title: Effects of turning on skin-bed interface pressures in healthy adults.
abstract: OBJECTIVE
  This paper is a report of a study of the effects of lateral turning on skin-bed interface pressures in the sacral, trochanteric and buttock regions, and its effectiveness in unloading at-risk tissue.
  
  
  BACKGROUND
  Minimizing skin-support surface interface pressure is important in pressure ulcer prevention, but the effect of standard patient repositioning on skin interface pressure has not been objectively established.
  
  
  METHODS
  Data were collected from 15 healthy adults from a university-affiliated hospital. Mapped 24-inch x 24-inch (2304 half-inch sensors) interface pressure profiles were obtained in the supine position, followed by lateral turning with pillow or wedge support and subsequent head-of-bed elevation to 30 degrees .
  
  
  RESULTS
  Raising the head-of-bed to 30 degrees in the lateral position statistically significantly increased peak interface pressures and total area > or = 32 mmHg. Comparing areas > or = 32 mmHg from all positions, 93% of participants had skin areas with interface pressures > or = 32 mmHg throughout all positions (60 +/- 54 cm(2)), termed 'triple jeopardy areas'. The triple jeopardy area increased statistically significantly with wedges as compared to pillows (153 +/- 99 cm(2) vs. 48 +/- 47 cm(2), P < 0.05).
  
  
  CONCLUSIONS
  Standard turning by experienced intensive care unit nurses does not reliably unload all areas of high skin-bed interface pressures. These areas remain at risk for skin breakdown, and help to explain why pressure ulcers occur despite the implementation of standard preventive measures. Support materials for maintaining lateral turned positions can also influence tissue unloading and triple jeopardy areas.
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA. mpeterson@anest.ufl.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Peterson
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Schwab
authors.forename: Johannes H
authors.initials: JH
authors.lastname: van Oostrom
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Gravenstein
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Caruso
mesh_terms: D000328:Adult; D001513:Beds; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011312:Pressure; D003668:Pressure Ulcer / Q000451:nursing* / Q000517:prevention & control*; D011482:Protective Devices / Q000706:statistics & numerical data; D055815:Young Adult