Understanding and Preventing Pressure Ulcers

Understanding and Preventing Pressure Ulcers

Dealey, (1997) classified the causes of pressure damage into three groups: intrinsic, extrinsic and external factors. Whilst a great deal of research has focused on pressure sore aetiology, the actual interaction between extrinsic and intrinsic factors is still not understood.

Infarction of tissue can occur anywhere on the body. However, the greatest risk is to the skin and subcutaneous tissues, which bear the brunt of exogenous pressure on the body (Bliss 1993) and this is mainly bony prominences such as sacrum, hip and heel. A pressure ulcer is defined as a lesion caused by unrelieved pressure that results in damage to underlying tissue' (US Department of Health and Human Services 1992)

Bridel (1992) believes that most pressure ulcers can be prevented if an active preventative plan is initiated and implemented. As long ago as 1987, Hibbs stated that pressure ulcers were '95 per cent preventable'; the five per cent that were not preventable were possibly due to being admitted to hospital with a fractured neck of femur following a fall and the possibility of having been lying on the ground for some hours.

Estimates of hospital prevalence of pressure ulcers vary between five per cent and 10 per cent (Davies et al. 1991) although in certain specialities, the actual figure may be as high as 60 per cent (Verluysen 1986). In acute care, prevalence of pressure ulcer formation ranges from three per cent to 14 per cent and in long-term care it is as high as 15--25 per cent. National average of pressure ulcers was nine per cent in 1987 (Bergstrom et al. 1987) and Waterlow (1988) found an incidence of 15 per cent in acute settings with another study showing an incidence of 40 per cent in ITU. If Hibbs (1987) is correct and pressure ulcers are 95 per cent preventable, even taking into account pre-existing pressure ulcers, even nine per cent would be an unacceptable level of prevalence.

Pressure relieving mattresses are most appropriately used for those people known to have an elevated risk of pressure damage, or for those with existing pressure damage. This type of pressure mattress removes the source of pressure from the surface of the body and is achieved by alternately inflating cells so that the body is cyclically supported on one set of cells while the remaining cells deflate away from the body (Pring and Millman 1998, Phillips 1999). During deflation, part of the body is not subject to any pressure and this can be checked by the ability to slide a hand between the patient's body and the deflated cells.

Given appropriate equipment, pressure ulcers can be healed in the most seriously medically compromised patients, even though they may be dying at the time. Therefore, given appropriate pressure care equipment, these patients should not have developed pressure damage in the first place.

The LiteAir replacement pressure mattress and Altair bariatric mattress are the latest products available from Select Medical Ltd. Both of these pressure relief mattresses have been tested for reliability and contact pressure mapping testing has also been conducted with good results.

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