Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Dec 6;12(12):CD009362.
doi: 10.1002/14651858.CD009362.pub3.

Dressings and topical agents for preventing pressure ulcers

Zena Eh Moore  1 , Joan Webster
Affiliations
Meta-Analysis

Dressings and topical agents for preventing pressure ulcers

Zena Eh Moore et al. Cochrane Database Syst Rev. .

Update in

  • Dressings and topical agents for preventing pressure ulcers.
    Patton D, Moore ZE, Boland F, Chaboyer WP, Latimer SL, Walker RM, Avsar P. Patton D, et al. Cochrane Database Syst Rev. 2024 Dec 3;12(12):CD009362. doi: 10.1002/14651858.CD009362.pub4. Cochrane Database Syst Rev. 2024. PMID: 39625073 Free PMC article.

Abstract

Background: Pressure ulcers, localised injuries to the skin or underlying tissue, or both, occur when people cannot reposition themselves to relieve pressure on bony prominences. These wounds are difficult to heal, painful, expensive to manage and have a negative impact on quality of life. Prevention strategies include nutritional support and pressure redistribution. Dressing and topical agents aimed at prevention are also widely used, however, it remains unclear which, if any, are most effective. This is the first update of this review, which was originally published in 2013.

Objectives: To evaluate the effects of dressings and topical agents on pressure ulcer prevention, in people of any age, without existing pressure ulcers, but considered to be at risk of developing one, in any healthcare setting.

Search methods: In March 2017 we searched the Cochrane Wounds Group Specialised Register, CENTRAL, MEDLINE, MEDLINE (In-Process & Other Non-Indexed Citations), Embase, and EBSCO CINAHL Plus. We searched clinical trials registries for ongoing trials, and bibliographies of relevant publications to identify further eligible trials. There was no restriction on language, date of trial or setting. In May 2018 we updated this search; as a result several trials are awaiting classification.

Selection criteria: We included randomised controlled trials that enrolled people at risk of pressure ulcers.

Data collection and analysis: Two review authors independently selected trials, assessed risk of bias and extracted data.

Main results: The original search identified nine trials; the updated searches identified a further nine trials meeting our inclusion criteria. Of the 18 trials (3629 participants), nine involved dressings; eight involved topical agents; and one included dressings and topical agents. All trials reported the primary outcome of pressure ulcer incidence.Topical agentsThere were five trials comparing fatty acid interventions to different treatments. Two trials compared fatty acid to olive oil. Pooled evidence shows that there is no clear difference in pressure ulcer incidence between groups, fatty acid versus olive oil (2 trials, n=1060; RR 1.28, 95% CI 0.76 to 2.17; low-certainty evidence, downgraded for very serious imprecision; or fatty acid versus standard care (2 trials, n=187; RR 0.70, 95% CI 0.41 to 1.18; low-certainty evidence, downgraded for serious risk of bias and serious imprecision). Trials reported that pressure ulcer incidence was lower with fatty acid-containing-treatment compared with a control compound of trisostearin and perfume (1 trial, n=331; RR 0.42, 95% CI 0.22 to 0.80; low-certainty evidence, downgraded for serious risk of bias and serious imprecision). Pooled evidence shows that there is no clear difference in incidence of adverse events between fatty acids and olive oil (1 trial, n=831; RR 2.22 95% CI 0.20 to 24.37; low-certainty evidence, downgraded for very serious imprecision).Four trials compared further different topical agents with placebo. Dimethyl sulfoxide (DMSO) cream may increase the risk of pressure ulcer incidence compared with placebo (1 trial, n=61; RR 1.99, 95% CI 1.10 to 3.57; low-certainty evidence; downgraded for serious risk of bias and serious imprecision). The other three trials reported no clear difference in pressure ulcer incidence between active topical agents and control/placebo; active lotion (1 trial, n=167; RR 0.73, 95% CI 0.45 to 1.19), Conotrane (1 trial, n=258; RR 0.74, 95% CI 0.52 to 1.07), Prevasore (1 trial, n=120; RR 0.33, 95% CI 0.04 to 3.11) (very low-certainty evidence, downgraded for very serious risk of bias and very serious imprecision). There was limited evidence from one trial to determine whether the application of a topical agent may delay or prevent the development of a pressure ulcer (DermalexTM 9.8 days vs placebo 8.7 days). Further, two out of 76 reactions occurred in the DermalexTM group compared with none out of 91 in the placebo group (RR 6.14, 95% CI 0.29 to 129.89; very low-certainty evidence; downgraded for very serious risk of bias and very serious imprecision).DressingsSix trials (n = 1247) compared a silicone dressing with no dressing. Silicone dressings may reduce pressure ulcer incidence (any stage) (RR 0.25, 95% CI 0.16 to 0.41; low-certainty evidence; downgraded for very serious risk of bias). In the one trial (n=77) we rated as being at low risk of bias, there was no clear difference in pressure ulcer incidence between silicone dressing and placebo-treated groups (RR 1.95, 95% CI 0.18 to 20.61; low-certainty evidence, downgraded for very serious imprecision).One trial (n=74) reported no clear difference in pressure ulcer incidence when a thin polyurethane dressing was compared with no dressing (RR 1.31, 95% CI 0.83 to 2.07). In the same trial pressure ulcer incidence was reported to be higher in an adhesive foam dressing compared with no dressing (RR 1.65, 95% CI 1.10 to 2.48). We rated evidence from this trial as very low certainty (downgraded for very serious risk of bias and serious imprecision).Four trials compared other dressings with different controls. Trials reported that there was no clear difference in pressure ulcer incidence between the following comparisons: polyurethane film and hydrocolloid dressing (n=160, RR 0.58, 95% CI 0.24 to 1.41); Kang' huier versus routine care n=100; RR 0.42, 95% CI 0.08 to 2.05); 'pressure ulcer preventive dressing' (PPD) versus no dressing (n=74; RR 0.18, 95% CI 0.04 to 0.76) We rated the evidence as very low certainty (downgraded for very serious risk of bias and serious or very serious imprecision).

