Linen Usage Impact on Pressure Ulcer Prevention

The development of pressure ulcers in the hospitalized patient is an ongoing problem. The purpose of the study we conducted was to determine if limiting the number of layers under patients would decrease the development of pressure ulcers. Two medical/surgical units were chosen from a 400 bed Midwest hospital for the study. Prior to starting the study, we conducted a primary prevalence survey on those units and discovered that multiple layers of padding were being placed beneath the patients (highest was 9 layers). Staff was in-serviced on the protocol emphasizing patient teaching, obtaining patients consents and making beds according to the protocol. In-servicing was accomplished by a lecture as well as an instructional video. Using staff members as some of the actors added to the “buy-in” from the staff members on the units. Layers that were utilized on the patients were limited to a positioning glide sheet for the continent patients and adding a breathable under-pad for the incontinent patients. All patients were on viscoelastic expanded urethane foam type hospital mattresses. A prevalence survey was conducted three times a week during the study. During the surveys, we asessed layering on the bed and assessed the patients’ skin for signs of breakdown.  We collected and reviewed evaluations from the patients and the staff who participated in the study. It was discovered that the breathable underpads were unsatisfactory in absorbency. The positioning sheet glides worked well with cotton sheets. Midway through the study, the hospital changed from a cotton sheet to a knitted sheet. The positioning sheet glides were not satisfactory with the knit sheets. Ultimately, the study showed that the layering of linen does impact the development of pressure ulcers. Additionally, constant vigilance in limiting linen layering assists in the prevention of pressure ulcers.