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EHOB Clinicals
250 N. Belmont Ave. • Indianapolis, IN 46222 • 800.899.5553 • www.ehob.com
CLIN-0711-233
Independent, Evidence-Based Studies
Supporting the WAFFLE® Brand Products
All Over Protection
Table of Contents
Page
1
Featured Studies
Ankle Foot Orthoses in Prevention and Treatment of
Heel Pressure Ulcers: A Physical Therapy Perspective
Page
10
4 North Action Plan for Heel Ulcers
In-Vivo (CT Scan) Comparison of Vertical Shear in
Human Tissue Caused by Various Support Surfaces
Count Down to Decreasing Pressure Ulcer Prevalence
The Importance of Correct Product Selection While
Off-Loading a Heel Pressure Ulcer: Static Air Boot vs.
Ankle Foot Orthosis
11
4
Effectiveness of an Air Mattress Overlay and Seat
Cushion for the Prevention of Pressure Ulcers
On A Foot
12
Prevention of Heel Pressure Ulcers in Fractured Hip
Patients
13
14
Foot WAFFLE® Heel Cushion - Case Study
All Over Protection
15
16
EHOB’s PVC and PVC/PU Materials Resist
Bacterial Growth
St. Vincent’s Intensive Care Quality
Improvement Committee
Case Series Studying Nosocomial Pressure Ulcers in
the Post-Operative CABG Patient
Methodist Hospital Pressure Ulcer Prevalence Survey
Quality Improvement Skin Care Task Force
Determining the Right Mix of Support Surfaces to
Minimize Hospital Acquired Pressure Ulcers
Taking Pressure Ulcer Incidence to Zero
One Nursing Home’s Experience
Wounds Treated with Static Air Overlays
9
Cincinnati, OH
Aletha W. Tippett, BS, ChE, M.D.
PURPOSE: Evaluate a program of pressure ulcer prevention and treatment in
two 150-bed nursing homes with a frail elderly population.
METHOD: Develop and use a standard protocol for prevention and treatment of
pressure ulcers. Program development is based on efficacy and simplicity. This
involves two key elements: 1. Static air pressure support for mattress, chair and
heels, and 2. A medicated hydrogel dressing.
References
RESULTS AND CONCLUSIONS: In one nursing home, incidence of pressure ulcers acquired in the facility reduces from 17 percent to zero in six months,
and remains at less than 1 percent for four years. In the inpatient wound center, all
patients (72) with pressure ulcers treated according to the standard protocol over a
one year period approaches 95 percent within 12 weeks with average cost savings
over $6,000 per patient. Dramatic sustained reductions in pressure ulcer occurrence are achieved with use of static air support surfaces in a population of frail
elderly. Equally dramatic treatment and healing of pressure ulcers in this population
are achieved with the combined use of static air support surfaces and a medicated
hydrogel dressing. These simple yet effective solutions should be examined more
thoroughly in other settings.
About these studies
Foot WAFFLE® Air Cushion - Case Study
Foot WAFFLE® Heel Cushion - Case Study
Support Surface Principles – Based on Scientific Fact
A Lift Team’s Approach to Selecting Transferring and
Positioning Devices
A Simple Way to Prevent and Treat Pressure Ulcers
Heel Pressure Ulcer Prevention
Effects of a Support Surface on Homeostasis
Keep it Simply Scientific
The Effect of WAFFLE® Polyvinyl and Foam
Polyurethane Mattress Materials on the Growth of
Escherichia Coli Pseudomonas Aeruginosa, and
Staphylococcus Aureus
The Effectiveness of Two Heel Pressure Reduction
Devices for the Heel Pressure Ulcer Prevention
A 3-Year Retrospective Analysis Comparing the
Effectiveness of Medical Devices to Non-Medical
Devices in the Treatment of Heel Pressure Ulcers
A Clinical Study of Hospital Replacement Mattresses
8
Reducing Heel Ulcer Incidence Among Hip Fracture
Patients by Introducing a Clinical Algorithm
Prevention of Heel Ulcers Among Hip Fracture
Patients
Skin Failure What Happens When This Organ System
Fails?
7
Ways to prevent pressure ulcers and treat them in a cost effective
manner are sorely needed.
4. Treatment of Pressure Ulcers. Clinical Practice Guideline Number 15. U.S. Department of Health and Human Services,
Public Health Service, Agency for Health Care Policy and Research, Rockville, MD, AHCPR Publication No. 95-0652,
December 1994.
Pressure Ulcers Patient Outcomes on a Kinair® Bed
or EHOB Mattress
Protocols for Prevention of Pressure Ulcers
in Home Care
Pressure ulcers have a reported prevalence up to 25% (1). There is no consensus concerning best practices for prevention, and even modest reductions
are noteworthy (2). Besides the cost in human suffering, treatment of pressure
ulcers is calculated to be approximately $1,600 per patient per month (3), an
expense totaling more than a billion dollars per year (4), borne mostly by
Medicare and Medicaid (1).
2. Cuddigan, J., Berlowitz, D., Ayello, E. Pressure Ulcers in America: Prevalence, Incidence, and Implications for the
Future An Executive Summary of the National Pressure Ulcer Advisory Panel Monograph. Advances in Skin & Wound
Care: The Journal for Prevention and Healing. July/August 2001. Volume 14 Number 4,pp. 208-215.
Taking Pressure Ulcer Off in the ICU
6
Aletha W. Tippett, M.D.
3. Southwest Missouri State University, Four-Day Wound Management Workshop, Sept. 2001.
Improving Quality of Life in the LTC Hemodialysis
Patient
On A Bed
A Simple Way to Prevent and Treat Pressure Ulcers
1. Medical Expenditure Panel Survey. Chartbook #3: Nursing Home Trends, 1987 and 1996. J. Rhoades, N. Krauss.
Agency for Healthcare Research and Quality, Rockville, MD. Http://www.meps.ahrq.gov/papers/cb3_990032/cb3.htm.
Oct. 2004.
Healing a Stage IV Pressure Ulcer on the Elbow Using
a Static Air Boot
5
The mouse that roared: How tweaking its pressure
ulcer prevention program led to postive outcomes for
a small hospital and community at large
Reduction of Pressure Ulcer Incidence and Specialty
Bed Rental Dollars Across the Continuum of Care
Reduction of Community Acquired Pressure Ulcers
Using a Static Air Pressure Relief Support System
Decrease in pressure ulcers
using static air - 17 percent
to zero.
BACKGROUND
How to Prevent Pressure Ulcers on a Kinetic Therapy
Support Surface
3
Decreasing Pressure Ulcer Nosocomial Rates at a
Large Metropolitan Teaching Hospital
Pressure Ulcer Care for a Terminally Ill Patient Being
Cared for at Home
Decreasing Hospital Acquired Pressure Ulcers in the
Acutely Ill Med-Surg Patient
2
On A Bed
EHOB, Incorporated was founded in 1985 with a special interest in soft tissue research, education
and product development. Today, a leading company in pressure ulcer management, EHOB continues to be an innovator of affordable products effective in the prevention and treatment of pressure ulcers – simple products that work!
This catalog represents more than twenty years of product trials and clinical documentation that
we proudly offer to you. EHOB is committed to earning the trust and loyalty of the professional
health care community by not just saying a product works, but by proving it with these significant
patient studies. A summary is provided for each study to use as a quick reference but is in no way
meant to replace or discount its full content. We encourage you to read the study in its entirety.
To obtain a full study, contact EHOB at 800.966.3462 or contact your local EHOB Sales
Representative. You may also access these studies at www.ehob.com.
