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Static overlays for pressure ulcer prevention: a hospital-based health technology assessment

25 June 2020
Volume 29 · Issue 12



At Odense University Hospital (OUH) alternating-air mattresses (AAM) are used in the prevention of pressure ulcers (PU); however, static overlays might be more effective and have lower costs. To investigate the properties and consequences of using static overlays for prevention of PU at OUH, a hospital-based health technology assessment (HTA) was conducted.


Two types of static overlays were tested in an observational study and compared with AAM for patients with a medium–high risk of PU in geriatric and orthopaedic wards at OUH. Incidence of PU was investigated 7 months before (n=720) and 6 months after implementation (n=837). Staff attitudes were examined in a questionnaire survey (n=55) and focus group interviews (n=13). Patients who had tried one of the overlays and the AAM were interviewed (n=12).


No statistical difference in PU incidence was found before and after the implementation of overlays (2.5% before, 2.7% after, P=0.874, n=1557) and no patients lying on overlays developed PU (n=123). Staff had mixed attitudes, but the majority preferred having overlays as an option for their patients. Interviewed patients preferred overlays due to less noise and improved mobility.


Both types of overlay are effective in PU prevention. However, overlays introduce challenges for staff and clear guidelines for the selection of support surfaces are needed. Overall, it is recommended that static overlays are considered as an alternative to AAM for PU prevention.

Pressure ulcers (PUs) are a frequently occurring adverse event in hospitals, especially among immobilised patients (Fremmelevholm and Soegaard, 2019). In Denmark, there are no national data for PU prevalence, but studies at four hospitals between 2002 and 2018 showed a PU prevalence of between 14% and 43% (Bermark et al, 2009). A 2007 European study (5947 patients) across 25 hospitals in Belgium, Italy, Portugal, Sweden and the UK showed a PU prevalence of 18.1% among admitted patients (Vanderwee et al, 2007). At Odense University Hospital (OUH), the prevalence is assessed yearly and a successful quality improvement intervention has reduced the PU prevalence from 10% in 2012 to 2% in 2018 (Fremmelevholm and Soegaard, 2019).

PUs are painful and have severe consequences for patients as well as the economy. In the UK, PUs have been estimated to cost up to 4% of the annual healthcare budget (Bennett et al, 2004). The annual treatment cost of pressure ulcers in the Danish Healthcare System is estimated to be €174.5 million (£154 million) (Mathiesen et al, 2013) Support surfaces, such as mattresses and overlays, play an important role in PU prevention (European Pressure Ulcer Advisory Panel et al, 2014; Nixon et al, 2019). At OUH, alternating-air mattresses (AAM) are used for patients with a medium to high risk of developing PUs. According to a review of randomised controlled trials (RCTs) there are no differences in PU incidence between static mattresses or overlays and AAM (Chou et al, 2013). Qaseem et al (2015) recommended static mattresses or overlays due to their lower costs. Furthermore, AAM are not preferred by patients owing to the reduced ability to move and noise nuisance (Nixon et al, 2019).

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