The Effect of Offloading Heels on Sacral Pressure

The biomechanical efficacy of a dressing with a soft cellulose fluff core in protecting prone surgical patients from chest injuries on the operating table

Pressure ulcers are soft‐tissue damage associated with tissue exposure to sustained deformations and stress concentrations. In patients who are proned for ventilation or surgery, such damage may occur in the superficial chest tissues that are compressed between the rib cage and the support surface. Prophylactic dressings have been previously proven as generally effective for pressure ulcer prevention. In this study, our goal was to develop a novel computational modelling framework to investigate the biomechanical efficacy of a dressing with a soft cellulose fluff core in protecting proned surgical patients from chest pressure ulcers occurring on the operating table, due to body fixation by the Relton‐Hall frame. We compared the levels of mechanical compressive stresses developing in the soft chest tissues, above the sternum and ribs, due to the trunk weight, whilst the body is supported by the Relton‐Hall frame pads, with versus without the prophylactically applied bilateral dressings. The protective efficacy index for the extremely high stresses, above the 95th‐percentile, were 40.5%, 25.6% and 24.2% for skin, adipose and muscle, respectively, indicating that the dressings dispersed elevated soft‐tissue stresses. The current results provide additional support for using soft cellulose fluff core dressings for pressure ulcer prophylaxis, including during surgery.

Risk factors for developing heel ulcers for bedridden patients: A finite element study

BACKGROUND

The heel is one of the most common sites of pressure ulcers and the anatomical location with the highest prevalence of deep tissue injury. Several finite element modeling studies investigate heel ulcers for bedridden patients. In the current study we have added the implementation of the calf structure to the current heel models. We tested the effect of foot posture, mattress stiffness, and a lateral calcaneus displacement to the contact pressure and internal maximum shear strain occurring at the heel.

METHODS

A new 3D finite element model is created which includes the heel and calf structure. Sensitivity analyses are performed for the foot orientation relative to the mattress, the Young's modulus of the mattress, and a lateral displacement of the calcaneus relative to the other soft tissues in the heel.

FINDINGS

The models predict that a stiffer mattress results in higher contact pressures and internal maximum shear strains at the heel as well as the calf. An abducted foot posture reduces the internal strains in the heel and a lateral calcaneus displacement increases the internal maximum shear strains. A parameter study with different mattress-skin friction coefficients showed that a coefficient below 0.4 decreases the maximum internal shear strains in all of the used loading conditions.

INTERPRETATION

In clinical practice, it is advised to avoid internal shearing of the calcaneus of patients, and it could be taken into consideration by medical experts and nurses that a more abducted foot position may reduce the strains in the heel.

Sacral Pressure Injury Prevention in Trauma Patients: Silicone-Bordered Multilayered Foam Dressing

BACKGROUND

Hospital-acquired pressure injuries are a chronic phenomenon in health care, and their prevention is an ongoing challenge. This study aims to investigate whether the application of a silicone-bordered multilayered foam dressing during the initial trauma resuscitation reduces sacral hospital-acquired pressure injury occurrence in trauma patients.

METHODS

This is a single-center quality improvement study using a nonequivalent control group posttest-only design to study the effect of silicone-bordered multilayered foam dressing on the incidence of hospital-acquired pressure injuries. The study population included admitted, highest tier trauma activations, age 18 years and older. Preimplementation 2014 data were compared with postimplementation 2018 data.

RESULTS

The result showed no statistically significant reduction in hospital-acquired pressure injury occurrence between the control and intervention groups. Incident rates for sacral hospital-acquired pressure injuries were 0.23% (2014) compared with 0.21% (2018). No statistically significant difference was found in the hospital and intensive care lengths of stay or injury severity. Preventive dressing costs were $7,689 annually compared with the estimated treatment costs of $70,000 per hospital-acquired pressure injury.

CONCLUSION

Although this study's hospital-acquired pressure injury reduction rate was not significant, the inclusion of multidisciplinary team members in the quality improvement project led to the cultural hardwiring of hospital-acquired pressure injury prevention among all team members beyond that of just nursing.

High body mass index is a strong predictor of intraoperative acquired pressure injury in spinal surgery patients when prophylactic film dressings are applied: A retrospective analysis prior to the BOSS Trial

We reported the efficacy of soft silicone multilayered foam dressings in preventing intraoperatively acquired pressure injuries (IAPIs) in the prone position using a Relton-Hall frame (BOSS trial). The aim of this study was to clarify the incidence and extract the risk factors for IAPIs in cases in which polyurethane film dressing was used against IAPIs before the BOSS trial period. This study conducted as a retrospective dual-center cohort study between August 2014 and Jun 2015 using the medical records in the operating room. The incidence of IAPIs that developed within 24 hours after surgery was 7.1% (7/99). The multivariate logistic regression analysis revealed that body mass index (BMI) (P = .0016, odds ratio [OR]: 1.22, 95% confidence interval (CI) 1.08-1.4) and length of surgery (P < .0001, OR 2.47, 95% CI 1.86-3.51) were independently associated with the development of IAPIs. Since high BMI was not extracted in BOSS trial, we conclude that the application of soft silicone multilayer foam dressings is important for preventing the development of IAPIs in patients with high BMI values.

The effectiveness of curvilinear supine position on the incidence of pressure injuries and interface pressure among surgical patients

BACKGROUND

Intraoperative pressure injury is still a major problem of perioperative nursing. Reducing the peak interface pressure is a valid clinical intervention for reducing the incidence of intraoperative pressure injuries. However, studies of repositioning and pressure-redistributing for surgical patients are still lacking. In this context we aimed to evaluate the effect of a curvilinear supine position on incidence of pressure injury with surgical patients in a hospital setting.

METHODS

This was a prospective, randomized, controlled study, carried out from May to December 2016, included 104 surgical patients from a university hospital in China (experimental group, n = 52; control group, n = 52). Incidence of pressure injury, interface pressure, comfort and satisfaction scores from surgeons, anesthesiologists, OR nurses were recorded. Mann-Whitney U Chi-square test was used for difference of pressure injury's incidence and mixed linear model was used for interface pressure.

RESULTS

Overall the intervention group had significant fewer intraoperative pressure injuries than the control group (0 patients [0%] vs. 9 patients [17.65%], p = 0.002). Compared with control group, the experimental group had significantly lower interface pressures in the sacrum and heel regions (F = 23.81, p < 0.001; F = 60.71, p < 0.001). The subjects felt comfortable in two groups were 40(80%) vs. 3(5.88%) (experimental group vs. control group), respectively (p < 0.001).

CONCLUSIONS

Curvilinear supine position could significantly decrease the incidence of perioperative pressure injuries in surgical patients with surgery duration more than three hours. Considering these results, we recommend that curvilinear supine position use as effective interventions to inform perioperative care delivery, reducing perioperative pressure injuries. These findings may serve to guide the application of pressure redistribution in the surgical positioning of patients during prolonged surgery.