Comparing the effects of 3 different pressure ulcer prevention support surfaces on the structure and function of heel and sacral skin: An exploratory cross‐over trial

Abstract

Special support surfaces are key in pressure ulcer prevention. The aim of this study was to measure the effects of 3 different types of mattresses (reactive gel, active alternating air, basic foam) on skin properties of the sacral and heel skin after 2 hours loading. Fifteen healthy females (median age 66 years) were included. Transepidermal water loss, skin surface temperature, erythema, stratum corneum hydration, epidermal hydration, skin extensibility, elastic function, and recovery as well as skin roughness parameters were measured under controlled room conditions before loading, immediately after loading, and 20 minutes post-loading in the supine position on the different mattresses. The highest increases in transepidermal water loss, skin temperature, and erythema were observed for the foam mattress after loading, indicating higher deformation and occlusion. Cutaneous stiffness decreased in all 3 groups, indicating structural changes during loading. There was a substantial decrease of mean roughness at the heel skin in the foam group, leading to a flattening of the skin surface. Study results indicate that the type of support surface influences skin structure and function during loading. The gel and air mattress appeared to be more protective compared with the foam mattress, but the differences between the gel and air were minor.

Comparing the effects of three different multilayer dressings for pressure ulcer prevention on sacral skin after prolonged loading: An exploratory crossover trial

“…This interpretation is supported by results from a similar comparison after lying for 1 hour on a standard foam mattress with and without different dressings 18 . The baseline median sacral SCH ranging from 24.8 to 30.1 AU was similar to previous baseline estimates in a comparable setting 23,24 . After 3.5 hours loading there was an increase in all four groups indicating the accumulation of water molecules in the stratum corneum caused by occlusion.…”

“…Especially, the repeated backrest elevation induces friction to the sacral skin area and high degrees of mechanical deformation 35 . Compared to similar simulation studies in this area 23,24,26 a loading period of 3.5 hours was very long.The baseline sacral skin temperature of approximately 30°C was within the typical skin temperature range between 29°C and 31°C reported in comparable previous studies 15,24 . The skin temperature increased in all four groups, indicating occlusion and accumulation of heat.…”

“…Skin functional parameters such as erythema or stratum corneum hydration (SCH) and structural parameters, like structural stiffness, have been successfully measured in previous PU prevention research 22,23 . These parameters are able to discriminate effects of different loading intensities and skin‐support surface interactions to measure PU preventive device performance 24 . Recently, it has been shown that there are associations between structural and functional skin changes at the heel and sacral area during loading 23 .…”

The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture

“…However, care providers must be aware that patients must be repositioned even when placed on advanced surfaces. Heels must be off-loaded at all times, as these surfaces are not able to provide effective pressure relief to prevent tissue injury at the heel (Tomova-Simitchieva, et al, 2017). Individuals at high risk of developing PU/PI should be placed on a pressure-relieving surface.…”

The Effect of Support Surfaces on the Incidence of Pressure Injuries in Critically Ill Patients: A Randomized Clinical Trial

“…As an example, the less the occlusive materials are used, the greater evaporative capacity and the less the changes occur in the microclimate. Powered airflow support systems reduce humidity adjacent to the skin and induce less water accumulation when compared to standard mattress [30]. Viscoelastic and pyramidal foam do pressure redistribution and are nonpowered devices; both surfaces probably have similar effects on microclimate.…”