The selection of cushioning and padding materials for effective prophylaxis of medical device-related pressure ulcers: clinical intuition does not always work

Amit Gefen is Professor of Biomedical Engineering and the Berman Chair in Vascular Bioengineering at the Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel

      Currently, the most commonly used dressing materials for the prevention of facial medical device-related pressure ulcers/injuries are hydrocolloids and foams. Often, clinicians who choose one type over the other are unaware of the underlying differences in material behaviours, and the biomechanical considerations and implications of their selection, in particular concerning the compatibility of these dressing types with skin. Accordingly, this article aims to compare the suitability of hydrocolloids versus foams for the specific purpose of facial medical device related pressure ulcer prevention, based on biomechanical considerations which are explained here in a non-technical language. In particular, the alleviation of localised and sustained tissue loads are the most fundamental requirement from any type of prophylactic dressing, and avoiding sharp stiffness gradients between the skin and the protecting dressing serves this purpose. The compressive stiffness matching ratio explained here is an intuitive and easy-to-implement biomechanical performance measure of this skin-dressing stiffness gradient. Specifically, the compressive stiffness of a dressing used for prophylaxis and the compressive stiffness of the skin region covered by the dressing are the most important and relevant properties to consider, given the common techniques of device attachment to skin which apply localised, intense compressive forces to the skin, such as for ventilation masks that are strapped to the head. Based on the above criterion, hydrocolloids exhibit poor biomechanical prophylactic efficacy in protecting healthy skin, and more so, in preventing injuries in fragile or aged skin. Foams, on the other hand, have stiffness properties that closely resemble those of human skin, and, though foam dressings by different manufacturers vary in their specific stiffness properties, some low-stiffness foams provide a near ideal stiffness matching with skin. Wound care professionals should adopt objective, standardised and quantitative research-based approaches in their clinical decision making processes, to grade and then select the optimal dressings for prophylaxis of injuries caused by medical devices. This article discusses an example basic bioengineering measure, i.e., the stiffness matching ratio, which should be demanded by clinicians and disclosed by manufacturers for best-practice.

Single use negative pressure wound therapy (suNPWT) system with controlled fluid management technology — an evaluation of performance

Author: Anette Svensson Henriksson

Anette Svensson Henriksson is Senior Product Developer, Mölnlycke Health Care AB, Gothenburg, Sweden In this article, the results from simulated clinical use tests evaluating the performance of a single use negative pressure wound therapy (suNPWT) system (Avance® Solo NPWT System, Mölnlycke Health Care AB) are presented. This suNPWT system is designed with a negative pressure pump, a distal canister and an absorptive multilayer dressing, and introduces Controlled Fluid Management (CFM) Technology™. The performance was compared to those of two canister-less suNPWT systems, designed around absorptive multilayer dressings and solely relying on the capacity of the dressings to manage fluid through absorption and moisture vapour transmission (evaporation). Method: The technical performances of the suNPWT systems were evaluated with respect to fluid management and delivery of the intended negative pressure using a wound model simulating clinical use on a moderate exudating wound and a 3-day dressing change regimen. Results: With the canister-less suNPWT systems, a loss of performance of the intended negative pressure was observed as saturation of the dressing occurred during the 72-hour test time. In comparison, the canister-based suNPWT system continuously delivered the intended negative pressure to the simulated wound throughout the 72-hour testing time, without any saturation of the dressing observed. Conclusion: The results could be explained by the design of the canister-less suNPWT systems, managing fluid in the dressing only, and that dressing saturation impedes the delivery of the intended negative pressure. In comparison, the canister-based suNPWT system has the capacity to transport excess exudate and infectious material from the dressing to the canister, thereby reducing the risk of dressing saturation.

Screening tool provides insight to the depths of diabetes-related distress

Amanda Dudley, Tiffany Ballentine, Tanya Cohn

Citation: Dudley A, Ballentine T, Cohn T (2022) Screening tool provides insight to the depths of diabetes-related Nursing. 26: [Early view publication]

Article points

1. Each day, people with diabetes are routinely faced with countless decisions regarding the management of their blood glucose levels.

