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PubMed2000

Beds, mattresses and cushions for pressure sore prevention and treatment.

OBJECTIVES: To assess the effectiveness of pressure relieving beds, mattresses and cushions (support surfaces) in the prevention and treatment of pressure sores. SEARCH STRATEGY: Searches of 19 databases, hand searching of journals, conference proceedings, and bibliographies. SELECTION CRITERIA: Randomised controlled trials evaluating support surfaces for the prevention or treatment of pressure sores. There was no restriction on articles based on language or publication status. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality was undertaken by two reviewers independently. Trials with similar patients, comparisons, and outcomes were pooled. Where pooling was inappropriate, trials are discussed in a narrative review. MAIN RESULTS PREVENTION: 29 RCTs of support surfaces for pressure sore prevention were identified. Some high specification foam mattresses were more effective than 'standard' hospital foam mattresses in moderate-high risk patients. Pressure relieving mattresses in the operating theatre reduced the incidence of pressure sores post-operatively. The relative merits of alternating and constant low pressure, and of the different alternating pressure devices are unclear. Seat cushions and simple, constant low-pressure devices have not been adequately evaluated. Limited evidence suggests that low air loss beds reduce the incidence of pressure sores in intensive care. TREATMENT: 6 RCTs of support surfaces for pressure sore treatment were identified. There is good evidence that air-fluidised and low air loss beds improve healing rates. Seat cushions have not been adequately evaluated. 2 RCTs evaluated surfaces for both prevention and treatment in the same trial. REVIEWER'S CONCLUSIONS: PREVENTION - There is good evidence of the effectiveness of high specification foam over standard hospital foam, and pressure relief in the operating theatre. Treatment - There is good evidence of the effectiveness of air-fluidised and low air loss devices as treatments. Overall, however, it is impossible to determine the most effective surface for either prevention or treatment.

Beds↗

PubMed1994

Benzyl-benzoate foam: effects on mite allergens in mattress, serum and nasal secretory IgE to Dermatophagoides pteronyssinus, and bronchial hyperreactivity in children with allergic asthma.

Home mattresses of 24 asthmatic children with house dust mite allergy were sprayed with either benzyl-benzoate foam or placebo in a double blind fashion, 10 days before the children left the residential house for asthmatic children Istituto Pio XII (located in the Italian Alps in an environment free of mites) and went back to their own home for the Christmas and Easter holidays. A further group of 8 children, whose mattresses received no treatment, was kept as an absolute control. Two days after spraying, benzyl-benzoate or placebo were vacuumed from the mattresses. Acarex test was performed immediately before spraying and at the end of each holiday period of 20 and 10 days, respectively. Bronchial hyperreactivity as well as serum and nasal secretory specific IgE for Dermatophagoides pteronyssinus were assessed in all children immediately before leaving and within 48 hr after returning to the residential house. The results of the study show that sprayed benzyl-benzoate foam was no more effective than placebo in reducing the level of house dust mite recovered from patients' mattresses, or in reducing bronchial hyperreactivity and IgE concentration in serum and nasal secretions.

Adolescent↗

PubMed1999

[The effect of soft care mattresses on subcutaneous tissue pressure and pO2 over the os sacrum].

In this study the influence of soft-care systems on subcutaneous tissue pressure and pO2 has been examined. In 14 volunteers 3 probes were implanted over the os sacrum for measurement during the 20-minute periods. Then the probands were asked to lie on a standard mattress, on 8 static beds of various kind and on 3 dynamic soft-care systems. The clinical mattress pressure values amounted to 25.5 mm Hg (+/- 5.2; n = 14). The gell-cushion showed increased values (26.9 +/- 9.5 mm Hg; n = 5). Compared to the standard mattress the other systems showed reductions in pressure from 32.7% to 83.1%. The lowest pressure was recorded with an air-supported mattress (8.3 +/- 2.3 mm Hg; n = 5). The pO2 initial values before lying down varied greatly from individual to individual (26.9-71.3 mm Hg). In the course of the 20-minute periods the pO2 value sometimes remained constant, sometimes increased and at other times it decreased. Under extreme conditions (with 8 probands asked to lie on the floor) a correlation (r = -0.787) between pressure and pO2 was observed (pressure values between 20.6 and 192.9 mm Hg). The results indicate the use of modern soft-care systems depending on the individual risk of pressure sores.