Authors' conclusions: Most of the trials exploring the impact of topical applications on pressure ulcer incidence showed no clear benefit or harm. Use of fatty acid versus a control compound (a cream that does not include fatty acid) may reduce the incidence of pressure ulcers. Silicone dressings may reduce pressure ulcer incidence (any stage). However the low level of evidence certainty means that additional research is required to confirm these results.

PubMed Disclaimer

Conflict of interest statement

Zena Moore: has received an honorarium for speaking at a professional meeting for Smith & Nephew and Molnlycke. The School of Nursing and Midwifery, RCSI has received a research grant from BSN Medical.

Joan Webster: none known.

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
4
4
Forest plot of comparison 1. Fatty acid versus other topical intervention or standard care, outcome: 1.1 Pressure ulcer
5
5
Forest plot of comparison 3. Silicone dressing versus no dressing, outcome: 3.1 Any pressure ulcer
6
6
Forest plot of comparison 3 Silicone dressing versus no dressing, outcome: 3.3 Pressure ulcer stage
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Chiew 2010 {published data only}
    1. Chiew SF, Liu HJ, Toh HT, Dari R. Does sanyrene solution reduce incidence of pressure ulcer among the elderly with hip fracture? A randomised controlled trial. Proceedings of Singapore Healthcare 2010;19(2 (Suppl)):S154.
Diaz‐Valenzuela 2014 {published data only}
    1. Diaz‐Valenzuela A, Valle Canete MJ, Carmona Fernandez PJ, Garcia‐Fernandez FP, Pancorbo‐Hidalgo PL. Efficacy for preventing pressure ulcers of the virgin extra olive oil versus hyper‐oxygenated fatty acids: intermediate results from a non‐inferiority trial [Eficacia en la prevención de úlceras por presión del aceite de oliva virgen extra frente a los ácidos grasos hiperoxigenados: resultados intermedios de un estudio de no inferioridad]. Gerokomos 2014;25(2):74‐80.
Dutra 2015 {published data only}
    1. Dutra RA, Salome GM, Alves JR, Pereira VO, Miranda FD, Vallim VB, et al. Using transparent polyurethane film and hydrocolloid dressings to prevent pressure ulcers. Journal of Wound Care 2015;24(6):268, 270‐1, 273‐5. - PubMed
Forni 2018 {unpublished data only}
    1. Forni C. Effectiveness of using a new polyurethane foam multi‐layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: a pragmatic randomised controlled trial. International Wound Journal 2018; Vol. 04. - PMC - PubMed
Green 1974 {published data only}
    1. Green MF, Exton‐Smith AN, Helps EP, Kataria MS, Wedgewood J, Williams TP. Prophylaxis of pressure sores using a new lotion. Modern Geriatrics 1974;4(9):376‐84.
Han 2011 {published data only}
    1. Han J, Li G, Wang A. Control study on pressure sore prevention for patients accepting posterior spinal surgery. Chinese Nursing Research 2011;25:308‐10.
Houwing 2008 {published data only}
    1. Houwing R, Zwet W, Asbeck S, Halfens R, Arends JW. An unexpected detrimental effect on the incidence of heel pressure ulcers after local 5% DMSO cream application: a randomized, double‐blind study in patients at risk for pressure ulcers. Wounds 2008;20(4):84‐8. - PubMed
Kalowes 2016 {published data only}
