Is Your Patient’s Mattress Healing Pressure Injuries—or Creating Them?

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Five things to look for in a mattress for wound prevention and healing

Melissa Mangold

The quality of a patient’s mattress can make a great difference in not only patient comfort, but in wound healing, prevention, and ultimately, the cost of medical care.

The Agency for Healthcare Research and Quality reports that 2.5 million U.S. patients are afflicted with pressure wounds each year, with the cost to treat individual patients ranging from $20,900 to $151,700 per pressure injury. The agency estimates that 60,000 patients die as a direct result of a pressure injury per year. 

While there are many medical challenges patients face during their continuum of care, the quality of a patient’s mattress can limit a patient’s ability to move comfortably in bed and cause the patient to sweat, which increases moisture and can cause pressure injuries to form. Of most concern are mattresses that lack proper cushioning for bedridden patients, which can increase pressure points and the formation of pressure injuries.

The Centers for Disease Control and Prevention reports that almost 40 percent of Americans are obese, a disease that affects 93.3 million adults. Obesity can lead to significant health problems which often result in hospitalizations or bed rest for significant periods of time. When you combine bed rest and obesity, plus poor mattress quality and lack of mobility, the end result equals the creation of more pressure wounds.

 Shelly Byington

Shelly Byington, an R.N. who is wound care certified (W.C.C.) and a quality consultant and healthcare expert with Casco Manufacturing Solutions in Cincinnati, is a traveling nurse who calls on about 30 home-bound patients each week throughout mid- to southeastern Ohio.

A 23-year expert in wound care and member of the National Pressure Ulcer Advisor Panel (NPUAP), Byington began her career by caring for senior citizens at nursing homes. She drives an average of 200 to 300 miles per day visiting home bound patients with diabetes, obesity-related diseases and chronic cardiovascular or vascular diseases.

“Nurses everywhere should ask themselves whether their patients’ mattresses are helping or hindering healing,” said Byington. “Pressure injuries that form from a poor mattress, recliner chair or wheelchair cushion can become chronic or infected, and slow to heal, which can cause increased pain and unnecessarily long recoveries.”

  Byington has worked with Casco for the past three years to help the soft goods manufacturer innovate and continuously improve its line of C-Matt™ health care and institutional mattresses. Casco is a 59-year-old certified, woman-owned company in Cincinnati that specializes in American-made cutting, sealing, and sewing OEM manufacturing – making top-quality products for industry leaders in institutional, healthcare, outdoor and custom manufacturing markets. 

Byington has conducted five case studies on patients with multiple classifications and stages of wounds and their recovery rates based on the quality of their mattresses since she has been working with Casco. She created a list of the five most important attributes to consider when selecting a mattress that will help heal—not harm—home bound patients.

Pressure redistribution— The insides of mattresses are extremely important, along with the insides of recliner chairs or wheelchair cushions, said Byington. Venous leg ulcers impact more than 2.5 million people annually, according to the American Venous Forum. These wounds are often caused by weak blood circulation common in patients and are very slow to heal. 

A great mattress provides multiple layers with different zones of padding. There should be a support layer on the bottom, with a softer layer in the middle, and a top comfort piece, said Jerry Williams, engineering specialist at Casco. Mattresses that distribute a patient’s weight evenly across the surface of the mattress and include a sloped heel zone for pressure redistribution help eliminate pressure points, which, along with conjunctive therapies, can assist in the healing process, he added.

“This is so important,” said Byington. “More than half of long-term care patients have moderate to severe peripheral vascular disease, which puts them at risk for developing lower extremity ulcers.”

Look for mattresses with an extra-soft, larger heel section, starting at the knee, which cushions legs better and re-distributes support to all bony prominences, which promotes healing, said Byington.  Pinpoint convoluted foam relieves pressure and a multi-zoned foam core for anatomically-dependent pressure redistribution provides additional comfort and protection from skin breakdown, added Williams, so a great mattress, along with appropriate wound care, and regular turning and re-positioning can dramatically aid in patient healing.

“Typically, patients who are malnourished and possibly have mental health issues in which they don’t comprehend the need to move are high-risk for pressure injuries and should have a better mattress,” she added. “There could be problems related to moisture and temperature, where the risk of friction and shearing can increase. Can a patient move, turn and re-position themselves?  The more immobile a patient is, the more crucial it becomes that he or she needs a top-quality mattress.”

