Sacral Pressure Ulcer Prevention in Trauma Patients

Pressure Ulcer Prevention has been a significant focus at our Southeast regional level one trauma hospital since 2012. 

Several hospital wide prevalence audits revealed the Trauma ICU hospital acquired pressure ulcer rate was close to 50%.  Investigation revealed many of these patients were transfers from the Emergency Department.  Some were transported via helicopter on long boards and many lay on stretchers for a number of hours after being triaged in the trauma bays of the Emergency Department.  Still others went directly to emergency surgery where they were supine for many hours.

An IRB approved study placed bordered silicone sacral dressings on all level one and two trauma patients coming into the hospital through the Emergency Department.  These patients were followed in their respective intensive care units for the duration of the ICU stay by the wound care team.  The dressings were changed and the sacral skin assessed three times weekly.

The study was conducted over an eight month period.  The process involved placing foam on a rotating cycle of one week on and then one week off to create both an experimental and a control group.  Due to the nature of some of the trauma's involved, not all patients who should have received foam did.  Others who received foam went directly to the floor or home and were not followed by the wound care nurses.  As a result, 39 patients received the dressing.  Only one of these developed a pressure ulcer on the sacrum.  The control group consisted of 83 patients, 19 of which developed a sacral pressure ulcer.

The use of silicone bordered foam is effective in the prevention of sacral pressure ulcers in trauma patients.  As a result, bordered sacral and heel foam have been implemented as part of the ICU bundle for all patients.