Heel Response to External Pressure: Is it the Same in Healthy Community-Dwelling Adults and in Hip Surgery Patients?

Effect of Pressure Loading on Heel Skin Temperature and Moisture in Healthy Volunteers: Preliminary Results

Recent studies emphasize the significance of skin microclimate in the prevention of pressure injuries (PI). The objective was to evaluate the effect of pressure loading on skin temperature and moisture in the heels of healthy adults. This is a before-and-after study performed at Brazil, in October 2022. Skin temperature (°C) was measured by an infrared digital thermometer, and skin moisture (%) using electrical bioimpedance. Ten individuals/twenty heels were evaluated. The average temperature of the right and left heel was the same at baseline (27.2 °C). It was recognized that after 30 min of pressure loading on the heels, there was a decrease in temperature, and after 15 min of pressure offloading, the temperature decreased again. It was found that at t0, the moisture of the right heel (12.6%) was lower than the left heel (15.6%). The median moisture in the right heel increased from t0 to t1 and decreased in t2, while in the left heel, there was a small variation of the median from t0 to t1, as well as to t2. The pressure loading leads to a decrease in temperature and changes the skin moisture of the heels of healthy individuals.

Prevention of heel pressure ulcers among adult patients in orthopaedic wards: an evidence-based implementation project

BACKGROUND

Immobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels.

AIMS

The evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel pressure ulcers.

METHODS

The project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and involved a sample consisting of 30 adult patients.

RESULTS

Nurses' compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project resulted in more than 50% reduction in stage one heel pressure ulcers.

CONCLUSION

The implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.

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

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.

Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes

We examined subepidermal moisture (SEM) and visual skin assessment of heel pressure injury (PrI) among 417 nursing home residents in 19 facilities over 16 weeks. Participants were older (mean age 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, 21% Hispanic), and at risk for PrI (mean Braden Scale Risk score = 15.6). Blinded concurrent visual assessments and SEM measurements were obtained at heels weekly. Visual skin damage was categorised as normal, erythema, stage 1 PrI, deep tissue injury (DTI) or stage 2 or greater PrI. PrI incidence was 76%. Off-loading occurred with pillows (76% of residents) rather than heel boots (21%) and often for those with DTI (91%). Subepidermal moisture was measured with a device where higher readings indicate greater moisture (range: 0-70 tissue dielectric constant), with normal skin values significantly different from values in the presence of skin damage. Subepidermal moisture was associated with concurrent damage and damage 1 week later in generalised multinomial logistic models adjusting for age, diabetes and function. Subepidermal moisture detected DTI and differentiated those that resolved, remained and deteriorated over 16 weeks. Subepidermal moisture may be an objective method for detecting PrI.