1. Layers of linen used in conjunction with pressure ulcer prevention
Kelly Suttle BSN, RN, CWOCN

2. Reduce the Pressure, reduce the risk

3. Excessive Pressure on Tissues
Pressure is the major causative factor for pressure ulcers. These factors determine if the pressure is enough to cause a pressure ulcer:
Intensity of Pressure
Duration of Pressure
Tissue Tolerance

4. Excessive pressure on tissues
Intensity of pressure
Capillary closing pressure 30-40mmHg
Interface pressures

5. Excessive pressure on tissue
Duration of pressure
Inverse relationship between duration and intensity of pressure
High pressure for short periods of time
Low pressure for long periods of time

6. Excessive pressure on tissue
Tissue tolerance
Redistribution of pressure
Tissue that is already damaged is higher risk for pressure ulcer

7. Blue= lower pressure Green Yellow Red= high pressure
Portable pressure mapping system was used on top of linens to demonstrate how excess layers of linen can cause higher interface pressures
Blue= lower pressure
Green
Yellow
Red= high pressure

8. One layer reusable chux HOB flat
side

9. One layer reusable chux HOB 30
Flat
Side

10. 2 layer reusable chux HOB flat
Side

11. 2 layer reusable chux HOB 30
Flat
side

12. 3 layer reusable chux
HOB flat
Hob 30 side view

13. Bariatric on Low Air Loss
UAB Hospital
Bed Making Standard
Standard Items on all beds:
Items as needed:
Low Air Loss Surface
NO fitted sheet
1 Driflo (blue back) disposable underpad
Underpads (choose 1 of appropriate pad)
Reusable
Disposable underpad
Disposalbe Driflo underpad
Draw Sheet
Fitted Sheet
Flat Sheet
Pillowcase
Blanket/Spread
Pillow
Ambulatory
Fitted sheet atop regular mattress
DO NOT use underpad
Place top sheet, tuck into foot of bed and miter corners
Needing Assistance
or Bed Bound
Fitted sheet atop regular mattress
Draw sheet folded in half placed over center of bed to assist with turning/positioning/lifting
1 of appropriate underpad
**DO NOT layer - Change underpad as needed
Place top sheet, tuck into foot of bed and miter corners
Bariatric on Low Air Loss
1 flat sheet for positioning
1 Driflo (blue back )disposable underpad

14. conclusions
These pressure maps show that excess linen can be a cause of pressure ulcers
We are not really saving any time by “padding” our beds
Excess linen on beds can increase linen costs
This should be a component of a pressure ulcer prevention program

15. References
Messer, M. S. (2010). Pressure Ulcer Risk in Ancillary Services Patients. Wound Ostomy Continence Nursing,
Pieper, B. (2000). Mechanical Forces: Pressure, Shear, and Friction. In R. A. Bryant, Acute and Chronic Wounds: Nursing Management (pp ). St Louis: Mosby.
Suttle, K., & Dockery, J. (2013, September). Using Shared Governance to Evaluate Appropriate Use of Underpads for Pressure Ulcer Prevention. Birmingham.