    1. Kalowes P, Messina V, Li M. Five‐layered soft foam dressing to prevent pressure ulcers in the intensive care unit. American Journal of Critical Care 2016;25:e108‐e119. - PubMed
Lupianez‐Perez 2015 {published data only}
    1. Lupianez‐Perez I, Uttumchandani SK, Morilla‐Herrera JC, Martin‐Santos FJ, Fernandez‐Gallego MC, Navarro‐Moya FJ. Topical olive oil is not inferior to hyperoxygenated fatty aids to prevent pressure ulcers in high‐risk immobilised patients in home care. Results of a multicentre randomised triple‐blind controlled non‐inferiority trial. PLoS ONE 2015;10(4):e0122238. - PMC - PubMed
Nakagami 2007 {published data only}
    1. Nakagami G, Sanada H, Konya C, Kitagawa A, Tadaka E, Matsuyama Y. Evaluation of a new pressure ulcer preventive dressing containing ceramide 2 with low frictional outer layer. Journal of Advanced Nursing 2007;59(5):520‐9. - PubMed
Otero 2017 {published data only}
    1. Otero DP, Domínguez DV, Fernández LH, Magariño AS, González VJ, Klepzing JV, et al. Preventing facial pressure ulcers in patients under non‐invasive mechanical ventilation: a randomised control trial. Journal of Wound Care 2017;26(3):128‐36. - PubMed
Qiuli 2010 {published data only}
    1. Qiuli B, Qiongyu J. Observation on effect of Mepilex on the prevention and treatment of pressure sores. Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University 2010.
Saab 2015 {published data only}
    1. Saab I, Solomon JF, Allen L, Siddiqui A. Hydrocellular foam is a cost‐effective dressing for preventing pressure ulcers: a randomized controlled study. Journal of the American College of Surgeons 2015;221(4 (1 Suppl)):S114.
Santamaria 2015 {published data only}
    1. Santamaria N, Gerdtz M, Sage S, McCann J, Freeman A, Vassiliou T, et al. A randomised controlled trial of the effectiveness of soft silicone multi‐layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the Border Trial. International Wound Journal 2015;12(3):302‐8. [DOI: 10.1111/iwj.12101] - DOI - PMC - PubMed
    1. Santamaria N, Liu W, Gerdtz M, Sage S, Mccann J, Freeman A, et al. The cost‐benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within‐trial analysis of the Border Trial. International Wound Journal 2015;12(3):344‐50. [DOI: 10.1111/iwj.12160] - DOI - PMC - PubMed
Smith 1985 {published data only}
    1. Smith RG, Everett E, Tucker L. A double blind trial of silicone barrier cream in the prevention of pressure sores in elderly patients. Journal of Experimental Gerontology 1985;7(4):337‐46.
Torra i Bou 2005 {published data only}
    1. Torra i Bou J, Gomez TS, Soriano JV, Bonmati AN, Lopez JR, Arboix i Perejamo M. The effectiveness of a hyper‐oxygenated fatty acid compound in preventing pressure ulcers. Journal of Wound Care 2005;14(3):117‐21. - PubMed
Van Der Cammen 1987 {published data only}
    1. Cammen TJ, O'Callaghan U, Whitefield M. Prevention of pressure sores: a comparison of new and old pressure sore treatments. British Journal of Clinical Practice 1987;41(11):1009‐11. - PubMed
Walker 2015 {published data only}
    1. Walker R, Aitken LM, Huxley L, Juttner M. Prophylactic dressing to minimize sacral pressure injuries in high‐risk hospitalized patients: a pilot study. Journal of Advanced Nursing 2015;71(3):688‐96. [DOI: 10.1111/jan.12543] - DOI - PubMed

