Scientific basis for the selection of absorbent underpads that remain securely attached to underlying bed or chair

The occurrence of pressure ulcers in patients is very high in certain high-risk groups. These special high-risk groups include elderly patients, patients with spinal cord injuries, or any individual with an impaired ability to reposition. Prevention of pressure ulcers is by far the best treatment of this condition, warranting certain interventions and preventive measures. One major risk factor to be minimized is the exposure of skin to moisture. Underpads are often used to protect the skin of patients who are incontinent. These products effectively absorb moisture and present a quick-drying surface to the skin. The construction of an underpad should accomplish three goals. First, its backing should have a low coefficient of friction to prevent frictional skin injuries. Second, an inner absorbent core should rapidly contain moisture and disseminate it throughout the entire pad. Third, the core and coverstock should successfully work together to retain moisture and prevent wet-back or fluid return. The purpose of this study was to determine the performance of three commercially available underpads in reducing the development of pressure sores in patients at high risk. In this study we selected three underpads that could be securely attached to either the underlying bed or the chair. The three performance parameters examined were absorbent capacity, wetback prevention, and holding security of the underpads. Measurements of these performance parameters can be easily replicated in other laboratories. The results of these studies provide a scientific basis for selecting and purchasing an underpad to prevent pressure ulcers in patients. In this comprehensive evaluation, we assess an absorbent underpad with polyethylene flaps and two absorbent underpads with adhesive. The absorbent capacity results showed Tranquility SlimLine Peach Sheet to be the most absorbent. The wet-back results showed Tranquility SlimLine Peach Sheet to be the only underpad with no wet-back, with no fluid returning through the coverstock. The Tranquility SlimLine Peach Sheet Underpad has four adhesive strips attached to each of the four ends of the underpad surface. These 5 cm long strips secure well to the seat of a wheelchair or chair. In contrast, they do not maintain secure attachment to a bed sheet, making the bed sheet vulnerable to urine or stool penetration. When the clinical staff used the Tuckable on the bed surface, they were all impressed by the secure fit of the plastic wings, which easily tucked around the mattress. The wings remained in place throughout the night. Realizing the stability of the Tuckable underpads, the clinical staff suggested that the Tuckable underpad be placed first on the bed, then the Tranquility SlimLine Peach Sheet can be placed on top of the Tuckable underpad, using the four adhesive strips to attach it to the surface of the Tuckable underpad. All of the staff were impressed that the adhesive strips remained securely attached to the Tuckable. This clinical decision was found to be very cost efficient, because the Tuckable could remain in place more than a week without changing. Even though we have developed a unique scientific basis for the selection of underpads for use on either chairs or beds, it can be a financial challenge to the patient or healthcare setting to use these products, because Medicare provides no reimbursement for underpads, an invitation to pressure ulcer formation. In the absence of responsible federal government policy, we are making recommendations for the selection of a cost-conscious and responsible company that sells incontinence products--Home Deliver Incontinent Supplies Co., Inc., (HDIS), Olivette, Missouri.