Whether we refer to them as pressure injuries or pressure ulcers, their impacts can't be disputed. In the UK, which calls them 'ulcers', they cost the NHS £2.1 billion a year. In the US, where the term 'injury' is now preferred, the total figure is $11 billion. What's more, the Centers for Medicare and Medicaid Services will no longer reimburse stage 3 and 4 pressure injuries that are hospital acquired. And those expensively elongated hospital stays are far from figures and formalities - each pressure injury contributes to greater patient suffering, and some can lead to premature mortality. Approximately 60,000 people die from complications arising from pressure injuries every year.
"Pressure injuries can affect every aspect of your life," says Jessica Pehrson, senior technical service engineer and nursing expert at 3M Health Care. "It's time away from your family as well as increased pain and suffering. Pressure injuries can also leave scars or deformities. Chronic pressure injuries that cause long term pain can affect your psychological well-being as well. People can or may feel isolated and alone."
Prevention starts the moment a patient enters the care setting and/or has a medical device installed. Care providers need to be aware of the issues that can arise from the patient's location and the patient themselves. This is about more than regular repositioning, though that is vital, it also means routine skin and risk assessments that that take into account age, health, blood flow, mobility, diet and more. "It's not just about where a patient is positioned and what dressings we put on them," explains Pehrson, "it's also about them."
Typically, an injury will start on an area of the skin overlaying a bony prominence. Indeed, more than 50% of these injuries start in the innocuous-seeming regions of the sacrum and the heels, areas that are subject to large amounts of pressure, moisture, friction and shear, particularly in bed-bound patients. Unhelpfully, those are not neatly partitioned causes, and need to be managed with a holistic approach. This is not simple. Moisture on the skin can increase the risk of pressure injuries by as much as 22 times, but many of the creams and ointments long used to combat it can actually increase the friction coefficient at the skin surface. By contrast, the 3M Cavilon Advanced Skin Protectant creates a film over the patient's skin, minimising friction, shear and moisture all at once.
By her own account, Pehrson dreams of pressure injuries. As part of her work, she monitors best practice guidelines around the world and educates caregivers about how to implement them. Previously a nurse in trauma and burn units, at 3M she uses her practical knowledge and experience to shed "clinical light" on the company's wound care innovations. It's about achieving the same goals on a far larger scale. "In the hospital setting I could affect several patients every day," she explains, "but what I do now can affect thousands."
The value of her work is clear with the 3M Tegaderm Foam. The 3M patented spoke delivery system, holding the dressing firm so it can be applied easily with one hand - even while wearing gloves. They're a technical service innovation. It's part of a five-layer dressing that effectively distributes pressure while outlasting other dressings. Equally, although the product is designed to re-adhere so clinicians can access and assess the wound, the low-profile edge doesn't roll up in highshear situations.
By focusing on how 3M's products fit into practical healthcare situations and day-today clinical requirements, Pehrson and her colleagues are able to help refine them until they're as functional and user-friendly as possible. "We really just have an honest look at each product," she explains. "Sometimes we point out something that isn't going to work for a nurse: perhaps the dressing isn't shaped right for them; or, on the other hand, it might be too small for patients with different body types, for instance." 3M's silicone foam dressings, are designed to be thin, comfortable and patient-friendly while being easy to apply correctly. As such, 3M supports its best practice education initiatives with products that meet and exceed best practice guidelines.
"We're really looking at the whole picture, our whole patient," explains Pehrson. "It's our job to protect the patient from beginning to end." There's no better way to tackle pressure injuries. Or pressure ulcers, for that matter.