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alternating pressure, immobility, long-term care, mechanical ventilation, postacute care, pressure injury, support surface



  1. Stone, Arthur DPM


BACKGROUND: Pressure injuries (PIs) are a significant concern for patients with very limited mobility in skilled nursing facilities. Conflicting clinical guidelines and a lack of effectiveness data for the various support surfaces reduces the efficacy of PI prevention programs.


OBJECTIVE: To assess the preventive effectiveness (incidence of facility-acquired PIs) of a low-profile alternating pressure (AP) support surface plus facility-specific PI prevention programs in patients at high risk for PI.


DESIGN AND SETTING: Prospective, multicenter, point-of-care observational study in two for-profit nursing homes in the northeastern US.


PATIENTS AND INTERVENTION: A retrospective review of 101 residents was performed to determine baseline PI incidence. Then, a consecutive sample of 25 participants was selected based on the following eligibility criteria: high risk for PI, bedbound (20 hours or more per day), and stay in a mechanical ventilation unit for more than 5 days. The participants were placed on an AP overlay positioned above a facility-provided nonpowered reactive support surface.


MAIN OUTCOME MEASURE: The development of any new PI (stage 1-4), deep-tissue injury, or unstageable PI in participants using the AP overlay. The PI incidence for the AP group was compared with the retrospective baseline PI incidence from the same units in the two nursing homes.


MAIN RESULTS: The group using the AP overlay had a significantly lower PI incidence (0/25, 0%) compared with baseline (22/101, 21.8%; P < .001). Almost 80% of the study participants in the AP group were completely immobile, 100% of the participants were bowel- and bladder-incontinent, their average time on the AP overlay was 140.9 +/- 94.1 days, and average length of stay in the facility was 633.9 +/- 1,129.1 days.


CONCLUSIONS: The low-profile AP overlay was significantly more effective than facility-specific prevention programs alone in preventing PIs in a high-risk nursing home population over an extended period.