EUROPEAN PRESSURE ULCER ADVISORY PANEL

AN EUROPEAN PUBLIC TENDER FOR ANTI-DECUBITUS MATTRESS MATERIAL IN AN ACADEMIC HOSPITAL CENTER; A CHALLENGING PROCESS

F. Heule (1,2), D. van der Eijk (1,2), Alexander Doeff (3)
(1) Dept. of Dermatology, (2) Local Pressure Ulcer Advisory Panel (PUAP), (3) Dept. of Purchasing, Erasmus Medical Center, PO box 2040, Room H-897, 3000 CA, Rotterdam, The Netherlands.

Introduction

European rules dictate an European Public Tender (EPT) procedure for deliverance of goods or services with a value of Euro 249,000 and over. For all pressure ulcer preventive or curative (p/c) mattress material on a rental basis an average sum of Euro 450,000 in Erasmus MC, a 1300 bed hospital, is spent annually. Therefore, it was decided to start an EPT procedure.

Material and methods

The local PUAP and the Department of Purchasing worked together to make an overview of needs and wishes regarding product type, quality and management aspects. It was our goal to select a small gamma of products for a fair price from one or two trustful external partners. In three boxes low, middle and high-class p/c mattress material was discerned. In a matrix model standardised quality criteria were summarised, interface pressure measurements being a research spearhead activity in our center, was a major citerium, and linked to a point qualification system. Also for purchasing aspects, deliverance estimates and subscription of a basic contract were credited with points.

Results

After six months the formula were ready. After publication of the EPT procedure in the European electronic pathway for these announcements, five companies subscribed, all of them having a basis in the Netherlands. The offered material was unevenly spread over the boxes. Answering of the criteria was often inaccurate. In general the material for documentation (like brochures) of products was of low quality; outdated and partly in a foreign language (English). The information on the most important aspect, i.e., pressure relief capability was limited and inadequately sustained. Pricing was competitive, certainly in view the previous package. The total of points has resulted in the choice of two (potential) partners for the three boxes.

However, one of them appeared not to be able to realise the offered quality and prices, and dropped out. The second in row was then invited and, after further discussions, the deals were confirmed. The total new set of p/c mattress material will now be introduced in the hospital.

Summary

The first EPT in the Netherlands of special mattresses for the prevention and treatment of pressure ulcers has been a learning experience both for the companies as for the decision-makers in the hospital. It was a time consuming and nerve tracking process in spite of the preparation work. Key words like professionally, teamwork, and fair play are relevant in this complex project. An evaluation of this obligatory EPT procedure is warranted. Time will show if it is rewarding.

Reference

Schofield T. Producing criteria for static mattress tender and purchase. J Woundcare 2001; 10(3): 77–9.

PRESSURE ULCERS IN THE PERIOPERATIVE ENVIRONMENT: THE RESEARCH EVIDENCE

‘… the operating table, [is] where so many so-called “postoperative” pressure sores originate’ (Norton, 1967)
‘theatre tables and trolleys are probably the root case of a large proportion of pressure sores in surgical areas’ (Waterlow 1996)

Eileen M Scott RGN, BA(Hons), MLitt, PhD
Research and Development Co-ordinator, and Nurse Researcher, North Tees and Hartlepool NHS Trust, Stockton-on-Tees, TS19 8PE, England, UK

The above comments illustrate the received wisdom that the operating theatre is a high risk area. They are the words of prominent British nurses – Doreen Norton and July Waterlow – whose views have the authority of the ‘expert’ on pressure ulcers.

This paper, which is based on the author’s doctoral thesis (Scott 2000) will provide a review of the existing research evidence, from the 1970s to the current day. Key areas are:

• Risk assessment
• Effects of anaesthesia and surgical trauma
• Inequalities of risk
• Duration and intensity of pressure

The main findings will be summarised and areas where further research is needed will be identified.

References

Norton D (1967), Preventing lesions of the pressure areas, Nursing Mirror (14th July) 341–343.
Scott E M (2000), Hospital acquired pressure sores in surgical patients. Unpublished PhD thesis, University of Teesside, UK.
Waterlow J (1996), Operating table. The root cause of many pressure sores? British Journal of Theatre Nursing 6 (7) 19–21.

DISABILITY – PRESSURE SORE PREVENTION – A MULTIDISCIPLINARY APPROACH

Margaret Ryan RGN RSCN, Maria Collins, Head of Nursing Department, CRC
Nursing Department, Central Remedial Clinic, Vernon Avenue, Clontarf, Dublin 3, Ireland

Introduction

The Central Remedial Clinic (CRC) is a national organisation for the care, treatment and development of children and adults with physical and multiple disabilities. In 2002, a nurse-led Pressure Management Committee was formed with the remit of developing a multidisciplinary, multifaceted approach to pressure ulcer prevention and management. Nurse leaders coordinate the services of a multidisci-plinary team including medical consultancy, seating and assistive technology, physiotherapy, occupational therapy, dietetics, social work and psychology.