References to studies excluded from this review

Alvarez Vázquez 2014 {published data only}
    1. Alvarez Vázquez JC, Estany Gestal A, Álvarez Suárez T, Mosquera J, Castro Prado J, Gutiérrez Moeda E, et al. Prevention of deterioration of the cutaneous integrity in the sacral area through the application of an atraumatic self‐adherent foam dressing. Metas de Enfermería 2014;17(2):14‐20.
Callaghan 1998 {published data only}
    1. Callaghan S, Trapp M. Evaluating two dressings for the prevention of nasal bridge pressure sores. Professional Nurse 1998;13(6):361‐4. - PubMed
Declaire 1997 {published data only}
    1. Declaire V. The usefulness of topical application of essential fatty acids (EFA) to prevent pressure ulcers. Ostomy/Wound Management 1997;43(5):48‐54. - PubMed
Duimel‐Peeters 2007 {published data only}
    1. Duimel‐Peeters IG, Halfensa RJ, Ambergen AW, Houwing RH, Berger MP, Luc HE, et al. The effectiveness of massage with and without dimethyl sulfoxide in preventing pressure ulcers: a randomized, double‐blind cross‐over trial in patients prone to pressure ulcers. International Journal of Nursing Studies 2007;44(8):1285‐95. - PubMed
Garcia Fernandez 2005 {published data only}
    1. Garcia Fernandez FP, Pancorbo Hidalgo PL, Rodriguez Torres MC. Protective bandage or hydrocellular dressing to prevent pressure ulcers on heels?. Gerokomos 2005;16(1):54‐8.
Hsu 2011 {published data only}
    1. Hsu MY, Hsiu SR, Chung HC, Chang SC, Tang M, Tai CH. Evaluating dressings for the prevention of facial pressure ulcers caused by the application of noninvasive positive pressure ventilation: a pilot study. EWMA Journal 2011;11(Suppl):213.
Huang 2009 {published data only}
    1. Huang TT, Tseng CE, Lee TM, Yeh JY, Lai YY. Preventing pressure sores of the nasal ala after nasotracheal tube intubation: from animal model to clinical application. Journal of Oral and Maxillofacial Surgery 2009;67(3):543‐51. - PubMed
Kalowes 2013 {published data only}
    1. Kalowes P, Li M, Carlson C, Carr L, Llantero L, Lukaszka D, et al. Use of a silicone border sacrum dressing to reduce pressure ulcer formation in critically ill patients: a randomized clinical trial. EWMA Journal 2013;13(1 Suppl):63. [Abstract 88]
Kuisma 1987 {published data only}
    1. Kuisma I, Tamelander G. Mucopolysaccharide polysulphate cream in the prevention of pressure sores‐a double blind study. Annals of Clinical Research 1987;19(6):374‐7. - PubMed
Park 2014a {published data only}
    1. Park KH. The effect of a silicone border foam dressing for prevention of pressure ulcers and incontinence‐associated dermatitis in intensive care unit patients. Journal of Wound, Ostomy, and Continence Nursing 2014;41(5):424‐9. - PubMed
Park 2014b {published data only}
    1. Park KH. The effect of a ceramide‐containing dressing in preventing pressure ulcers. Journal of Wound Care 2014;23(7):347‐53. [DOI: ] - PubMed
Santamaria 2013 {published data only}
    1. Santamaria N, Gerdtz M, Vassiliou T, Knott J, DeVincentis S, Sage S, et al. The border trial: a prospective randomised controlled trial of the effectiveness of multi‐layer silicone dressings in preventing intensive care unit pressure ulcers. EWMA Journal 2013;13(1 Suppl):93. [Abstract 147]
Smith 2010 {published data only}
    1. Smith G, Ingram A. Clinical and cost effectiveness evaluation of low friction and shear garments. Journal of Wound Care 2010;19(12):535‐42. - PubMed
Stoker 1990 {published data only}
    1. Stoker FM. A major contributor. Evaluation of Comfeel pressure relieving dressing. Professional Nurse 1990;5(12):644‐53. - PubMed
Torra i Bou 2009 {published data only}
    1. Torra i Bou JE, Narváez EH, Martinez‐Esparza EH, Segovia Gómez T, López JR, Blanco Blanco J, et al. Preventing pressure ulcers on the heel: a Canadian cost study. Dermatology Nursing 2009;21(5):268‐72. - PubMed
Wen‐Yi 2013 {published data only}
    1. Wen‐Yi T, Shu‐Fen L, Harmod T, Ru‐Ping L. A comparison of the efficacy of different wound dressing management techniques in preventing pressure ulcers. Journal of Nursing (Zhonghua Hu Li Za Zhi) 2013;60(4):65‐75. [DOI: 10.6224/JN.60.4.65] - DOI - PubMed

