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Objective: Recent clinical evidence has suggested that certain wound dressings may play a significant role in protocols to prevent or reduce pressure injury (PI) in patients at risk by modifying the pressure, friction, and shear forces that can contribute to PI. The aim of this study was to investigate the pressure reduction properties of commercially available wound dressings in vitro., Methods: Using a standardized protocol (1.7 kg, 7.5-cm sphere), testing was performed in a controlled environment by the same clinician using a pressure mapping device (XSENSOR LX205; XSENSOR Technology Corporation, Calgary, Alberta, Canada) to measure and compare the pressure mitigation properties in a variety of wound dressings., Results: A total of 13 different commercially available dressings were tested in triplicate for changes in pressure redistribution as compared with the control. One dressing demonstrated the greatest reduction of pressure forces (OxyBand PR; 50.33 ± 1.45 mm Hg) compared with the control (302.7 ± 0.33 mm Hg) and the greatest surface area of all the study dressings tested. There was a negative correlation (R2 = 0.73) between the average pressure distribution of a wound dressing and its contact area. Further, the peak pressure for OxyBand PR (P ≤ .05) was significantly different from all other tested dressings., Conclusions: One dressing (OxyBand PR) provided superior pressure redistribution and significantly reduced peak pressure in this study when compared with currently available standard foam and silicone dressings that are marketed for the purpose of PI prevention., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Use of a hydrocolloid dressing (HCD) is generally recommended to help prevent pressure ulcers (PUs) in high-risk patients, including ulcers caused by noninvasive ventilation (NIV)., Purpose: The study was conducted to compare the effect of preventive use of HCD to other methods in the rate of facial PUs caused by NIV., Methods: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data were searched from date of index inception to August 2018 without language restrictions to identify randomized controlled trials (RCTs) that compared HCD use to other NIV-related PU prevention measures. Publications were systematically reviewed, data were extracted, and study quality was assessed using the Jadad scale. Odds ratio (OR) with 95% confidence intervals (CIs) for PU incidence in patients using HCD versus patients managed with gauze or standard skin care procedures (control) were calculated using a fixed-effects model., Results: The search yielded 80 publications; 40 met the study criteria for full-text and 22 met the meta-analysis inclusion criteria (total study participants = 2519). Patients who used a HCD (n = 1260) had a significantly decreased incidence of PU (OR = 0.15; 95% CI: 0.11-0.20) compared with control group patients (n = 1259). Subgroup analysis by age showed a lower incidence in children (OR = 0.09; 95% CI: 0.01-0.81) and adults (OR = 0.16; 95% CI: 0.12-0.22) in the HCD group than in the control group. PU incidence using HCD was lower compared to gauze (OR = 0.17; 95% CI: 0.10-0.28) and regular skin care (OR = 0.13; 95% CI: 0.09-0.19). Funnel plot diagrams suggested a risk of bias. Sensitivity analysis using a random-effects model did not change the result of the main meta-analysis., Conclusion: Using a HCD significantly decreased the incidence of facial PUs caused by NIV. Additional high-quality, prospective research to confirm the effectiveness of HCD in preventing NIV-related PUs is warranted.

Recent clinical research has generated interest in the use of sacral wound dressings as preventive devices for patients at risk of ulceration. This study was conducted to identify the modes of action through which dressings can add to pressure ulcer prevention, for example, shear and friction force redistribution and pressure distribution. Bench testing was performed using nine commercially available dressings. The use of dressings can reduce the amplitude of shear stress and friction reaching the skin of patients at risk. They can also effectively redirect these forces to wider areas which minimises the mechanical loads upon skeletal prominences. Dressings can redistribute pressure based upon their effective Poisson ratio and larger deflection areas, providing greater load redistribution., (© 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Objective: Pressure Ulcers (PUs) often is an indication of quality of nursing care as it remains as severe manifestation of the integrity of impaired skin. Our study designed to evaluate the effectiveness of hydrocolloid dressings and ceramide dressings in healing of PU., Patients and Methods: The study was done at Chinese hospital between Feb 2014-November 2014. 72 study group patients and 25 control group patients were included in the study. The study group patients were divided into Group A with 24 patients received only ordinary hydrocolloid dressings, Group B with 24 patients who ceramide containing hydrocolloid dressings and Group C with 24 patients received both hydrocolloid and ceramide dressings. Dressings were applied for 4 weeks. The dressings were changed every 10 days and skin conditions such as pH of the skin, hydration are measured by capacitive method., Results: Among 72 study population 48 (66.7%) were male and 24 (33.3%) were females. Group A with 18 (75%) males and 6 (25%) females, group B with 20 (83.3%) males and 4 (16.7%) females, and group C with 10 (41.7%) males and 14 (58.3%) females. 25 Control group patients with 8 (32%) males and 16 (68%) females. Erythema seen in 4/24 (16.67%) group A patients, group B and C patients had 1/24 (4.17%) erythema. In control group patients 6/25(24%) developed erythema., Conclusions: In our study, we evaluated the effectiveness of the hydrocolloid dressings and ceramide containing dressings in which ceramide containing dressings showed effective prevention and water holding capacity. Our study highlights that ceramide containing dressings found to be more effective in reducing erythema and improving the healing of PU.

Objective: In acute respiratory failure, non-invasive ventilation (NIV) treatment is used to prevent the need for intubation. NIV applied through a face mask may contribute to the development of facial skin lesions. This study was conducted to compare the efficacy of protective dressings and of using no materials for pressure ulcer prevention., Methods: There were 90 participants in this study. The participants were assigned into three groups: control group, tegasorb group, and tegaderm group., Results: The tegasorb group and tegaderm group, in contrast to the control group, had fewer pressure ulcers based on our statistics and occurrence duration time (p<.01). However, there were no significant difference in occurrence duration time between the tegasorb group and tegaderm group., Conclusions: This result revealed that tegasorb and tegaderm could be used on the face of NIV patients to prevent pressure ulcers.

