The cost‐benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within‐trial analysis of the Border Trial

Abstract

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit

“…This cost savings estimate related to prevention is also consistent with other cost analysis studies of pressure ulcers. [63][64][65][66] Our robust prevention program, now including the dressing, has yielded a substantial cost savings and has contributed to our sustained pressure ulcer incidence of zero to 0.2 (all stages of HAPUs) in the past 2 years since completion of this trial.…”

Use of a Comprehensive Program to Reduce the Incidence of Hospital-Acquired Pressure Ulcers in an Intensive Care Unit

“…Concerted efforts were made to be more proactive in implementation of prevention strategies, such as encouraging the use of fluidized positioners and use of silicone gel adhesive dressings whenever there were pressure points, depending on the patient's position. Although it is difficult to isolate the effects of individual program components, previous studies 4,11 have shown that application of 5-layer, silicone foam dressings can complement an existing pressure ulcer prevention program. It was our understanding that use of dressings contributed to the reduction in device-related HAPUs.…”

“…In a database of 710 626 patients in adult critical care, step-down, medical, surgical, and medical/ surgical units, 3.6% of all patients and 7.9% of those considered at risk had hospital-acquired pressure ulcers (HAPUs; ie, pressure ulcers noted ≥ 24 hours after admission) develop. 2 In acute care settings, the estimated incidence of HAPUs varies widely (eg, from 0.4 to 12% 3 and from 3.3 to 53.4% 4 ).…”

Avaliação de custo-efetividade de dois tipos de curativos para prevenção de úlcera por pressão

“…A controlled clinical trial with 440 patients from an emergency service and intensive care unit at a hospital in Australia (11) found that absorbent foam dressing with a silicone border prevents sacral and calcaneus pressure ulcers, and, consequently, resulted in an economic saving for the hospital. In this sense, it is important to consider the evaluation of absorbent foam dressing with a silicone border in comparison with transparent film dressing, which in our study was more cost-effective in preventing sacral pressure ulcer.…”