title: Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial.
abstract: OBJECTIVE
  Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU).
  
  
  METHODS
  A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial.
  
  
  RESULTS
  Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs.
  
  
  CONCLUSIONS
  We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.
authors.affiliation: University of Melbourne & Royal Melbourne Hospital.
authors.forename: N
authors.initials: N
authors.lastname: Santamaria
authors.affiliation: University of Melbourne & Royal Melbourne Hospital.
authors.forename: M
authors.initials: M
authors.lastname: Gerdtz
authors.affiliation: Adelphi University, New York.
authors.forename: W
authors.initials: W
authors.lastname: Liu
authors.affiliation: Melbourne Health.
authors.forename: S
authors.initials: S
authors.lastname: Rakis
authors.affiliation: Melbourne Health.
authors.forename: S
authors.initials: S
authors.lastname: Sage
authors.affiliation: Melbourne Health.
authors.forename: A W
authors.initials: AW
authors.lastname: Ng
authors.affiliation: Melbourne Health.
authors.forename: H
authors.initials: H
authors.lastname: Tudor
authors.affiliation: Royal Melbourne Hospital.
authors.forename: J
authors.initials: J
authors.lastname: McCann
authors.affiliation: Royal Melbourne Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Vassiliou
authors.affiliation: Melbourne Health.
authors.forename: F
authors.initials: F
authors.lastname: Morrow
authors.affiliation: Royal Melbourne Hospital.
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.affiliation: University of Melbourne & Royal Melbourne Hospital.
authors.forename: J
authors.initials: J
authors.lastname: Knott
authors.affiliation: University of Melbourne & Royal Melbourne Hospital.
authors.forename: D
authors.initials: D
authors.lastname: Liew
mesh_terms: D000328:Adult; D000368:Aged; D001458:Bandages; D015331:Cohort Studies; D064648:Critical Care Nursing / Q000379:methods*; D005260:Female; D016523:Foot Ulcer / Q000451:nursing*; D006365:Heel / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000517:prevention & control*; D012828:Silicones / Q000627:therapeutic use*; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D012828:Silicones
keywords: Mepilex Border heel dressing; critical illness; intensive care unit; pressure ulcer; wound dressings