Influence of different bed support surface covers on skin temperature
Marta Elena Losa Iglesias
Department of Nursing, Health Sciences School, King Juan Carlos University, Madrid, Spain
Paloma Posada-Moreno
School of Nursing, Physiotherapy and Podiatry, Medical School, Complutense University of Madrid, Madrid, Spain
Ricardo Becerro de Bengoa Vallejo
School of Nursing, Physiotherapy and Podiatry, Medical School, Compultense University of Madrid, Spain
Ismael Ortuño Soriano
School of Nursing, Physiotherapy and Podiatry, Medical School, Compultense University of Madrid, Spain
Ignacio Zaragoza-García
School of Nursing, Physiotherapy and Podiatry, Medical School, Compultense University of Madrid, Spain
Carmen Martínez-Rincón
School of Nursing, Physiotherapy and Podiatry, Medical School, Compultense University of Madrid, Spain
PP: 206 - 220
Abstract
Pressure ulcers represent an ongoing challenge, particularly in immobile patients, that must be met by all health professionals. Extrinsic influential factors involved in the development of pressure ulcers include local shear forces, skin friction, moisture, and temperature for a patient in bed.
Objectives: Based on the relationship between pressure ulcers and skin temperature, we sought to study the influence of different bed support surface covers on skin temperature. The purpose of this study was to determine the influence of support surface materials and their effects on skin temperature at high risk areas of the body known to develop pressure ulcers. A quasi-experimental study with a non-probability sampling was used. A total of 31 subjects (14 males and 17 females) between 19 and 29 years old participated in this study.
Methods: The same standard foam bed cushion was used and three different types of surface protectors (also known as ticking) were chosen for comparison: no cover, cotton, or plastic. Skin temperature measurements were obtained from areas of high risk for developing pressure ulcers: sacrum, right and left scapula, right and left elbow, and right and left calcaneus.
Results: Upon analysis of the protective effect of different support surface coverings on the local skin temperature, we observed that temperatures were lower in all risk areas that had no support surface protector and were greater when the surfaces were in contact with protector material, with increases up to 2.13°C.
Conclusions: The type of support surface protector material greatly influences skin temperature depending on the specific area of the body in contact with the surface. The protective plastic that is currently used in hospitals may increase the risk of skin lesions. Simple changes in practices could help minimize the negative impact that plastic protectors contribute to the skin. Regardless, the surface area should be covered with protective covers that do not produce an increase in local temperature and hygienically maintain their integrity.
Keywords
skin temperature; bed covers
References
Agency for Health Care Policy and Research. (1992, May). Pressure ulcers in adults: Prediction and prevention (Clinical practice guideline; no. 3) (p. 63). Rockville, MD: AHCPR, US Department of Health and Human Services, Public Health Service.
Angelidis, I., Lidman, D., Sjöberg, F., & Thorfi nn, J. (2009). Decubitus ulcer development: Pressure alone increases tissue temperature. European Journal of Plastic Surgery, 32(5), 241-244.
Ayello, E., & Braden, B. (2002). How and why to do pressure ulcer risk assessment. Advances in Skin and Wound Care, 15(3), 125-131.
Baldwin, K. M. (2001). Transcutaneous oximetry and skin surface temperature as objective measures of pressure ulcer risk. Advances in Skin and Wound Care, 14(1), 26-31.
Barnett, R. I., & Ablarde, J. A. (1995). Skin vascular reaction to short durations of normal seating. Archives of Physical Medicine and Rehabilitation, 76(6), 533-540.
Bergstrom, N., Braden, B. J., Laguzza, A., & Holman. V. (1987). The Braden scale for predicting pressure sore risk. Nursing Research, 36(4), 205-210.
Brattgard, S. O., & Severinsson, K. (1978). Investigations of pressure, temperature and humidity in the sitting area in a wheelchair. In E. Asmussen & K. Jorgensen (Eds.), Biomechanics VI-B (pp. 270-273). Baltimore, MD: University Park Press.
Brienza, D. M., Karg, P. E., & Brubaker, C. E. (1996). Seat cushion design for elderly wheelchair users based on minimization of soft tissue deformation using stiffness and pressure measurements. IEEE Transactions on Rehabilitation Engineering, 4(4), 320-327.
Brown, S. J. (2001). Bed surfaces and pressure sore prevention: An abridged report. Orthopaedic Nursing, 20(4), 38-40.
Crossley, A., & Holdcroft, A. (1999). Physiology of heat balance. Royal College of Anaesthetists Newsletter, 47, 155-158.
Cullum, N., McInnes, E., Bell-Syer, S. E., & Legood, R. (2004). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, (3), CD001735.
Dinsdale, S. M. (1974). Decubitus ulcers: Role of pressure and friction in causation. Archives of Physical Medicine and Rehabilitation, 55(4), 147-152.
Donovan, W. H., Dinh, T. A., Sorber, S. L., Krovskop, T. A., Rodriguez, G. P., & Shenaq, S. M. (1993). Pressure ulcers. In Rehabilitation medicine. In J. A. Delisa (2nd Edn.), Principles and practice (pp. 716-732). Philadelphia, PA: JB Lippincott.
Ek, A. C., Gustavsson, G., & Lewis, D. H. (1987). Skin blood flow in relation to external pressure and temperature in the supine position on standard hospital mattress. Scandinavian Journal of Rehabilitation Medicine, 19, 121-126.
Finestone, H. M., Levine, S. P., Carlson, G. A., Chizinsky, K. A., & Kett, R. L. (1991). Erythema and skin temperature following continuous sitting in spinal cord injured individuals. Journal of Rehabilitation Research and Development, 28, 27-32.
