Clinical experts regard the prevention and treatment of pressure injuries as a significant measurement in the quality of  nursing homes and long term care facilities.

The problem by the numbers


Despite major advances in prevention protocols and treatment options, 2.5 million people yearly, in the United States suffer from these injuries. 60,000 of them die.


Quoting from a major study of 2000 patients by UCLA, lead investigator, Dr. Courtney Lyder, Dean of the UCLA School of Nursing indicated “Hospital-acquired pressure ulcers were shown to be an important risk factor associated with mortality,”  Results of the study indicated that the odds of a patient dying in the hospital are 2.8 times higher if the patient has a pressure ulcer.


For most long term care providers, these numbers are untenable and they are constantly seeking new methods to prevent and treat the injuries.  Depending upon the stage and severity of the pressure ulcer, present costs of treating just one can range from $21,000-150,000.


Yet most pressure injuries are preventable.


What can be done to help?


Fortunately, cost and discomfort have led to a significant focus on pressure ulcer prevention procedures and equipment.  The National Pressure Ulcer Advisory Board has even changed the name of the problem from ‘pressure ulcers’ to ‘pressure injuries’.  They did so to focus attention on prevention and treatment to the first stages when the patient has only non-open skin issues.


Prevention starts with assessing the causes of the problem:


  • pressure builds up on one area of skin because the patient can’t ‘sink into’ the bed or cushioned seat. This lack of immersion means that the sleeping or sitting surface focuses pressure on one spot causing major irritation to both the skin and underlying tissue.
  • heat and moisture build-up between the sleeping surface and an immobile patient create an unhealthy microclimate. This causes  the patient to stick to the surface making movement tear the skin.  It also fosters infection.
  • gravity pulling on patients in a sitting (Fowler) position creates shear where the skin gets stretched or torn because it can’t move freely.


Working towards a solution


Most preventative measures focus on regularly relieving the pressure on individual skin areas.  This involves constant vigilance and careful movement of the patient; and, is critical to prevention. Nursing homes and long term care facilities also find that selecting a medical mattress which  reduces underlying causes can be a vital factor in both patient comfort and reduced staff time.


Manufacturers have responded  to the need with several options:  Medicare has grouped them into three categories:


Power Driven Systems (0277)


The basic approach for a power-driven medical mattress is to blow air in and out of alternating parts of the mattress. Varying the amount of air in each area changes the pressure on the patient’s body without a staff person having to move the patient, The effect is to significantly reduce a major source of pressure ulcers.


Moving air also improves the microclimate of the mattress further reducing the chance for infection.


Static Systems (E0184)


A variety of  non-powered systems rely on complex foam structures to better immerse the patient.  Each type utilizes a pattern of foam pieces or cuts in the foam to distribute pressure more evenly across the patient’s body.


Static systems, do not  address the issue of the microclimate and so continue to build up heat and moisture.


Hybrid Systems (0373)


A third category, designated hybrids, now offers several other options for non-powered pressure reducing medical mattresses. All are designed to increase air flow and reduce pressure on the patient. Some have air pockets in foam.  Others provide innovative approaches and materials such as rebounding gels and polymer string technology.  .


With hybrids, nursing home operators  are assured of purchasing a quality product because Medicare holds these innovative medical mattresses to a higher standard. They must outperform five inches of foam.


Mattress covers can also be part of reducing pressure ulcers.


The AirString mattress and cover system combines a number of benefits to provide nursing home operators and their patients with enhanced pressure injury prevention.  The mattress is based on a completely new concept which encapsulates pocket of air in a nest-like structure of flexible polymer strings which pull against each other to move as the patient moves.  This unique mattress and its innovative cover address all three fundamental causes of pressure injuries:


  • The medical mattress provides significant patient immersion. The airstring technology distributes pressure across the entire surface touched by the patient’s body.  It also gives the sleeper great ease of movement.  As a result, no single area receives excess pressure which can lead to a pressure injury..
  • It addresses the microclimate issue in two ways: the nested structure of the medical mattress core holds large pockets of air which is constantly being circulated just by patient movement. This unique quality means that there is no build up of either heat or moisture to make the patient uncomfortable and set the starting conditions for a pressure injury.  A unique feature is that, should the mattress become soiled, the core can easily be taken out and washed under a shower.
  • The cover also plays a large part in pressure ulcer prevention. In addition to reducing  the heat and moisture based stickiness that leads to shearing of the skin, the AirString mattress cover has a stretch quality which helps it move with the patient, even,  in the Fowler position. This reduction of skin rubbing on cloth significantly reduces the chance of tearing the skin.  .  . the most commonly mentioned cause of pressure injuries.


Are pressure injuries truly preventable?  An attentive staff working with the right equipment can certainly make a critical difference.