The Prophylactic Use of a Silicone Border Foam Dressing for the Prevention of Sacral Pressure Ulcers in Acute Hip Fracture Patients Requiring Surgical Repair

Purpose and significance- The prevention of pressure ulcers has become an indicator for quality of care.  Impaired mobility, pain, decreased quality of life, and financial burden for treatment are considerations for implementing preventative measures.  Our community hospital had 183 hip pinning surgeries in 2012 with 43 documented pressure ulcers (23.5% incidence).  A retrospective review focusing on the months of May and June 2012 had five patients with hospital acquired pressure ulcers. This study evaluated the effectiveness of a silicone sacral dressing in the reduction of hospital acquired pressure ulcers in the acute hip fracture population requiring surgical repair. 

Methodology- IRB approval was obtained. A silicone foam sacral dressing was placed on admission to the orthopedic floor. Patients were not included in the study if there were signs of breakdown on admission.  If the patient was admitted directly to the operating room suite, the operating room nurse would assess and place the dressing prior to surgery.  Reassessment of sacrum was done upon arrival to orthopedic floor and every day for three days post-operatively.  The certified wound and ostomy nurses performed follow-up at 72 hours post procedure. 

Results- During the study period of May – June 2013, no documented pressure ulcers occurred on the surgical hip patients. The total cost for the dressings for the 28 study participants was $648.43.  Potential cost savings were significant. Estimated treatment costs for the five patients who developed pressure ulcers during the May-June 2012 time period could have totaled over $185,000 (Brindle, 2012). 

Conclusions- Silicone sacral dressings have the potential to reduce shear forces, absorb moisture within the gluteal cleft, and reduce friction by separating skin folds. This study took a step back to initiate prevention practice prior to the surgical procedure.  Future studies could incorporate placement in the Emergency Department for at risk populations.