Authors (including presenting author) :
Lam MY(1), Chau WS(1)
Affiliation :
(1)Department of Medicine, Yan Chai Hospital
Keyword 1: :
Prophylactic dressing
Keyword 2: :
Pressure Injury
Introduction :
Pressure injuries (PI) commonly occur over the sacral area, particularly in older adults and those with impaired mobility. International guidelines, including the 2019 European Pressure Ulcer Advisory Panel (EPUAP) recommendations, support the use of prophylactic polyurethane foam dressings on bony prominences such as the sacrum to prevent PI caused by pressure, friction, and shear. Evidence from clinical studies and meta-analyses indicates that sacral prophylactic dressings, when used in conjunction with standard prevention protocols (e.g., repositioning, moisture management, and nutritional support), significantly reduce PI incidence compared to standard care alone.
Objectives :
This pilot program aimed to evaluate the effectiveness of prophylactic sacral dressings in preventing pressure injuries over the sacrum area in at-risk patients at Yan Chai Hospital, as part of a bundled evidence-based approach to PI prevention.
Methodology :
This prospective pilot program was conducted in the Medical department of Yan Chai Hospital from the fourth quarter of 2023 to the first quarter of 2025. Patients at high risk of sacral pressure injuries received prophylactic application of a 5-layer bordered silicone foam dressing to the sacral area, integrated with standard prevention protocols. Patients were automatically included when their Norton score was ≤ 12, or presence of stage 1 PI over sacrum area; those with diarrhea, IAD, or pre-existing stage 2 and onwards sacral PI were excluded. Patient demographics, baseline skin condition, and outcomes were recorded. Skin assessments were conducted to track changes in sacral skin status throughout the program period. Staff satisfaction and feasibility were evaluated through a survey conducted in the first quarter of 2025.
Result & Outcome :
A total of 441 patients at high risk of sacral pressure injuries received prophylactic dressing application. Patients were predominantly elderly (mean age 83 years; 86% >70 years) and male (54%). At baseline, 43% (192/441) had normal sacral skin, while 57% (249/441) presented with Stage 1 PI. At program completion, 81% (359/441) showed no change in skin status, 7% (32/441) improved (Stage 1 to normal), and the overall incidence of new or worsened PI was low at 8.4% (37/441), comprising progression from normal to Stage 1 (2%), normal to Stage 2 (2%), and Stage 1 to Stage 2 (4%). Notably, only 6.4% (28/441) developed Stage 2 or higher stages of PI. The program demonstrated high feasibility, compliance, and staff acceptance, with positive feedback from the satisfaction survey completed by 286 nursing staff, supporting ease of use and integration into daily practice. It was deemed cost-effective, as the expense of prophylactic dressings is substantially lower than the cost of treating established pressure injuries. These findings support the use of prophylactic dressings as an effective adjunct in PI prevention bundles.