Adult↗

PubMed2004

Microbial exposure of rural school children, as assessed by levels of N-acetyl-muramic acid in mattress dust, and its association with respiratory health.

BACKGROUND: Endotoxin exposure has been shown to be associated with a decreased prevalence of atopic sensitization and symptoms. Yet endotoxin represents only a part of the indoor microbial exposure. Muramic acid, a constituent of peptidoglycan, is present in gram-negative and gram-positive bacteria in the environment and may therefore serve as an additional marker of microbial exposure. OBJECTIVE: To study the factors determining the level of indoor exposure to muramic acid/peptidoglycan, as well as its potential association with respiratory health. METHODS: In 553 farm and nonfarm school children from Austria, Switzerland, and Germany, mattress dust muramic acid concentrations were determined, and health was assessed by using IgE measurements and questionnaire information. RESULTS: The muramic acid concentration was found to be significantly higher in dust from farm children's mattresses than in dust from nonfarm children's mattresses (157 vs 131 ng/mg). Children with higher mattress dust muramic acid concentrations had a significantly lower prevalence of wheezing (odds ratio of highest vs lowest tertile of muramic acid concentration, 0.3; 95% CI, 0.1-0.9), regardless of farming status and endotoxin exposure. The association for asthma was similar, and no association was found with atopic sensitization. CONCLUSION: Next to endotoxin, muramic acid provides us with an independent marker of microbial exposure. Unlike endotoxin, muramic acid was inversely associated with wheezing rather than with atopic sensitization.

Asthma↗

PubMed1998

A sequential randomised controlled trial comparing a dry visco-elastic polymer pad and standard operating table mattress in the prevention of post-operative pressure sores.

Four hundred and forty-six general, vascular and gynaecological surgical patients were recruited to a two centre, double triangular sequential randomised controlled trial to compare the post-operative pressure sore incidence in patients positioned on the standard operating table mattress with those positioned on the dry visco-elastic polymer pad (Action Products Inc.). Two hundred and twenty two patients were randomised to the experimental group and 224 to the standard mattress. The main endpoint failure rate (a pressure sore) was found to be 11% (22/205) for patients allocated to the dry visco-elastic polymer pad and 20% (43/211) for patients allocated to the standard operating table mattress. There was a significant reduction in the odds of developing a pressure sore on the dry visco-elastic polymer pad as compared to the standard, [symbol see text] = 0.46 with 95% confidence interval of (0.26, 0.82), P = 0.010. The adjusted point estimates of the probability of developing a pressure sore on the dry visco-elastic polymer pad and the standard operating table mattress were 0.11 and 0.21 respectively.

Aged↗

PubMed1995

Toxic gas generation from plastic mattresses and sudden infant death syndrome.

Microbial generation of toxic gases from antimony, arsenic, or phosphorus in compounds used as fire retardants in cot mattresses has been proposed as a cause of sudden infant death. To test this hypothesis, 23 polyvinyl chloride mattress samples from cot death cases were incubated on malt agar plates until good microbial growth was obtained. Silver nitrate and mercuric chloride test papers were then inserted and the colour reactions recorded. The predominant organism, recovered from all mattresses tested, was not, as claimed in earlier work, the fungus Scopulariopsis brevicaulis, but a mix of common environmental Bacillus spp. Test paper colour changes occurred whenever bacterial growth was present, but these reactions also occurred in control tests in which no mattress material was present on the plates. Chemical and instrumental analyses of exposed test papers showed that the colour reactions were not due to deposits of antimony, arsenic, or phosphorus. Our findings do not support the hypothesis that toxic gases derived from antimony, arsenic, or phosphorus are a cause of sudden infant death. More sulphur was found in test papers exposed in plates containing bacterial growth than in those without such growth. This result suggests that the test paper reactions were due to the generation of sulphur-containing compounds during bacterial growth on the agar medium.

Bacillus↗

PubMed1998

A study of the performance of a pressure reducing foam mattress after three years of use.

