The Effects of Linen Layers on Pressure Ulcer Development: Does more linen negatively impact the microclimate of the skin?

Hospital Acquired Pressure Ulcers (HAPU) have a negative impact on patient morbidity and mortality. The microclimate between linen and the patients’ skin may have a negative effect on the rate of pressure ulcer development. Multiple linen layers between the patient and the bed surface may negatively affect the microclimate of the skin and increase the patient’s risk of developing a HAPU.  This 496 bed academic medical center located in an urban setting had maintained a hospital wide incidence rate of 1.4% for over a year. In an effort to further reduce the incidence rate the question “ Will reducing the number of linen layers under the patient decrease the incidence of hospital acquired pressure ulcers?” was posed to the Nursing Practice and Education Council. With the backing of this council and the Nurse Executive Council bed making practice was changed, limiting the number of linen layers to no more than two layers( fitted sheet and disposable incontinence pad if needed) under each patient.

Utilizing a prospective, descriptive design, data was collected on a medical intensive care unit, a progressive care unit and two telemetry units.  Data was collected monthly over a six month period of time. The sample (n=382) were recruited from Medical ICU (n=74) with average Braden score of 15.81, progressive care unit (n=43) with average Braden score of 16.05 and two telemetry units medical (n=112) with average Braden score of 19.42 and surgical (n=153) with average Braden score of 19.31. The average linen layers for the study units were 1.72.  During the study period, only 4 (1%) patients developed HAPU breakdown with three related to devices and the other breakdown was not related to microclimate. The incidence rate for HAPU decreased to 0.8% immediately following the implementation of less linen, and has been maintained for 9 months.