Objectives

• The utilisation of all available resources to achieve a reduction in the incidence of pressure ulcers.
• To devise a multidisciplinary approach to pressure ulcer prevention.
• To reduce the personal and economic cost of pressure ulcer treatment.

Methods

• Nursing assessment of risk factors.
• Coordination of multidisciplinary team/services, ie, utilisation of pressure monitoring system through seating/assistive technology.
• Mobilisation of relevant treatment/services.
• Implementation of planned and sustained programme of action.

Result

• An improved quality of life for our clients.
• A more cost effective use of clinical resources.

Summary

Primary indicators of this prospective programme of pressure prevention, which is still in its infancy, promise a reduction in pressure ulcers through this multidisciplinary approach.

PADS AND PRESSURE: AN INVESTIGATION INTO THE EFFECTS OF ABSORBENT INCONTINENCE PADS ON PRESSURE MANAGEMENT MATTRESSES

Fader M, Bain D, Cottenden A.
Continence Technology Group, Departments of Medicine/Medical Physics and Bioengineering; Tissue Viability Research Unit, Centre for Disability Research and Innovation, University College London, England

Introduction

Pressure ulcers and incontinence often co-exist.1 Urinary incontinence has been found to be a significant risk factor for pressure ulcers2 and there is a strong association between poor mobility and continence problems.3 Patients using pressure management products are therefore also likely to be using absorbent pads but the effect that pad wearing has on pressure-relieving products is unknown. The aim of this study was to determine the effects that absorbent pads have, in both dry and wet states, on the pressure-relieving properties of standard and pressure management mattresses.

Methods

An instrumented articulated anthropometric phantom (Patent IPC 94928968.0) with simulated soft body ‘tissues’ in the gluteal and sacral areas was used as the ‘subject’. The soft tissues of the pelvic region are a silicone polymer compound with the same mean instantaneous static hardness value as the buttock tissues of a cohort of elderly volunteers (mean age 68.2 years, SD 3 years)4. The silicone compound was moulded in a CNC-generated mould representing the shape derived from numerical topography data acquired by laser scanning the same cohort of volunteers. The phantom is fixed on a ceiling-mounted guidance system for positioning on different surfaces. The phantom produces reproducible pressures (co-efficient of variation around 2%) compared to humans and is the method recommended by the European Pressure Ulcer Advisory Panel (EPUAP) for testing pressure management products.5

A commonly used, commercially available absorbent pad and pant system for moderate to heavy incontinence was selected (Tena Comfort Super, SCA Hygiene Products AB, Göteborg, Sweden). This was tested with three different mattresses: (A) a standard foam mattress, (B) a visco-elastic (VE) foam mattress and (C) a surface-cut VE foam mattress. Mattresses (B) and (C) are marketed as pressure management mattresses. The phantom was raised and lowered onto the three mattresses in three states: naked, wearing a dry pad and wearing a wet pad following a standard operating protocol. The pressure mapping device Xsensor version 4 (Xsensor Technology Corporation, Calgary, Canada) was used to record the distribution of pressure over the sacral and ischial areas of the phantom. Peak pressure was used as the primary outcome variable and ten repeats were made on each mattress under each condition.

Results

The table below shows that presence of an incontinence pad between the patient and the support surface raises the peak pressure by around 20–25%, a difference which is likely to be of clinical importance. Peak pressures frequently occurred over areas of pad folds. Additional testing showed that pads that were ‘smoothed’ by hand had significantly lower peak pressures than ‘unsmoothed’ pads.

Summary

This study demonstrated that absorbent pads have a substantial adverse effect on the pressure redistribution properties of mattresses. Pad folds appear to contribute to this effect. Absorbent pad manufacturers should consider engineering pads that minimize disruption to pressure management. Further examination of continence and pressure management products is necessary to establish optimum combinations.

References

1. Guralnik JM, Harris TB, White LR, Cornoni-Huntley JC. Occurrence and predictors of pressure sores in the National Health and Nutrition Examination survey follow-up. J Am Geriatr Soc 1988 Sep; 36(9): 807–122.
2. Spector WD, Fortinsky RH (1998), Pressure ulcer prevalence in Ohio nursing homes:clinical and facility correlates. J Aging Health 10(1) 62-80.
3. Sgadari A, Topinkova E, Bjornson J, Bernabei R. Urinary incontinence in nursing home residents: a cross-national comparison. Age Ageing 1997 Sep; 26 Suppl 2: 49–54.
4. Bain DS, Nicholson N, Scales JT. A phantom for the Assessment of Patient Support Systems. Med Eng & Phys. 21 (1999), 293–301.
5. European Pressure Ulcer Advisory Panel, Working Group 2, Guidelines for the measurement and presentation of interface pressure data on support surfaces, January 2002.