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8/6/2011

A patient who is immobile due to illness or injury is at high risk for developing pressure ulcers because they are unable to shift weight by turning in bed or moving in a chair. Pressure over bony prominences such as hips, buttocks, sacrum, or heels may cause shearing and friction. Moisture from sweating, urinary, or fecal incontinence can also contribute to pressure ulcers. According to the National and European Pressure Ulcer Advisory Panels, incontinence associate dermatitis (IAD) differs from that of a pressure ulcer, however these conditions often coexist.  Persons with fecal incontinence are 22 times more likely to develop a pressure ulcer. Poor nutrition, reduced blood flow due to circulatory disease, loss of sensation in extremities from diabetes and other diseases, cognitive impairment, restraints, medications, hydration, and old age can also be significant risk factors.

Pressure ulcers can be a costly complication for both the patient and hospital. Pressure ulcers are painful to the patient and can be very upsetting to the patient’s family and caregivers. If a pressure ulcer occurs, it can take a week, sometimes months, to heal depending on the severity. This extends the stay of the patient.  protevo_blogIn some severe cases, septicemia can result, which is a life threatening condition. Patients can develop osteomyelitis (bone infection), which leads to long term and costly intravenous antibiotic therapy. Stage III or Stage IV pressure ulcers may require surgical debridement or muscle flap grafts to help close the wound.  Patients are often required to be bed bound to offload severe pressure ulcers for weeks or months.  Surgical interventions are costly to the facility if hospital-acquired.  Once a severe pressure ulcer heals there is still potential of recurrence at the wounds site due to decreased tensile strength of the tissue. Pressure ulcers are the second iatrogenic cause of death, after adverse drug reactions. The financial burden to the hospital for any stage wound can be significant and a stage IV pressure ulcer can be more than $100,000 for treatment and related complication costs, which may be unrecoverable with the reimbursement changes.

Prevention is key. A patient who is confined to a bed or chair needs to be repositioned at least once every two hours to reduce mechanical load and skin care treatment programs. These are also key in preventing pressure ulcers.

How does LINET fit in? Lateral Turn assist! The bed becomes part of the “turning team”. Use of positioning pillows, wedges, and floating of the heels is also recommended. Frequent skin assessment will help determine the turning schedule. Manual turning increases potential of caregiver injury. Turn assist will help make the two hour turn more efficient and with less discomfort to the patient. It’s easier to clean the patient and/or do skin and wound care. The bed will hold the patient in place better.

Pressure Relief: How does LINET help?
The use of a pressure-redistribution mattress is also recommended. However, this does not negate the need for turning or repositioning. At LINET, we have a full surface portfolio, including foam and gel prevention surfaces, hybrid surfaces, and fully integrated all air solutions. The Protevo GTE mattress offers an excellent option with static surface that can be converted to an active therapy surface by adding a simple pump.

Microclimate management-Moisture and Humidity control: How does LINET help?
Skin care teams can help to develop protocols for prevention of pressure ulcers and also utilizing a structured skin care regime for incontinent patients. Utilizing microclimate management (Symbioso 200) to prevent and treat IAD (incontinence induced dermatitis). Moist skin is at higher risk for shearing and can cause bacteria growth.  Minimizing layers of fabric under patients may inhibit the effectiveness of microclimate management from support surfaces.

Remember:
• HAPU- prevention is key, turning patients and keeping skin dry to minimize tissue injury
• Promote turning schedule compliance with easier controlled turn with Lateral Tilt
• Surface portfolio options from prevention to treatment
• Microclimate management (Symbioso) should always be recommended for ICU, with the exception of trauma unstable spine units.

References
High Cost of Stage IV Pressure Ulcers / Harold Brem, MD, Jason Maggi, MD, David Nierman, MD, Linda Rolnitzky, MS, David Bell, BS, Robert Rennert, BA, Michael Golinko, MD, Alan Yan, MD, Courtney Lyder, ND, and Bruce Vladeck, PhD

Patient Safety and Quality: An Evidence Based Handbook for Nurses.
Courtney H. Lyder; Elizabeth A. Ayello.

National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel:  Prevention and Treatment of Pressure Ulcers:  Clinical Practice Guideline.  Washington, D.C.: National Pressure Ulcer Advisory Panel; 2009.

To learn more about LINET, visit www.linetamericas.com or join us on social media.

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