Keeping Pressure Ulcers at Bay
17
A Simple Way to Prevent and Treat Pressure
Ulcers
17
All Over Protection
EHOB products effectively
control growth of MRSA
• EHOB’s PVC and PVC/PU Materials •
Resist Bacterial Growth
B
acteria and fungi can flourish
almost anywhere organic material
can be found. This includes hospitals, retirement facilities and home-care
settings. Some of these microorganisms
can cause allergic reactions, infection,
and even death.
Unlike topical treatments, which may
lose their effectiveness after cleaning,
the antibacterial properties of EHOB’s
formulas remain active throughout the
useful life of the product. This is
achieved by blending in precise amounts
of bacteria-fighting additives, directly
into the formulation of the product.
These additives slowly and continuously
migrate to the surface of the mattress
to inhibit the growth of bacteria. So
even immediately after cleaning, fresh,
anti-microbial is making its way to the
products’ surface. And that includes
those “hard to reach” areas too!
The effectiveness of any anti-microbial
in prohibiting the growth of microorganisms is dependent on the type of additive selected as well as its presence in
sufficient amounts on the surface of the
product. To demonstrate the bacteriafighting effectiveness of the EHOB® PVC
and PVC/PU blend materials, they were
subjected to an Agar Plate Test inoculated with ten (10) microorganisms commonly found in healthcare facilities.
The Agar Plate Test is an In Vitro test.
Ten nutrient-rich, tryptic soy agars (gelatin-like-solutions) were prepared and
inoculated with one of the specified
microorganisms. EHOB® chose Klebsiella
pneumoniae, Escherichia coli,
Pseudomonas aeruginosa, MethicillinResistant Staphylococcus Aureus
(MRSA), Salmonella choleraesuis,
Enterococcus faecium, Bacillus subtilis,
Clostridium difficile, Candida albicans,
and Aspergillus niger for this test.
Three replicate circular material samples
(30 mm in diameter) of both the PVC
and a PVC/PU blended materials, were
then placed on top of each of the test
organisms. The specimens were incubated at 30 - 35°C (86°F - 95°F) for 48
± 2 hours, the ideal environment to
promote bacterial growth. After the
incubation period, each plate was visually examined. If the bacterium were able
to grow or reproduce under the material
sample (result = “Growth”), the antimicrobial would be considered ineffective. A result of “No Growth” (= 30
mm) or “Zone of Inhibition” (> 30 mm)
would indicate that the anti-microbial
was effective in preventing the growth
and reproduction of the tested bacteria.
EHOB’s PVC and PVC/PU Materials Resist Bacterial Growth
Northbrook Laboratories, Inc.
Featured Studies
2008 1st Place Winner Clinical Symposium
Ankle Foot Orthoses in Prevention and Treatment of Heel
Pressure Ulcers: A Physical Therapy Perspective
Clarian Health, Methodist Hospital-Physical Therapy Wound Management Indianapolis, IN
Sharon Lucich, PT, CWS, and Jaimee Haan, PT, CWS
PURPOSE: To test the effectiveness of the antimicrobial agent used in EHOB’s PVC
and PVC/PU blended materials.
PURPOSE: The purpose of this case report is to determine the safety and effectiveness of
METHOD: Materials samples are subjected to an Agar Plate Test and inoculated with ten
heel pressure relieving ankle foot orthoses.
microorganisms commonly found in healthcare facilities.
METHOD: In order to determine the safety and effectiveness of each AFO as outlined above,
RESULTS AND CONCLUSIONS: The PVC and PVC/PU blended materials, used in
physical therapists trial each product at home to simulate typical patient usage.
all EHOB products, effectively controlled the growth of each microorganism, including
Methicillin-Resistant Staphylococcus Aureus (MRSA).
RESULTS AND CONCLUSIONS: The FootHold With Splint by EHOB rates the highest
in 4 out of 5 categories.
Note: Independent tests were performed by Northview Laboratories, Inc.
WAFFLE® Overlay used in ICU
St. Vincent’s Intensive Care Quality Improvement Committee
27 percent down to
0 percent nosocomial rate
St. Vincent Hospital and Health Care Center, Indianapolis, IN
4 North Action Plan for Heel Ulcers
St. Agnes Hospital, Baltimore, MD
Juanita Hardy, RN and Karen Nolan, RN, BSN
4 North Action Plan for Heel Ulcers
Team Members, St. Agnes Hospital, Baltimore, MD
PURPOSE: To discover why the pressure ulcer incidence rate and the usage of specialty beds
in an intensive care unit remain high.
METHOD: Patient data is reviewed and collected. Specialty bed criteria is developed to assist
staff in choosing the correct bed therapy for patients. New pressure reduction mattresses are
purchased and mattress overlay trials are initiated based on skin protection, user friendliness and
cost effectiveness to the hospital and patient.
RESULTS AND CONCLUSIONS: The WAFFLE® Overlay, selected by staff because of its
ability to logroll and transfer patients, helps decrease the “per patient” bed charges, “per month”
specialty bed placement and “per patient” average days on specialty beds. Over a six month period, skin breakdown decreases by two-thirds and $500,000 is saved.
Keeping Pressure Ulcers at Bay
Rush Foundation Hospital, Meridian, MS
Dianne McCollum RN, CWOCN, ET Nurse
4 North’s Action Plan
4 North’s Skin Care Action Plan came
about due to a unit rate nosocomial
pressure ulcer score of 27.3% in 2003.
The highest % of Stage I and II pressure ulcers in heels and coccyx at St.
Agnes Hospital and Ascension Health.
The hospital overall score was 7.8%.
In prior years our averages were: 2001
- 12.5% and 2002 - 4.3%. We knew we
needed to implement a new practice.
Team Members
Juanita J. L. Hardy RN Nurse Manager
Jennie Linatud RN BSN Clinical Unit Coordinator
Judy Lazor RN. Orthopedic Joint Coordinator
Karen McLaughlin, MA, RN. Clinical Educator
Karen Moody RN Clinical Unit Coordinator
Olanike Akindele, RN
Cindy Anderson, RN
Mary Grace Anora, RN
Elizabeth Awuah, RN
Maria Castro, RN
Donnell Clark, RN
Cathy Dymex, RN
Chatal Fokum, RN
Dolly George, RN
Mary Anne Hanson, RN
Edith Jones, RN
Wilhelmenia Kalyniuk, RN
Shenna Kwon, RN
Christi Litz, RN
Mary Beth Martinak, RN
Susan McCloskey, RN
David Radziewicz, RN
Tomiko Ross, RN
Jessica Sol, RN
Joan Spencer, RN
Kate Srour, RN
Melissa Stump, RN
Janet Tacka, RN
PURPOSE: To develop and implement an initiative to reduce the nosocomial rate of pressure
ulcers on the heel.
METHOD: More than four hundred patients are included in the sample study within four years.
As a new step in the practice of nursing care, the Foot WAFFLE® and Heel Elevator are applied
to patients who are on bed rest, post-op, frail and weak, patients who are unable to lift a foot off
of the bed and all ortho patients. Additional protocols are put into place. A key question asked to
each patient is “Can you lift your foot off the bed on your own?”
RESULTS AND CONCLUSIONS: A 27 percent nosocomial pressure ulcer rate is reduced
to 0 percent in three years.
2010 Symposium on
Advanced Wound Care
Poster Award Winner
Decreasing Hospital Acquired Pressure Ulcers in the Acutely Ill
Med-Surg Patient
Mercy Hospital, Springfield, MA
Margaret-Ann Azzaro RN, MSN
PURPOSE: To become more proactive in our practice of preventing pressure ulcers.
