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News archive - January 2015

Taking the pressure off

Taking the pressure off

Pressure ulcers - also known as pressure sores or bed sores - are a painful, distressing, and largely-preventable condition that costs the NHS an estimated £3.8m A DAY.

Each new sore costs an average of £4,000 in nursing care, with treatment for severe cases believed to be in excess of £40,000 per patient. It is also believed that the condition accounts for 2% of all preventable deaths.

The problem occurs when the skin is put under pressure, disrupting blood flow and leading to the breakdown of the skin and the formation of ulcers. At their most severe, these ulcers can expose the bone or muscle beneath and potentially lead to blood poisoning or gangrene.

Those most at risk include people with reduced mobility, in particularly the elderly, and patients with vascular damage or conditions that affect blood flow, such as type 2 diabetes. Those who are malnourished or dehydrated are also particularly liable to develop pressure ulcers.

On a mission

With 700,000 people affected every year, and a large majority of ulcers acquired by patients while in hospital, it is no surprise that the NHS is on a mission to reduce the problem.

In 2010, the NHS adopted a ‘zero tolerance’ approach to the problem, with the now-defunct National Patient Safety Agency conducting a number of briefings and workshops at NHS organisations, highlighting and urging staff to share best practice. The National Institute for Health and Care Excellence (NICE) also updated its Prevention and Management of Pressure Ulcers guidance last spring; and the Royal College of Nursing has published the document, The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care.

As a result NHS organisations are beginning to wise up to the need to adopt novel technologies that can help both to reduce the chance of patients getting pressure ulcers, and to stop them getting worse once they develop.

The NICE guidance states that high-specification foam pressure-relieving mattresses should be used for adults who are admitted to secondary care and have been assessed as being at high risk of developing an ulcer. It also recommends foam theatre mattresses or equivalent pressure-redistributing surfaces for all adults undergoing surgery and all at-risk neonates, infants and children.

“The management of pressure ulcers requires a multidisciplinary approach for optimum management to be achieved,” the document states.

“Usually the first requirement when a pressure ulcer develops is to remove the causal process by introducing pressure-relieving strategies such as repositioning and the use of appropriate support surfaces.

“A vast range of devices, including different types of mattresses, overlays, cushions and seating, are available, which vary considerably in both cost and mechanism.

Make your choice

“Generally, these devices work by reducing pressure, friction or shearing forces and may be unpowered and considered ‘low-tech’ or ‘static’, or powered devices which are ‘high-tech’.

“The selection of device by the healthcare professional is likely to depend upon the person’s mobility, the result of skin assessment, the severity and site of the pressure ulcer, weight, staff availability and skill.

“The choice of a pressure-redistributing device by a healthcare professional should also account for a person’s wishes and tolerability of the device.”

Speaking to hdm, Kerry High, commercial manager at Sidhil, which manufactures a range of pressure-relieving mattresses, said: “Most healthy people can reposition regularly and independently and relieve pressure, but some patients are unable to or have poor blood circulation, poor skin integrity, poor nutrition etc and need assistance to reposition and allow consistent blood flow.”

The most-common type of pressure-relieving mattress is alternating therapy. This works by mimicking natural repositioning by deflating alternate cells with the mattress over a certain time period.

Constant Low Pressure mattresses use a low-pressure static air surface which reduces peak pressures in vulnerable areas by increasing the surface contact area. The patient immerses into the mattress more, spreading contact over a larger area. These are often used for patients who do not like a moving surface or as a step-up or step-down from a standard static foam mattress.

Low air loss mattresses provide extreme immersion, giving extremely low pressures, making them suitable for pain management, palliative care, burns patients, and in paediatrics.

Mattresses are also zoned so there are different pressures in different areas ie static head section, body section, or heel section.

Fully-automatic systems, which are becoming increasingly popular assess the patient’s weight/distribution and adjust internal pressures accordingly.

Reducing the risk

High said: “Mattresses can be an extremely useful tool in reducing the risk of developing pressure ulcers, but in addition to the supply of the mattress, it is important for staff to be able to use them effectively, so training is very important.

“Mattresses are not effective on their own and it is important for continuous assessment and intervention by the carer or clinical team. Management of mattress usage is also useful to ensure they are used for appropriate patients and that they are stepped down onto a foam mattress when appropriate as it is important to maintain patients’ independence.”

When choosing mattresses, she advises the following:

  • Ensure the mattress does everything needed, but is not too complicated that staff do not use it effectively
  • Look for features such as a cable tidy to reduce trip hazards, a non-slip base, covered zips, and ease of access for CPR, even when the safety sides are raised
  • Clear indication of any fault
  • Ensure it is not too deep as this can increase the risk of injury in the event of a fall from the bed
  • Ensure it fits the bed frame - current standards BSEN - 60601-2-52 state recommended dimensions
  • Ensure sufficient patient weight limit. Don’t always go for the highest weight limit if the majority of the patients do not require this. The higher weight limit could make the mattress less clinically effective for lower-weight patients or the mattress may be deeper
  • Ensure the mattress is easy to clean and maintain and that spare parts are not too expensive

Sidhil has supplied mattresses to a large number of NHS hospitals, including the Royal Liverpool University Hospital and Broadgreen Hospital. Products available include its flagship Artemis model, a fully-automatic dynamic mattress; and the Apollo Dynamic mattress, a dual therapy system offering both alternating and static therapies for effective pressure relief.

Doncaster and Bassetlaw Hospitals NHS Foundation Trust is also addressing the problem. Last year it took delivery of 114 Transair mattresses, developed by Karomed. They work by detecting pressure points on a patient’s body, such as the shoulders, buttocks and heels. The skin is then protected by air-filled cushions located inside the mattress, which gently inflate and deflate via an electric pump.

And Medstrom recently signed a commercial partnership deal with the Welsh Wound Innovation Centre for the provision of bed and pressure care products and services.

The future

This increased interest in pressure-relieving mattress technology is expected to drive further enhancements over the coming months and years.

High said: “There has been increased use of hybrid mattresses, which are foam/air solutions. In addition, some of these mattresses allow you to fix a pump to offer a change in pressure.

“Valve technology, in particular, is a valued feature as the NICE guidelines identify the benefits of offloading pressures on the heels, a particularly vulnerable area.”

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