Objective: We compared the shear forces exerted over the heel between a pressure ulcer preventive dressing and a thin-film dressing in a clinical setting. Interface pressures were measured as well., Design: Quasi-experimental clinical trial., Setting and Subjects: Participants were 30 elderly patients (5 men, 25 women; mean age, 86.4 +/- 8.0 years) hospitalized in a geriatrics hospital in Japan; all had a Braden score of less than 14 (mean, 10.1 +/- 1.1). Informed consent was obtained from all the patients.A shear force and pressure sensor including a strain gauge, and an oval airbag-type pressure sensor were used., Methods: The sensor was attached to one heel using double-sided tape; then the target dressing was applied over the sensor and on the opposite heel to avoid the influence of the opposite heel on the shear force measurement. Interface pressures were measured with the patient in a stationary supine position; shear force was then measured at 0.2-second intervals, while the sheet was manually pulled at a velocity of around 5 cm/second. Shear force was determined by averaging the stable shear force lasting for 10 measurement points., Results: The mean interface pressures with the PPD and the film dressings were 70.7 +/- 16.5 and 70.2 +/- 15.2 mmHg, respectively; this difference was not statistically significant. The shear force produced during the pulling of the sheet was 2.2 +/- 1.4 and 11.7 +/- 5.8 N, respectively (P < .001, Wilcoxon signed-rank test)., Conclusions: The results of this study suggest that a dressing with a low-friction external surface (such as the pressure ulcer preventive dressing) can significantly reduce shear force. However, results also suggest that external dressings do not significantly reduce interface pressures and cannot be used as a substitute for heel elevation in an immobile patient.

Considerable progress has been made in the prevention and treatment of pressure ulcers but they remain a significant healthcare problem, particularly among the elderly. Treatment may include the use of wound dressings such as hydrogels as well as debridement products that contain relatively high concentrations of various enzymes. Unlike enzymes found in debridement products, low concentrations of endopeptidase enzymes can cleave to denatured proteins. Many endopeptidases have been reported to enhance the healing process. To evaluate the effect of a hydrogel wound dressing containing a combination of endopeptidases on pressure ulcers, a 12-week prospective preliminary study was conducted involving 10 nursing home patients with Stage II (n = 3) or Stage III (n = 7) ulcers that had failed to respond to previous treatments. Seven subjects (three with Stage II ulcers and four with Stage III ulcers) completed the study. Healing was based on wound closure by re-epithelialization as determined by area measurement and clinical assessment. All three Stage II ulcers and two of the Stage III ulcers healed completely; four Stage III ulcers were categorized as healing (>60% improvement) after 12 weeks of care. No dressing-related adverse events occurred and subject acceptance of the product, including comfort, was high. These results suggest that additional studies designed to define the possible contribution of endopeptidase enzymes in wound healing are warranted.

Objective: To compare a hydrogel dressing with a conservative topical wound-care regimen (gauze with povidone-iodine) for the treatment of pressure ulcers., Method: A prospective study comprising 27 (24 male and three female) spinal-cord injury patients with a total of 49 pressure ulcers. Wounds were randomised into a treatment group (n=25) or control group (n=24). The primary outcome measure was the rate of wound healing (cm2/days)., Results: Healing rates in the treatment group were higher than in the control group, although this was not statistically significant. Some 84% of the wounds in the treatment group and 54% in the control group epithelialised, which was statistically significant (p=0.04). The mean healing time in the treatment group was 48 days compared with 45 days for the controls., Conclusion: Our results suggest that hydrogel occlusive wound dressings facilitate healing by promoting more rapid epithelialisation of pressure ulcers, when compared with conservative wound care.

This study investigates whether vacuum-assisted closure (VAC) therapy, alginate or hydrocolloid dressing are most effective in the treatment of pressure ulcers. A total of 281 patients were included in this study. The response of each patient's wound was monitored, satisfactory wound closure was examined and the time taken to attain satisfactory wound closure was also taken into consideration. An original analysis of the published data was carried out. Most of the pressure ulcers showed some response in all of the categories investigated, with pressure ulcers in the VAC therapy group showing a greater response in all aspects than those in the other two groups.

Objective: A trial of a self-adhesive hydropolymer foam dressing (Tielle, Johnson & Johnson) demonstrated that it prevented the development of friction-generated pressure ulcers on the heels of ICU patients. Following the trial, use of the foam dressing became a standard preventive measure in the ICU and the prevalence of heel ulcers decreased by 72% in two years. This follow-up study evaluated the foam's effectiveness in preventing heel pressure ulcers in surgical patients., Method: A total of 140 surgical patients were screened over a four-month period. They were assigned to one of two groups, depending on their pressure ulcer risk score and the anticipated length of the surgical procedure. The foam dressing was used as a barrier on the heels, depending on the patient's risk status, which was assessed using a modified Norton scale, and the duration of their surgery. Heels were inspected on a daily basis for up to 10 days. All 23 patients in the group whose surgery lasted less than 90 minutes dropped out of the study as they were discharged with insufficient data., Results: A 76.7% reduction in heel pressure ulcers was achieved with this preventive measure., Conclusion: Use of an adhesive foam dressing on surgical patients can prevent heel ulcers. Research is needed on the effects of friction on the heel during the transfer and movement of surgical patients., Declaration of Interest: This study was sponsored by Johnson & Johnson Medical.