This document discusses reducing pressure sores and shearing damage for bed-bound individuals. It defines pressure sores and shearing damage, explains how they occur and common risk factors. It also describes a study that introduced leave-in bed positioning systems, which found reductions in pressure sore incidence and manual handling injuries/costs for carers after 12 weeks. The study suggests leave-in systems can help prevent pressure sores while improving patient comfort and safety during transfers.

1. Reducing the incidence of pressure
sores and shearing damage for bed-
bound individuals
MHANZ 23rd March 2012
Melanie Sturman-Floyd, MSc, RGN.
Moving and Handling Consultant

2. What are pressure ulcers and shearing
damage?
• A pressure sore/decubitus ulcer is a local
injury to the skin or underlying tissue over
a bony prominence, caused by
prolonged, sustained pressure.
• Shearing damage is caused by
pulling/tearing of the tissue.

3. Pressure and Shear
Pressure – presses tissue together
Shear – pulls/tear tissue
Shear and friction – cause pressure
sores
Blood vessel
Skin layer 3 (dermis)
Shear between
Skin layer 2 (cutis)
skin layers
Skin layer 1 (epidermis)

4. Why does the pressure damage occur?
• Poor Nutrition
• Dehydration
• Poor Circulation
• Incontinence
• Old Age
• Immobility
• Insufficient Moving/Turning in Bed, Chair or Wheelchair
• Poor Moving and Handling Techniques
• Unsuitable Mattress

5. Common Pressure Ulcer Sites
• The areas most effected are:
• Back of heels
• Sacrum
• Sometimes scapula area
• Hip, when the patient is lying in the foetal
position.

6. Pressure Ulcer Classification Grade 1.
European Pressure Ulcer Advisory
Panel. Pressure Ulcer Treatment
Guidelines
Non-blanchable erythema (redness) of
intact skin.
Discolouration of the
skin, warmth, oedema, induration or
hardness may also be used as
indicators, particularly on individuals with
darker skin.

7. Pressure Ulcer Classification grade
2
• Partial thickness skin loss
involving
epidermis, dermis, or
both.
• The ulcer is superficial
and presents clinically as
an abrasion or blister.

8. Pressure Ulcer Classification
Grade 3
• Full thickness skin
loss involving damage
to or necrosis of
subcutaneous tissue
that may extend down
to, but not through
underlying fascia.

9. Pressure Ulcer Classification
Grade 4
• Extensive
destruction, tissue
necrosis, or damage
to muscle, bone, or
supporting structures
with or without full
thickness skin loss.

10. In which environments do pressure sores
occur?
• 20 % service users in acute care
(large hospitals)
• 30 % people in community (own
home and community hospitals)
• 20 % people in nursing/residential
homes

11. The annual cost of pressure
ulcers in the UK
The cost is 1.4 -2.1 billion/year = Mental Health or
Community Health Services Budget
The cost per service user ranges between £11k – £40k
References:
Bennett G., Dealey C. & Posnett J. The cost of pressure ulcers in the UK. Age and Ageing. 2004; 33(3): 217-218.
Vanderwee K, Clark M, Dealey C et al. (2007). Pressure ulcer prevalence in Europe: a pilot study. Journal of Evaluation in
Clinical Practice. 13(2):227-235.
Phillips L, Buttery J Exploring pressure ulcer prevalence and preventative care. [Journal Article] Nursing Times 2009 Apr
28-May 4; 105(16):34-6.
EPUAP (2009) European Pressure Ulcer Advisory Panel. EPUAP Review 2009; 10(1):1-28.

12. Pressure ulcer productivity calculator
Section A: Total number of pressure ulcers
350
How many pressure ulcers does your organisation treat? (enter a number and press ENTER)
Section B: Pressure ulcers by grade
Grade 1 122
How many pressure ulcers of each grade does your organisation treat? Grade 2 144
Grade 3 45
The default numbers are based on percentages Grade 4 39
from the academic research study. Please overwrite
if you are confident your numbers are different. Total 350 (Total of section B must be the )
same as the number in section A)
Section C: Results: Estimated cost of pressure ulcer care at 2008/09 prices
(rounded to the nearest thousand £s)
Central estimate Lower range Higher range
Grade 1 177,000 143,000 214,000
Grade 2 862,000 699,000 1,044,000
Grade 3 449,000 363,000 543,000
Grade 4 552,000 447,000 668,000
Total 2,040,000 1,652,000 2,469,000
Section D: Potential savings if the number of pressure ulcers is reduced
Enter a planned percentage reduction
in the green box, to see the impact on
number of ulcers, and cost pressures:
25% A reduction of 25% in pressure ulcers would mean 88 fewer pressure ulcers and a
potential cost saving of £510k
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuid
ance/DH_116669

13. How can pressure damage be reduced?
• Activate the Service User when Possible
• Improved Nutrition and Hydration
• Pressure Relieving Mattresses and Cushions
• Improved Standard of M/H Equipment
• Reduce friction and shearing with equipment and
manual handling techniques.
• Well-Trained Staff
• Change position regularly.

14. Preventative approach – Cost-benefits
• Activate service user whenever possible
• Work with minimal force
• Reduce carer’s injuries
• Reduce cost of care

15. Reducing the incidence and risk of pressure sores and
shearing damage for bed-bound individuals.
•An equipment evaluation conducted by:
•Melanie Sturman-Floyd MSc RGN
•Norfolk County Council & MSF Manual Handling &
BackCare
•www.manualhandlingconsultancy.co.uk

16. The Thesis
“Does leaving a leave in bed positioning system under a
person lying in bed exacerbate or increase the
incidence of pressure ulcers?”
• Other questions asked.
“Does leaving a leave in bed positioning system reduce
the number of carers for moving and handling tasks?”
“Does leaving a leave in bed positioning system increase
patient comfort?”

17. Study Inclusion
• 110 clients evaluated.
• Criteria for inclusion, predominately
bedbound, tissue viability mattress.
• Require assistance with moving and
handling activities.
• Support provided by family or employed
handler.

18. Introduction of equipment.
• Balance between managing manual handling risks
and pressure ulcer incidence.
• Discussed with Tissue Viability Nurse.
• No previous research.
• Wendy Lett systems introduced.
• Record types of tissue viability mattresses used.
• At start of trial record pressure ulcer incidence.
• At start of trial record number of patient handlers.
• At start of trial measure and record handler
perceived rate of exertion.

19. Findings
• Pressure ulcer incidence – start of trial 79 clients
had pressure ulcers,
• Grades Start 6 weeks 12 weeks
• Grade 1 25 5 2
• Grade 2 3 2 1
• Grade 3 2 2 0
• Grade 4 1 1 0
Projected costs of pressure ulcer management for
N79 at start £88,000 and at end of study £9,000.

20. Reducing handler costs and
manual handling injuries
• Reducing carer costs
• Introducing system enabled a reduction of carers for 28 clients.
Cost at start of trial £711,349, Cost at end of study was £422,276.
• Reducing manual handling injuries
• 232 carers were asked to rate perceived rate of exertion, at start of
trial range was 14-17, (high risk). Changing technique and
introducing the leave in systems reduced range to 5-9, (low risk).
• Using systems with bariatric clients – reduces manual handling effort
from positioning slide sheets.
• Using systems with clients who have complex behavioural needs –
reduces challenging behaviour.
• Increased patient comfort and facilitated transfers/independence.