Improving Skin Damage from Moisture and Pressure: Remember "Less is Best"

At the 2009 National Pressure Ulcer Advisory Panel conference, a poster was presented on the effects of how multiple linen layers increase interface pressure and temperature on both foam and low air loss surfaces.  Heat increases moisture and moisture increases friction and shear, all adding to the risk of pressure ulcer development.  The main culprit for increasing pressure and temperature appeared to be the reusable cloth underpad.  The CWOCN and Skin Care Champions at an academic medical center recognized this opportunity to translate research into practice.

After completing baseline “linen layer audits”, Champions discovered that 78% of the time a bed was made up with a cloth underpad even if the patient did not have a moisture issue and 50% of the time there was a pad – there were multiple pads.  Since all patient rooms had ceiling mounted lifts, a cloth underpad should only have been needed for moisture management and not repositioning.

A “Less is Best” campaign began June 1, 2009 with the goal of reducing linen layers to avoid unnecessary increases in pressure and temperature. Posters were displayed. Champions educated their peers in the importance of using only one cloth underpad only if there was a moisture problem.  Monthly audits of linen layers were conducted.

Outcomes of the first phase of the “Less is Best” campaign not only contributed to a reduction in HAPU but also reduced linen laundry by 6019 pounds over the first 12 months and saved $62,861 in laundry costs in the first 12 months. Subsequently, there was a trial of a highly absorbent air permeable disposable underpad. Trial evaluations showed significant decreases in  HAPU. Cost analysis showed that replacing cloth underpads with the disposable underpads housewide would produce additional savings. These practice changes have contributed to a 68% reduction in HAPU.