title: Clinical and cost effectiveness evaluation of low friction and shear garments.
abstract: OBJECTIVE
  To determine the effectiveness of Parafricta low-friction garments in reducing the incidence and prevalence of pressure ulceration and to evaluate the curative aspects of these products on pre-existing skin breakdown within a hospital setting.
  
  
  METHODS
  Patients with a Waterlow score of >15 and who were unable to reposition independently were offered the low-friction undergarments and bootees. A total of 650 patient cases were initially reviewed. Of these, 204 met the criteria for use of the products in the 3 months prior to the start of the evaluation (cohort 1) and 165 patients met the criteria during the period when the garments were used (cohort 2). Data collected included pressure ulcer incidence, location, grading, and outcome of ulcer on discharge. Locally derived costs for length of stay, wound dressings, pressure-redistributing mattresses and additional cost of the low-friction garments were applied to build a cost-effectiveness model.
  
  
  RESULTS
  In patients at risk of skin breakdown there was a statistically significant reduction in the number of patients who developed pressure ulcers following use of the low-friction garments in cohort 2 when compared with cohort 1 (16% reduction; p = 0.0286). In addition, the number of patients who were ulcer free on admission but who developed ulcers and then improved or completely healed before discharge was also statistically significant (41% increase; p = 0.0065) when cohort 2 was compared with cohort 1. Fewer patients admitted with ulcers deteriorated when using the low-friction garments (21% reduction; p = 0.0012). The costs, which were calculated by comparing patient throughput for these patients, suggest that the savings associated with preventing skin breakdown outweighed the cost of the products used (base case model indicated a saving of over £63,000 per 100 at risk patients).
  
  
  CONCLUSIONS
  The results support the conclusion that low-friction garment products have a role to play in the prevention of skin breakdown, and appear to be both clinically effective and cost effective.
  
  
  BACKGROUND
  The authors have no conflicts of interest to declare. APA Parafricta provided the products, as well as financial support for training of the ward staff who participated in the evaluation and for the data collection and analysis (which was performed by Xcelerate Health Outcomes Unit, NHS Innovations London).
authors.affiliation: Tissue Viability Nurse, St. Mary's Hospital, Isle of Wight, UK. Glenn.Smith@low.nhs.uk
authors.forename: G
authors.initials: G
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Ingram
mesh_terms: D001513:Beds; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D017276:Friction; D006801:Humans; D007902:Length of Stay; D003668:Pressure Ulcer / Q000191:economics* / Q000517:prevention & control*; D011481:Protective Clothing / Q000191:economics*; D006113:United Kingdom