This paper details the follow up clinical evaluation of a pressure reducing foam mattress (PRFM) three years after a randomised controlled trial. The PRFMs involved in the 1993 randomised controlled trial were used constantly for three years and recalled in 1996. In the original trial the control group had consisted of 18 standard NHS mattresses. In 1996 none of these mattresses were still in use which made it impossible to replicate the 1993 randomised controlled trial. Instead a clinical evaluation using the 1993 methods was carried out using the PRFMs only. Recruitment to the evaluation proved difficult because changes in clinical practice between the two studies had resulted in shorter lengths of stay in hospital for the target population. Comparison of the two outcome measures namely pressure sore incidence and the subjects' perception of comfort showed no statistically significant change between 1993 and 1996. With the exception of two damaged mattress covers all of the original foam components and covers remained in working order in 1996. During the time between the two studies, a pressure sore prevention programme was implemented within the research area. This programme has resulted in a year by year drop in the Directorate incidence rate. It is therefore not possible to attribute the low pressure sore incidence rate to the PRFMs alone. The results obtained suggest that the PRFMs appear to be providing a similar level of performance after three years of use.

Aged↗

PubMed2003

An association between plastic mattress covers and sheepskin underbedding use in infancy and house dust mite sensitization in childhood: a prospective study.

BACKGROUND: Higher house dust mite (HDM) allergen exposure during infancy has been associated with increased HDM sensitization. Infant bedding has been associated with the accumulation of varying levels of HDM. Prospective data on the relationship between infant bedding and the development of HDM sensitization has not been previously examined. OBJECTIVES: To determine if particular types of bedding used in infancy are associated with increased risk of house dust mite sensitization in childhood. METHODS: A population-based sample (n = 498) of children born in 1988 or 1989, and who were resident in Northern Tasmania in 1997, participated in this study. These children were part of a birth cohort study (1988-95), the Tasmanian Infant Health Survey. Data on infant underbedding and mattresses was available on 460 and 457 children, respectively. The main outcome measure was HDM sensitization defined as a skin prick test (SPT) reaction of 3 mm or more to the allergens of Dermatophagoides pteronyssinus and/or Dermatophagoides farinae. RESULTS: The use of either sheepskin underbedding or plastic mattress covers in infancy was associated with an increased risk of sensitization to HDM allergens at age 8 years. The adjusted risk ratio (RR) for sensitization to HDM with sheepskin in infancy was 2.27 (95% CI: 1.14, 4.55), P = 0.020. The adjusted RR for sensitization to HDM with the use of plastic mattress covers in infancy was 2.06 (95% CI: 1.22, 3.51), P = 0.007. The use of a foam mattress in infancy was not related to subsequent HDM sensitization. CONCLUSION: Infant's bedding plays a role in the development of HDM sensitization in childhood. Intervention studies to examine mite allergen levels and the role of underbedding on the development of HDM sensitization are required.

Animals↗

PubMed2000

Quantification of pressure relief using interface pressure and tissue perfusion in alternating pressure air mattresses.

OBJECTIVE: To examine whether the interface pressure (IP) relief provided by alternating pressure air mattresses (APAMs) is matched with maintenance of tissue perfusion over the points of contact by measuring transcutaneous oxygen and carbon dioxide (tcPO2, tcPCO2). DESIGN: Comparative analysis of 2 APAMs with a 2-parameter continuous time-based method for quantifying pressure relief (PR) and transcutaneous gas measurement for assessing tissue perfusion. SETTING: Rehabilitation research facility in a university hospital. PARTICIPANTS: Eleven able-bodied adult postgraduate student volunteers. MAIN OUTCOME MEASURES: Two full-replacement APAM systems were used. For each mattress the mean maximum and minimum interface pressures; mean peak air pressures in the mattresses; interface pressure durations below 30, 20, and 10 mmHg over a 60-minute period; mean maximum tcPCO2 and minimum tcPO2; and mean area under the tcPO2 and tcPCO2 curves were measured for each subject. RESULTS: IP on the sacrum was held below thresholds of 30, 20, and 10 mmHg longer on a 2-cell, low pressure system than on a 3-cell, high pressure system (p < .001). Integrated over time, tcPO2 levels also indicated that the 2-cell system retained oxygen levels closer to the unloaded baseline than did the 3-cell system (p < .01). tcPCO2 levels did not rise significantly (p > 0.1) compared with the baseline measurement in both mattresses. CONCLUSIONS: PR was sensitive to the design of the APAM, especially its inflation pressure, cycle time, and inflation sequence. If future trials demonstrate that PR values and transcutaneous blood gas measurements correlate significantly with the clinical incidence of pressure sore formation, then this technique may prove useful in assessing the effectiveness of alternating pressure support surfaces.