PURPOSE: To decrease HAPU’s in patients with multiple co-morbidities on a 26-bed
METHOD: Four-Fold Approach implemented: 1. Establish a pressure ulcer task force;
Respiratory Unit.
2. Review the facility’s current procedures; 3. Revise where needed; 4. Educate patient care
providers.
METHOD: Formed a Pressure Ulcer Prevention (PUP) Team who instituted a signal system
RESULTS AND CONCLUSIONS: Through program review, education and implementing
to indicate patients at risk. The at-risk patients were given a strict turning schedule, placed on
a WAFFLE® Seat Cushion for an hour each day and fitted with a Foot WAFFLE®.
the WAFFLE® Overlay, Bariatric Cushion, Seat Cushion and the Foot WAFFLE®, the facility’s
Stage II pressure ulcer rates dropped from 103 to 18 during the five year trial period.
16
RESULTS AND CONCLUSIONS: Following the formation of the PUP Program and the
implementation of the WAFFLE® products, the facility saw a 83 percent reduction in hospital
acquired pressure ulcers.
1
Featured Studies
All Over Protection
Count Down to Decreasing Pressure Ulcer Prevalence
17.4 percent prevalence
reduced to 1.7 percent
Barberton Citizens Hospital, Barberton, OH
Deanna Vargo, RN, BSN, CWS, FCCWS
Determining the Right Mix of Support Surfaces to Minimize Hospital
Acquired Pressure Ulcers
PURPOSE: To reduce the 17.4 percent hospital-wide pressure ulcer incidence rate at this
University Hospital, Washington, DC
Cynthia J. Sylvia, RN, BSN, CETN
facility.
METHOD: Daily documentation of skin inspection and risk assessment are initiated and
proper prevention orders are written for all patients at risk. WAFFLE® products are used as
part of this protocol (WAFFLE® Overlay, Foot WAFFLE® and WAFFLE® Seat Cushion). A
full-time wound care nurse oversees the new protocol.
PURPOSE: To examine the effect of the introduction of hospital replacement mattresses and
the decreased use of two-inch convoluted foam overlays and static air overlays, on the incidence
of hospital acquired pressure ulcers.
METHOD: Initially, hospital replacement mattresses were implemented in the hope of eliminat-
RESULTS AND CONCLUSIONS: Facility acquired pressure ulcers decrease from 17.4
ing overlays. This study demonstrates a significant correlation between the decreased number of
static air overlays used and an increased number of hospital acquired pressure ulcers during the
first two months following introduction of hospital replacement mattresses.
percent to 1.7 percent in eighteen months as well as a significant savings in specialty bed rental
costs
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The Importance of Correct Product Selection While Off-Loading a Heel
Pressure Ulcer: Static Air Boot vs. Ankle Foot Orthosis
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Wellstar Kennestone Hospital - Outpatient Wound Treatment Center, Marietta, GA
Yvette Mier, BSN, RN, CWOCN
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PURPOSE: To discuss the use of a static air boot versus an ankle foot orthosis (AFO) to
offload a Stage III heel pressure ulcer in a wheelchair dependent patient with contractures
and neuropathy in the lower legs.
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RESULTS AND CONCLUSIONS: Following the reintroduction of static air overlays, the
pressure ulcer incidence in the study returns to baseline. The key is the right mix of products to
minimize hospital acquired pressure ulcers and to minimize associated costs. The implementation of hospital replacement mattresses does not eliminate the use of static air overlays. Instead,
it shows that the prevalence of pressure ulcers cannot be reduced with the sole use of hospital
replacement mattresses. With the combined use of hospital replacement mattresses and static
air overlays, however, the use of two-inch convoluted foam overlays is totally eliminated.
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METHOD: A 53 year old patient with multiple sclerosis presented with a Stage III
pressure ulcer to her right heel that had been open for two months. The wound was treated
with gel and the Foot WAFFLE was implemented to offload. The Foot WAFFLE did not offer
enough protection from the wound rubbing against the wheelchair. An ankle foot orthosis
(WAFFLE FootHold) was applied to the patient.
Facility-wide use of WAFFLE®
Overlay, Cushion and
Foot WAFFLE®
RESULTS AND CONCLUSIONS: While the static air boot is usually effective in
pressure ulcers.
Taking Pressure Ulcer Incidence to Zero:
One nursing home’s experience
Aletha W. Tippett. BS, ChE, M.D.
Physician Wound Consultant • ©2009
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How to Prevent Pressure Ulcers on a Kinetic Therapy Support Surface
Baptist Medical Center South, Montgomery, AL
Michael Byars BSN, RN, CWOCN, Kay Raxter BSN, RN-BC, CWOCN and
Ramona Reed-Chism BSN, RN
PURPOSE: Prevention of skin breakdown while patient uses Kinetic Therapy Support
Riverview Skilled Nursing Facility, Cincinnati, OH
Aletha W. Tippett, BS, ChE, M.D.
PURPOSE: To report the efforts of one skilled nursing facility to solve its problem of
non-ambulatory patients, the combination of contracture with leg spasms necessitated the
sturdier ankle foot orthosis. The wound closed within three months.
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Taking Pressure Ulcer Incidence to Zero; One Nursing Home’s Experience
METHOD: A comprehensive wound program is implemented that includes education,
evidence-based protocols and a facility wide adoption of the WAFFLE® Overlay,
WAFFLE® Seat Cushion and WAFFLE® Heel Elevator.
RESULTS AND CONCLUSIONS: The pressure ulcer incidence is reduced from eleven
percent to zero percent in four months. A 0 percent to 1 percent incidence rate is maintained
for eight more months and the facility continues to consistently retain a low pressure ulcer
incidence.
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METHOD: Protocols were instituted for skin assessment every shift, air flow absorbent
pads, silicone based dressings placed over sacral skin and the usage of a WAFFLE Seat
Cushion under the patients sacral area and under their head.
RESULTS AND CONCLUSIONS: Within four months of beginning the new protocols
the incidence rate for PU development was zero for all patients on kinetic therapy support
surface beds. By using a combination of absorbent pad, silicone dressing and the WAFFLE
Seat Cushion this acute care facility was able to not only decrease their HAPU but were also
able to elevate the nursing staff awareness in prevention and promotion of best practice for
their kinetic therapy support surface patients.
2
15
On a Foot
Foot WAFFLE® Air Cushion - Case Study
VNA of Northern Virginia
Janice Mentz, RN, BSN, CETN
Featured Studies
Reduction of Pressure Ulcer Incidence and Specialty Bed Rental Dollars
Across the Continuum of Care
Pressure ulcer incidence
rate reduced to 0 percent
Memorial Hermann Northwest Hospital, Houston, TX
Jean Stow, RN, MSN,CNS, CWOCN
PURPOSE: To report the case study of a fifty-seven year old female with ESRD,
diabetes with neuropathy and retinopathy. She has a fractured right tibia ORIF and a
non-healing
pressure ulcer on her right heel that has been present for three years.
PURPOSE: To initiate new protocols and guidelines to reduce the pressure ulcer incidence
rate 17 percent and 33 percent respectively in a two hundred bed acute care hospital and in
the nineteen bed rehabilitation unit. Reducing unnecessary specialty bed expenditures is also
addressed.
METHOD: Initial treatment starts with Curasol® Hydrogel wound dressing to soften
eschar. A physician requests a Foot WAFFLE® after the soft cast on her right leg is
removed. The Foot WAFFLE® conforms to the deformed foot.
