The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers

Background: Turning is considered to be an effective way of preventing pressure ulcers, however almost no research has been undertaken on this method. Aim: The aim of the study was to investigate the effect of four different preventative regimes involving either frequent turning (2, 3 hourly) or the use of a pressure-reducing mattress in combination with less frequent turning (4, 6 hourly). Subjects: 838 geriatric nursing home patients participated in the study. Methods: During 28 days, four different turning schemes were used: turning every 2 h on a standard institutional (SI) mattress (n = 65), turning every 3 h on a SI mattress (n 65), turning every 4 h on a viscoelastic foam (VE) mattress (n = 67), and turning every 6 h on a VE mattress (n 65). The remaining patients (n = 576) received standard preventive care. Main results: The incidence of non-blanchable erythema (34.8-38.1%) was not different between the groups. The incidence of grade 11 and higher pressure ulcers in the 4 h interval group was 3.0%, compared with incidence figures in the other groups varying between 14.3% and 24.1%. Conclusions: Turning every 4 h on a VE mattress resulted in a significant reduction in the number of pressure ulcer lesions and makes turning a feasible preventive method in terms of effort and cost. (C) 2004 Elsevier Ltd. All rights reserved.