Adult↗

PubMed2001

The effectiveness of a thermal mattress in stabilizing and maintaining body temperature during the transport of very low-birth weight newborns.

The purpose of this study was to determine the effectiveness of a thermal mattress in stabilizing and maintaining body temperature during the transport of newborns who weigh less than 1,500 g. We compared 91 infants who were transported without a thermal mattress from April 1995 to March 1996 with 100 infants who were transported with the use of a transport thermal mattress (TTM) from April 1998 to October 1999. Temperature data were collected on arrival to the referring hospital, on departure from the referring hospital, and on arrival to the tertiary neonatal intensive care unit. The findings support that, over time, infants who were transported on a TTM had a greater increase or greater stability in body temperature, in comparison with infants who were not transported on a TTM (t = 5.1, p <.001). The data also supported that infants on a TTM maintained body temperature during stabilization and transport (F = 12.33, p =.001) better than the no mattress group did (F = 3.6, p =.061). Use of the TTM in the prevention of hypothermia in unstable environmental conditions can be extended to other areas within the hospital when thermoregulation of the premature infant is a concern, especially that of very low-birth weight infants. However, hyperthermia may also be a concern; body temperature should be monitored to watch for it.

Analysis of Variance↗

PubMed2002

Effect of mattress encasings on atopic dermatitis outcome measures in a double-blind, placebo-controlled study: the Dutch mite avoidance study.

BACKGROUND: House dust mite (HDM) allergen might induce and maintain atopic dermatitis (AD). Reduction of allergen load by applying encasings might improve the clinical symptoms of AD. OBJECTIVE: We sought to investigate, in a randomized, double-blind, placebo-controlled study, whether reducing HDM allergen levels by using mattress, duvet, and pillow encasings for 12 months will result in improvement in AD symptoms. METHODS: Patients with AD (8-50 years old and allergic to HDM), having a Leicester sign score (a dermatitis score) of at least 1% extent and a severity score of 6 points or greater, were randomly allocated to an active (n = 45) or a placebo allergen-avoidance group (n = 41). Avoidance measures consisted of applying HDM-impermeable encasings for mattresses, pillows, and duvets for the active treatment group and cotton encasings for the placebo group. Effect on allergen concentrations (Der p 1 and Der p 1 plus Der f 1), Leicester sign score extent and severity, visual analogue scale scores for itching and sleeplessness, intradermal test results, atopy patch test results, total serum IgE levels, anti-Der p 1-specific IgE levels, and total blood eosinophil counts were studied. RESULTS: The active encasings reduced the Der p 1 allergen concentration in the mattress after 12 months with a factor 2.1 (P =.007) and the Der p 1 plus Der f 1 allergen concentration with a factor of 2.5 (P =.005); no significant change in allergen concentrations in mattresses was seen in the placebo group. Although the decrease in allergen load was significant, no differences in treatment-induced changes were seen between the placebo and active groups. CONCLUSIONS: Use of HDM-impermeable encasings resulted in a significant decrease in Der p 1 and Der p 1 plus Der f 1 allergen concentrations. However, this reduction in allergen load did not result in significant changes in clinical parameters between the groups. Reduction of allergens in other environments (work, school, and outdoors) might be equally important in improving symptoms of AD.

Adolescent↗

PubMed2003

Effect of mattress and pillow encasings on children with asthma and house dust mite allergy.