METHOD: The staff identifies the protocols/guidelines as outdated with no prevention
strategies in place. A plan of action includes educating the staff on prevention strategies,
methods to enhance healing potential, and how to use products available within the formulary.
Also, protocols/guidelines are revised with emphasis on prevention and early intervention
strategies. The use of static air technology (WAFFLE® Overlay, WAFFLE® Seat Cushion and
Foot WAFFLE®) is implemented into the program.
RESULTS AND CONCLUSIONS: Remarkable changes are seen in the erythema around the right pressure ulcer within two to three days. The erythema quickly
changes from non-blanchable erythema to blanchable erythema. Despite the client’s
“failing” condition, the Foot WAFFLE® provides pressure relief and the wound
improves within a three-month period of time.
RESULTS AND CONCLUSIONS: A follow-up prevalence and incidence study
identifies an incidence rate of 7.1 percent for acute care and 0 percent for rehabilitation.
This is a 59 percent and 100 percent reduction respectively from the previous year. Within
the next year the incidence rate of 0 percent for acute care and 0 percent for rehabilitation is
realized. Additionally, there is a 49 percent reduction in specialty bed rentals.
Foot WAFFLE® Heel Cushion - Case Study
VNA of Northern Virginia
Janice Mentz, RN, BSN, CETN
PURPOSE: To report the case study of a seventy-six year old female with a pressure ulcer on the heel.
METHOD: Initial wound care orders are to elevate the heel on a pillow and apply a
dressing to cover and protect the area. A WOC nurse assessment finds the periwound area macerated and the use of a pillow ineffective at keeping the heel elevated. Even though the wound cannot be staged until the necrotic tissue is debrided, the
clinician suspects the wound to be a shallow Stage III. The revised treatment plan
includes the Foot WAFFLE® for heel elevation.
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RESULTS AND CONCLUSIONS: The Foot WAFFLE® is effective for heel elevation while the pillow is not. The Foot WAFFLE® facilitates healing for a necrotic
heel wound and wounds on the calf.
Foot WAFFLE® Heel Cushion - Case Study
VNA of Northern Virginia
Janice Mentz, RN, BSN, CETN
PURPOSE: To report the case study of an eighty-seven year old female, who is
admitted to a local hospital with a yeast infection from the waist down and multiple
Stage II &III pressure ulcers. The patient is unable to move the left side of her body
from a prior CVA.
METHOD: The yeast infection is treated and a pillow is used to elevate the heel off
the bed. The patient is very combative and the pillow is ineffective in elevating the
heel off the bed. A more aggressive treatment is started to the left lower extremity
including the application of the Foot WAFFLE® .
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Reduction of Community Acquired Pressure Ulcers Using a Static Air
Pressure Relief Support System
Atlantic Home Care, Atlantic City, NJ
Stephanie Hill-Brown RN, MSN, CWOCN
PURPOSE: To reduce the rate of community acquired pressure ulcers for patients in the home
care setting.
METHOD: Agency WOCN was awarded a grant to purchase 650 pressure relief seat cushions. Visiting Nurses distributed cushions to patients deemed at risk for developing a pressure
ulcer by a Braden score of 18 or less. Retrospective chart review was done 2007 – 2010 to
establish pressure ulcer trend and compare outcomes.
RESULTS AND CONCLUSIONS: Pressure Ulcer incidence in 2010 was reduced to
2 percent.Significant cost savings for agency and greatly improved outcomes for at-risk patients.
Outcome of this project supports the evidence-based intervention of providing pressure relief
support surfaces to homebound patients at risk for pressure ulcer development.
RESULTS AND CONCLUSIONS: The Foot WAFFLE® corrects a pronated
position and provides proper elevation for the heel. The wound on the left heel shows
marked improvement within two weeks.
14
3
On a Foot
Featured Studies
WAFFLE® Chair Pad helps
heal Stage III pressure ulcer
Improving Quality of Life in the LTC Hemodialysis Patient
Bellflower, CA (Long-Term Care)
JoAnn Christiason, RN, Long-Term Care Director
Comparison of two
heel devices
The Effectiveness of Two Heel Pressure Reduction
Devices for Heel Pressure Ulcer Prevention
patient.
Abstract
METHOD: Due to a Stage III sacral pressure ulcer, a long term care, hemodialysis patient must receive treatment at bedside instead of travelling to an outpatient
center. The patient becomes depressed because of the confinement. The staff
implements the WAFFLE® Chair Pad as a pressure ulcer treatment device and uses
it during the patient’s transportation to the center and throughout dialysis treatment.
Judith K. Harwood RN,CWOCN, Wound Ostomy Consultant;
JoAnn Christiason RN, Long-Term Care Director
Bellflower, California Long Term Care
A descriptive study design using a convenience sample of thirty-four acute care patients was conducted to comparatively evaluate
the effectiveness of the EHOB Foot WAFFLE® Air Cushion and the Stryker® Air-Shu Boot at relieving tissue interface pressure at
the heel. Subjects were studied for a maximum period of seven days, with tissue interface pressure readings taken on day one,
three, and seven. During the study, subjects wore the Foot WAFFLE® Air Cushion on the right foot and the Stryker® Air-Shu
Boot on the left foot. General skin condition, product application, and subjective data were collected. Analysis of the data using
one-tailed T-test demonstrated that the EHOB Foot WAFFLE® Air Cushion was more effective at relieving heel interface pressure
with the subject positioned both supine (p=.00005) and supine with 30 degrees of head elevation (p=.00005). There was no significant difference between the two products at reducing pressure at the Achilles of calf. Subjective responses from subjects demonstrated a preference for the Foot WAFFLE® Air Cushion.
Purpose
Healing a Stage IV Pressure Ulcer on the Elbow Using
a Static Air Boot
Lewis-Gale Medial Center, Salem, VA
Kimberly D. Hall RN, BSN, MSNc, CWCN
Introduction
Heel pressure ulcers constitute 30% of all pressure ulcers in hospitalized patients (Dekeyser, Dejarger, Meyst, and Evers, 1994).
While many treatments are available to heel pressure ulcers, prevention remains the best method of treatment.
Currently there are several devices available for heel pressure relief. There is, however, little data comparing the effectiveness of
them. An effective pressure relieving device should decrease pressure concentration over the bony prominence by dispersing that
pressure over a greater support surface area and should control the shear force generated on the skin surface. Pressure in the
soft tissue should be reduced to 32 mm HG or lower as this is the approximate pressure exerted by the capillaries (Landis, 1930)
When choosing a pressure relieving device, additional factors must be considered. These include patient comfort, ease of application, and the ability to easily evaluate the effectiveness of the device at relieving pressure. The heel is susceptible to pressure
ulcer development because it is thinly covered with fat and thus offers little protection from pressure exerted by the weight of the
foot. In addition, the relatively large width of the calcaneus bone in relation to the small skin surface of the heel compounds the
problem (Gray 1977).
This study was undertaken to evaluate the
products comparatively and to enable us
to make a research based decision as to
which product to offer our patients.
Ineffectiveness of pillows
and no devices.
METHOD: A retrospective study of one hundred patients with heel ulcers is conducted.
The data review reveals various types of therapeutic management, including multiple, commercially available heel products.
RESULTS AND CONCLUSIONS: The alternate use of the Foot WAFFLE®
helped heal the patient’s elbow ulcer 100 percent over a twelve week period.
RESULTS AND CONCLUSIONS: The use of medical devices as part of the treatment
plan for heel ulcers increases the rate of wound closure. The rate of wound closure is significantly faster for subjects receiving a device than for subjects receiving a pillow. The rate is
also significantly faster for subjects receiving the Foot WAFFLE® than for all other subjects
grouped together.
