The Challenge

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  Pressure Ulcers: Avoidable or Unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference

  2011

  The National Pressure Ulcer Advisory Panel (NPUAP) hosted a conference in 2010 to establish consensus on the avoidability of pressure ulcers. An overall 80% agreement was reached among representatives, with unanimous consensus reached for the following: most PrUs are avoidable; not all PrUs are avoidable; there are situations that render PrU development unavoidable, including hemodynamic instability that is worsened with physical movement and inability to maintain nutrition and hydration status and the presence of an advanced directive prohibiting artificial nutrition/hydration; pressure redistribution surfaces cannot replace turning and repositioning; and if enough pressure was removed from the external body the skin cannot always survive.

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  Pressure Ulcer Incidence and Progression in Critically Ill Subjects: Influence of Low Air Loss Mattress Versus a Powered Air Pressure Redistribution Mattress

  2012

  This study evaluated the change in existing pressure ulcers and incidence of new pressure ulcers in surgical ICU patients using a new low-air-loss, weight-based, microclimate management (LAL-MCM) system compared to the standard SICU bed with an integrated, powered air pressure redistribution (IP-AR) surface. Incidence of supine pressure ulcers was 0% in the LAL-MCM group and 18% in the IP-AR group (P=0.046), despite more comorbidities in the patients in the LAL-MCM group. 

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  The Effect of Using a Low-Air-Loss Surface on the Skin Integrity of Obese Patients: Results of a Pilot Study

  2009

  This study assesses the impact of a new low-air-loss, continuous lateral rotation therapy bed in 21 obese, bariatric acute care patients. During this pilot study, pressure ulcers decreased in size from an average 5.2 cm2 to 2.6 cm2, and no new pressure ulcers developed. 

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  Treating Severe Pressure Ulcers in the Home Setting: Faster Healing and Lower Cost with Air Fluidized Therapy

  2004

  This article describes how AFT is technologically different from Group 1 (Static devices / mattresses) and Group 2 (dynamic powered and nonpowered mattress replacements and overlays). Using the healing rates described by Ochs, (2004) Cuddigan and Ayello model treatment costs for severe ulcers. They find a net savings of $39, 642 to heal a 49-cm2 stage III/IV ulcer when using AFT compared to Group 2 surfaces. 

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  Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients

  2011

  Air-fluidized therapy beds were provided for patients who required vasopressors and mechanical ventilation for at least 24 hours postoperatively. While on therapy beds, only 1 of 27 patients developed a stage I ulcer versus 40 ulcers developed in 25 patients prior to therapy bed implementation despite already being a high-risk population for the development of pressure ulcers due to severity of illness.

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  Comparison of Air-Fluidized Therapy With Other Support Surfaces Used to Treat Pressure Ulcers in Nursing Home Residents

  2005

  This retrospective pressure ulcer prevention and treatment study compared healing rates for different support surfaces in nursing home residents. Support surface types were categorized into 3 groups: static overlays and replacement mattresses (1); low-air-loss beds, alternating pressure, and powered/nonpowered overlays/mattresses (2); and air-fluidized beds (3). Mean healing rates were as follows: 5.2 cm2/wk (Group 3); 1.8 cm2/wk (Group 2); 1.5 cm2/wk (Group 1) (P=0.007 comparing Group 3 to 1 and 2). Mean healing rates were also significantly greater for stage III/IV ulcers on Group 3 surfaces. Groups 1 and 3 had fewer hospitalizations and ER visits compared to Group 2 (P=0.01). 

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  High Pressure Ulcer Risk Patients and Specialty Surface Utilization: Data From the 2010 International Pressure Ulcer Prevalence™ Survey

  2011

  This study evaluated current practice trends in surface utilization for patients at high risk for developing pressure ulcers. Surface types used for high-risk patients were powered static air (28%), foam (21.7%), low air loss (16%), self-adjusting technology (8%), alternating pressure (5.2%), nonpowered static air (2.0%), and air-fluidized therapy (1.8%), demonstrating that high-risk patients were most often placed on surfaces that are inferior to specialty surfaces with regard to pressure ulcer development and breakdown. 

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  Identifying Gaps, Barriers, and Solutions in Implementing Pressure Ulcer Prevention Programs

  2011

  This project identified 3 major barriers to pressure ulcer prevention program implementation: limitations in staff education and training, poor communication of at-risk status, and insufficient quality improvement evaluation of bedside practices. The study noted insufficient clarity for selecting and securing appropriate therapy surfaces. Guidelines were identified for addressing these barriers. 

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  The Path to Excellence: How One Facility Received and Maintained a CMS 5 Star Rating

  2010

  This whitepaper describes surveillance and documentation processes for quality measure, including facility-acquired pressure ulcers, weight loss, medical errors, and infection control. Quality improvement process changes incorporating the use of pressure-redistributing mattresses have improved rates and facility-acquired pressure ulcers

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  A Pilot Study of Pressure Ulcer Incidence and Healing of Pressure Ulcers Comparing Subjects Placed on the LAL-MCM Mattress Versus a Standard Bed SICU Mattress

  2010

  This study evaluated the change in existing pressure ulcers and incidence of new pressure ulcers in surgical ICU patients using a new low-air-loss, weight-based, microclimate management (LAL-MCM) system compared to the standard SICU bed with an integrated, powered air pressure redistribution (IP-AR) surface. Incidence of supine pressure ulcers was 0% in the LAL-MCM group and 18% in the IP-AR group (P=0.046), despite more comorbidities in the patients in the LAL-MCM group.

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