Abstract: Use of a Soft Silicone, Self-Adherent, Bordered Foam Dressing to Reduce Pressure Ulcer Formation in High Risk Patients: A Randomized Clinical Trial (45th Annual Conference (June 22-26, 2013 ))

Sunday, June 23, 2013: 2:03 PM

Peggy Kalowes, RN, PhD, CNS, FAHA¹, Melanie Li, RN, MSN, NP, CWOCN², Carole Carlson, RN, BSN, CWOCN², Leslie Carr, RN, BSN, CWOCN¹, Leonora Llantero, RN, BSN³, Diana Lukaszka, RN, BSN, CWOCN², Kelly Martinez, RN, BSN⁴, Rowena Tan-Manrique, RN⁵, Lety Sia-McGee, RN, BSN⁶, Valerie Messina, RN, BSN, CWOCN⁷ and Adele Sandusky, RN, BSN⁴, (1)Long Beach Memorial and Miller Children's Hospital, Director, Nursing Research, Innovations and Evidence Based Practice, Long Beach, CA, (2)Long Beach Memorial and Miller Children's Hospital, WOCN, Long Beach, CA, (3)Long Beach Memorial and Miller Children's Hospital, ICU, Staff Nurse, Long Beach, CA, (4)Long Beach Memorial and Miller Children's Hospital, Staff Nurse, CCU, Long Beach, CA, (5)Long Beach Memorial and Miller Children's Hospital, RN, Staff Nurse CCU, Long Beach, CA, (6)Long Beach Memorial and Miller Children's Hospital, Staff Nurse ICU, Long Beach, CA, (7)Long Beach Memorial and Miller Children's Hospital, Director, Wound Care Services and Hyperbaric Program, Long Beach, CA

Purpose: To determine if prophylactic use of a Silicone Border Sacrum Dressing* reduces the incidence of sacral pressure ulcers (PUs), among critically ill patients, when compared to standard preventive interventions.

Methods: Experimental two-group design was used to enroll 367 subjects, with Braden⁵ Score ≤13; intact skin. N=184 randomized to intervention group (IG) receiving the SKIN⁴ Bundle and Silicone Border Sacrum Dressing and N=183 to Control Group (CG) receiving SKIN⁴Bundle (usual care). Team did daily skin assessments on all subjects; changed dressing every 3-days. No statistically significant difference in covariate was found in the groups (P= .058). Cox hazard ratio was 3.6 in relation to IG, although it was not statistically significant (P=.3).

Descriptive statistics was used to analyze the study characteristics, and incidence of PUs. Survival analysis was used to determine difference in PU incidence rates per group; logistic regression was used to evaluate potential interactions between demographic and physiological variables between groups and incidence rates.

Results: Sample mean age ±67.5 yrs, Braden⁵ Score of ±11.2. ICU LOS 6.82 days. Eight PUs developed „Ÿ7 in the CG; and 1 PU in the IG. High-severity of illness was noted in most subjects, (APACHE IV⁴Mortality Risk .60-.90%). Results show the Border Sacrum Dressing was effective in preventing PUs in 98% of IG (significant at P=.001). Risk factors found to be strong correlates (r=.72) among patients with PUs were „Ÿaltered LOC, vasopressors, increased LOS, mechanical ventilation; >4 comorbidities.

Conclusions: This RCT validates recent studies ^{1,2, 3} thus, adding more science to guide clinicians to become early adopters of this new wound technology. Border Sacrum Dressing provided superb absorption, and appears to reduce friction, shear, moisture, by providing a barrier between the bed surface/skin. Identifying unique risk factors related to development of PUs should prompt nurses to deploy aggressive preventive measures.

1304 Use of a Soft Silicone, Self-Adherent, Bordered Foam Dressing to Reduce Pressure Ulcer Formation in High Risk Patients: A Randomized Clinical Trial