Around 4,300¹ pressure injuries occur in Australian hospitals each year. Patients with this type of injury spend on average an extra 23 days in the hospital due to the extended healing process, which is not a good outcome for the hospital or the patient.

Therefore, the prevention of hospital-acquired pressure ulcers is an ongoing concern for hospitals and aged care centres whose patients are already vulnerable. While prevention practices such as regular turning and proper wound care play an important role, pressure care equipment such as air mattresses and pressure relief cushions can greatly assist in the prevention of hospital-acquired pressure ulcers.

What is a pressure ulcer?

A pressure ulcer is a localised injury to the skin and underlying tissue. They usually occur over a bony prominence as a result of pressure, often in combination with friction.

Pressure injuries take a long time to heal, which can impact on a patient's quality of life. Such injuries can cause severe pain, resulting in sleep and mood disturbance, as well as making patients more susceptible to infection. Pressure ulcers also adversely affect rehabilitation, mobility and long-term quality of life.

Reducing in-chair risk

Lying on a pressure-relieving air mattress is considered the gold standard for helping to reduce pressure ulcer risk. However, not all patients lay in bed all day. Sitting in a chair without utilising pressure ulcer prevention equipment means the weight of a seated patient against a chair compresses soft tissue, which restricts blood flow.

Combine this with limited movement, malnutrition and advanced age, and it may lead to pressure ulcer formation around the buttocks, lower back, hips and thighs. These risks make it important to factor in the correct seating position, regular movement, and pressure relief cushions among a facility’s in-chair pressure ulcer prevention plan.

Selecting the right pressure relief cushion

Choosing the right cushion for each patient is a complex process of assessing comfort and the patient’s ability to correct their own posture, as well as reducing the concentration of pressure and assessing function and safety.

Pressure relief cushions fall into two broad categories; those that reduce pressure and those that relieve pressure.

Cushions that reduce pressure increase the skin-to-cushion surface area, encouraging patients to mould into their material. Cushions that relieve pressure reduce the peak pressures, thus lowering the perfusion within the skin when the patient is sitting on the cushion.

Foam cushions

Foam cushions are the most common pressure relief cushions and differ in size, colour and quality. These cushions vary between 1, 2, or 3 piece cushions. The recommended minimum and maximum weights of a person for these cushions to function best depends on the quality of the foam.

Foam varies in density, with the higher density foam tending to be more durable. Foam cushions are a popular option because they are relatively inexpensive, and provide a stable support surface when used in a chair or sofa.

Static air cushions

Due to the nature of their material, static air cushions are light and easy for the patient to mould into. Some cushions come with a strap to secure patients to the chair, which may be an option for patients who are a fall risk. The ability of static air cushions to accommodate very low body weight is excellent, and they can support heavier individuals as well.

Air cushions also reduce heat and moisture buildup, enhancing patient comfort. Air cushions need to be checked regularly to make sure their inflation levels are appropriate for allowing proper immersion when a user sits on them.

Gel cushions

Gel cushions are designed to optimise pressure relief by allowing the patient’s pressure points to immerse into a gel pack. Gel cushions typically have a contoured base and highly advanced positioning characteristics.

However, constant movements within the fluid may cause the fluid to redistribute, allowing for ‘bottoming out’ and increased risk of pressure points experiencing friction and shear.