C. Tod Brindle and Jacob A. Wegelin have won the clinical research manuscript of the year award from the Journal of Wound, Ostomy and Continence Nursing for their pioneering work on the use of foam dressings to prevent pressure ulcers.(1)
The article, “Prophylactic Dressing Application to Reduce Pressure Ulcer Formation in Cardiac Surgery Patients,” received the honor as the best original, clinical research peer-reviewed article published in the journal in the past year. Brindle, MSN, RN, ET, CWOCN, is a member of the Virginia Commonwealth University Health System Wound Care Team in Richmond, Virginia. Wegelin, PhD, is a biostatistician in the Department of Biostatistics at VCU Medical Center. Both were honored June 22-26 at the WOCN annual conference in Seattle, WA. JWOCN is the official publication of the Wound Ostomy Continence Nurses Society (WOCN).
Published in the March/April 2012 issue of JWOCN, the manuscript details a study involving patients at Virginia Commonwealth University Medical Center in Richmond, Virginia.
The study was designed to determine if the application of a self-adherent silicone border foam dressing would reduce pressure ulcer incidence when compared to standard preventive interventions for cardiac surgery patients. These patients are considered one of the most at-risk patient populations, with incidence rates reported as high as 29.5 percent. The high level of risk associated with critically ill cardiac surgery patients is attributed both to the underlying comorbid conditions of these patients and to factors associated with their surgical procedure. When a surgical patient develops a pressure ulcer within three days after his or her procedure, it most likely indicates that the ulcer occurred during surgery.
All patients in this study had a dressing applied during their surgical procedures (cardiothoracic) and no PUs developed until six days following surgical procedure in either group.
Following the OR procedure the patients admitted to the CSICU were assigned to either standard treatment or an intervention group consisting of standard preventive care plus application of the silicone border foam dressing. The study was not able to show a statistically significant difference between the two groups due to a reduced sample size. It concluded that further research is needed to evaluate the efficacy of a silicone border foam dressing for reduction of hospital-acquired PU via a study that enrolls a larger sample size with adequate power analysis and uses random allocation to the treatment and control groups.
The study follows another that Brindle conducted in 2008 on surgical trauma and prophylactic dressings in the ICU.(2)
“The goal,” Brindle says, “was to provide more definitive evidence that silicone border foam dressings applied prophylactically can prevent pressure ulcers from forming in high-risk cardiac-care patients.” In both studies Brindle and company used the Mepilex® Border Sacrum silicone foam dressing from Mölnlycke Health Care US.
The major benefit of those studies was that they opened the door for future research, Brindle said. A recent randomized clinical trial on prophylactic dressings was published by Dr. Nick Santamaria in the International Wound Journal.(3) In his study, he proved that not only did Mepilex® Border Sacrum prevent sacral pressure ulcers but that Mepilex® Heel was associated with statistically significant results in the prevention of heel ulcers. Dr. Peggy Kalowes of Long Beach Memorial Hospital has done a similar randomized controlled trial showing that Mepilex® Border Sacrum prevents pressure ulcers when used as part of a comprehensive program for pressure ulcer prevention.4
Brindle says that while he is pleased he and the staff at Virginia Commonwealth University Medical Center are being recognized for their work, “I am more satisfied that it has led to the first two randomized controlled trials on this dressing, which have proven the outcomes we were trying to achieve. To potentially improve the health and safety of others across the globe, that’s pretty powerful.”
Mepilex® Border Sacrum is an all-in-one foam dressing for both prevention and treatment of sacral pressure ulcers. The dressing minimizes pain and skin damage at dressing change.(5) It absorbs exudate, maintains a moist wound-healing environment and minimizes the risk for maceration. Mepilex® Heel is a soft and conformable foam dressing that absorbs wound fluid (exudate) but keeps the wound sufficiently moist to support healing. The dressing is a version of Mepilex® that is specifically shaped to fit the heell.
1. Brindle CT Wegelin J. Prophylactic Dressing Application to Reduce Pressure Ulcer Formation in Cardiac Surgery Patients. JWOCN 2012:39(2):133-142.
2. Brindle CT. Outliers to the Braden Scale: Identifying High Risk ICU Patients and the Results of Prophylactic Dressing Use. Journal of the World Council of Enterostomal Therapists. 2010; 30(1):2-8.
3. Santamaria N Gerdtz M Sage S, et al. A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J 2013; doi: 10.1111/iwj.12101.
4. Kalowes P. Li P, Carlson C, et al. Use of a Soft Silicone, Self-Adherent, Bordered Foam Dressing to Reduce Pressure Ulcer Formation in High Risk Patients: A Randomized Clinical Trial. In press, 2013.
5. White R. A Multinational survey of the assessment of pain when removing dressings. Wounds UK, 2008.