Beyond the Bundles: Use of a Prophylactic Sacral Dressing for the Reduction of Hospital Acquired Pressure Ulcers in the CVICU

Objective: The purpose of this study is to determine if the use of a prophylactic sacral dressing (Hydrofiber® layered foam dressing with a silicone border) in addition to the previous standard prevention bundle reduces the number of hospital acquired sacral/coccygeal pressure ulcers in the CVICU.   

Background: Patients in the intensive care setting (ICU) are at high risk for development of hospital acquired pressure ulcers (HAPU) as a result of their high acuity illness, comorbid conditions, and factors such as mechanical ventilation, use of vasopressors, and moisture/shearing forces. Despite the use of pressure ulcer prevention bundles and the introduction of foam padding on the OR table, our cardiovascular patients remained at high risk for the development of HAPUs.  Studies have found the application of a prophylactic sacral dressing can decrease the incidence of HAPU when included in a comprehensive protocol of care to protect against skin breakdown.

Method:  A baseline for the number of sacral/coccygeal hospital acquired pressure ulcers was established for the 9 months prior to the initiation of the study.  Comparing this baseline data, we studied the effects of applying a sacral foam dressing over the sacrum/coccyx area as a preventative measures in combination with our standard prevention measures to the CVICU patients over a 9 month period. 

Results: In the preceding 9 months of our study we documented 5 avoidable sacral/coccygeal pressure ulcers.  After implementing the use of the sacral dressing for 9 months we had 0 avoidable sacral/coccygeal pressure ulcers. 

Conclusions:  With the success of using the sacral foam dressing for preventing the development of HAPU to the sacrum/coccyx area in the CVICU, our medical center plans to expand this dressing into all our intensive care units.