PRODUCT FOCUS

SimCair: a simple mattress system to support pressure ulcer prevention

Sylvie Hampton

ressure ulcer prevention is expensive and at times difficult to achieve. However, pressure ulcer prevention and management should be an integral part of nursing practice (Moore. 2001) and each nurse should be educated in prevention strategies including the rationale of equipment selection. However, although many strategies have been developed in order to prevent pressure ulcere, they remain a significant healthcirc problem, particularly for chronically ill patients in rehabilitation facilities (Sae-Sia and Wipke-Tevis, 2(){)2).This has led to government White Papers reinforcing the move towards evidence-based heaith care that includes performance measures, clinical effectiveness and ongoing professional development (Stephens and Bick, 2002).

Abstract
Assessing skin is a simple method of reducing pressure ulcer occurrence and is easily accomplished by both trained and untrained staff. The important issue, once the risk has been identified, is to supply equipment in the shortest time possible. A new mattress, SimCair, developed by Hill-Rom Ltd, is designed for just such a reason. It is a lightweight overlay that combines air and viscoelastic foam in order to redistribute the body weight and thus reduce risk. SiniCair is easily transported and can be ready for instant and automatic inflation as soon as it is required. It is also durable and simple to clean between patients. A small evaluation was undertaken in one nursing home to assess the benefits to the residents. Key words: Patients: welfare Pressure ulcers therefore, a light-weight mattress that is a simple but inexpensive system has a role iii tlic prevention of pressure ulcers. This product focus reviews the efficacy and appropriateness of a new, light-weight mattress for patients who are at risk of pressure damage in the community.

Prevention of pressure damage

If pressure damage is recognized in the ven' early stages, before deterioration within the tissues, and suitable equipment or repositioning is commenced, then pressure ulcration will be unlikely to occur (Gledhill and Hampton, 2004). The

Fisiire t.Titt SimCair mattress.

Figure 1. The SimCair mattress incorporates temperature-sensitive mscoelastic

/iiiiffl lechnotogy.

All pressure ulcers are chronic wounds that have an inherent, physiologic impairment to heahng (Brem et al, 2()2) and are areas of soft tissue breakdown that result from sustained mechanical loading of the skin and underlying tissues. They can affect the quality of life of many individuals (Bouten et al, 2003) and cause anxiety and distress for families.The optimum solution to this ancient problem is not to allow the pressure damage to occur in the first place. As any community nurse will know, delivering a specialist mattress to patients who are at risk of this pressure damage can be slow owing to the difficulty of obtaining a mattress at the time of specific need. In nursing homes,ftmdingis often an issue when mattresses are required (Hampton and Collins, 2003) and.
Sylvie Hampton is Tissue Viability Consultant, Eastbourne

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assessment for the risk ofpressure ulcer developnienr need not be more difficult or complicated than examining the skin (Gledhill and Hampton, 2004). When pressure is present, the skin turns white as the blood is prevented from entering the area of the pressure, and when the pressure is reheved, the skin flushes inmiediately red. This response is perfectly normal and can be seen in liealthy people as well ns those who are Luiwell. This redness disappears quite quickly but is an indicator tliat pressure has been applied to that area for too long a period (Hampton and Collins. 2003). When the skin develops this redness, a tinger pressed over the area will produce a white mark as the blood is once again prevented from entering that area. Tbe ability' for the skin to recover from this blood deprivation indicates that there is no actual damage occurring and can act as a warning that pressure has been applied for too long a period and the resident has been ui danger of developing pressure damage (Cedhill and Hampton, 2004). Owing to accoinpiin^nng illnesses, the ageing population is at high risk and more predisposed to the development ot pressure ulcers (Jaul, 2001). The phenomenon of pressure ulcers in tbe
Figure .*. SimCair in comparison to a current air-fiUed overlay.

elderly patient often requires an alternative management policy to that of the standard treatment and, in general, the therapeutic approach to pressure ulcers in elderly people should be dirterent to that in younger patients. This modification is owing to the accompanying co-morbidity so often associated with ageing (Jaul, 2001). Although considered by many healthcare workers to be an inevitable probleui of ageing, pressure ulcers are in actuality preventable and their prevention is a quality outcome of care (Murray and ilaylock, 1994). Conversely, relatives and patients who in the past also appeared to accept that pressure ulcers were an inevitable result of chronic conditions and reduced mobility, now view them as evidence of a failure to provide a reasonable standard of care and often bring action for compensation against those responsible (Hampton, 2004). Therefore, it is important to provide support and education for all healthcare workers, partictilarly healthcare assistants (HCAs). HCAs are in the frontline of care (I^imond, 2003) and are caring for increasingly dependent residents who are consequently at great risk of developing pressure injuries (Clay, 2000), particularly as these injuries are common among frail elderly people. It is also important to provide the required equipment at the time that it is
Interface pressure mapping on a 1,75 m 150 Kg subject

Interface pressure mapping on a 1,60 m 58 Kg subject

Supine position (0)

Supine position (0)

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needed, and to not cause the patient to wait while funding is identified and a mattress provided. The SimCair is one solution to this common problem as it is much cheaper than dynamic systems.