BACKGROUND: House dust mite (HDM) allergy is a frequent cause of allergic asthma in children. Reduction of exposure seems to be the most logical way to treat these patients. OBJECTIVE: Our aim was to investigate whether mattress and pillow encasings resulted in an effective long-term control of HDM allergen levels, thereby reducing the need for asthma medication in children with asthma and HDM allergy. METHODS: In a prospective, double-blind, placebo-controlled study 60 children (age range, 6-15 years) with asthma and HDM allergy were randomized to active (allergy control) or placebo mattress and pillow encasings. After a 2-week baseline period, follow-up was performed every 3 months for 1 year. During the entire study period, the dose of inhaled steroids was tapered off to the lowest effective dose according to well-defined criteria. RESULTS: Fifty-two patients completed the trial, and 5 were excluded, leaving data from 47 children (26 in the active treatment group and 21 in the placebo group) for analysis. A significant perennial reduction in HDM allergen concentrations was seen only for the active treatment group. Also, a significant decrease in the dose of inhaled steroids (mean, 408 to 227 microg/d; P <.001) was found for the active treatment group only, with significant differences between groups after 9 and 12 months. After 1 year, the dose of inhaled steroids was reduced by at least 50% in significantly more children in the active treatment group than in the placebo group (73% vs 24%, P <.01). CONCLUSION: Encasing of mattresses and pillows resulted in a significant long-term reduction in HDM allergen concentrations in mattresses and in the need for inhaled steroids in children with asthma and HDM allergy.

Adolescent↗

PubMed2005

Economic assessment of pressure sore prevention using a computerized mattress system in patients with spinal cord injury.

PURPOSE: To assess the economic profitability of a new computerized mattress system in patients with spinal cord injuries (SCI) by comparison with two other alternatives, as an example of the use of a quantitative approach for decision-making in choosing between alternatives for sore prevention. METHOD: The cost of achieving one day without signs of impending pressure sore was compared between the alternative options using cost minimization analysis. Savings in nursing costs for the three options were calculated for cost-benefit analysis. RESULTS: A foam mattress system is significantly cheaper than the other examined alternatives, and if the nursing manpower cost is constant and the nursing staff is capable of performing sufficient repositioning, this system would achieve the desired medical outcome at a minimal cost. However, if the nursing staff cannot perform sufficient repositioning, or if the use of nursing manpower can be adjusted to the actual need, then it is the computerized mattress system that achieves the desired outcome at the minimal cost. In this case, less than 20 New Israeli Shekels (NIS) per day spent on the equipment save NIS 45 per day in labor costs. CONCLUSIONS: The economic evaluation indicates that the computerized mattress system is advisable for patients with SCI who require assistance for repositioning, but its profitability depends on the employment terms of the nursing manpower. In addition, other possible alternative pressure management systems should be examined, and additional research may be needed to determine the optimal combination of such systems for a spinal cord rehabilitation department.

Beds↗

PubMed1992

Matching patient need for pressure sore prevention with the supply of pressure redistributing mattresses.

The authors have conducted a series of pressure sore prevalence surveys within one health district over a 4-year period. Additional surveys of the availability and deployment of pressure redistributing (PR) bed mattresses have also been made within the same district. The prevalence of pressure sores increased from 6.8% (1986) to 14.2% (1989) while the available stocks of PR mattresses increased from 69 (1987) to 186 (1989). Our results appear to question the common assumption that successful pressure sore prevention can be achieved through expanding the stocks of PR mattresses. Five possible reasons why the increase in mattress provision was matched with an increased prevalence of pressure sores are forwarded. The use of measures of prevalence rather than incidence rates to monitor the effects of clinical initiatives is discussed.

Beds↗

PubMed1995

House-dust mite content in mattresses in relation to residential characteristics and symptoms in atopic and nonatopic children living in northern Norway.