References to studies awaiting assessment

Aloweni 2017 {published data only}
    1. Aloweni F, Lim ML, Chua TL, Tan SB, Lia SB, Ang SY. A randomised controlled trial to evaluate the incremental effectiveness of a prophylactic dressing and fatty acids oil in the prevention of pressure injuries. Wound Practice and Research: Journal of the Australian Wound Management Association 2017;25(1):24‐34.
Guo 2015 {published data only}
    1. Guo H. Effect comparison of nursing of foam dressing in prevention of pressure sores in patients with preoperative and postoperative ambulatory surgery in the department of orthopedics. Chinese Community Doctors 2015;31(34):130‐1.
Imbulana 2018 {published data only}
    1. Imbulana DI, Owen LS, Dawson JA, Davis PG, Manley BJ. The pronose study: a randomised controlled trial of a nasal barrier dressing to reduce injury in preterm infants receiving binasal non‐invasive respiratory support. Journal of Paediatrics and Child Health 2018;54(Suppl 1):82‐3.
Kim 2016 {published data only}
    1. Kim H, Lee SM, Choi HY, Jung YJ. Prophylactic effect of transparent film dressing on sacrum and coccyx in SICU patients. Journal of Korean Academy of Fundamentals of Nursing 2016;23(3):256‐63.
Tai 2016 {published data only}
    1. Tai CH, Hsu MY. Preventing facial pressure injuries in patients who use noninvasive positive pressure ventilators: the efficiency of dressings. Hu Li Za Zhi [Chinese Journal of Nursing] 2016;63(5):86‐94. - PubMed
Wang 2016 {published data only}
    1. Wang L, Zhao Y, Ma J. Effect of prevention of adhesive dressing (ALLEVYN) to use of noninvasive ventilator caused by pressure ulcers. Chest 2016;1:A161.

References to ongoing studies

JPRN‐UMIN000024609 {published data only}
    1. JPRN‐UMIN000024609. Prevention effect of wound dressings for pressure sores in high‐risk patients. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN‐UMIN000024609 (first received 28 October 2016).
NCT01640418 {unpublished data only}
    1. NCT01640418. Prevention of sacral pressure ulcers with preventive dressings (SACRESS). clinicaltrials.gov/ct2/show/NCT01640418 (first received 11 July 2012).
NCT02295735 {unpublished data only}
    1. NCT02295735. Effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention. clinicaltrials.gov/ct2/show/NCT02295735 (first received 10 November 2014).
NCT02565745 {unpublished data only}
    1. NCT02565745. Impact of the use of dressings versus lubrication of the skin with cream to prevent pressure ulcers: clinical trial (PENFUP). clinicaltrials.gov/ct2/show/NCT02565745 (first received 29 September 2015).
NCT03039179 {published data only}
    1. NCT03039179. Polyurethane foam on the heel for prevention in children (SCHIUMABIMB). clinicaltrials.gov/ct2/keydates/NCT03039179 (first received January 31st 2017).
RBR‐4s8qjx {published data only}
    1. RBR‐4s8qjx. Effect of soft silicone foam dressing compared to film transparent dressing in pressure ulcer prevention. www.who.int/trialsearch/Trial2.aspx?TrialID=RBR‐4s8qjx (first received 31 August 2017).

