Dynamic and static support mattresses and overlays decreased pressure ulcer incidence when compared to standard care in adult acute care settings.

Prepared by:

Beth Fulton (email: bethf@chw.edu.au),
 Alison Monro and Margaret Wallen

Occupational Therapy Department,
The Children’s Hospital at Westmead, Sydney, Australia

Date:

May 2007

Review Date:

May 2009

Clinical Question:

What are the most effective support surfaces for preventing pressure areas in children in the paediatric acute care setting?

Clinical Scenario:

People who are immobile due to severe acute illnesses (eg. those in intensive care units) or neurological deficits are at risk of developing pressure ulcers. Pressure areas can lead to major skin breakdown and infection, and reduce participation in rehabilitation and daily activities. There is also a significant cost associated with the prevention and treatment of pressure ulcers.
Occupational therapists prescribe equipment for people with limited mobility. Therapists need to be aware of risk factors for pressure ulcers and effective preventative treatments. There are many mattresses, cushions, and other devices available commercially for pressure area prevention. However, information regarding the most effective surfaces is limited, particularly for paediatric populations. Many pressure area prevention devices are designed for adults and may not be suitable for children. For instance, alternating pressure solutions may not always be appropriate for children who weigh less than the manufacturer’s recommended minimum weight. Neonates have reduced muscle bulk, fat reserves and collagen levels, placing them at increased risk of developing pressure areas despite their small weight. In general the ratio of surface area of a child’s head to body is larger than in an adult, meaning there is increased pressure and risk of ulcer development on a child’s head (Murdoch 2002).

Clinical Bottom Line:

Dynamic and static support mattresses and overlays decreased pressure ulcer incidence when compared to standard care in adult acute care settings. Turning of patients was not included as part of the interventions in the trials. There is no evidence specific to paediatric acute care.

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