Prospective, Nonrandomized Controlled Trials to Compare the Effect of a Silk-Like Fabric to Standard Hospital Linens on the Rate of Hospital-acquired Pressure Ulcers
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Index: Ostomy Wound Manage. 2012;58(10):14–31.
Hospital bedding and gowns influence skin moisture, temperature, friction, and shear, which in turn may affect the development of pressure ulcers. To evaluate the effect of a new silk-like synthetic fabric on the incidence of pressure ulcers in an acute care setting, two consecutive 6-month clinical trials were conducted among 307 consecutively admitted patients in a Medical Renal Unit (August 2008 and March 2010) and in 275 patients admitted to a Surgical Intensive Care Unit (ICU) (September 2009 to March 2010). During the first 8 weeks, all patients used standard hospital bed linens, reusable underpads, and gowns. During the second 8 weeks, all admitted patients used the intervention linens (a silk-like fabric) followed by another 8 weeks of control (standard linen) use. Demographic variables and the prevalence of pressure ulcers on admission were statistically similar for control and intervention groups in both study populations with the exception of gender in the Renal Unit study (13% higher proportion of men in intervention group).
Average Braden Scores were also similar and low (<18) in all study patients. Upon admission to the Medical Renal Unit, 21 of 154 patients (13.6%) in the control and 26 of 153 patients (17.0%) in the intervention group had a pressure ulcer. The incidence of new ulcers was 12.3% in the control and 4.6% in the intervention group (P = 0.01); average length of stay was 5.97 days (s = 4.0) for control and 5.31 days (s = 3.8) for intervention patients (P = 0.07). In the Surgical ICU group, 18 of 199 patients in the control (9.1%) and four of 76 patients in the intervention group (5.3%) were admitted with a pressure ulcer; the incidence of new pressure ulcers was 7.5 % in the control and 0% in the intervention group (P = 0.01). Average length of stay was 4.5 days and 4.33 days in the control and intervention groups, respectively (P = 0.33). The significant differences between the control and intervention group in the rate of pressure ulcer development suggests that the type of linens used affect pressure ulcer risk and that this silk-like synthetic fabric technology may help reduce the incidence of pressure ulcers in high-risk patients. Controlled clinical studies in other patient populations are warranted.
Keywords: clinical study, bedding and linens, pressure ulcer, prevention, incidence
Potential Conflicts of Interest: Ms. McPhail and Dr. Montgomery disclose they are employees of Precision Fabrics Group, Inc, Greensboro, NC, the manufacturer of the study fabric.
Whether patients are cared for at home, in hospitals, or in nursing homes, their support surfaces are typically covered by bed linens manufactured of fabrics comprised of either polyester/cotton or 100% cotton fibers.1 Patient gowns are made of similar fabrics. These cotton-blend fabrics have no special properties or performance attributes, such as moisture management or antimicrobial properties, despite the special needs of healthcare environments.2 In most healthcare facilities, bed linens and patient gowns are managed as housekeeping items.3 Although a patient’s skin remains in constant contact with bedding and gown fabrics during the hospital stay, these cotton linens and gowns are not intended to be part of the therapeutic process.