Additional references

Alderden 2011
    1. Alderden J, Whitney JD, Taylor SM, Zaratkiewicz S. Risk profile characteristics associated with outcomes of hospital‐acquired pressure ulcers: a retrospective review. Critical Care Nurse 2011;31(4):30‐43. - PubMed
Bader 1990
    1. Bader DL. Effects of compressive loading regimens on tissue viability. In: Bader DL editor(s). Pressure Sores: Clinical Practice and Scientific Approach. London: MacMillan, 1990:191‐201.
Barbarel 1977
    1. Barbarel JC, Jordan MM, Nicol SM, Clark MO. Incidence of pressure sores in the greater Glasgow Health Board area. Lancet 1977;2(8037):548‐50. - PubMed
Bergstrom 1987
    1. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nursing Research 1987;36(4):205‐10. - PubMed
Black 2007
    1. Black J, Baharestani M, Cuddigan J, Dorner B, Edsberg L, Langemo D, et al. National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Dermatology Nursing 2007;19(4):343‐9. - PubMed
BNF 2017
    1. Royal Pharmaceutical Society. British National Formulary. www.evidence.nhs.uk/formulary/bnf/current/a5‐wound‐management‐products‐a... (accessed 25 January 2017).
Brown 2003
    1. Brown G. Long‐term outcomes of full‐thickness pressure ulcers: healing and mortality. Ostomy/Wound Management 2003;49(10):42‐50. - PubMed
Butcher 2009
    1. Butcher M, Thompson G. Dressings can prevent pressure ulcers: fact or fallacy? The problem of pressure ulcer prevention. Wounds UK 2009;5(4):80‐93.
Call 2015
    1. Call E, Pedersen J, Bill B, Black J, Alves P, Brindle CT, et al. Enhancing pressure ulcer prevention using wound dressings: what are the modes of action?. International Wound Journal 2015;12:408‐13. - PMC - PubMed
Clark 2014
    1. Clark M, Black J, Alves P, Brindle C, Call E, Dealey C, et al. Systematic review of the use of prophylactic dressings in the prevention of pressure ulcers. International Wound Journal 2014;11(5):460‐71. - PMC - PubMed
Collier 2006
    1. Collier M, Moore Z. Pressure ulcer aetiology and risk factors. In: Romanelli M, Clark M, Cherry G, Colin D, Defloor T editor(s). Science and Practice of Pressure Ulcers. London: Springer‐Verlag, 2006:27‐36.
Dealey 2012
    1. Dealey C, Posnett J, Walker A. The cost of pressure ulcers in the United Kingdom. Journal of Wound Care 2012;21(6):261‐6. - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JP, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group. Chapter 9: Analysing data and undertaking meta‐analysis. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Demarre 2015
    1. Demarre L, Lancker A, Hecke A, Verhaeghe S, Grypdonck M, Lemey J, et al. The cost of prevention and treatment of pressure ulcers: a systematic review. International Journal of Nursing Studies 2015;52:1754‐74. - PubMed
EPUAP 1999
    1. European Pressure Ulcer Advisory Panel (EPUAP). Guidelines on treatment of pressure ulcers. EPUAP Review 1999;2:31‐3.
Gallagher 2008
    1. Gallagher P, Barry P, Hartigan I, McCluskey P, O'Connor K, O'Connor M. Prevalence of pressure ulcers in three university teaching hospitals in Ireland. Journal of Tissue Viability 2008;17(4):103‐9. - PubMed
García‐Fernández 2014
    1. García‐Fernández FP, Soldevilla Ágreda JJ, Pancorbo Hidalgo PL, Verdú Soriano J, López‐Casanova P, Rodríguez‐Palma M. Classification/categorisation of dependence‐related lesions [Clasificación‐categorización de las lesiones relacionadas con la dependencia]. Serie Documentos Técnicos GNEAUPP no.II. 2nd Edition. Logroño, Spain: Grupo Nacional para el Estudio y Asesoramiento en Úlceras Por Presión y Heridas Crónicas, 2014.
Gefen 2017
    1. Gefen A. Why is the heel particularly vulnerable to pressure ulcers?. British Journal of Nursing 2017;26:S62‐S74. - PubMed
Gibbons 2006
    1. Gibbons W, Shanks HT, Kleinhelter P, Jones P. Clinical excellence series. Eliminating facility‐acquired pressure ulcers at Ascension Health. Joint Commission Journal on Quality & Patient Safety 2006;32(9):488‐96. - PubMed
Gorecki 2009
    1. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. Journal of the American Geriatrics Society 2009;57(7):1175‐83. - PubMed
Gorecki 2012
    1. Gorecki C, Nixon J, Madill A, Firth J, Brown JM. What influences the impact of pressure ulcers on health‐related quality of life? A qualitative patient‐focused exploration of contributory factors. Journal of Tissue Viability 2012;21:3‐12. - PubMed
GRADEpro GDT 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 20 July 2018. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Graves 2005
    1. Graves N, Birrell FA, Whitby M. Modelling the economic losses from pressure ulcers among hospitalized patients in Australia. Wound Repair and Regeneration 2005;13(5):462‐7. - PubMed
Guest 2015
