Clinical Trial of Silk-Like Bed Linens for Prevention of Unit-Acquired Pressure Ulcers

Development of a hospital acquired pressure injury (HAPI) affects patients’ quality of life, morbidity and mortality, hospital reimbursement, and quality reporting indicators.  Research has demonstrated that moisture, friction, and shear contribute to HAPI development. Cotton linens increase skin moisture, friction, shear, and temperature.  This study investigated if bed linens made from a newly developed silk-like polyester fiber affected the rate, time to development, and severity of HAPI in critically ill adult inpatients.  A cluster randomized crossover design was used to explore this question in the medical intensive care units (MICU) of a Midwest United States 1200-bed quaternary-care medical center. With few exclusions, data on the rate of unit-acquired HAPI development, time to development of the first HAPI, and maximum severity of HAPI for all patients admitted to the MICU were abstracted from the electronic medical record.  Mixed effect logistic and Poisson regression models were used to evaluate differences in the prevalence and rate of occurrence.  A random effect for patients was included to account for multiple admissions by the same patient during the study.  Time to the first pressure ulcer was evaluated using a marginal Cox proportional hazards model with repeated admissions from the same patient accounted for by use of a sandwich estimator of the variance.  The final analysis included 3,332 MICU admissions.  The experimental and control groups were similar on all demographic factors except race.  Controlling for race, there was no statistically significant difference for rate, time to development, or maximum severity of HAPI.  Studies conducted in other hospitals and settings have demonstrated that silk-like linens have a significant positive effect on HAPI frequency.  The participating units in this study have maintained a low HAPI incidence rate with robust pressure injury prevention initiatives sustaining this metric.  Further research is warranted in sites with a higher incidence of HAPI.