).
Selection criteria: Randomised controlled trials (RCTs) and quasi-randomised trials, published or unpublished, that assessed the effects of any support surface for prevention of pressure ulcers, in any patient group or setting which measured pressure ulcer incidence. Trials reporting only proxy outcomes (e.g. interface pressure) were excluded. Two review authors independently selected trials.
Data collection and analysis: Data were extracted by one review author and checked by another. Where appropriate, estimates from similar trials were pooled for meta-analysis.
Main results: For this fourth update six new trials were included, bringing the total of included trials to 59.Foam alternatives to standard hospital foam mattresses reduce the incidence of pressure ulcers in people at risk (RR 0.40 95% CI 0.21 to 0.74). The relative merits of alternating- and constant low-pressure devices are unclear. One high-quality trial suggested that alternating-pressure mattresses may be more cost effective than alternating-pressure overlays in a UK context.Pressure-relieving overlays on the operating table reduce postoperative pressure ulcer incidence, although two trials indicated that foam overlays caused adverse skin changes. Meta-analysis of three trials suggest that Australian standard medical sheepskins prevent pressure ulcers (RR 0.56 95% CI 0.32 to 0.97).
Authors' conclusions: People at high risk of developing pressure ulcers should use higher-specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure ulcers are unclear, but alternating-pressure mattresses may be more cost effective than alternating-pressure overlays in a UK context. Medical grade sheepskins are associated with a decrease in pressure ulcer development. Organisations might consider the use of some forms of pressure relief for high risk patients in the operating theatre.
Conflict of interest statement
Nicky Cullum was the Principal Investigator in the PRESSURE Trial, one of the trials included in this review (Nixon 2006), however, she was not involved in the data extraction or analysis for this trial. Kinetic Concepts Inc (KCI) supplied (free of charge) three VAC therapy units and starter packs for use in a pilot RCT of negative pressure wound therapy for pressure ulcers. They also provided product training, support and access to the KCI 24hr advice service for clinical and technical queries. However KCI had no input into the design, conduct, analysis or reporting of that research or this review which is not concerned with this technology. E McInnes: no interests declared. A Jammali‐Blasi: no interests declared. SEM Bell‐Syer: no interests declared. JC Dumville: no interests declared. V Middleton: was funded as research assistant by Nursing Research Institute (Australian Catholic University) to assist with this review.
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Source: PubMed