PRODUCT FOCUS

SimCair: a simple mattress systemto support pressure ulcer preventionSylvie Hampton

Pressure ulcer prevention is expensive and at timesdifficult to achieve. However, pressure ulcer preventionand management should be an integral part of nursingpractice (Moore. 2001) and each nurse should be

educated in prevention strategies including the rationale ofequipment selection. However, although many strategies havebeen developed in order to prevent pressure ulcere, theyremain a significant healthcirc problem, particularly forchronically ill patients in rehabilitation facilities (Sae-Sia andWipke-Tevis, 2(){)2).This has led to government White Papersreinforcing the move towards evidence-based heaith care thatincludes performance measures, clinical effectiveness andongoing professional development (Stephens and Bick, 2002).

Figure 1. The SimCair mattress incorporates temperature-sensitive mscoelastic/iiiiffl lechnotogy.

All pressure ulcers are chronic wounds that have an inherent,physiologic impairment to heahng (Brem et al, 2()Ü2) and areareas of soft tissue breakdown that result from sustainedmechanical loading of the skin and underlying tissues. Theycan affect the quality of life of many individuals (Bouten et al,2003) and cause anxiety and distress for families.The optimumsolution to this ancient problem is not to allow the pressuredamage to occur in the first place.

As any community nurse will know, delivering a specialistmattress to patients who are at risk of this pressure damage canbe slow owing to the difficulty of obtaining a mattress at thetime of specific need. In nursing homes, ftmding is often an issuewhen mattresses are required (Hampton and Collins, 2003) and.

AbstractAssessing skin is a simple method of reducing pressure ulcer occurrenceand is easily accomplished by both trained and untrained staff.The important issue, once the risk has been identified, is to supplyequipment in the shortest time possible. A new mattress, SimCair,developed by Hill-Rom Ltd, is designed for just such a reason.It is a lightweight overlay that combines air and viscoelastic foamin order to redistribute the body weight and thus reduce risk. SiniCairis easily transported and can be ready for instant and automatic inflationas soon as it is required. It is also durable and simple to clean betweenpatients. A small evaluation was undertaken in one nursing hometo assess the benefits to the residents.

Key words: • Patients: welfare • Pressure ulcers

therefore, a light-weight mattress that is a simple but inexpensivesystem has a role iii tlic prevention of pressure ulcers.

This product focus reviews the efficacy and appropriatenessof a new, light-weight mattress for patients who are at risk ofpressure damage in the community.

Prevention of pressure damageIf pressure damage is recognized in the ven' early stages, beforedeterioration within the tissues, and suitable equipment orrepositioning is commenced, then pressure ulcération will beunlikely to occur (Gledhill and Hampton, 2004). The

Fisiire t.TittSimCair mattress.

Sylvie Hampton is Tissue Viability Consultant, Eastbourne

i Joiiriui uf Nursing. 2(>i)5,Val 14. No 7 409

assessment for the risk ofpressure ulcer developnienr need notbe more difficult or complicated than examining the skin(Gledhill and Hampton, 2004). When pressure is present, theskin turns white as the blood is prevented from entering thearea of the pressure, and when the pressure is reheved, the skinflushes inmiediately red. This response is perfectly normal andcan be seen in liealthy people as well ns those who are Luiwell.This redness disappears quite quickly but is an indicator tliatpressure has been applied to that area for too long a period(Hampton and Collins. 2003).

When the skin develops this redness, a tinger pressed overthe area will produce a white mark as the blood is once againprevented from entering that area. Tbe ability' for the skin torecover from this blood deprivation indicates that there is noactual damage occurring and can act as a warning that pressurehas been applied for too long a period and the resident hasbeen ui danger of developing pressure damage (CÜedhill andHampton, 2004).

