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Prophylactic dressings

The first edition of the comprehensive Clinical Practice Guidelines was published in 2009 as a result of a four-year collaboration between  the  NPUAP  and  the  European  Pressure  Ulcer  Advisory  Panel  (EPUAP). A second edition, published in 2014, added the Pan Pacific Pressure Injury Alliance to the collaboration.
The groups also published a Quick Reference Guide that presents a comprehensive review and appraisal of the best available evidence at the time of literature search related to the assessment, diagnosis, prevention and treatment of pressure ulcers. 

Recommendations for the use of prophylactic dressings in the Quick Reference Guide   state:

Use of a prophylactic dressing

1. Consider applying a polyurethane foam dressing to bony prominences (e.g., heels, sacrum) for the prevention of pressure ulcers in anatomical areas frequently subjected to friction and shear. (Strength of Evidence = B; Strength of Recommendation = 1 thumbs up)

2. When selecting a prophylactic dressing consider:
- ability of the dressing to manage microclimate;
- ease of application and removal;
- ability to regularly assess the skin;
- anatomical location where the dressing will be applied; and
- the correct dressing size.
(Strength of Evidence = C; Strength of Recommendation = 1 thumbs up)

Prophylactic dressings differ in their qualities; therefore it is important to select a dressing that is appropriate to the individual and the clinical use.

3. Continue to use all other preventive measures necessary when using prophylactic dressings. (Strength of Evidence = C; Strength of Recommendation = 1 thumbs up)

4. Assess the skin for signs of pressure ulcer development at each dressing change or at least daily, and confirm the appropriateness of the current prophylactic dressing regimen. (Strength of Evidence = C; Strength of Recommendation = 1 thumbs up)

5. Replace the prophylactic dressing if it becomes damaged, displaced, loosened or excessively moist. (Strength of Evidence = C; Strength of Recommendation = two thumbs up).

Prophylactic dressings do not negate the need for thorough and regular skin assessment, therefore their design often facilitates regular skin assessments (e.g., soft silicone borders that are easy to lift for routine skin checks without creating tape burns or other skin injuries).



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