2. This constant management can have emotional, psychological and physiological implications that can lead to diabetes-related distress.

3. If not identified through screening, diabetes related distress can lead to poor health outcomes and decreased self-care. Despite this, assessment is not routinely performed.

Key words - Burnout - Diabetes-related distress - Mental health

Authors Amanda Dudley, Critical Care Nurse; Tiffany Ballentine, Outpatient Surgical Nurse; Tanya Cohn, Associate Professor of Practice and Director of the Doctor of Nursing Practice Program, all at Simmons University, Boston, MA, USA.

      Diabetes-related distress differs from depression as it develops from the mental and emotional burden that comes from the constant management of diabetes. Despite the increased awareness and knowledge of diabetes-related distress, patients with diabetes are not routinely screened during clinic visits. In order to potentially encourage providers to implement the 17-item Diabetes Distress Scale (DDS-17) into practice and clinic appointments with patients, the authors researched and analysed results from voluntary and anonymous participants with diabetes, aged 18 years and older, who completed demographic survey questions and the DDS-17. The results revealed that areas of statistically significant distress can be found in people recently diagnosed with diabetes and occurs more often in those with type 1 diabetes compared with type 2 diabetes.

The Legs Matter campaign: buzzing about legs and feet!

MARGARET SNEDDON Chair, British Lymphology Society, Member of Legs Matter Coalition, Hon. Sen Res Fellow, University of Glasgow

Frailty Syndromes: should wounds be considered an additional syndrome?

SAMANTHA HOLLOWAY Academic Editor, Wounds UK; Reader, Programme Director, Cardiff University School of Medicine, Cardiff

"...chronic wounds could be considered an additional frailty syndrome based partly on the notion of skin failure"

Effects of a breathable silk-like, 3-layer ventilating mattress sheet on selfrepositioning, repositioning support and pressure ulcer incidence; a pragmatic observational study

MWF van Leen is Elderly Care Physician, Ruitersbos, Breda Netherlands;

WIJ van Ratingen is Biometrician, WvR research & development, Neer, Netherlands;

JMGA Schols is Professor of Old Age Medicine, Caphri, Dept. Health Services Research, Maastricht University, Maastricht, Netherlands

      Besides pressure relief by using special support surfaces and repositioning, pressure ulcer guidelines on prevention and treatment nowadays also advise on shear force reduction and regulation of the microclimate by using silk-like mattress covers instead of cotton covers. Skincair® (Sense Textile), a newly developed breathable silk-like, 3-layer ventilating mattress sheet, reduces shear forces and is able to absorb excess fluid, which may result in better self-repositioning in bed, reduced nursing repositioning support and enhanced pressure ulcer (PU) prevention. Moreover, reducing the amount of fluid and improving the microclimate may result in lesser damage of the skin overall. A total of 112 residents of eight nursing homes at risk of PU development, participated in a 12-weeks observational study. Residents were selected, based on the following criteria: age >65 year, Braden score <18, laying on standard cotton mattress cover around a preventive mattress and need of nursing support for repositioning. During the first 6 weeks, all 112 residents laid on the cotton sheet (control period) and during the second 6 weeks all residents laid on the new 3-layer ventilating mattress sheet (intervention period) while receiving care as usual. There were no mattress changes during this 12-week period. On the cotton sheet all residents were unable to perform self-repositioning in bed and, therefore, needed nursing support for repositioning. At the end of the 6 weeks intervention period, 69.6% of the residents were able to change their position in bed without nursing support, implicating that the requirement of nursing support for repositioning decreased significantly. The development of pressure ulcers (PUs) was also monitored. In the control period, when residents were laying on the cotton sheet, 22 residents developed 41 PUs (category 2). In the intervention period, two residents developed a category 2 PU and one resident showed deterioration of a category 2 into a category 3 PU. This study showed that the use of the new breathable silk-like, 3-layer ventilating mattress sheet, which acts as the direct patient interface, improved self-repositioning of patients in bed and led to less need for nursing support during repositioning. Moreover, a lower PU incidence was observed.