The occurrence of house-dust mites (HDMs) was investigated in the mattresses of 19 children previously found to be skin prick test (SPT) positive to HDM and in 19 nonatopic children derived from an extensive survey of 424 schoolchildren, all living in northern Norway. Domestic mites were counted and identified microscopically. Mite counts ranging from 10 to 1800 mites per gram mattress dust were found in 10 of the 19 HDM-sensitized children compared to none in the control group, corresponding to an odds ratio of more than 20. Of the 540 domestic mites found, 70 were identified by species. Dermatophagoides pteronyssinus (Dpt) was the only HDM species identified (64 mites), while five were storage mites and one was a Tarsonemus species. Positive radioallergosorbent tests (RAST) to Dpt were demonstrated in 9/10 children with and in 5/9 without mite infestation compared to none in the control group. Elevated IgE levels were also found more frequently in children with mite-infested mattresses than in those without. IgE levels were within normal levels in all 19 children in the control group. Latent atopy was found in four children, three with and one without mite infestation. There was no correlation between the concentration of mites and the degree of sensitization. Poor ventilation, increased humidity, and water leak(s) were associated with the presence of domestic mites in mattresses. As HDM growth is highly dependent on humidity and microhabitat, it should be possible to avoid HDM exposure and allergy in this region.

Animals↗

PubMed1996

Does benzyl benzoate prevent colonization of new mattresses by mites? A prospective study.

In 12 house-dust-mite-infested double beds, one of the mattresses was replaced by a new one, the other being regarded as a mite source. All new mattresses were treated in a double-blind fashion, with either benzyl benzoate or placebo before being placed on the bed as well as 1 year later. They were examined for mites and allergen concentrations over a period of 18 months. This period of time covered two mite seasons. Dust samples were taken bimonthly and analyzed by guanine test strip, microscopic mite counting, and determination of the mite allergens Der p 1 (Dermatophagoides pteronyssinus) and Der f 1 (D. farinae) by ELISA. Although, at the end of the observation period, the new mattresses still had significantly lower mite and allergen levels than the old mattresses, there were no significant differences between the placebo and the benzyl benzoate groups. In our setting, benzyl benzoate plus frequent cleansing was not significantly more effective in controlling mites than frequent cleansing alone.

Allergens↗

PubMed2005

Enhanced cosmetic outcome with running horizontal mattress sutures.

BACKGROUND: Cutaneous sutures should provide good wound eversion, firm closure, and cosmetically elegant results. Simple running sutures are commonly employed in cutaneous surgery but may not always be effective in achieving wound eversion. OBJECTIVE: We compared the cosmetic results of simple running nonabsorbable sutures with running horizontal mattress sutures in primary closures of facial defects. METHODS: Fifty-five patients with facial Mohs surgery defects appropriate for primary multilayer repair were randomized into one of two arms. Either the superior or the inferior half of the wound was closed with a running horizontal mattress suture. The other half of the wound was closed with a traditional simple running suture. At 1 week, 6 weeks, and 6 months, the cosmetically superior half of the wound, if any, was blindly determined by the investigators. RESULTS: The running horizontal mattress suture was significantly more cosmetically pleasing than the simple running suture. Forty-seven patients completed the study. At the 6-month follow-up, 25 patients did better with the horizontal suture and 5 did worse, and with 17 patients, there was no clinically perceptible difference. The 6-week scores predicted the outcome at 6 months, but the 1-week scores did not. CONCLUSIONS: In primary closures of the face, the running horizontal mattress suture is a cosmetically elegant alternative to a traditional running cutaneous suture. The final scar appears smoother and flatter than those produced by traditional simple running sutures.

Dermatologic Surgical Procedures↗

PubMed1989

Rewarming preterm infants on a heated, water filled mattress.

Sixty low birthweight infants (1000-2000 g) admitted to a neonatal care unit in Turkey were studied. Those not requiring intensive care were randomly assigned for treatment either in a cot on a heated, water filled mattress kept at 37 degrees C (n = 28) or in air heated incubators with a mean air temperature of 35 degrees C (n = 32). On admission 53 (88.3%) of the infants had body temperatures between 30 degrees and 36 degrees C. There was good correlation between axillary and rectal temperatures in the infants while they were hypothermic. Normal temperatures were achieved within the first day and remained within this range during the subsequent days after admission in all the infants treated on the heated, water filled mattress, whereas they were not achieved until three days later in the incubator group. The neonatal mortality among those treated on the heated, water filled mattress was 21%, and among those treated in the incubator 34%. The heated, water filled mattress provides a good alternative to skin to skin contact with the mother, and to the use of a complex and expensive incubator for rapidly attaining and maintaining normal temperatures in the low birthweight newborn.

Beds↗