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Sugrue C, Avsar P, Moore Z, Patton D, O'Connor T, Nugent L, Budri A. The Effect of Prophylactic Silicone Dressings on the Incidence of Pressure Injuries on Patients in the Acute Care Setting: A Systematic Review and Meta-analysis. J Wound Ostomy Continence Nurs 2023; 50:115-123. [PMID: 36867034 DOI: 10.1097/won.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE To explore the effect of silicone dressings on the prevention of pressure injuries in patients cared for in the acute care setting. Three main comparisons were explored: silicone dressing versus no dressing, all anatomical areas; silicone dressing versus no dressing on the sacrum; and silicone dressing versus no dressing on the heels. METHODS Using a systematic review methodology, published randomized controlled trials and cluster randomized controlled trials were included. The search was conducted from December 2020 to January 2021 using CINAHL, full text on EBSCOhost, MEDLINE on EBSCOhost, and Cochrane databases. The search returned 130 studies; 10 met inclusion criteria. Data were extracted using a predesigned extraction tool. The Cochrane Collaboration tool was used to assess the risk of bias and the certainty of the evidence was appraised using a software program specifically designed for this purpose. RESULTS Silicone dressings probably reduce the incidence of pressure injuries compared to no dressings (relative risk [RR]: 0.40, 95% confidence interval [CI]: 0.31-0.53; moderate certainty evidence). Furthermore, silicone dressings probably reduce the incidence of pressure injuries on the sacrum compared to no dressings (RR: 0.44, 95% CI: 0.31-0.62; moderate certainty evidence). Finally, silicone dressings probably reduce the incidence of pressure injuries on the heels compared to no dressings (RR: 0.44, 95% CI: 0.31-0.62; moderate certainty evidence). CONCLUSION There is moderate certainty evidence of the effect of silicone dressings as a component of a pressure injury prevention strategy. The main limiting factor in the study designs was a high risk of performance and detection bias. Although this is a challenge to achieve in trials such as these, consideration should be given to how the effect of this could be minimized. A further issue is the lack of head-to-head trials that limits clinicians' abilities to determine whether any of the products in this category are more effective than others.
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Affiliation(s)
- Claire Sugrue
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Pinar Avsar
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Aglecia Budri
- Claire Sugrue, MSc, BSc, RGN, St James's Hospital, Dublin, Ireland
- Pinar Avsar, PhD, MSc, BSc, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Zena Moore, PhD, MSc, FFNMRCSI, PG Dip, Dip First Line Management, RGN, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Lida Institute, Shanghai, China; and University of Wales, Cardiff, United Kingdom
- Declan Patton, PhD, MSc, PGDipEd, PGCRM, BNS(Hons), RNT, RPN, Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; and Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Tom O'Connor, EdD, MSc, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Lida Institute, Shanghai, China; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Linda Nugent, PhD, MSc, FFNMRCSI, PG Dip Ed, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; and Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Aglecia Budri, PhD, BSc, RGN, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
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Lovegrove J, Fulbrook P, Miles SJ. Use of a Sacral Foam Dressing to Prevent Pressure Injury in At-Risk Subacute Hospitalized Older Adults: A Pilot Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2022; 49:322-330. [PMID: 35809008 DOI: 10.1097/won.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this pilot study was to inform a future trial aimed at comparing the effectiveness of a prophylactic sacral dressing plus standard care to standard care only to reduce sacral pressure injuries (PIs) in at-risk older adults admitted to a subacute hospital setting. DESIGN A pilot study with a pragmatic, open-label, randomized controlled trial design. SAMPLE AND SETTING One hundred thirty participants were randomized (intervention n = 66, 50.8%; control n = 64, 49.2%). Protocol violations occurred in 48 participants (intervention n = 33, 68.8%; control n = 15, 31.3%). The study setting was a subacute hospital inpatient care unit located in Queensland, Australia. METHODS Participants were randomly allocated 1:1 to the intervention (prophylactic dressing plus standard care) or control group (standard care). Standard care included regular PI risk and skin assessments, and selection and implementation of preventive interventions (eg, support surfaces and increased repositioning) from a PI prevention care plan. The sacral dressing was applied for intervention participants immediately following recruitment. Ward and research staff collected data and assessed skin integrity daily; participants were followed up until onset of a PI or up to 28 days without PI occurrence. In addition, retrospective chart reviews were undertaken to verify PI occurrences. Patient comfort and dressing utility were also evaluated. RESULTS Two (3.0%) participants in the intervention group and 1 (1.6%) in the control group developed a sacral PI. The difference was not statistically significant. Only 1 PI was recorded prospectively, while 2 PIs were identified via retrospective chart review. Participants rated dressing comfort highly, particularly during the first 2 weeks, and nurses rated utility highly. Based on the intention-to-treat results, a sample size of 1799 per arm would be required in a definitive trial. CONCLUSIONS A definitive trial is feasible and warranted. However, the large sample size required in a definitive trial indicates the need for multiple sites.
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Affiliation(s)
- Josephine Lovegrove
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Paul Fulbrook
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Sandra J Miles
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
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