Owing to accoinpiin^nng illnesses, the ageing population is athigh risk and more predisposed to the development ot pressureulcers (Jaul, 2001). The phenomenon of pressure ulcers in tbe

Figure .*. SimCair in comparison to a current air-fiUed overlay.

elderly patient often requires an alternative management policyto that of the standard treatment and, in general, thetherapeutic approach to pressure ulcers in elderly peopleshould be dirterent to that in younger patients. Thismodification is owing to the accompanying co-morbidity sooften associated with ageing (Jaul, 2001).

Although considered by many healthcare workers to be aninevitable probleui of ageing, pressure ulcers are in actualitypreventable and their prevention is a quality outcome of care(Murray and iîlaylock, 1994). Conversely, relatives andpatients who in the past also appeared to accept that pressureulcers were an inevitable result of chronic conditions andreduced mobility, now view them as evidence of a failure toprovide a reasonable standard of care and often bring actionfor compensation against those responsible (Hampton,2004). Therefore, it is important to provide support andeducation for all healthcare workers, partictilarly healthcareassistants (HCAs). HCAs are in the frontline of care(I^imond, 2003) and are caring for increasingly dependentresidents who are consequently at great risk of developingpressure injuries (Clay, 2000), particularly as these injuriesare common among frail elderly people. It is also importantto provide the required equipment at the time that it is

Interface pressure mapping on a 1,60 m 58 Kg subject

Supine position (0°)

Interface pressure mapping on a 1,75 m 150 Kg subject

Supine position (0°)

410 otNursiiiy. 2(KI5.Vd 14. No 7

Hill-Rom

For further information on the SimCair mattressplease contact

Liz.Mcgowan@hill-rom.comHill-Rom. Ashby Park. Ashby de la zouch.

Leicesershire LE65 1|Gdetails on application)

Figun4. TheSlmCair mattressis tiglu weightand can easilyhe tarried hy oneperson.

needed, and to not cause the patient to wait while fundingis identified and a mattress provided. The SimCair is onesolution to this common problem as it is much cheaperthan dynamic systems.

The SimCair mattressThe SimCair mattress, developed by Hill-Rom Ltd, is a self-inflating mattress overlay {Figtm. 1) that requires little set-upeducation for nurses before use. The mattress is unique as itcombines temperature-sensitive viscoelastic foam technology

combined with static-airtechnolog)' which conforms tothe patient, allowing betterredistribution of the bodyweight, reducing overalluiteiface pressures (Figure 2).This can clearly be seen in theinterface pressure mapping.Figure 3 compares SimCairwith another static air product.

The SimCair mattress overlayhas a rapid inflation and deflationwith a dual twist action, high-flow valve system enablingautomatic inflation and ease oftransport for immediate usewhen required. The overlay istight weight and therefore iseasily carried by one person, ftconsequendy would beextremely useflil to communitynurses to ensure patients haveimmediate cover to prevent

pressure damage. After use, the mattress can be cleaned and thenreused. !t is easily rolled Lip in the carry bag {Figure 4), andtransported to a loan store or to another parient. Once stored in thecarry bag, the SimCair weighs only 8 kg.

The cover is a high-stretch polyurethane that is waterproofand non-slip. There is a stretch terry-towelling cover that can bepurchased separately to the mattress. After single patient use, thecover can be washed or discarded and replaced, ensuringsupport of infection control.The system is also easily repairableif damage should occur. The SimCair is guaranteed for 3 yearsbut is expected to last for a longer period of rime.

The SimCair mattress overlay is a new product and. as such,must undergo evaluation to provide evidence of its ability toprevent pressure ulcers.

KEY POINTS• Although considered by many to be inevitable, pressure ulcers are largely

preventable if appropriate equipment is supplied at the time it is required.• When skin becomes red it should be taken as a warning that pressure damage

could soon occur and equipment supplied.• The SimCair mattress can be easily transported as it fits in a small carry bag, and

several could easily be carried in the boot of a car.• The cost of the SimCair is a fraction of the cost of dynamic systems.

