Foam mattresses can reduce risk of pressure ulcers

A new study suggests that by using high-density foam mattresses, nursing homes may not have to turn residents every two hours to prevent pressure ulcers, a practice that has been used for more than 50 years.

According to the study, led by the University of Texas Health Science Center at Houston (UTHealth), conventional coil-spring mattresses expose residents to higher pressure, which exacerbates the risk of pressure ulcers. High-density foam mattresses create less pressure on the body, which may eliminate the need to turn patients every two hours.

The study - dubbed Turning for Ulcer ReductioN (TURN) - included nearly 1,000 residents from 29 nursing facilities in the United States and Canada, participating over 19,000 resident days. Randomized schedules for turning were set up for study participants who were risk of developing pressure ulcers.

A nurse, blinded to turning frequency, documented skin condition every week, along with type of reposition, heel position, brief condition and skin care at each turn. No serious pressure ulcers developed during the study.

“The TURN Study showed that moderate- and high-risk nursing home residents cared for on high-density foam mattresses could be turned at two-, three- or four-hour intervals and the goal of preventing pressure ulcers can be met,” lead author Nancy Bergstrom, Ph.D., UTHealth associate dean, tells Dermatology Times. “There is one very important caveat, though: all of these residents received a safety check at every turning episode. Less frequent turning may promote better rest, but vigilance on the part of staff requires safety observations at each turning episode.”

Dr. Bergstrom noted that those episodes include turning position and timing, documenting that heels are up, monitoring skin (red, bruised, open, normal), monitoring briefs (dry, wet, soiled), and brief care (cleaned, barrier cream, dry briefs).

“This one-minute observation check list is an important part of less-frequent turning and brief changes,” she says.

The study findings were published in the Journal of the American Geriatric Society.