    1. Guest JF, Ayoub N, McIlwraith T, Uchecbu I, Gerrish A, Weidlich D, et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open 2015;5:e009283. - PMC - PubMed
Haalboom 2000
    1. Haalboom JR. Some remarks about overlays in the prevention and treatment of pressure ulcers. EPUAP Review 2000;2:67‐70.
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistencies in meta‐analysis. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011a
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011b
    1. Higgins JP, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011c
    1. Higgins JP, Deeks JJ, Altman DG, on behalf of the Cochrane Statistical Methods Group. Chapter 16: Special topics in statistics. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hopkins 2006
    1. Hopkins A, Dealey C, Bale S, Defloor T, Worboys F. Patient stories of living with a pressure ulcer. Journal of Advanced Nursing 2006;56(4):345‐53. - PubMed
Huang 2015
    1. Huang L, Woo KY, Liu LB, Wen RJ, Hu AL, Shi CG. Dressings for preventing pressure ulcers: a meta‐analysis. Advances in Skin and Wound Care 2015;28(6):267‐73. - PubMed
International Review 2010
    1. International Review. Pressure ulcer prevention: pressure, shear, friction and microclimate in context. A consensus document. www.woundsinternational.com/media/issues/300/files/content_8925.pdf (accessed 25 January 2017).
Jenkins 2010
    1. Jenkins ML, O'Neal E. Pressure ulcer prevalence and incidence in acute care. Advances in Skin and Wound Care 2101;23:556‐9. - PubMed
Khor 2014
    1. Khor HM, Tan J, Saedon NI, Kamaruzzaman SB, Chin AV, Poi PJ, et al. Determinants of mortality among older adults with pressure ulcers. Archives of Gerontology and Geriatrics 2014;59:536‐41. - PubMed
Kosiak 1959
    1. Kosiak M. Etiology and pathology of ischaemic ulcers. Archives of Physical Medicine and Rehabilitation 1959;40(2):62‐9. - PubMed
Kottner 2009
    1. Kottner J, Balzer K, Dassen T, Heinze S. Pressure ulcers: a critical review of definitions and classifications. Ostomy/Wound Management 2009;55(9):22‐9. - PubMed
Kröger 2008
    1. Kröger K, Niebel W, Maier I, Stausberg J, Gerber V, Schwarzkopf A. Prevalence of pressure ulcers in hospitalized patients in Germany in 2005: data from the Federal Statistical Office. Gerontology 2008;55(3):281‐7. - PubMed
Lahmann 2011
    1. Lahmann NA, Kottner J. Relation between pressure, friction and pressure ulcer categories: a secondary data analysis of hospital patients using CHAID methods. International Journal of Nursing Studies 2011;48(12):1487‐94. - PubMed
Langer 2003
    1. Langer G, Knerr A, Kuss O, Behrens J, Schlömer GJ. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003216] - DOI - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J, on behalf of the Cochrane Information Retrieval Methods Group. Chapter 6: Searching for studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Levy 2015
    1. Levy A, Frank MB, Gefen A. The biomechanical efficacy of dressings in preventing heel ulcers. Journal of Tissue Viability 2015;24:1‐11. - PubMed
Liberati 2009
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine 2009; Vol. 6:e1000100. - PMC - PubMed
Lundh 2012
    1. Lundh A, Sismondo S, Lexchin J, Busuioc OA, Bero L. Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews 2012, Issue 12. [DOI: 10.1002/14651858.MR000033.pub2] - DOI - PubMed
McCusker 2010
    1. McCusker MM, Grant‐Kels JM. Healing fats of the skin: the structural and immunologic roles of the omega‐6 and omega‐3 fatty acids. Clinical Dermatology 2010;28(4):440‐51. - PubMed
McInnes 2011
    1. McInnes E, Jammali‐Blasi A, Bell‐Syer SE, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews 2011, Issue 4. [DOI: 10.1002/14651858.CD001735.pub4] - DOI - PubMed
Meuleneire 2013
    1. Meuleneire F, Rücknagel H. Soft silicones made easy. Wounds International 2013; Vol. Available from: www.woundsinternational.com:Accessed 4 January 2018.
Moore 2006
    1. Moore Z. Current issues in wound management. Irish Pharmacy Journal 2006;January:25‐9.
Moore 2008
    1. Moore ZE, Cowman S. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD006471.pub2] - DOI - PubMed
Moore 2011b
    1. Moore Z, Cowman S, Conroy RM. A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers. Journal of Clinical Nursing 2011;20(17‐18):2633‐44. - PubMed
Moore 2012
    1. Moore Z, Cowman S. Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland. Journal of Clinical Nursing 2012;21:362‐71. - PubMed
Moore 2013b
    1. Moore Z, Johansen E, Etten M. A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (Part I). Journal of Wound Care 2013;22:1‐7. - PubMed
Nixon 2005
    1. Nixon J, Cranny G, Bond S. Pathology, diagnosis, and classification of pressure ulcers: comparing clinical and imaging techniques. Wound Repair and Regeneration 2005;13(4):365‐72. - PubMed
Norton 1975