Taking the Pressure Off in the ICU
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High Point Regional Health System, High Point, NC
Susan Dunzweiller, RN, CWOCN, Wound Care Patient Care Coordinator,
Karen Gammons, RN, Director of Collaborative Patient Care Management and
Laura Hinson, RN, Pulmonary Patient Coordinator
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PURPOSE: To decrease the risk, incidence and prevalence of nosocomial
pressure ulcers in the adult ICU.
METHOD: Subject sample consisted of ICU patients who qualified with certain
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WAFFLE®
Overlay and Foot WAFFLE. Weekly charts,
conditions for using the
audits and rounds were performed by the CWON and the Project Champion to
monitor the effectiveness of the static air products. An objective data collection tool
was utilized.
RESULTS AND CONCLUSIONS: There were no HAPU on any patient
using the WAFFLE Overlay. The Foot WAFFLE results were not as conclusive
due to 50 percent of the patients who had an existing pressure ulcer. A 21 percent
nosocomial pressure ulcer rate was reduced to 0 percent in three months. The
WAFFLE Overlay and Foot WAFFLE played a significant role in reduction of HAPU.
4
A 3-Year Retrospective Analysis Comparing the Effectiveness of
Medical Devices to Non-Medical Devices in the Treatment of Heel
Pressure Ulcers
PURPOSE: To compare the clinical outcomes of heel pressure reduction devices, pillows
elbow, a Foot WAFFLE® was fitted to the patient’s arm, with the ‘foot’ portion
cradling the elbow. The ‘leg’ area of the Foot WAFFLE® protected the patient’s
forearm.
2.7=< 8;
95*,.1*- =1;.. 8; 68;. 27
ria. Each patient wears a Foot WAFFLE® on the right foot and a Stryker® Boot on the left
foot. Pressure readings are taken on pre-determined areas (heel, Achilles, calf) at pre-determined intervals. Subjective data is also collected.
Kathi Whitaker, ET, MSN, CNS, Glenda Motta RN, ET, MPH, and
Anand Vidashankar, Ph.D
METHOD: After several failed attempts to properly treat an ulcer on the patient’s
#
METHOD: Thirty-four adult patients are selected based on pre-established inclusion crite-
heel than the Stryker® Boot. The Foot WAFFLE® readings on the Achilles and calf are
slightly higher, but are not statistically significant, nor do the clinicians want any changes to
the Foot WAFFLE®. The patients prefer the Foot WAFFLE® over the Stryker® Boot.
spinal cord injured adult using a static air support device.
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Boot in reducing tissue interface pressures at the heel and in the prevention of heel ulcers.
This research will be utilized to make product selection decisions at the hospital.
RESULTS AND CONCLUSIONS: The Foot WAFFLE® has lower readings on the
PURPOSE: To treat an unusual Stage IV pressure ulcer on the elbow in a
#
PURPOSE: To compare the effectiveness of the Foot WAFFLE® and the Stryker® Air-Shu
The purpose of this study was to compare the effectiveness of the Stryker® Air-Shu Boot and the Foot WAFFLE® Air Cushion in
reducing tissue interface pressures at the heel and in the prevention of heel pressure ulcers. The redistribution of pressure to
other surfaces of the leg was also examined.
Objective
RESULTS AND CONCLUSIONS: The patient’s wound closes in two months
while her quality of life improves due to a simple pressure relieving surface that
enables her to be transported to her outpatient dialysis center.
Hospital of St. Raphael, New Haven, CT
Anne Aquila, MSN, RN, CS and Deborah Ferretti, MS, RN, CS
Anne Aquila MSN, RN, CS
Deborah Ferretti MS, RN, CS
Hospital of Saint Raphael, New Haven, Connecticut
PURPOSE: To address a Stage III sacral pressure ulcer in a hemodialysis
Improving Quality of Life in the
LTC Hemodialysis Patient
The Effectiveness of Two Heel Pressure Reduction Devices for the Heel
Pressure Ulcer Prevention
Foot WAFFLE® chosen
when clinical staff evaluates
multiple heel devices
Heel Pressure Ulcer Prevention
Duke University Hospital, Durham, NC
Penny Jones, RN, MN, CWS, and Nancy Payne, RN, BSN, CWOCN
PURPOSE: To evaluate and select a pressure ulcer prevention device with the goal of
reducing the nosocomial heel ulcer rate within the facility.
METHOD: The surgical intensive care unit and two post surgical units are indentified as
having the highest nosocomial heel ulcer rate and are selected to participate in the nursing
trial. A tool is developed to identify patients at risk. Multiple, commercially available heel
pressure reduction devices are evaluated based on effectiveness, ease of application, cost,
durability, flexibility of application using dressings and more.
RESULTS AND CONCLUSIONS: Based on the trial, the Foot WAFFLE® is the
product that best meets the criteria and is implemented throughout the hospital. In the five
months following the trial, the heel nosocomial pressure ulcer rate for the identified units
decreases to 1.58 percent for the SICU and zero percent for the post surgical units.
13
On a Foot
Heel ulcers reduced in
hip fracture population
On a Bed
Reducing Heel Ulcer Incidence
Among Hip Fracture Patients by Introducing a Clinical Algorithm
Phelps County Regional Medical Center, Rolla, MO
Retta Sutterfield, RN, BSN, CWOCN
WAFFLE® vs low air loss
PURPOSE: There is an estimated 25 percent incidence of Stage I and II
heel ulcers at this acute care facility. This study examines the effectiveness of
a traumatic hip fracture algorithm, including use of the Foot WAFFLE®, in the
prevention of heel ulcers among patients with hip fractures.
Brook Army Medical Center, Ft. Sam Houston, TX
Gladys A. Cobb, RN, MSN, CETN,
LTC Linda H. Yoder, RN, MBA, PhD, AOCN, and
Joseph B. Warren, RN, BSN,CNRN
METHOD: The algorithm is designed to standardize and improve the quality
PURPOSE: To evaluate the clinical use and cost of preventing pressure ulcers in
of prevention being delivered with high risk-patients. It focuses on nutrition,
mobility, proper use of the Braden Scale for all orthopedic admissions, as well
as required use of the Foot WAFFLE® immediately after surgery.
high-risk patients with specific focus on the KinAir® Low Air Loss Bed and
WAFFLE® Overlays.
METHOD: Over a 14 month period, 123 adult volunteers without a pre-existing
RESULTS AND CONCLUSIONS: The implementation of the Foot WAF-
ulcer, assessed as “high-risk” are enrolled in the study. This study addresses the following research questions: 1.) What is the demographic profile of the patient?
2.) Is there a difference in the number of pressure ulcers or the seriousness of pressure ulcers that develop among high-risk patients when the KinAir® Low Air Loss specialty beds are used compared to WAFFLE® Overlays? 3.) Is there a difference in
cost related to the two products?
FLE® in a heel ulcer prevention protocol for patients with hip fractures reduces
heel ulcer development, while increasing patient and staff satisfaction and overall cost of care.
Incidence rate to zero
on heel
Prevention of Heel Ulcers Among Hip Fracture Patients
Greater Niagara General Hospital, Niagara Falls, Ontario, Canada
Joanna Mataya, BHSC, OT
RESULTS AND CONCLUSIONS: There is no statistically significant difference
between the two surfaces in reduction of pressure ulcers. For most high-risk patients
a low-tech, less expensive mattress overlay is found to be as effective as a high-tech,
high-cost specialty bed. Costs for pressure ulcer prevention and treatment are significantly different when comparing the surfaces. The facility implements a pressure ulcer
prevention program utilizing the WAFFLE® Overlay.
