Clinical evidence: Prevention of pressure ulcersI
In this white paper, we compile relevant clinical studies and scientific data to provide an in-depth insight into how advanced support surface technology can help prevent severe pressure injuries, optimise resource utilisation, and reduce patient suffering.
This phrasing sets a very heavy, academic tone for the studies and references you are about to present.
Which specific clinical studies or research results are we going to look at in this section?
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Pressure ulcers cost Swedish healthcare close to 3 billion SEK every year. However, the cost is not only measured in money but also in unnecessary human suffering. By understanding pressure, shear, and the properties a healthcare mattress should possess, the opportunities to prevent injuries before they occur increase.
Here we clarify the concepts around pressure distribution, why ”common weight” is a blunt measure and why a fit for purpose The mattress does not need a separate heel zone.
To understand why pressure ulcers occur, we need to look at the entire care chain. Let’s take a real-life example: 80-year-old Elsa falls at home. She lies on the floor for two hours before the home care service finds her. She is then taken by ambulance to A&E, where she faces a long wait.
Statistics from the National Board of Health and Welfare show that the median waiting time in an emergency department for patients over 80 years old is 3 hours and 39 minutes [1]. By the time Elsa is finally wheeled into a ward with an adequate pressure-distributing support, she has already spent nearly seven hours on hard stretchers and trolleys. As harmful pressure in an early stage impairs tissue resistance later on, there is a significant risk that pressure damage has already been initiated.
A pressure injury is defined as localised damage to the skin and/or underlying tissue, usually over a bony prominence. The injury occurs as a result of pressure, or pressure combined with shear, leading to mechanical tissue deformation and localised oxygen deprivation when the blood supply is cut off. Several factors often interact in this process:
Statistics show that up to 95 % of all pressure ulcers develop at anatomical risk sites where bony prominences lie close to the skin, particularly at the sacrum (the crossbone) and the heels.[5]
Why do some patients develop pressure ulcers while others avoid them, despite the same immobility period? The answer often lies in microcirculation.
Normally, the body has a physiological defence mechanism known as pressure-induced vasodilation (PIV). When tissue is subjected to pressure, the blood vessels dilate (vasodilation) to maintain perfusion (blood flow) and oxygenation. However, research shows that a significant proportion of high-risk patients have impaired or completely absent PIV function. In these individuals, microcirculation is immediately compromised upon mechanical loading, without this physiological compensatory mechanism being activated.
As it is clinically impossible to identify, with the naked eye, which patients lack this protective mechanism, the healthcare mattress must act as a proactive safety barrier for all individuals. The design must provide such effective and optimised pressure distribution and immersion that external mechanical stress is minimised. By reducing tissue deformation, the right conditions are created to protect the patient – even when the body’s own physiological defences fail.
Achieving effective pressure redistribution requires more than just softness. It requires a support surface that operates on the biomechanical principles of immersion and envelopment, combined with regular and structured repositioning of the patient.
In this context, OptiCell Tender has been developed. It is a system designed to integrate these three critical components into a single mattress solution, providing the caregiver with an effective and reliable aid in preventing and supporting the treatment of pressure sores.
1. Immersion
In order to distribute body weight over as large a contact area as possible, the patient must be allowed to sink deeply into the surface. The larger the surface area supporting the body mass, the lower the local pressure on individual and particularly vulnerable anatomical risk points (such as the heels and sacrum).
2. Envelopment
Immersion alone is not enough – the material must also be able to conform to the body's irregularities without generating harmful counter-pressure. The surface should envelop the body contours and fill the cavities around them.
If the support is inadequate, a so-called ”hammock effect” occurs, whereby the surface layer is stretched horizontally and the patient ends up lying on top of the material. This concentrates and dramatically increases the pressure on protruding body parts and bony prominences.
3. Repositioning (Change of position)
No mattress can entirely eliminate the need for movement. Pressure ulcers develop over time, and therefore, regular repositioning is crucial to give the tissue a chance to recover.
Turning schedules: By systematically changing the patient’s position (e.g. from a supine position to a side-lying position), the pressure is shifted to new areas.
The right technique: When repositioning a patient, it is crucial to avoid shearing and friction. Use slide sheets and lifting aids to avoid ”pulling” on the skin, which can damage microcirculation.
Many public procurement tenders now specify a so-called ‘heel zone’ – a specific area on the mattress designed to protect the sensitive heel. This seems a logical requirement, as more than one in five pressure ulcers develop precisely over the heels [2].
Whilst some mattress designs use localised zoning systems with softer foam to reduce pressure at specific points around the heels, our design philosophy is based on a different biomechanical principle. Instead, we focus on the mattress’s overall and comprehensive ability to sink and cradle the body.
The aim is for the entire mattress to provide uniform, high-performance pressure distribution. When a mattress delivers a consistently low counter-pressure across the entire contact surface, the patient’s total body weight is distributed as widely as possible. By reducing the overall pressure, the conditions are created for effective pressure equalisation across the whole body – including the heels – regardless of how the patient is positioned on the mattress.
If the mechanical load is distributed evenly and effectively over the entire body surface, adequate tissue protection can be achieved without the need for supplementary or fixing zone systems.
In public procurement, purchasers and those setting requirements are often forced to navigate parameters such as ”maximum user weight”. However, this is an undefined and clinically vague concept, where it remains unclear whether the specification is intended to protect the patient from tissue damage, or the bed and mattress core from mechanical overload [4].
To ensure that the substrate actually fulfils its intended clinical purpose, the requirements specification should instead be based on the established measurement method standard SS 876 00 13. This method uses standardised indenters to objectively measure and classify the actual pressure distribution of the mattress, enabling procurers to compare different products on a completely objective and equal footing [4].
The standard measures precisely the counter-pressure generated by the mattress under varying levels of load. One of the most critical measurement points is specifically designed to simulate the load on protruding anatomical features – such as the heels and shoulders.
By setting precision requirements in the procurement process, you ensure that your organisation is supplied with products of documented and verifiable performance. Use the following parameters as objective evaluation criteria in your next procurement process:
Evidence-based pest control
In this White Paper, we review clinical studies to provide a deeper insight into technology that can help save lives.
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