    1. Norton D, McLaren R, Exton‐Smith AN. An Investigation of Geriatric Nursing Problems in Hospital. 2nd Edition. New York: Churchill Livingstone, 1975.
NPUAP/EPUAP/PPPIA 2014
    1. National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP), Pan Pacific Pressure Injury Alliance (PPPIA). Prevention and treatment of pressure ulcers: quick reference guide. October 2014. www.npuap.org/wp‐content/uploads/2014/08/Quick‐Reference‐Guide‐DIGITAL‐N... (accessed 25 January 2017).
O'Callaghan 2007
    1. O Callaghan M, Reilly S, Seery A. Pressure. Exploring Science. Dublin: Education Company, 2007:270‐7.
Oomens 2015
    1. Oomens CJ, Bader D, Loerakker S, Baaljens F. Pressure induced deep tissue injury explained. Annals of Biomedical Engineering 2015;43:297‐305. - PubMed
Reddy 1981
    1. Reddy NP, Cochran GV, Krouskop TA. Interstitial fluid flow as a factor in decubitus ulcer formation. Journal of Biomechanics 1981;14(12):879‐81. - PubMed
Reddy 2006
    1. Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA 2006;296(8):974‐84. - PubMed
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Riaz 2015
    1. Riaz H, Raza S, Khan MS, Riaz IB, Krasuski RA. Impact of funding source on clinical trial results including cardiovascular outcome trials. American Journal of Cardiology 2015;15:1944‐7. - PubMed
Russo 2006
    1. Russo C, Steiner C, Spector W. Hospitalizations related to pressure ulcers among adults 18 years and older, 2006. Healthcare Cost and Utilization Project (HCUP). Statistical Brief #64. www.hcup‐us.ahrq.gov/reports/statbriefs/sb64.pdf (accessed 25 January 2017). - PubMed
Ryan 2016
    1. Ryan R, Hill S. How to GRADE the quality of the evidence. Cochrane Consumers and Communication Group. Version 3.0 December 2016. available at http://cccrg.cochrane.org/author‐resources.
Schünemann 2011a
    1. Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Schünemann 2011b
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JP, Deeks JJ, Glasziou P. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Sheerin 2005
    1. Sheerin F, Gillick A, Doyle B. Pressure ulcers and spinal‐cord injury: incidence among admissions to the Irish national specialist unit. Journal of Wound Care 2005;14(3):112‐5. - PubMed
SIGN 2017
    1. Scottish Intercollegiate Guidelines Network (SIGN). Search filters. www.sign.ac.uk/search‐filters.html (accessed 30 October 2017).
Spilsbury 2007
    1. Spilsbury K, Nelson A, Cullum N, Iglesias C, Nixon J, Mason S. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. Journal of Advanced Nursing 2007;57(5):494‐504. - PubMed
Stekelenburg 2007
    1. Stekelenburg A, Strijkers GJ, Parusel H, Bader DL, Nicolay K, Oomens CW. Role of ischemia and deformation in the onset of compression‐induced deep tissue injury: MRI‐based studies in a rat model. Journal of Applied Physiology 2007;102(5):2002‐11. - PubMed
Sullivan 2013
    1. Sullivan N, Schoelles KM. Preventing in‐facility pressure ulcers as a patient safety strategy: a systematic review. Annals of Internal Medicine 2013;158:410‐6. - PubMed
Surgical Materials Testing Lab 2007
    1. Surgical Materials Testing Lab 2007. Alphabetical list of dressings data cards. www.dressings.org/dressings‐datacards‐by‐alpha.html (accessed 25 January 2017).
Tarnowski Goodell 2013
    1. Tarnowski Goodell T, Moskovitz Z. Characteristics of hospitalised US veterans with nosocomial pressure ulcers. International Wound Journal 2013;10:44‐51. - PMC - PubMed
Thomas 1996
    1. Thomas DR, Goode PS, Tarquine PH, Allman RM. Hospital‐acquired pressure ulcers and risk of death. Journal of the American Geriatric Society 1996;44:1435‐40. - PubMed
Tsuji 2005
    1. Tsuji S, Ichioka S, Sekiya N, Nakatsuka T. Analysis of ischemia‐reperfusion injury in a microcirculatory model of pressure ulcers. Wound Repair and Regeneration 2005;13(2):209‐15. - PubMed
Vanderwee 2009
    1. Vanderwee K, Grypdonck M, De Bacquer D, Defloor T. The identification of older nursing home residents vulnerable for deterioration of grade 1 pressure ulcers. Journal of Clinical Nursing 2009;18(21):3050–8. - PubMed
Wann‐Hansson 2008
    1. Wann‐Hansson C, Hagell P, Willman A. Risk factors and prevention among patients with hospital‐acquired and pre‐existing pressure ulcers in an acute care hospital. Journal of Clinical Nursing 2008;17:1718‐27. - PubMed
Waterlow 1985
    1. Waterlow J. A risk assessment card. Nursing Times 1985;81(48):49‐55. - PubMed

References to other published versions of this review

Moore 2011a
    1. Moore Z, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews 2011, Issue 8. [DOI: 10.1002/14651858.CD009362] - DOI - PubMed
Moore 2013a
    1. Moore ZE, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews 2013, Issue 8. [DOI: 10.1002/14651858.CD009362.pub2] - DOI - PubMed

Publication types

MeSH terms