A small-scale evaluation of SImCaIr

In March 2004. a sniall-scale unstructured assessment was undertaken by a tissue viability nurse consultant to evaluate tbe SimCair mattress on participants in nursing homes. Each participant said they welcomed the trial as they enjoyed giving their opinion and taking part in the assessment and each participant understood that they could withdraw at any time if they wished. The average age of the participants (four males and 15 females) was H9 years, with the eldest being 102 years and the youngest 67 years. Each paricipant was able to give fully informed consent to taking part in the evaluation. The assessment took place over a 4-week period. The participants' pressure areas were examined daily by their carers (this is normal care) and examinations undertaken on day 1, day 7, day 8, day 15 and tiay 22. The assessor also reviewed the subject on day 2 for any redness.The assessment included observation of bony prominences. If redness was noted on any bony prominence, this would have been considered an adverse effect and the patient would have been withdrawn from the assessment. Twenty-two participants were enrolled in the assessment. One participant died and two withdrew before conunencement with no reasons given. Therefore, the assessment was based on the remaining 19 participants. The 19 participants had Waterlow scores that averaged 17 with the highest being 22. Two participants who had minor damage at commencement of the study weie healed at the end of the 4-week period. All participants said they were satisfied with the comfort of the SimCair and all 19 participants remained free of pressure damage (redness) during the 4 weeks and a followup call revealed that they remained free from redness for a further 4 weeks.

The SimCair mattress

The SimCair mattress, developed by Hill-Rom Ltd, is a selfinflating mattress overlay {Figtm. 1) that requires little set-up education for nurses before use. The mattress is unique as it combines temperature-sensitive viscoelastic foam technology combined with static-air technolog)' which conforms to the patient, allowing better redistribution of the body weight, reducing overall For further information on the SimCair mattress uiteiface pressures (Figure 2). please contact This can clearly be seen in the Liz.Mcgowan@hill-rom.com Hill-Rom. Ashby Park. Ashby de la zouch. interface pressure mapping. Leicesershire LE65 1|G Figure 3 compares SimCair details on application) with another static air product. The SimCair mattress overlay has a rapid inflation and deflation with a dual twist action, highflow valve system enabling automatic inflation and ease of transport for immediate use when required. The overlay is tight weight and therefore is easily carried by one person, ft consequendy would be extremely useflil to community nurses to ensure patients have immediate cover to prevent pressure damage. After use, the mattress can be cleaned and then Figun4. The reused. !t is easily rolled Lip in the carry bag {Figure 4), and Conclusion SlmCair mattress is tiglu weight transported to a loan store or to another parient. Once stored in the The SimCair mattress could be a strong support to conmiumty and can easily carry bag, the SimCair weighs only 8 kg. nurses as the mattress rolls small enough to be kept in a car he tarried hy one person. boot. It can therefore be used immediately by patients who are The cover is a high-stretch polyurethane that is waterproof newly diagnosed as being 'at risk' of pressure damage. It would and non-slip. There is a stretch terry-towelling cover that can be also provide a cost-effecdve mattress for nursing homes that purchased separately to the mattress. After single patient use, the need to provide a support surface for their clients to prevent cover can be washed or discarded and replaced, ensuring pressure damage. Therefore, the SimCair is a simple to use support of infection control.The system is also easily repairable system that would fulfil these requirements. ^H if damage should occur. The SimCair is guaranteed for 3 years but is expected to last for a longer period of rime. The SimCair mattress overlay is a new product and. as such, Uouten CV. Oomens CW. Baaijciis FP. Bader DL (2003) The eooiogy of pressure ulcers: skin deep or iiiLiscic bound? Arch I'liyx Aicrf Rehahil 84(4); 6 1 6 - i y must undergo evaluation to provide evidence of its ability to Hreni H. Niermau DM, Nelson JE (2lKi2) Pres'iiire iilcersr in the chronically prevent pressure ulcers. crincaliy lU paoeiu. Critical Care Clinician 18(3): 683-94

Hill-Rom

KEY POINTS
Although considered by many to be inevitable, pressure ulcers are largely preventable if appropriate equipment is supplied at the time it is required. When skin becomes red it should be taken as a warning that pressure damage could soon occur and equipment supplied. The SimCair mattress can be easily transported as it fits in a small carry bag, and several could easily be carried in the boot of a car. The cost of the SimCair is a fraction of the cost of dynamic systems.

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