Fabric—Breathable mattress fabrics using select polyurethane and vinyl are most preferred, said Byington. Two-way stretch fabrics provide added comfort and durability. They also prevent “hammocking” and allow for easier patient transfers. 

The best fabrics absorb body heat and perspiration and disperse it away from the body, said Byington, keeping patients cool and dry and reducing the possibility of skin breakdown. Bio-stretch fabrics also tend to inhibit bacteria growth.

Antimicrobial properties— All mattresses, no matter the quality, should offer easy cleaning and maintenance, said Byington. Chronic wounds and pressure injuries are known to carry a “bio burden,” or bacteria, which put the patient at risk for infection. Mattress fabrics should all be antimicrobial and hypoallergenic, as well as treated to inhibit bacterial growth. This is extremely important in order cut down or eliminate infections. 

Seams—Mattress seams should be sealed, not sewn, which decreases the likelihood of body fluids or secretions entering into the core of the mattress. 

“Mattress manufacturers who use ultrasonic welding, which creates a watertight seal, and radio-frequency welding, which creates a strong bond and prevents contamination, are best,” said Byington. “Look for a waterfall zipper flap, which secures the insides and prevents body fluids or germs from entering the mattress, too. The very best quality mattresses are FDA-registered. Patient comfort, safety, infection control, and easy cleaning and maintenance are crucial to improving the comfort of these patients and speeding their recovery time.”

Patient comfort— A patient’s comfort is not an indulgence; it’s a component of preventing skin breakdown and ensuring a faster, more complete recovery, said Byington.

Regarding mattress quality overall, Byington said to check the warranty before purchasing a healthcare or institutional mattress. 

“Mattresses should be very comfortable,” said Byington, because comfort helps patients rest better, which promotes relaxation, and sleep better, which is connected to faster recovery time.

“Firm perimeters of foam in the side rails keep the patient nestled toward the center of the bed, promoting additional patient safety,” she said. “When the patients are transferring out of bed, there should be a firm perimeter of foam along the edge to prevent them from sliding out of bed and risking further injury.”

Mattresses should be selected according to the needs of the patient, not the lowest price an insurance company often approves, she added. “Obese patients need mattresses that can accommodate from 350 to 500 pounds. Some higher-quality mattresses use interconnected air chambers that provide quiet, non-powered pressure redistribution that allows the mattress to automatically adjust to patient movement. These mattress systems are best for pressure injury prevention and treatment.” 

Quiet, non-powered mattress technology allows for even body weight distribution and reduces the risk of skin breakdown. Some mattresses have air chambers that are motorized, but if the motor breaks down or the settings are wrong, pressure injuries can form quickly, she added. 

Over the past three years, Byington has conducted five case studies on home bound patients under her care. She studied the length of time and rate of recovery of patients with multiple classifications and stages of wounds after changing to a Casco, C-Matt Prevention mattress, a comfortable, higher-quality mattress than many home mattresses. 

While all five patients reported faster healing on the Casco surface, Byington said three of the cases stood out in terms of dramatic healing rates once they were provided the new mattresses.

One of Byington’s patients was a 39-year-old woman named Lori who had a complex medical history that included chronic kidney disease, COPD, anemia and epilepsy.

Lori also had a rod inserted into her back due to scoliosis and a rod in her leg from a prior femur fracture. Because of the rods, she was unable to reposition herself in bed – which is a major contributing factor to the development and progression of pressure wounds, said Byington.

“Lori was in the hospital for three months, and developed two, Stage 3 pressure injuries: one on her coccyx and one on her right ischial (lower back, upper leg),” said Byington. “When she returned home, her family and care team thought the wounds would heal.” 

Instead, the wounds worsened on her regular home mattress. “I knew we had a long journey ahead of us to get her healed,” said Byington. “I knew we needed to get her on the best mattress as soon as possible.”

