Using dressings such as an absorbent soft silicone self-adherent bordered foam dressing (Mepilex Border Sacrum, Mölnlycke Health Care) to protect vulnerable areas – particularly the sacrum, pelvic area and heels – of patients at risk of developing pressure ulcers is a relatively economic and practical means of reducing pressure ulcer incidence.

INTRODUCTION

Over the past 30 years clinicians have sought to find approaches to care that will solve the thorny issue of pressure ulcer damage. Huge amounts of effort and money have been put into developing care frameworks, educational packages and high-tech pressure-relieving equipment. These efforts should be applauded and yet provision of care free from the fear of pressure ulcer development is still not universally available. 

The international economic downturn means that healthcare providers must look at reducing expenditure and investing in low-cost approaches and strategies to care provision. In the UK, all the major political parties have indicated that public service funding will be reduced following the 2010 general election and, in the US, the estimated cost of pressure ulcers to the US hospital sector is considered unsustainable and unacceptable at $11 billion a year [1]. Therefore, in an effort to control costs and raise quality standards, the Centers for Medicare and Medicaid Services has determined it will no longer reimburse hospitals for treating a range of hospital-acquired conditions, including pressure damage [2].

One approach to this problem could be to explore the possible role of relatively simple dressings to minimise extrinsic mechanical risks associated with pressure ulcer development. This innovation could make preventative approaches accessible to a larger number of patients and could have benefits where high-tech approaches are not effective. 

INTERVENTIONS DESIGNED TO REDUCE SHEAR AND FRICTION

Although there have been many studies focusing on the pivotal role of pressure in pressure ulcer development, owing to technical and ethical issues, little research has been undertaken on the action of shear and friction and how the impact of these mechanisms can be reduced [3].

Some progress has been made; certain practices, such as massage, for example, have been found to be dangerous and have been largely abandoned [4-7]. Clinicians are advised to use care in positioning patients to minimise shear forces [8-10], and to use low-friction turning and repositioning aids to minimise soft tissue damage [11]. Although some authors have advocated the use of preventive dressings and skin sealants to help reduce friction and shear, and thereby reduce the risk of skin damage, work in this area has been at best sporadic [10-12].

The practice of using simple adhesive dressings to minimise friction is accepted by many in healthcare as a commonsense approach, in much the same way as wound plasters are used to prevent new footwear rubbing and producing painful blisters. However, from experience there appears to be a reluctance amongst some practitioners to embrace this concept, stating that dressings do not prevent pressure damage, are not scientifically validated in this indication and are not cost-effective. The implications of this view cannot be overstated when it is considered that while the clinical community is aware of the mechanisms of pressure-related damage and the enormous amount of money that has been invested in pressure-redistributing surfaces, pressure ulcers remain such a common occurrence [13].