The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

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

The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex^® Border Sacrum and Mepilex^® Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer.

Switching on the chronometer of history : communism, postcommunism and heritage

The destruction of monuments accompanying the fall of Communism ignited debates about preservation of manifestations of a hated regime. While heritage professionals called for their preservation as ‘historical documents’, many monuments were destroyed or removed. Yampolsky sees anti-Communist iconoclasm as a rejection of the totalitarianism of time embodied in Communist monuments. These ‘intentional monuments’ were intended to ‘negate the march of time and oppose to it the permanence of human action’. They demonstrated the alleged end of history in a classless utopia.

Iconoclastic acts against these monuments involved the crossing of ‘the invisible boundaries of the sacral zone surrounding monuments, switching on the chronometer of history’. In doing so, iconoclasts provide the conditions for reassertion of heritage practices: heritage requires a sense of the flow of time, a difference between past, present and future.

Having restarted the chronometer of history, a society is forced to assess where it stands in relation to its past. Will it continue on a path of ‘wilful forgetting’, or seek to confront the past? The danger of wilful forgetting is the creation of nostalgia. Alternatively, preservation of places of memory helps processing of the past required for movement into the future. ‘One need only consider the way in which Berliners tore down the hated Berlin Wall in the aftermath of 1989’, Fulbrook writes, ‘to understand the desire to rid the landscape of a hated excrescence, a symbol of a rejected political past. But…for those who come after, the effort of historical imagination is all the greater for lack of a topography of experience’.

Heritage preservation can produce a ‘topography of experience’, through which the experience of Communism is examined. Reassertion of a humanistic historical time through heritage practices reveals the arrogant futility of utopian projects seeking to bring history to an end.

Exploring known risk factors for pressure injury with visual technology

This research has identified that the use of visual technology can support the correlation between peak interface pressure and pressure gradients in the understanding of deep tissue injury. In addition as a pilot study the visual assessment of buttock shape has demonstrated potential for identifying risk of ischial or sacral pressure injury.