PURPOSE: To determine if the introduction of the Foot WAFFLE® reduces the
fifty-three percent incidence rate of heel ulcers in the fractured hip patients admitted
to this facility.
METHOD: During a seven month time period, sixty hip fracture patients are
admitted to this facility. Each patient is given a Foot WAFFLE® per the new
prevention program. All patients are between sixty-one and ninety-two years of age.
RESULTS AND CONCLUSIONS: All sixty patients utilize the Foot WAFFLE®
and no pressure ulcers develop. The incidence rate drops to 0 percent.
Pressure Ulcers Patient Outcomes on a KinAir® Bed
or EHOB Mattress
When are pressure
ulcers unavoidable?
Skin Failure What Happens When This Organ System Fails?
Indianapolis, IN
James G. Spahn, MD, FACS, Lisa Hobbs, RN, BSN, CWOCN, and
Christie Sprinkle, RN, BSN, CWOCN
PURPOSE: To examine why some pressure ulcers are unavoidable.
2004 WOCN Conference Blue
Ribbon Poster Award
Prevention of Heel Pressure Ulcers in Fractured Hip Patients
Columbus Regional Hospital, Columbus, IN
Lena McCubbin, MS, RN, CWOCN, Donna Smith, RN, UBCM and
Kathy Jackson, BSN, RN, CRRN
PURPOSE: To examine the effectiveness of early intervention to prevent heel
ulcers in hip fractured patients.
METHOD: The authors hypothesize that air overlays help prevent post-fracture heel ulcers. Patient populations are evaluated in a before and after group
study. Standard practice to protect the heel in the before group is pillows for prevention and heel boots for treatment. The after group is evaluated using only static overlay mattresses.
METHOD: A seventy-three year-old patient has a medical history of gastrointestinal bleed and Parkinson’s disease. A motor vehicle accident leaves him with
multiple fractures and a closed head injury. He develops respiratory failure and
has twenty-six nosocomial wounds before he dies. An autopsy reveals that
Multiple Organ Dysfunction Syndrome (MODS) is the cause of death.
RESULTS AND CONCLUSIONS: Multiple Organ Dysfunction Syndrome
(MODS) makes tissue necrosis inevitable. Until clinicians fully understand the
pathophysiology of MODS-like occurrences and have the capability to diagnose,
prevent and treat them, pressure ulcer formation cannot be completely avoided.
RESULTS AND CONCLUSIONS: Nosocomial heel ulcers drop from
5.6 percent to 0 percent by using no other heel device, following protocols and
placing hip fracture patients on static air overlays within eight hours of admission.
In addition, no sacral ulcers are identified in the after group.
12
5
On a Bed
On a Bed
Protocols for Prevention of Pressure Ulcers in Home Care
Battle Creek, MI
Linda Warren, RN, CETN, MSN, FNP-C
The mouse that roared: How tweaking its pressure ulcer prevention program led to
positive outcomes for a small hospital and the community at large.
C.A. Bream, BSN, RN, WOCN – North Okaloosa Medical Center - 77acute beds
Case Study
PURPOSE: To give a nurse a step by step protocol to assess and initiate
care based on the pressure ulcer risk factors of the patient. The criteria is based
on Braden Scale, Homecare Guidelines and AHCPR Guidelines.
METHOD: Support surface protocols include the WAFFLE® Overlay for
Group 1 and Hill-Rom® Products for Group 2 & 3 support surfaces.
RESULTS AND CONCLUSIONS: The protocols decrease the number
of pressure ulcers, improve the compliance of the nurses to initiate early steps
to prevent pressure ulcers and provide the nurses with a tool to select the
appropriate support surface based on the risk factors of the patient.
WAFFLE® Overlays used
on hospital replacement
mattresses
A Clinical Study of Hospital Replacement Mattresses
Pittsburgh and McKeesport, PA
Gwen Johnson, RN, BSN, CETN, Carol Daily, RN, BSN, CETN and
Veronica Franciscus, RN, BSN, CETN, MA
As part of its continuous Quality Improvement Program, a small community hospital set out to reduce its
nosocomial pressure ulcer incidence rate. The hospital’s Wound Committee conducted a thorough assessment of all hospital processes related to pressure ulcer prevention, identifying six critical issues:
1. The nursing staff was compliant with the policy and procedures
for risk assessment* and request for therapeutic support surfaces (TSS).
2. TSS were not always available immediately from the rental
company. There was no space to store or maintain TSS at the hospital.
3. Most frequently rented devices were low air loss mattress replacements
(LALMR). Set-up and patient transfer to the surface was not a user or
patient-friendly process.
4. Patients frequently refused LALMR, complaining that they were
uncomfortable and noisy.
5. Compliance with repositioning schedules and heel floating was mildly
deficient on the inpatient nursing units and very deficient across
disciplines. (example: when patient transported off the nursing unit for
a procedure).
6. Acquiring 2nd person if needed to assist with repositioning was an
obstacle.
The Wound Committee implemented two changes initially, and monitored the result. A WAFFLE®
Mattress Overlay* * (WMO) was added to existing TSS selection algorithm. WMO became a regularly
stocked item in the Materials Department. A “turning song” was implemented as a reminder to reposition patients and as a reminder to available personnel, including managers, to assist staff during turns.
* Braden Scale® – ** EHOB WAFFLE® Mattress Overlay
The mouse that roared: How tweaking its pressure ulcer prevention
program led to postive outcomes for a small hospital and
community at large
North Okaloosa Medical Center, Crestview, FL
C.A. Bream, BSN, RN, WOCN
PURPOSE: As part of its continuous Quality Improvement Program, a
small community hospital set out to reduce its nosocomial pressure ulcer incidence rate.
METHOD: The hospital’s Wound Committee conducts a thorough assessment of all
®
hospital processes related to pressure ulcer prevention. A WAFFLE Mattress Overlay
(WMO) is added to existing therapeutic support surfaces (TSS) selection algorithm.
RESULTS AND CONCLUSIONS: Hosptial-acquired pressure ulcer rate is
reduced from 14 percent to 5 percent.
WAFFLE® Overlays and
Seat Cushions trialed
Effectiveness of an Air Mattress Overlay and Seat Cushion for the
Prevention of Pressure Ulcers
Shore Health System, a division of University of Maryland Medical System, Easton, MD
Amy B. Stafford, MSN, RN, CMSRN, and Jeanne Brower, MSN, RN, BC
Effectiveness of an Air Mattress Overlay and
Seat Cushion for the Prevention of Pressure Ulcers
PURPOSE: To explore the performance of various hospital replacement mattresses (HRM’s) in the hospital setting and to determine if they provide pressurerelieving capabilities that are sufficient enough to eliminate or decrease mattress
overlays such as foam, gel or air.
METHOD: Four Pittsburgh hospitals participate in a study of seven HRM’s from
seven companies. Fifty-five patients participate in the study with a total of thirty
pre-existing pressure ulcers.
RESULTS AND CONCLUSIONS: It is recommended that institutions consider eliminating use of the two-inch foam mattress, since it is appropriate only as
a comfort device. Any higher quality overlays, such as the static air mattresses,
which are often used for the patient at higher risk, should be kept on hand until it
is certain that the HRM chosen by a facility can replace the established need for
these. The heel area should be assessed frequently, and it may be necessary to
use additional products such as heel protectors to elevate the heels above the
mattress surface at all times.
