Pressure Relief, Visco-Elastic Foam with Inflated Air? A Pilot Study in a Dutch Nursing Home

There is still little evidence regarding the type of mattress that is the best for preventing pressure ulcers (PUs). In a Dutch nursing home, a new type of overlay mattress (air inflated visco-elastic foam) was tested to analyze the opportunity for replacement of the normally used static air overlay mattress in its three-step PU prevention protocol In this small pilot the outcome measures were: healing of a category one pressure ulcer, new development or deterioration of a category one PU and need for repositioning.

We included 20 nursing home residents with a new category one pressure ulcer, existing for no longer than 48 h following a consecutive sampling technic. All residents were staying for more than 30 days in the nursing home and were lying on a visco-elastic foam mattress without repositioning (step one of the 3-step protocol) at the start of the pilot study. They had not suffered from a PU in the month before. The intervention involved use of an air inflated foam overlay instead of a static air overlay (normally step 2 of the 3-step protocol). At the start; the following data were registered: age; gender; main diagnosis and presence of incontinence. Thereafter; all participating residents were checked weekly for PU healing tendency; deterioration of PUs; new PUs and need of repositioning. Only when residents showed still a category one PU after 48 h or deterioration of an existing pressure ulcer or if there was development of a new pressure ulcer, repositioning was put into practice (step 3 of the PU protocol). All residents participated during 8 weeks.

Seven residents developed a new pressure ulcer category one and still had a category one pressure ulcer at the end of the study period. One resident developed a pressure ulcer category 2. Fifteen residents needed repositioning from one week after start of the study until the end of the study.

Overall 40% of the residents developed a pressure ulcer. Seventy five percent of the residents started with repositioning because there was no healing tendency of their category one PU diagnosed at the start of the pilot. Because this new type of overlay mattress resulted in an increased PU incidence, and almost standard need of repositioning with accompanied high costs, this type of overlay mattress gives no benefit above the traditional visco-elastic foam mattresses in combination with the originally used static air overlay.