March 3, 2015 — The American College of Physicians (ACP) published two
evidence-based clinical practice guidelines in Annals of Internal
Medicine for the prevention and treatment of bedsores, also called
pressure ulcers. Bedsores commonly occur in people with limited mobility, such
as those in hospitals or long-term care settings.
to $11 billion is spent annually in the United States to treat bedsores and a
growing industry has developed to market various products for pressure ulcer
prevention,” said Dr. David Fleming, president, ACP. “ACP's
evidence-based recommendations can help physicians provide quality care to
patients while avoiding wasteful practices.”
recommends that physicians perform an assessment to identify patients who are
at risk of developing bedsores. The evidence is not conclusive to show any
difference between clinical judgment or risk assessment scales on reducing
bedsore incidence. Risk factors include older age, black race or Hispanic
ethnicity, lower body weight, cognitive impairment, physical impairments, and
other comorbidities that affect soft tissue integrity and healing, such as
urinary or fecal incontinence, diabetes, malnutrition, edema, impaired
circulation of the blood in the smallest blood vessels, and low blood level of
patients who are at increased risk of developing bedsores, ACP recommends that
physicians choose an advanced static mattress (a mattress made of foam or gel
that does not move when a person lies on it) or an advanced static overlay (a
material such as sheepskin or a pad filled with air, water, gel, or foam that
is secured to the top of a bed mattress), which are associated with a lower
risk of bedsores compared to standard hospital mattresses. Advanced static
mattresses and overlays are also less expensive than alternating air or
low-air-loss mattresses and they can be used as part of multicomponent approach
to bedsore prevention.
the evidence does not show a clear benefit for prevention, ACP recommends
against using alternating air mattresses and alternating air overlays for
patients who are at increased risk of developing bedsores. Also known as
dynamic mattresses and overlays, these devices can alter the level of support
by adjusting the level of air or fluid.
the High Value Care section of the guideline, ACP states that advanced static
mattresses and overlays were associated with a lower risk of bedsores compared
to standard mattresses in higher risk patients. Many hospitals in the United
States utilize alternating air and low-air-loss mattresses and overlays despite
the lack of evidence showing any potential benefit in the reduction of bedsores
in high-risk populations. Using these support systems is expensive and adds
unnecessary burden on the health care system, ACP advises.
recommends that physicians use protein or amino acid supplementation and
hydrocolloid or foam dressings in patients with bedsores to reduce wound size.
Protein supplementation was assessed in conjunction with standard therapies
such as dressings or support surfaces. The evidence showed that hydrocolloid
dressings are better than gauze dressings for reducing wound size and resulted
in similar complete wound healing as foam dressings. ACP also recommends that
physicians use electrical stimulation as adjunctive therapy in patients with
pressure ulcers to accelerate wound healing.
the High Value Care section of the guideline, ACP states that it does not
recommend the use of various advanced support surfaces, including alternating
pressure and low-air-loss beds, since the quality of evidence evaluating these
surfaces was limited and the harms from these type beds were poorly reported
and could be significant given the immobility of the patient.
although low-quality evidence showed that dressings containing Platelet Derived
Growth Factor (PDGF) promoted healing, ACP supports the use of other dressings,
such as hydrocolloid and foam dressings which are effective at promoting
healing and cost less than PDGF dressings.
About the American College of Physicians
The American College of Physiciansis
the largest medical specialty organization and the second-largest physician
group in the United States. ACP members include 141,000 internal medicine
physicians (internists), related subspecialists, and medical students. Internal
medicine physicians are specialists who apply scientific knowledge and clinical
expertise to the diagnosis, treatment, and compassionate care of adults across
the spectrum from health to complex illness. Follow ACP on Twitter and Facebook
more information, visit http://annals.org/article.aspx?articleid=2173505