Atsuko Kitagawa

Comparison of two pressure ulcer preventive dressings for reducing shear force on the heel.

OBJECTIVE We compared the shear forces exerted over the heel between a pressure ulcer preventive dressing and a thin-film dressing in a clinical setting. Interface pressures were measured as well. DESIGN Quasi-experimental clinical trial. SETTING AND SUBJECTS Participants were 30 elderly patients (5 men, 25 women; mean age, 86.4 ± 8.0 years) hospitalized in a geriatrics hospital in Japan; all had a Braden score of less than 14 (mean, 10.1 ± 1.1). Informed consent was obtained from all the patients. A shear force and pressure sensor including a strain gauge, and an oval airbag-type pressure sensor were used. METHODS The sensor was attached to one heel using double-sided tape; then the target dressing was applied over the sensor and on the opposite heel to avoid the influence of the opposite heel on the shear force measurement. Interface pressures were measured with the patient in a stationary supine position; shear force was then measured at 0.2-second intervals, while the sheet was manually pulled at a velocity of around 5 cm/second. Shear force was determined by averaging the stable shear force lasting for 10 measurement points. RESULTS The mean interface pressures with the PPD and the film dressings were 70.7 ± 16.5 and 70.2 ± 15.2 mmHg, respectively; this difference was not statistically significant. The shear force produced during the pulling of the sheet was 2.2 ± 1.4 and 11.7 ± 5.8 N, respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS The results of this study suggest that a dressing with a low-friction external surface (such as the pressure ulcer preventive dressing) can significantly reduce shear force. However, results also suggest that external dressings do not significantly reduce interface pressures and cannot be used as a substitute for heel elevation in an immobile patient.

Randomised controlled trial to evaluate a new double-layer air-cell overlay for elderly patients requiring head elevation

A clinical investigation was conducted concerning the effects of a newly designed double-layer air-cell overlay in preventing the onset of pressure ulcers for patients with a Braden scale score of < or = 16, and who require a head-elevated position of 45 degrees or higher. A randomised controlled trial was undertaken involving 82 patients from a general hospital ward using one of the following three support surfaces: a double-layer air-cell overlay, a single-layer air-cell overlay or a standard hospital mattress. A significantly lower percentage of patients using the double-layer air-cell overlay developed pressure ulcers (3.4%) compared to 19.2% and 37.0% for those patients using the single-layer air-cell overlay and standard mattress respectively. Based on these findings, a double-layer air-cell overlay should be more effective in preventing the onset of pressure ulcers than either a single-layer air-cell overlay or a standard hospital mattress for subjects requiring head elevation.

Risk factors in the development of pressure ulcers in an intensive care unit in Pontianak, Indonesia

The purpose of this study was to identify risk factors associated with the presence of pressure ulcer development in adult patients at an intensive care unit hospital in Indonesia. The prospective cohort design was conducted in this study. A total of 105 patients participated and a pressure ulcer developed in 35 patients. The initial analysis identified several variables as significant risk factors for pressure ulcer development (interface pressure, fecal incontinence, skin moisture, diastolic blood pressure, smoking and body temperature). However, when entered into a final multivariate analysis, four factors, interface pressure [odds ratio (OR) 17·6, 95% confidence interval (CI) 4·1, 74·3], skin moisture (OR 8·2, 95% CI 2·2, 30·9), smoking (12·7, 95% CI 2·8, 56·7) and body temperature (OR 102·0, 95% CI 7·7, 98·8) were found to be significant. The results suggest that interface pressure measured using a multipad pressure evaluator, skin moisture measured by a moisture checker, thermometer for body temperature and smoking status are adequate instruments for the prediction of pressure ulcer development.

A new instrument for predicting pressure ulcer risk in an intensive care unit

The purpose of this study was to assess the utility of two instruments (the Braden scale and a multi-pad pressure evaluator) for predicting pressure ulcer development. A prospective cohort design was used and 105 intensive care unit patients participated in this study. The result was a 33% incidence of pressure ulcers. Both the Braden score and the multi-pad pressure evaluator instruments gave significant differences between patients who did and did not develop pressure ulcers. The predictive validity of these tools was calculated. The results indicated that the multi-pad pressure evaluator provided the best balance between sensitivity and specificity. We suggest that the multi-pad pressure evaluator may be better suited for assessing the risk of pressure ulcers in intensive care units.

Incontinence Induces Stratum Corneum Vulnerability and Impairs the Skin Barrier Function in the Perianal Region

Background: Incontinence leads to a reduced skin barrier function, while also increasing the risk of skin breakdown. Aim: To investigate the perianal skin barrier function of elderly patients with or without incontinence. Methods: We compared the skin barrier function by investigating the skin hydration, the skin pH, the amount of ceramide and by making a dermatological skin inspection of the perianal region in patients with and without incontinence. Results: Twenty-one incontinent patients (70.0%) showed a glossy skin, which indicates impairment of the skin barrier while none of the patients in the continence group did so. In the incontinence group, those who had a glossy skin showed a significantly greater skin pH and total amount of ceramide than those with a normal skin (p = 0.0099, p = 0.0179, respectively). Conclusions: These results demonstrate that a glossy skin may be a useful indicator of a reduced perianal skin barrier function.

Interface pressure distribution of elderly Japanese people in the sitting position

Aim. To investigate the characteristics of elderly Japanese people sitting in a wheelchair using pressure mapping and an objective method to classify sitting patterns. Method. This descriptive observational study was conducted in a senior care facility and a geriatric hospital, with 107 elderly subjects (37 group A (house-bound), 34 group B (chair-bound) and 36 group C (bed-bound)) and 36 able-bodied. Maximum pressure, total support area, distance from backrest to coccyx and sitting pattern were collected by using a pressure mapping system. Results. Maximum pressure was significantly lower for able-bodied than groups B and C (p < 0.001 and p = 0.024, respectively). Total support area was significantly larger for able-bodied than each elderly group (group A p = 0.014, group B p = 0.021, and group C p < 0.001). Distance from backrest to coccyx was significantly longer for group C than able-bodied (p < 0.001). The occurrence of proper sitting pattern significantly decreased as the degree of independence reduced (p < 0.001). Conclusion. Elderly people with disabilities have high interface pressure on a small support area, malposition, which is confirmed by longitudinal and lateral supporting balance indices, and imbalance in a wheelchair. The following concepts for developing cushions should be considered: low interface pressure with large support area, individual adjustment of sitting position and stability of body trunk.