Skin IQ Microclimate Manager made easy
23/05/11 | Complex wounds, Pressure ulcers, Skin integrity
This article describes the importance of microclimate control in pressure ulcer prevention and treatment.
Authors: Clark M, Black J
This article focuses on the structure and mode of action of a new cover system - the Skin IQ™ Microclimate Manager (KCI). For many years, the use of support surfaces in pressure ulcer prevention has concentrated on reducing the mechanical load on the skin. However, when selecting products, there is now a need for clinicians to also consider how well a support surface manages conditions at the interface between the skin and the support surface (the microclimate).
What is a microclimate?
In relation to pressure ulcer development, microclimate was initially a term used to describe three aspects of the interface between the skin and a support surface - skin temperature, humidity and air movement1. In early pressure ulcer publications, the maintenance of a favourable microclimate was seen to be a key modifier of the ability of skin and underlying soft tissue to withstand prolonged stress (eg pressure and shear). However, the concept has been largely overlooked since the 1970s .
In recent years, microclimate has again been attracting attention, but is now associated with two parameters - temperature (of the skin or the soft tissues) and humidity or skin surface moisture at the interface between the skin and the support surface [3,4]. Air movement has been omitted from the more recent definition as the movement of air can itself affect skin temperature and local humidity
Further clarification of the elements of microclimate is needed to aid clinicians in judging the condition of patients who are using support surfaces . Objective measurement of skin temperature and humidity presents practical problems and may require equipment not readily available in clinical settings. Box 1 outlines recently proposed definitions of microclimate, with suggestions for measurement of the parameters involved.
Why is microclimate important?
Successful pressure ulcer prevention depends upon a complex balance between two sets of parameters - the external loads applied to the skin and soft tissues, and the intrinsic ability of the skin and soft tissues to withstand prolonged or excessive loading. If loading increases, and/or the intrinsic resilience of the skin and soft tissues deteriorates, the balance is tipped and pressure damage is more likely to occur (Figure 1).
This concept is also illustrated in Figure 2. This is a modification of the Reswick-Rogers curve that describes the relationship between pressure and time . The area above the blue line indicates pressure and the duration of application that is likely to induce pressure damage. When the resilience of skin and soft tissue is compromised, however, the curve shifts to the left and down (the red line), demonstrating that in these cases lower pressure of a shorter duration can also cause damage.
As explained below, changes in the microclimate at the skin/support surface interface can affect the body's ability to withstand the effects of external factors, such as pressure. As a result, changes to microclimate may alter tissue tolerance and make pressure ulcers more or less likely to develop, depending on the temperature and humidity changes that have occurred.