6
Amy B. Stafford, MSN, RN, CMSRN • Jeanne Brower, MSN, RN, BC
Shore Health System, a division of University of Maryland Medical System
INTRODUCTION
Pressure ulcer prevention presents
healthcare organizations with many
challenges. Pressure ulcers are
defined as localized areas of tissue
necrosis that develop when soft tissue
is compressed between a body prominence and an external surface for a
prolonged period of time (National
Pressure, 1992). They are caused by
excess pressure, shearing or friction
forces (Benbow, 2006). Pressure
ulcers result in both increased length
of hospital stay and hospital costs
(Allman et al, 1999).
The
Joint
Commission
of
Accreditation
of
Healthcare
Organizations Patient Safety Goal
#14 is to prevent health care-associated
pressure
ulcers
(Joint
Commission, 2006). The process of
updating and publishing clinical
guidelines will help to make the prevention and treatment of pressure
ulcers central to good patient care
(Benbow, 2006).
The purpose of this research study
was to investigate whether the use
of an air mattress overlay and seat
cushion on all patients admitted to
the 3 East Surgical Unit would
decrease the incidence of pressure
ulcers as defined by the National
Pressure Ulcer Advisory Panel.
PURPOSE: This study investigated whether the use of an air mattress overlay and seat
cushion on all patients admitted to the 3 East Surgical Unit would decrease the incidence of
pressure ulcers as defined by the National Pressure Ulcer Advisory Panel.
METHOD: This study compares a one-day snapshot survey of patients with standard prevention strategies and a one-day snapshot survey after usage of an air mattress overlay and
seat cushion, education for the patient, families and nursing staff.
RESULTS AND CONCLUSIONS: The use of an air mattress overlay and seat cushion, along with education for the patient, families and nursing staff results in positive patient
outcomes. The nursing clinical implications of this study show that the use of an air mattress
overlay and seat cushion significantly reduces hospital acquired pressure ulcers.
11
On a Bed
Using overlays on
specialty beds
On a Bed
Decreasing Pressure Ulcer Nosocomial Rates at a Large Metropolitan
Teaching Hospital
Clarian Health Partners, Indianapolis, IN
Lisa Hobbs, RN, BSN, CWOCN and Michelle Kieninger, RN, BSN, CWOCN
Flotation therapy
supports soft tissue
Effects of a Support Surface on Homeostasis
Keep it Simply Scientific
Indianapolis, IN
James G. Spahn, MD, FACS and Christie Sprinkle, RN, BSN, CWOCN
PURPOSE: To decrease the high pressure ulcer incidence rate in the intensive care unit
of a large teaching facility.
PURPOSE: To explain the pathophysiology behind pressure ulcer development and
METHOD: The WOCN Team identifies contributing factors to skin breakdown among
assist caregivers in choosing support surfaces that facilitate the body’s ability to maintain
a stable internal environment (homeostasis).
ICU patients and uses this information to develop protocols. They pay close attention to
nutrition, heel evaluation and they place a WAFFLE® Overlay on top of a Total Care®
treatment surface.
METHOD: A literature review examines the key mechanical and physiologic factors
relating to tissue necrosis and pressure ulcer development.
RESULTS AND CONCLUSIONS: Education, support surface selection, skin care
rounds and the WOC nurse contribute to preventative measures and documentation that
lead to a lower nosocomial rate in this facility.
RESULTS AND CONCLUSIONS: The true culprit in tissue ischemia necrosis
(pressure ulcer) is endothelial damage. The laws of physics show that flotation therapy
provides volumetric support of soft tissue. Understanding the pathophysiology of support
surface-induced ischemia will lead clinicians to choose support surface products that
prevent endothelial damage and facilitate the autoregulation functions of the body
(homeostasis).
Pressure Ulcer Care for a Terminally Ill Patient Being
Cared for at Home
Jerra-Marie Sullivan, RN, BSN, CETN and Dianne Mackey, BSN, PHN, CETN
PURPOSE: To demonstrate the challenges to both caregiver and patient when addressing pressure ulcers.
METHOD: A sixty-six year old terminally ill patient is cared for in the home by his wife and
a visiting home health nurse. Due to the severity of the patient’s condition, pressure ulcers
develop and ET nurses are consulted. A new care plan is implemented to address the
patient’s multiple health issues while honoring his request to remain at home in the last
stages of life. The WAFFLE® Overlay provides comfort and pressure ulcer treatment.
RESULTS AND CONCLUSIONS: The goals of the patient and caregiver are ultimately met in the home using hospice care.
Shear causes soft
tissue distortion
Support Surface Principles – Based on Scientific Fact
Indianapolis, IN
James G. Spahn, MD, FACS, Lisa Hobbs, RN, BSN, CWOCN, and
Christie Sprinkle, RN, BSN, CWOCN
PURPOSE: To clarify misconceptions relating to effective support surface
management of pressure ulcers.
METHOD: Facts and myths with supporting scientific data are used to
Air vs. Foam
In-Vivo (CT Scan) Comparison of Vertical Shear in Human Tissue
Caused by Various Support Surfaces
Department of Biology, Indiana University-Purdue University, Columbus, IN
Lisa M. Conner, PhD, and James W. Clack, PhD
PURPOSE: To research deep tissue shear as a significant factor in the formation of pressure
ulcers by using human tissue in-vivo derived from CT scans.
METHOD: Pelvic CT scans of three subjects are examined lying upon three depths of foam
mattress overlays and an air mattress overlay commonly used in the prevention of pressure
ulcers. A comparison of subject to support surface contact area is made by measuring the line of
contact between the subject's skin and the mattress overlay.
demonstrate the mechanical forces of pressure ulcer formation and the
physiologic consequences of placing a body on a support surface.
RESULTS AND CONCLUSIONS: (1) Pressure ulcers do not occur from
pressure alone (2) Soft tissue distortion is caused by PresShear™ forces created
by the support surface (3) Bony prominence impaling into soft tissue leads to
distortion, ischemia and necrosis. (4) The type of material the support surface is
made of dictates what type of stress is placed on the body (5) Flotation therapy is
based on the weight of the body being unloaded in the fluid media. (6) All types
of ischemia are best prevented by a static fluid system.
RESULTS AND CONCLUSIONS: Human tissue is prone to both compression (pressure)
10
and shear force (vertical shear). The combination of an air mattress overlay on at least threeinches of foam has the lowest degree of tissue shear and provides the greatest area of contact
between surface support and subject when compared with foam. Tissue shear decreases as the
area of the load increases. Vertical shear is reduced with the air mattress thus decreasing the
risk of pressure ulcer development.
7
On a Bed
On a Bed
Proven anti-microbial
formula in WAFFLE® products
Title
The Effect of Waffle® Polyvinyl and Foam Polyurethane
Mattress Materials on the Growth of Eschrichia coli
Pseudomonas aeruginosa, and Staphylococcus aureus.
The Effect of WAFFLE® Polyvinyl and Foam Polyurethane Mattress
Materials on the Growth of Escherichia Coli Pseudomonas Aeruginosa,
and Staphylococcus Aureus
Hospital-acquired pressure
ulcers decreased by 90 percent
Central Baptist Hospital, Lexington, KY
Jeremy Honaker, RN, BSN, CWON and Emily Davis, RN, MSN, CWOCN
Reid Hospital and Health Care Services, Richmond, IN
David Velazco, Ph.D., Clinical Director of Microbiology
Introduction
In the long term care of non-ambulatory patients, therapeutic mattresses are often used to prevent
breakdown of skin and the information of decubitus wounds. These wounds often become colonized
and infected with microorganisms from the patient’s own bioflora. Bacterial species such as
Escherichia coli, Pseudomonas aeruginosa and Stapylococcus aureus are often encountered in these
wounds.
