Friday, December 29, 2017

Skin ulcer prevention for bed-bound patients - complete guide on choosing a low air-loss / alternating pressure air mattress

One of the most expensive aspects of caring for bed-bound patients are pressure ulcers and wound care. In those terms, they heavily affect both the families of the patients and, in the bigger picture, the economics of the healthcare system.

However, it's fair to say that the highest "cost" is the suffering of the affected patients.

The problem

There is no way of avoiding it altogether. However, the data shows a problematic trend that we want to talk about today.

It's the fact that the technology of low-air-loss and alternating pressure air mattresses has seen significant improvements over the last decade (best medical mattresses today even include both technologies working in synergy). BUT the incidence and prevalence of wound and ulcers development have not followed the significant leap in technology.

Our research shows that the two factors that play the biggest role in the disparity between the numbers are:
  1. The difference in the expertise between nursing and non-nursing facilities (as reported by the study conducted in Philadelphia between 1998 and 2001, you can see it here)
  2. Inadequate choice of medical mattresses, which especially goes for home settings
The bottom line is that the prevalence has not followed the technological advancements in the area of specialized mattresses. The debate about whether ALL pressure ulcers can be prevented is ongoing and is not likely to end any-time soon. With that in mind, we believe that the energy spent on debating the issue of occurrence and prevalence is (as far as the comfort of the patient goes) wasted and our efforts are better used minimizing the risks.

In the post below, we'll address some of the ways the choice can go wrong and look at some actionable tips to help those in need choose an alternating pressure mattress  to lower the risk of wound injury development.

Issue 1 - not adjusting the choice to wound staging

One of the most common mistakes you can make when choosing the right mattress is not taking the time to properly assess the risk and adjust.

It happens with people in home care if the physician is not consulted. To put it simply - people tend to think that all low air-loss and alternating pressure mattresses are created equal.

The proper way to choose a mattress is to make sure that it fits the wound staging as here defined by the  - National Pressure Ulcer Advisory Panel.

Note: Don't be confused by the terminology, NPUAP changed "pressure ulcers" to " pressure injury" back in 2016.

Following the guidelines defined by NPUAP, your physician will determined what type of injury-prevention mattress is the right fit.

Once you know this, you can take it there...the part where you have more "leeway" is choosing a specific product, NOT the mattress type.

Issue 2 - specific product choice

This is where we'll get more specific and even mention some trusted brands.

Mattresses and overlays of this type are regulated by the Part 880 Section 5500 of the Code of Federal regulations about "General and personal use devices."

This, of course, doesn't mean that all low air loss and alternating pressure mattresses are created equal.

It is still fair to say that your safest bet is going with a trusted brand.

In this year's update to their guide, has found that that, based on statistics, the most well-trusted brands among low air loss and medical alternating pressure air mattresses are Drive Medical, Vive and Invacare.

What to look for

Now that we've looked at some specific brands, let us take a step back and analyze types of mattresses available and look into some advantages and shortcomings of each.

Choice of a bed

The systems can come as independent products (overlays of mattresses) or with a bed.

Beds used with the systems can range from classic frames (in lower risk groups) to dedicated beds (the type you'd see in a hospital). The later usually use electric profiling, which reduces the need for manual repositioning and, in turn, the overall risk of injury.


First things first - let's make sure we fully understand the terminology you might come across.
You might see the surface of the mattresses and overlays described as: pressure relieving, reducing or redistributing.

The only term that can be universally applied to air mattress with alternating chambers is "relieving", the latter two indicate that the surface of the mattress plays the role of distributing weight across the surface.

For low risk patients

Classic hospital beds are sufficient for low-risk patients. Foam used for hospital beds offers enough comfort as per a study conducted in 2004 - you can see it here.

Dedicated foam mattresses

If there is any risk of pressure injury development but the risk is not as high as to require dynamic mattresses (we'll get to these in a minute), mattresses made of visco-elastic foam will be superior to standard hospital beds in terms of lowering the risk of pressure skin injury.


Dedicated overlays are usually made of fibre or foam (one piece or chunks). On the higher end of risk scale, the physician might recommend a fluidized overlay or mattress.

Non-dynamic fluid filling might be a good choice if access to power (electricity) is limited.

Dynamic systems

This is where low-air-loss and alternating pressure medical mattresses belong. The "dynamic" refers to the fact that these mattresses alternate the pressure in the air-filled cells.

We mentioned a few brands tested and recommended by above.

Final thoughts

The choice of the right mattress or overlay for pressure relief is sensitive and it has a long-term, both in terms of comfort of the affected patient and, in the big picture, the economics of the healthcare system.

It is not a choice that can be rushed or made randomly.


National Center for Biotechnology Information

This is a guest blog entry.

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