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[Decubitus: efficient prevention due to new pathogenetic knowledge].

Decubitus ulcers are spots of ischemic tissue necrosis caused by any imposed pressure which occludes the venules and arterioles. Therefore, the most important objective is to avoid completely or to lower the imposed skin pressure below the critical arterial occlusion pressure. This can be achieved by positioning the patient in the 30 degrees lateral position and/or by bedding them on a "supersoft" mattress. The efficacy of this method is demonstrated by recording the oxygen tension of compromised skin areas during these preventive measures and by an improving clinical statistics over a period of 5 years.

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Investigations on the fauna of beds in flats, children's sanatoria and old-age homes.

An analysis was carried of the fauna found in 338 beds from two old-age homes and from flats inhabited by asthmatic children. During hospitalization of these children the fauna in the flats was compared with that found in beds used by them in sanatoria. The most abundant species proved to be Dermatophagoides pteronyssinus that is also widely spread in other countries of Europe. The bed fauna in the sanatoria is very poor, corresponding to the improved state of health of patients during hospitalization. The authors assume that the low population density of fauna is influenced by constant airing of rooms and by strict separation of bedrooms from dining halls and other premises. Also the number of mites in different padding material used in mattresses was evaluated and an analysis of the general fauna per bed was carried out.

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[Special cloth futon-cover (Miroguard) as a protection against house dust mite exposure].

We studied the efficacy of a special cloth encasing (Microguard) in protecting against house dust mite exposure. We vaccumed dust from right or left half surface of a shiki-futon (Japanese style mattress). Then we encased the shiki-futon by a new special encasing, vaccumed dust from the other part of the shiki-futon and got a pair of dust samples. We had done the same of the same shiki-futon by a used special encasing (used for one and half years) for about 2 weeks later. We prepared 7 shiki-futons and collected 14 pair dust samples. We weighed the dust and measured the mite allergens with a monoclonal antibody to Dermatophagoides pteronissynius and Dermatophagoides farinae. The dust level was 1.0% of the control (no encasing) in the new encasing group and 2.0% of the control in the used encasing group. The Der I concentration was 2.5 micrograms/(g dust) in the new encasing group and 3.2 micrograms/(g dust) in the used encasing group. The Der II concentration was 1.6 micrograms/(g dust). The total amount of Der I was 0.1% of the control in the new encasing group and 0.5% of the control in the used encasing group. The total amount of Der II was 0.2% of the control in the new encasing group and 0.7% of the control in the used encasing group. We compared Der p and Der f levels in the dust samples which we assayed and found no significant differences either in Der I or in Der II allergen. We concluded that Microguard was a useful tool to avoid mite allergen exposure by reducing not only the concentration of mite allergens but also the amount of dust.

Allergens↗

Reassessment of the use of genuine sheepskin for pressure ulcer prevention and treatment.

The use of genuine sheepskin was compared to the use of synthetic sheepskin in two long term care institutions. Data for the control group of 44 residents placed on synthetic sheepskin were obtained by retrospective chart audit. Sixty-four residents were randomly placed on genuine merino sheepskin (WoolTec USA, Maspeth, NY). The two groups were similar in age, diagnosis, polypharmacy, and risk assessment score. In the control group 41% maintained skin integrity, 38% improved, and 21% deteriorated; in the study group 63% maintained skin integrity, 37% improved, and none deteriorated. The use of genuine sheepskin is recommended to reduce the risk factors of friction and shear.

Bedding and Linens↗

Cot death.

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Bedding and Linens↗

[Encasing evaluation: studies of dust retention and water permeability].

The use of allergenproof mattress casings for those allergic to house-dust mite is a vital component of therapeutic concepts concerning the avoidance of allergens. Encasings of different materials are available from a variety of manufacturers on the German market. The goal of this study was to investigate different encasing materials to test for their impermeability to dust and permeability to water vapour ("breathability"). Material samples from nine different manufacturers as well as one additional samples were tested by two independent institutes. The samples were coded with serial numbers and the product names and manufacturers were unknown to the testers. The degree to which particles could penetrate the materials (as a measure of dust penetration) was tested in two series of experiments using the naturally available ambient air and fine coaldust. A thermo-regulation model ("skin model") was used to test the materials for water vapour permeability. The results of three of the nine samples tested for particle penetration have to be considered unsatisfactory due to the number and size of the particles allowed to enter. Overall an additional synthetic layer appears to improve the materials capacity to prevent dust penetration. The water vapour permeability of three of the nine samples of encasing material must be classified as unsatisfactory with the consequence of possible sleep disturbance. From an allergological point of view, minimal particle penetration is an essential criteria. On the other hand, low water vapour transport properties can diminish the patients willingness to comply. The present study cannot be substituted for a clinical study of effectiveness but nonetheless reveals, in some cases, considerable differences in the physical properties of the various materials. It would be desirable for the individual product packaging to feature a declaration of the relevant test data, thus providing decision-making for those buying or prescribing.

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