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Efficacy of alternative hospital mattress compared to standard mattresses in reducing the risk of pressure ulcers in adult patients in acute care settings: A Literature Review


With increase of adult patients utilizing the acute settings, alternative hospital mattress as opposed to standard mattresses plays a great roe in reducing the pressure ulcers in the adult patients. Adults with severe acute difficulties are in a high risk of getting pressure ulcers with studies showing that few risks are associated to hospital contrasted with those with pre-existing conditions (Wann‐Hansson, et al. (2008). 17(13), 1718-1727). A pressure ulcer is a disease that commonly attacks the adults or those who are not mobile either in beds or when sitting its main source being friction and rubbing at body parts such as elbows and hips (Gillespie, B. M., et al. (2014). Many strategies and preventive measures have been put in place in hospitals so that they can reduce the risk of pressure ulcers this include alternative hospital mattress, repositioning of patients which plays a great role in pressure reduction and the sheering forces. More studies have been conducted yielding results that alternative mattresses generates alternating low and high interface between the patient’s body and the support through the process of inflation and deflation of air filled cells. Most of the information in this literature review was available from most journals and previous studies.


Pressure ulcer is a common problem among adult patients in acute settings. Several studies have been conducted internationally using different methodologies with a variation with the prevalence rates in Canada it was 25 percent in acute care settings, USA had a variation from 14-17 percent due to different methods used in the study the direct comparisons is impossible(Tubaishat,A.etal(2011). The continuous assessment of pressure ulcers prevalence within facilities has directs more focus in the prevention effort and creating effective resource utilization strategies. More acute care facilities have positively reported change substantial reductions of prevalence in pressure ulcers this is after implementing quality improvement initiative technique such as use of alternative mattresses. Thorough assessment of prevalence and incidence by subsequently creating pressure ulcers process programs to ascertain the changes to address skin care assessment, training on the staff and peer pressure ulcers prevention interventions making the facilities to achieve a success. With pressure ulcers still remaining the dormant health problem for many adult patients in hospitals and the focus of many studies being the patient in acute settings as they are constantly immobile which is the most critical risk factor for pressure ulcers. The medical conditions of a patient might increase the risk significantly to develop a pressure ulcer. Increase in time spent in hospital for patients with Pressure ulcers and relates to the facts that many pressure ulcers patients are already debilitated. High costs of treatment bringing mortality and suffering for the patients with pressure ulcers, this arise because of the use of specialized products in treating the wounds. More researches and studies have been conducting to compare alternating hospital mattress and standard mattress, for the prevention and reduction or pressure ulcers were eligible for inclusion.


Study conducted on alternative hospital beds and standard mattress (Vanderwee, et al. (2008). In its review alternating pressure mattress were defined as alternating pressure air replacements assessing effectiveness, contact interface pressure and blood perfusion comfort also the health costs. The author did not explore on how the data was collected or how many participants were there, Narrative synthesis, was deployed and the data presented in a table form. On randomized control trials to access different effectiveness different results were obtained, the results was also inconsistent as in the case of contact interface pressure and blood perfusion making the research easy and cheap to conduct.

Comparing alternating pressure mattress and high specification foam mattress to prevent pressure ulcer, the systematic review of the risk factors formed the conceptual framework of the pressure ulcers development, contrasting the relationship between direct causal factors and indirect causal factors. The main priority being reduction of pressure ulcers lack of evidence relating to effectiveness of mattresses, hoc practices in mattress allocations. Less facts and poor designing were the main problem, it was each and cheap to conduct

Multi-stage versus single stage inflation and deflation cycle for alternating pressure air mattress to prevent pressure ulcers in acute centers. A multi centered randomized trial design was deployed in a ratio of 1:1 thus it was well designed, having a 25 ward selected by the convenience method. The primary outcome being both mattresses resulted in a low pressure ulcer incidence this being the best of the three as it had more facts and it yields the required results. The aim of all the journals was to lower the pressure ulcer incidence levels, some got the it right while others did not. It informs the clinical practice to put more efforts in the alternating hospital mattresses compared to standard mattress as it can lower the incidence of pressure ulcers.


The review literature suggests that there are advantages of producing more alternative hospital mattress as contrasted to standard mattress since they were likely to reduce the risk of pressure ulcers. Major limitation of this review was that the information may differ from different journals.


Nixon J, Brown S, Smith IL, et al. Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT. Southampton (UK): NIHR Journals Library; 2019 Sep. (Health Technology Assessment, No. 23.52.) Chapter 1, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547035/

Vanderwee, K., Grypdonck, M., & Defloor, T. (2008). Alternating pressure air mattresses as prevention for pressure ulcers: A literature review. International journal of nursing studies, 45(5), 784-801.

de Medeiros Dantas, A. L., Ferreira, P. C., Valença, C. N., Diniz, K. D., de Paiva Nunes, J., & Germano, R. M. (2013). Complications of pressure ulcers in severely ill patients: a descriptive-exploratory study. Online Brazilian Journal of Nursing, 12(2), 319-329.

Margolis, D. J., Knauss, J., Bilker, W., & Baumgarten, M. (2003). Medical conditions as risk factors for pressure ulcers in an outpatient setting. Age and ageing, 32(3), 259-264.

Tubaishat, A., Anthony, D., & Saleh, M. (2011). Pressure ulcers in Jordan: a point prevalence study. Journal of tissue viability, 20(1), 14-19.

Wann‐Hansson, C., Hagell, P., & Willman, A. (2008). Risk factors and prevention among patients with hospital‐acquired and pre‐existing pressure ulcers in an acute care hospital. Journal of clinical nursing, 17(13), 1718-1727.

Demarré, L., Beeckman, D., Vanderwee, K., Defloor, T., Grypdonck, M., & Verhaeghe, S. (2012). Multi-stage versus single-stage inflation and deflation cycle for alternating low pressure air mattresses to prevent pressure ulcers in hospitalised patients: a randomised-controlled clinical trial. International journal of nursing studies, 49(4), 416-426.

Vanderwee, K., Grypdonck, M. H., & Defloor, T. (2005). Effectiveness of an alternating pressure air mattress for the prevention of pressure ulcers. Age and ageing, 34(3), 261-267.

Demarré, L., Verhaeghe, S., Van Hecke, A., Grypdonck, M., Clays, E., Vanderwee, K., & Beeckman, D. (2013). The effectiveness of three types of alternating pressure air mattresses in the prevention of pressure ulcers in Belgian hospitals. Research in nursing & health, 36(5), 439-452.

Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American

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