Pressure ulcer prevention protocol

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prevention chartEach year, more than 2.5 million people in the U.S. develop pressure injuries, with about 60,000 patients dying as a direct result1.

Pressure injuries have been estimated to cost a facility USD 10,669 per occurrence2. CMS and several private health insurance companies have stopped paying for Stage 3 and Stage 4 hospital-acquired pressure ulcers (HAPUs), and in 2014 CMS began penalizing hospitals based on their rate of pressure injuries and other hospital-acquired conditions2.

Lower HAPU rates translate into lower overall costs. Mölnlycke’s Mepilex® Border dressings showed a reduction in HAPUs from 3.8% to 0.5% in a randomized clinical trial when the dressing was added to the usual prevention protocol.3 For an ICU department with 1,000 admissions, this reduction could translate to a cost savings of USD 354,000.

Can pressure ulcers be avoided?

Noted pressure injury expert Joyce Black wrote the foreword of `Role of multi-layer foam dressings with Safetac® in the prevention of pressure ulcers: a review of the clinical and scientific data.´4 In the following passage she addresses the myth of “unavoidability” in pressure ulcers/injuries:

`Pressure ulcers in critically ill patients have often been described as unavoidable. However, the findings of studies on a bordered sacral foam dressing, when used prophylactically as part of a PU prevention strategy, have changed the paradigm of unavoidability in these patients.´

`Before 1990, the PU incidence in this patient group averaged 33%, with the ulcers often perceived as inevitable or unavoidable. Even with the advent of better support surfaces in the next decade, the incidence did not change much, ranging between 8% and 40%5. In the past decade, incidence has been reported more often by the type of patient, but surgical patients in intensive care unit (ICU) still have an incidence of 6.2% to 23.9%6

`Randomized controlled trials (RCTs) conducted in the ICU by Santamaria et al.7,8 have changed that paradigm of unavoidability. Their combined data show that the 371 critically ill patients who received customary care with the bordered sacral foam dressing in situ had PU rates of 0-3.1%, compared with 3.8-13.1% for the control groups. A variety of less well-controlled studies involving more than 1000 patients provide supporting data. These reductions in PU rates really challenge the perception of unavoidability in critically ill patients.´



1. Preventing Pressure Ulcers in Hospitals. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.

2. Spetz J. et al. The value of reducing hospital-acquired pressure ulcer prevalence: an illustrative analysis. J Nurs Adm. 2013 Apr;43(4):235-41. doi: 10.1097.

3. Kalowes P, Li, M, Carlson C. et al. Use of a soft silicone, self-adherent, bordered foam dressing to reduce pressure ulcer formation in high risk patients: a randomized clinical trial. Poster presented at the Symposium on Advanced Wound Care (Fall), Baltimore, Maryland, USA, 2012.

4. Davies P. Role of multi-layer foam dressings with Safetac in the prevention of pressure ulcers: a review of the clinical and scientific data. J Wound Care 2016; 25: 1, S1–S24

5. Cuddigan J. Critical care. In Cuddigan, J. Pressure Ulcers in America: Prevalence, Incidence, and Implications for the Future. NPUAP 2000.

6. Cuddigan J. Critical care. In: Pieper B, National Pressure Ulcer Advisory Panel, editors. Pressure Ulcers: Prevalence, Incidence, and Implications for the Future. NPUAP, 2012.[LH1]

7. Santamaria N, Gerdtz M, Sage S. et al. A randomized controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J 2015; 12: 3, 302–308.

8. Santamaria N, Gerdtz M, Liu W. et al. Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial. J Wound Care 2015; 24: 8, 340–345.

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