Impact of linen layers to interface pressure and skin microclimate

Adding layers of linens under the patient may inhibit the surfaces ability to redistribute pressure and maintain an optimal skin microclimate.  The purpose of the study was to quantify the change in interface pressure and low airloss performance with various linen layers on an air and foam surface.

A sensored pelvic indentor was used to measure the peak sacral and overall average pressure in mmHg.  Ten trials were performed at 0°, 30° and 45° head of bed elevations with five linen configurations.  Loads were adjusted appropriately. ANOVA was performed followed by the Fisher-Hayter test to determine statistical differences at a 95% confidence level.  The surfaces ability to withdrawal heat and moisture was measured using a technique adapted from the outdoor garment industry known as the sweating guarded hot plate method.  Six dry and six wet trials were performed at 0° head of bed elevation with six linen configurations.

A fitted sheet on an air and foam surface produced the lowest peak sacral pressures.  Adding a chux, slider sheet or disposable pad produced a statistically significant increase in peak sacral pressure on both surfaces.  No statistical difference in the overall average pressure was measured for both surfaces.

The low airloss surface with a sheet produced the highest total heat withdrawal and evaporative capacity.  The addition of a disposable pad or slider sheet did not significantly degrade the heat and moisture withdrawal capability of the surface.  The chux and multiple linen layers significantly decreased the heat withdrawal and evaporative capacity of the surface.

Pressure and skin microclimate are critical factors that contribute to skin breakdown.  Depending upon the type of linen under the patient, the peak sacral pressure can significantly increase and decrease the microclimate management capabilities to that of a non low airloss surface.