The easiest type of pressure injury to deal with is the one that never happens.
This is why health economists like William Padula, PhD are advocating the use of multi-layer prophylactic sacrum dressings for pressure injury prevention from the moment a patient enters the health system.
In an interview with MedTech Views, Dr Padula pointed out that pressure injuries can develop in as little as a few hours. “The primary cause is the combination of older age, malnourishment and a highly acute condition,” he explained.
Having carried out a five-year study of a million patients, the Assistant Professor in the Department of Health Policy & Management at Johns Hopkins Bloomberg School of Public Health observed that there was a major gap in care where patients are likely to develop a pressure injury.
According to Dr Padula, hospital-acquired pressure injuries are common, costly and deadly, particularly Stage 3, 4 and Unstageable pressure injuries, which cause over 60,000 deaths per year in the US alone.
Moreover, the cost of treating pressure ulcers is about $11 billion in the US, £2.1 billion in the UK and $1.6 billion in Australia.
“Let’s look at the example of an older person being checked into the Emergency Room,” he said. “The paramedic is focused on keeping the patient alive, the triage nurse is focused on assessing the gravity of the person’s condition, the surgeon is focused on dealing with the health issue at hand, and so on. It gets to the point where the patient is in critical care before nurses discover pressure injuries. It happens because people aren’t looking for them.”
Dr Padula and his team also found that using a specific type of five-layer self-adherent soft silicone bordered foam dressing to protect the sacrum led to reduced rates of hospital-acquired pressure ulcers by about 30%. In addition to potentially saving lives, the use of these prophylactic dressings translated into substantial savings for healthcare facilities.
The cost of a pressure ulcer is about $300 per patient per day, whereas implementing a prevention protocol using the dressing costs approximately $62 per patient per day, noted Dr Padula. “The dressings last two to three days, but even if patients got a new pad every day, hospitals would still save money.” Indeed, the study concluded that hospitals investing in these prophylactic dressings at a rate of one dressing per at-risk patient made 100% return on investment in less than one year.
“The dressing alone isn’t a magic bullet,” emphasised Dr Padula. However, using it as part of a robust prevention protocol that includes the dressings along with proper patient positioning, skin checks and nursing education about best-practices could lead to significant declines in pressure injury rates. “It appears to be a cost effective protocol but there needs to be further high quality research,” he concluded.
1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, Prevention and Treatment of Pressure Ulcers, Clinical Practice Guideline