The purpose of this study was to examine two commonly used therapeutic devices designed to prevent
skin breakdown and determine their effect on the growth of bacteria. In this study, the polyvinyl material used to make Waffle® Mattresses and polyurethane used in foam (egg crate) mattresses were
examined to determine if they exhibited any bacteriocidal or static activity against Escherichia coli,
Pseudomonas aeruginosa or Staphylococcus aureus. In these experiments, polyvinyl and polyurethane
samples were inoculated with test bacteria and controls. The inoculated samples were incubated and
aliquots were removed at various time intervals to determine colony counts.
Additionally, this study examined the effectiveness of a routine hospital disinfectant Quanto
(Huntington, laboratories) on a heavily soiled sample of the polyvinyl. In thispart of the investigation,
samples of mattress polyvinyl were inoculated with a 1.0 x 108 mixture of the test organisms. After 24
hours of incubation, the polyvinyl was rapidly dipped in the disinfectant, wiped dry, then cultured to
determine the number of surviving bacteria.
Methods and Materials
Determination of the colony count of a McFarland 0.5 cell suspension of Escherichia coli,
Pseudomonas aeruginosa, and Staphylococcus aureus. Young six hour cultures of Escherichia coli,
Pseudomonas aeruginosa and Stapylococcus aureus were diluted to a concentration equivalent to a
1:100 dilution of a McFarland 9.5 cell suspension. These cell suspensions were further diluted 1:10,
1:100, and 1:1000 and plated on TSA in duplicate to determine the cell count of the suspension. Colony
counts were determined after 18 hours of incubation at 37 degrees C.
Preparation of mattress material. A one inch square was cut from the polyvinyl and polyurethane and
used as a template to cut six identical pieces. Each piece of mattress material.
PURPOSE: To decrease the incidence of pressure ulcers among Coronary Artery Bypass
PURPOSE: To examine polyvinyl material used in
Overlays and polyurethane
used in foam mattresses to determine their effect on the growth of bacteria often associated
with skin infections.
Graft (CABG) patients post-operatively in the Cardiothoracic Intensive Care Unit.
WAFFLE®
Case Series Studying Nosocomial Pressure Ulcers
in the Post-Operative CABG patient.
for all post-op CABG patients upon transfer to ICU from the operating room. Secondly, nurses
are educated in three tiers: 1) Affirms prior knowledge regarding prevention of pressure ulcers
and clearly identifies the problem in their area 2) Reviews pressure ulcer prevention guidelines and policy changes 3) Conveys to staff recent advances in the field of pressure ulcer
staging, development and treatment.
METHOD: Each piece of mattress material (polyvinyl and polyurethane) is placed in a
test tube containing either bacteria (E. Coli, Pseudomonas, and Staphylococcus Aureus) or
sterile saline. The tubes are incubated for different time periods.
RESULTS AND CONCLUSIONS: The antimicrobial formula used in the polyvinyl of
RESULTS AND CONCLUSIONS: This simple and low cost intervention dramatically
Clarian Health, Indianapolis, IN
Terry Hobbs, RN, BSN, MSA
METHOD: The IUH Lift Team chose five pieces of equipment to assist with transfers,
positioning and lifting – WAFFLE®, Liftem® floor lift, gait belt, Slipp®, and AirPal®. Each piece
of equipment was evaluated for six months while patient handling injuries were documented.
RESULTS AND CONCLUSIONS: The annual cost of patient handling injuries
decreased from 283,861 to 56,988 over the evaluation period. And, among lift team members, WAFFLE® was deemed the most useful turning and transferring device available. In
August, 2006 the IUH critical care units adopted a policy of placing every patient on either
a WAFFLE® or specialty bed for decubitis ulcer prevention.
Wounds Treated With Static Air Overlays
Cincinnati, OH
Aletha W. Tippett, BS, ChE, M.D.
ASSUMPTIONS
Cases were selected randomly, based on
recall and availability of before and after
pictures. These are representative of the
standard care received, and what is
referred to as the Gemini™ Program.
Healing rates using this program approach
100% within 12 weeks.
Static air overlay is $70 with a 6 month
warranty. Medicated hydrogel wound
dressing is $8.00 for single 4x4 daily
dressing change. Top dressing is rather
insensitive to size change - zinc oxide ointment with plastic wrap – actual expense is
under $1.00 but $2.00 is used for this
analysis. HVPC reimburses about $50/45
minute treatment by Medicare. One treatment per week is $7.14 per day.
TREATMENT
Static Air Overlay
Medicated Hydrogel Wound Dressing
Weekly HVPC* Treatments
* High-voltage pulsed current electrical
stimulation therapy
All of these wounds were considered “untreatable” and had failed various standard
treatments. At least 2 of the 7 were hospice patients, and 2 more were at end of
life. To get these results in this patient
population is remarkable.
Dramatic cost savings
using WAFFLE®
Methodist Hospital Pressure Ulcer Prevalence Survey
Quality Improvement Skin Care Task Force
Methodist Hospital, Indianapolis, IN
Shelly Lancaster, RN, MSN
PURPOSE: To decrease the incidence of nosocomial pressure ulcers throughout
the hospital by increasing staff knowledge about skin care and promoting risk
assessment and prevention of pressure ulcers throughout the hospital.
METHOD: Indiana’s fifth largest hospital’s nosocomial rate increases following the
discontinuation of WAFFLE® Overlays and the implementation of new dynamic sleep
surfaces and pressure reducing mattress replacements. Methodist Hospital reinstates
the WAFFLE® Overlays as part of the hospital protocol and experiences the lowest
prevalence rate during the study.
RESULTS AND CONCLUSIONS: WAFFLE® products play a significant role
Aletha W. Tippett, M.D.
Cincinnati, Ohio
CASE STUDIES
reduces nosocomial pressure ulcer occurrence in a post-operative CABG population. This
combination of protocols set into place and staff education elevates the nurses' awareness of
skin integrity changes thus providing them with tools to diminish the incidence of pressure
ulcers.
A Lift Team’s Approach to Selecting Transferring and Positioning
Devices
PURPOSE: To examine equipment choices by the Indiana University Hospital (IUH) Lift
Team, and to chart injury reduction outcomes while transferring and positioning patients on
the chosen products.
Wounds Treated with
Static Air Overlays
METHOD: Faclity implements a protocol requiring the immediate use of a static air overlay
Jeremy Honaker, RN, BSN, CWOCN – Emily Davis, RN, MSN, CWOCN – Central Baptist Hospital, Lexington, Kentucky
WAFFLE® Overlays kills E. Coli. Polyurethane actually supports the growth of E. Coli and
Pseudomonas and delays the death of Staphylococcus Aureus. WAFFLE®’s polyvinyl can
be easily decontaminated with disinfectant, thus it appears to have an advantage over foam
in reducing the risk to patients for developing infections.
WAFFLE® products first
choice among lift team
members
Case Series Studying Nosocomial Pressure Ulcers in the
Post-Operative CABG Patient.
PURPOSE: To report the case study of seven patients with wounds considered to
be untreatable and whose wounds had failed various standard treatments.
in decreasing the facility’s nosocomial pressure ulcer rate and save the institution
millions of dollars over several years in specialty bed rentals.
METHOD: Patient’s are treated with static air overlays, medicated hydrogel
wound dressings and weekly high-voltage pulsed current electrical stimulation
therapy.
RESULTS AND CONCLUSIONS: With WAFFLE® products along with the
medicated hydrogel and wound dressings the wounds on the case study patients
healed within 12 weeks, with a total cost saving of $47.033.99.
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