A small-scale evaluation of SImCaIrIn March 2004. a sniall-scale unstructured assessment wasundertaken by a tissue viability nurse consultant to evaluate tbeSimCair mattress on participants in nursing homes. Eachparticipant said they welcomed the trial as they enjoyed givingtheir opinion and taking part in the assessment and eachparticipant understood that they could withdraw at any time ifthey wished. The average age of the participants (four malesand 15 females) was H9 years, with the eldest being 102 yearsand the youngest 67 years. Each paricipant was able to givefully informed consent to taking part in the evaluation.

The assessment took place over a 4-week period. Theparticipants' pressure areas were examined daily by theircarers (this is normal care) and examinations undertaken onday 1, day 7, day 8, day 15 and tiay 22. The assessor alsoreviewed the subject on day 2 for any redness.The assessmentincluded observation of bony prominences. If redness wasnoted on any bony prominence, this would have beenconsidered an adverse effect and the patient would have beenwithdrawn from the assessment.

Twenty-two participants were enrolled in the assessment.One participant died and two withdrew beforeconunencement with no reasons given. Therefore, theassessment was based on the remaining 19 participants.

The 19 participants had Waterlow scores that averaged 17with the highest being 22. Two participants who had minordamage at commencement of the study weie healed at the endof the 4-week period.

All participants said they were satisfied with the comfortof the SimCair and all 19 participants remained free ofpressure damage (redness) during the 4 weeks and a follow-up call revealed that they remained free from redness for afurther 4 weeks.

ConclusionThe SimCair mattress could be a strong support to conmiumtynurses as the mattress rolls small enough to be kept in a carboot. It can therefore be used immediately by patients who arenewly diagnosed as being 'at risk' of pressure damage. It wouldalso provide a cost-effecdve mattress for nursing homes thatneed to provide a support surface for their clients to preventpressure damage. Therefore, the SimCair is a simple to usesystem that would fulfil these requirements. ^H

Uouten CV. Oomens CW. Baaijciis FP. Bader DL (2003) The eooiogy of pressureulcers: skin deep or iiiLiscic bound? Arch I'liyx Aicrf Rehahil 84(4); 616- iy

Hreni H. Niermau DM, Nelson JE (2lKi2) Pres'iiire iilcersr in the chronicallycrincaliy lU paoeiu. Critical Care Clinician 18(3): 683-94

Clay M (2Ü()0) Présure sore prevenäon in nursing homes, Nun Stand 14(44):45-50; quiz 52.54

Dimond B (2(.M)3) Pre»ure uicers and litigation. Nurs Imws 99(5): íil-.'íGledhill L, Hampton S (2004) A simple method of assessing pressunc-ukcr risk.

Nursing luul Residmtinl Care 6(11): 532-5Hampton S (2004) The rofc of the expert witness. J Wmnrf Can.-13(10): 435-6Hampton S, Collins F (2003) Tissue Viahiliry. A Comprehmsive Guide. Whurr

PLiblicatiom, LondonJaiilE(2(H.)l) Pn.-ssure sorc.s unit — a 1-year study. HajriWi t4O(IO),9O.V-6,992,Moore Z (2001) improving pressure ulcer prevention through education. .\'Mrs

5toi<J 16(f)): 6+-«. 70Murray M, Blaylock B (1994) Maintaining effective pressure ulcer prevention

pKi¿ranis. Mfd.iuts Nim 3(2): 85-92. quiz 92-3Sae-Sia W, Wipke-levis D (2iHt2) PR-SSUR- ulcer previ-nbon and treatment

practices in inpatient i^habilitadon iacilicies, Rrhahiliutii>ii Niir/i- 27(5): 192-8Stephetw R Bick D (2<.K)2) A national pilot to implement pressure ulcer guidelines:

results of the haseline audit. BrJ Comniuiiily Nurs (Wound CaTC SuppI) 7(12):S34-S38

412 Briashjouriul of Nuriing.2(>()S,Vol 14, No 7