Fisher, S. V., & Kosiak, M. (1979). Pressure distribution and skin temperature effect of the ROHO wheelchair balloon cushion. Archives of Physical Medicine and Rehabilitation, 60(2), 70-71.
Goller, H., Lewis, D. W., McLaughlin, R. E., & Verhonick, P. J. (1976). The effect of external pressure on skin temperature distribution by thermography. Medical Research Engineering, 12(1), 6-8.
Knox, D. M. (1999). Core body temperature, skin temperature, and interface pressure. Relationship to skin integrity in nursing home residents. Advances in Wound Care, 12(5), 246-252.
Kokate, J. Y., Leland, K. J., Held, A. M., Hansen, G. L., Kveen, G. L., Johnson, B. A., et al. (1995). Temperature-modulated pressure ulcers: A porcine model. Archives of Physical Medicine and Rehabilitation, 76(7), 666-673.
Kosiak, M., Kubicek, W. G., Olson, M., Danz, J. N., & Kottke, F. J. (1958). Evaluation of pressure as a factor in the production of ischial ulcers. Archives of Physical Medicine and Rehabilitation, 39(10), 623-629.
Lachenbruch, C. (2005). Skin cooling surfaces: Estimating the importance of limiting skin temperature. Ostomy/Wound Management, 51(2), 70-79.
Lavery, L. A., Higgins, K. R., Lanctot, D. R., Constantinides, G. P., Zamorano, R. G., Armstrong, D. G., et al. (2004). Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care, 27(11), 2642-2647.
Linder-Ganz, E., & Gefen, A. (2009). Stress analyses coupled with damage laws to determine biomechanical risk factors for deep tissue injury during sitting. Journal of Biomechanical Engineering, 131(1), 011003.
Mahanty, S. D., & Roemer, R. B. (1979). Thermal response of skin to application of localized pressure. Archives of Physical Medicine and Rehabilitation, 60(12), 584-590.
Mahanty, S. D., & Roemer, R. B. (1980). Thermal response of skin to the application of localized pressure. Archives of Physical Medicine and Rehabilitation, 60, 584-590.
Mahanty, S. D., Roemer, R. B., & Meisel, H. (1981, December). Thermal response of paraplegic skin to the application of localized pressure. Archives of Physical Medicine and Rehabilitation, 62(12), 608-611.
Maklebust, J., & Sieggreen, M. (1996). Pressure ulcers: Guidelines for prevention and nursing management. Springhouse, PA: Springhouse.
Norton, D., McLaren, R., & Exton-Smith, A. N. (1975). An investigation of geriatric nursing problems in hospital. New York: Churchill Livingstone.
Olshansky, K. (2008). The 10 most important questions concerning pressure ulcers and quality of care. Advances in Skin and Wound Care, 21(11), 505-508.
Pajariño Gallego, B., Ruíz García, M. L., & Rizo Alfaro, P. (1993). Valoración y planifi cación de cuidados preventivos de las úlceras por presión. Enfermería Clínica, 3(6), 251-254.
Reddy, M, Gill, S. S., & Rochon, P. A. (2006). Preventing pressure ulcers: A systematic review. JAMA, 296, 974-984.
Reger, S. I., Adams, T. C., Maklebust, J. A., & Sahgal, V. (2001). Validation test for climate control on air-loss supports. Archives of Physical Medicine and Rehabilitation, 82(5), 597-603.
Reger, S. I., Ranganathan, V. K., & Sahgal, V. (2007). Support surface interface pressure, microenvironment, and the prevalence of pressure ulcers: An analysis of the literature. Ostomy/Wound Management, 53(10), 50-58.
Sae-Sia, W., Wipke-Tevis, D. D., & Williams, D. A. (2005). Elevated sacral skin temperature (T(s)): A risk factor for pressure ulcer development in hospitalized neurologically impaired Thai patients. Applied Nursing Research, 18(1), 29-35.
Schubert, V., & Fagrell, B. (1991). Post-occlusive reactive hyperemia and thermal response in the skin microcirculation of subjects with spinal cord injury. Scandinavian Journal of Rehabilitation Medicine, 23, 33-40.
Seymour, R. J., & Lacefield, W. E. (1985). Wheelchair cushion effect on pressure and skin temperature. Archives of Physical Medicine and Rehabilitation, 66(2), 103-108.
Smolander, J., & Holmer, I. (1991). Individual response to physical work in the heat in relation to sweating and skin blood flow. International Archives of Occupational and Environmental Health, 63(3), 225-226.
Soldevilla, J. J., Torra, J. E., Verdu, J., Martinez, F., Lopez, P., & Rueda, J., et al. (2006). Segundo estudio nacional de prevalencia de ulceras por presión en España: Epidemiologia y variables defi nitorias de las lesiones y pacientes. Gerokomos, 17(3), 154-172.
Sprigle, S., Linden, M., McKenna, D., Davis, K., & Riordan, B. (2001). Clinical skin temperature measurement to predict incipient pressure ulcers. Advances in Skin and Wound Care, 14(3), 133-137.
Thorfi nn, J., Sjöõberg, F., Sjöstrand, L., & Lidman, D. (2006). Perfusion of the skin of the buttocks in paraplegic and tetraplegic patients, and in healthy subjects after a short and long load. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 40, 153-160.
Wu, S. S., Ahn, C., Emmons, K. R., & Salcido, R. S. (2009). Pressure ulcers in pediatric patients with spinal cord injury: A review of assessment, prevention, and topical management. Advances in Skin and Wound Care, 22(6), 273-284; quiz 285-276.

eContent Home