Casco provided one of its C-Matt™ Staticare foam mattresses for Lori. The mattress features breathable, bi-directional stretch fabric with RF-welded seams; interconnected air cells for non-powered pressure distribution; and can support a patient who weighs up to 500 pounds.  Within nine weeks of using the mattress, Lori’s ischial pressure injury healed completely. After 24 weeks of being on the Staticare mattress, her coccyx wound completely healed. Lori’s been free from additional skin breakdown, even after undergoing invasive surgery that kept her in bed for six weeks, Byington said. Lori remained on the Staticare mattress in her home during the rest of her recovery.

“The role that the Staticare mattress played in Lori’s healing was remarkable,” Byington said. “This points up the need to do more comprehensive studies on mattress quality and their general role in wound healing and recovery.”

Another of Byington’s patients was a 93-year-old woman named Ruth, whose medical history included hypertension, asthma and osteoarthritis. Ruth was non-ambulatory, and mostly sat in her bed or chair. She was also incontinent, which presented an additional challenge to healing wounds on her backside.

Ruth lived in an assisted living home and had developed pressure injuries on her coccyx and an unstageable wound on her ankle. After her wound care team recommended she start using the C-Matt™ Prevention Plus mattress, Byington said her wounds healed remarkably well.

Within four-and-a-half weeks of using the Prevention Plus mattress, the pressure injury on her coccyx had completely healed. In three months, the wound on her ankle was also completely healed.

In the past, Ruth had complained of heel pain on her old mattress, said Byington. Once she started using the C-Matt Prevention Plus mattress, she reported experiencing less pain and her overall wellbeing was greatly improved. Ruth’s daughter reported that her mother began to sleep through the night and was not as restless as she had been on her old surface.

“The C-Matt mattresses are ideal for prevention in hospitals and long-term care facilities to prevent breakdown and progression of wounds,” said Byington. “Patients like Ruth, who are at high-risk for skin breakdown, would also benefit from using the Prevention as their regular in-home mattress.”

A third case study involved 66-year-old Mary, who was diagnosed with multiple sclerosis and multiple myeloma. She was wheelchair bound and suffered from a Stage 3 pressure wound to her coccyx for 1.5 years, despite trying a variety of wheelchair pads, gel pads, foam pads and air pads.

Mary was provided a Casco C-Matt Prevention Chair Pad and within three months, her pressure injury was 100 percent resolved, said Byington. 

“The only difference between my care for Mary during those three months was the use of the C-Matt Prevention Pad,” said Byington. “Mary rated the pad as very comfortable and told me it significantly reduced her pain level, improving her quality of life. Another benefit is that the Casco brand cost significantly less than other marketed name brands.”

Casco has always been an innovator in soft goods manufacturing, said Melissa Mangold, Casco CEO and owner. “In fact, we hold the patent on the waterfall zipper innovation,” she said.  “Shelly’s clinical observations regarding patient comfort and healing outcomes have resulted in recommendations that help us continually improve the high quality of our mattress, stretcher pad and wheelchair pad line.”

Roz Jordan of Tuscaloosa, Ala., a clinical consultant for several manufacturers of pressure injury-related products for 25 years, concurred that comfortable, high-quality mattresses and wheelchair pads improve patient comfort and promote faster healing.

Jordan is one of the co-founders of the National Pressure Ulcer Advisory Panel’s Support Services Standards Initiative (S3I), and vice president of the National Alliance of Wound Care. She has participated in clinical education programs and clinical research studies for three support surfaces manufacturers and several surface distributors over the past 25 years, and said she sees a need for clinical studies measuring mattress and pad quality and how they affect pressure injury healing outcomes. 

“At the NPUAP S3I, we are working on developing testing standards for surfaces and encouraging clinicians to do outcome studies,” she said. “A few case studies do not provide the highest realm of research, but they add data. And if the data area is used in reporting, manufacturers have some marketing material they can use when approaching nurses on the front lines of wound care and health care purchasing agents.”

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About Casco Manufacturing Solutions:

Casco Manufacturing Solutions is a 59-year-old certified, woman-owned company in Cincinnati that specializes in cutting, sealing, and sewing OEM manufacturing – making top quality products for industry leaders in institutional, healthcare, outdoor and custom manufacturing markets. All Casco manufactured products are made in America. For more information about Casco products, visit www.cascomfg.com or call (513) 681-0003. 

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