Preventing Pressure injuries in Patients with Reduced Mobility

Reduced mobility is a significant risk factor for pressure injury development, international guidelines emphasise the need for regular turning and repositioning of patients to help prevent skin damage¹. While a pressure redistribution mattress may enable the repositioning regimen to be individualised, regular postural change is still important but not without risk to the patient or caregiver.

Repositioning is undertaken to reduce the duration and magnitude of pressure over vulnerable areas of the body, and to contribute to the patients comfort, hygiene, dignity and functional ability¹. Common repositioning activities however could contribute to the risk of pressure injury development due to the increased shear and friction forces generated between the skin and the surface the patient is on. 

From a caregiver perspective,  repositioning dependant patients within the bed is the single greatest risk factor for musculoskeletal injuries amongst healthcare professionals².  A study of musculoskeletal injuries resulting from patient handling tasks identified that 32% of injuries resulted from repositioning/turning or lifting patients in bed³.  As dependency levels of patients cared for in hospitals and care homes increase, along with the rise in obesity and the ageing population, patient handling transfers are likely to become more frequent and more physically demanding.

Frequent repositioning in bed can be made easier and safer for both patients and caregivers with the use of appropriate patient handling aids.  This may include the use of friction reducing slide sheets and or patient lifts/slings.

Additional layers between a patient’s skin and a support surface has the potential to increase pressure or negatively impact the skin microclimate increasing the risk of pressure injury⁴.  Sling features including material breathability, thickness and location of seams, should be assessed prior to the sling being left under a patient. For each patient caregivers should critically review the impact, both risk and benefit, of leaving a sling beneath a patient.

Risk is particularly high when patients are sitting in a chair, given that the pressure exerted over the bony pelvis is naturally elevated⁵. Aside from limiting sit time, pressure redistributing chair cushions are recommended for individuals with reduced mobility.  For those chair bound patients, the use of a standing and raising aid such as Sara® Plus or Sara® Stedy can help facilitate regular standing to allow regular skin inspection and to temporarily relieve the sustained high pressures normally encountered during sitting out of bed.

An integrated approach to pressure injury prevention which includes an holistic assessment of the patient, safe handling techniques, repositioning, promoting mobility and the allocation of appropriate support surface technologies for both bed and chair are key.  Our solutions are designed to help create safer and more efficient healthcare environments.  From patient handling and mobilisation to hygiene and pressure injury prevention, we can help you to meet the new and continually evolving challenges of today’s acute and long-term care settings.

For more information on our solutions please download our clinical evidence summary.

References:

_{1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline, Emily Haesler (Ed.). EPUAP/NPIAP/PPIA:2019. Section 8: Repositioning and Early Mobilisation. Recommendation 5.6 Repositioning Techniques. Page 121}

_{2. McCoskey KL. Ergonomics and Patient Handling. AAOHN Journal, 2007, 55(11): 454–62}

_{3. Pompeii LA et al. Musculoskeletal injuries resulting from patient handling tasks among hospital workers. Am J Ind Med, 2009. 52(7): p. 571-8}

_{4. Williamson R, Lachenbruch C, Van Gilder C. A Laboratory Study Examining the Impact of Linen Use on Low-Air-Loss Support Surface Heat and Water Vapor Transmission Rates. OWM 2013; 59(8):32-41}

_{5. Section 10: Support Surfaces. Seating Support Surfaces for Individuals with or at Risk of Pressure Injuries. Page 172}