How to Match Mattress Types to Patient Wound Care Needs

• By Joseph Duffy
• Jul 01, 2011

The prevention of wounds must be a top concern for providers who sell mattresses to bed-bound patients, or patients that spend a considerable amount of time in their beds. The population of bariatric patients is increasing, with obesity rates for adults aged 20 and older at about 34 percent, according to the Centers for Disease Control & Prevention. When it comes to wound care and pressure sores, bariatric patients are at a greater risk because of their size and immobility. There is a greater skin to weight ratio in these patients, confounded, in many cases, by their inability to turn every two hours.

Obesity places extra strain on the heart and lungs to distribute oxygen and nutrients around the body. The lack of oxygen and blood can result in chronic skin and wound problems. Blood supply to fatty tissue may not be adequate to provide appropriate oxygen and nutrition. In addition, obese patients are prone to profuse sweating. The moisture can cause skin breakdown and rashes that can lead to a sore. Moreover, pressure sores can become infected if left untreated, and that can become a life-threatening condition.

Fortunately for bariatric patients, technological advances continue to increase the likelihood of prevention and successful treatment. However, providers need to keep up to date on these issues and understand these technologies to give bariatric wound care patients the best possible standard of care and a fighting chance against debilitating pressure wounds.

Wound Staging

Here is a summary of the National Pressure Ulcer Advisory Panel’s guidelines on staging pressure sores:

Suspected Deep Tissue Injury — This will have a purple or maroon localized area of discolored intact skin or blood-filled blister.
Stage 1 — Intact skin with non-blanchable redness of a localized area usually over a bony prominence.
Stage 2 — Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, but without slough.
Stage 3 — Full thickness tissue loss with visible subcutaneous fat. Slough might be present and the wound might include undermining and tunneling.
Stage 4 — Full thickness tissue loss with exposed bone, tendon or muscle; slough or eschar might be present; and will often include undermining and tunneling.
Unstageable — Full thickness tissue loss in which the base of the ulcer is covered by an eschar in the wound bed.

There are many effective mattresses that address wound care issues in the bariatric population. But be aware that no one mattress can effectively address all patients. Matching the right mattress to the patient versus a patient to a mattress is key to effectively addressing any wound care issue. Here are some tips to consider when matching mattresses to patients:

Generally, the more severe a pressure wound, the more complex the mattress that will be required. A patient with a single stage 2 sore or less might simply need a gel overlay, while a patient with multiple stage 3 or 4 wounds might need a low-air loss, alternating pressure mattress.

There are two standard mattress types that have been on the market for some time: low air loss mattresses and alternating pressure mattresses. Low air loss mattresses provide airflow to help keep skin dry, as well as to relieve pressure. Both features help prevent pressure ulcers. Alternating pressure mattresses help treat pressure sores by providing two sets of air cells that expand and contract on an alternating basis so as to continually shift pressure.

True low air loss with alternating pressure is a good solution for treating pressure wounds, regardless of the patient’s weight. When dealing with bariatric patients you will need a higher volume of airflow to counteract the increased perspiration and to adequately supply enough airflow to alternate pressure in the mattress.

You don’t want a mattress to fail on a patient that is at risk for pressure ulcers, so reliability is an important element in selecting the right mattress. Foam mattresses can break down and blower motors can overheat and fail. Make sure to look at blower motors and pumps that can hold up to around-the-clock use. For instance, motors that use air that is already in the cells, rather than those that circulate outside air into the mattress, won’t have to work as hard.

The mattress should accept the patient and allow for adequate pressure redistribution of the weight presented by the patient. This requires that patients are enveloped by the mattress to a certain degree and not just be on top of the surface.

Make sure the mattress is truly suited for bariatric weight loads. Using equipment that maximizes the weight capacity leads only to failure, providing unsafe and substandard care. Looking for products that exceed needs is safer and more efficient by providing shorter recovery periods.

Providing the proper support is critical and correct adjustment of the mattress to give adequate pressure redistribution must be accomplished. Overpressurizing of the surface can result in the problems that providers are trying to eliminate. Asking clients if they are comfortable is critical. Education of the family and caregivers is very important.

This article originally appeared in the July 2011 issue of HME Business.