Pressure Ulcer Prevention: Comparing Support Surfaces

Most pressure ulcers can be prevented with good nursing care, and those Stage I pressure ulcers that do appear need not worsen under most circumstances. However, for patients considered to be at high risk, even the most vigilant nursing care may not prevent pressure ulcer development. An intensive effort must be aimed at reducing risk factors and incorporating research-based preventative measures. The purpose of the proposed study is to expand on information learned from a previous study, "Pressure Ulcers: Patient Outcomes on Kinair Bed or EHOB Mattress," by comparing the incidence of pressure ulcer development in patients randomized to one of two pressure reduction support surfaces. Subjects will consist of patients considered to be at high risk for pressure ulcer development as determined by the Braden scale for Predicting Pressure Sore Risk. The specific aims of this study are as follows: 1) Determine the demographic characteristics that differ between patients who do and those who do not develop pressure ulcers, 2) Compare the incidence of pressure ulcers between the patients on the KinAir bed and patients on the EHOB WAFFLE mattress, 3) Determine the difference in length of stay and monetary expenditure for individuals within the two support surface groups who do not develop pressure ulcers, and 4) Determine the difference in length of stay and monetary expenditure for individuals within the two support surface groups who do develop pressure ulcers. The proposed study utilizes a prospective, quasi-experimental design. In a three year period, 560 subjects will be recruited at two military tertiary medical centers and randomly assigned to one of two support surfaces. Data to be collected will include a pressure sore risk assessment, daily skin integrity assessments, data on pressure ulcer development and progression, and selected demographic variables. Demographic variables will be compared using chi-square for dichotomous variables and t tests for continuous variable; logistic regression will be applied to the variables that differ significantly between the two groups. Chi square will be used to evaluate the proportion of patients on each support surface type who develop pressure ulcers. Severity of sores and skin assessment scores for the two treatment groups will be compared using the Mann-Whitney U test. Differences in length of hospital stay and cost of hospital care between treatment groups will be compared using independent t tests. This analysis will be made independently for patients who do develop pressure ulcers and for those who do not.

Given the current healthcare economy, it is important that hospitals make sound decisions about the support surfaces used for high risk patients. This research team is dedicated to investigating the pressure ulcer prevention efficacy of two support surfaces with the hopes of making informed, cost-conscious decisions in the near future.