The (Not-So) Hidden Costs of Pressure Injuries: And a long-term solution

TORONTO - June 6, 2016 - PRLog -- Roughly 50% of all admissions and 8% of all deaths at specialized spinal-injury hospitals are due to pressure sores, now commonly referred to as pressure injuries.(1) These numbers indicate that pressure injuries represents one of the most pressing issues in the healthcare industry. The cost to individuals, health institutions, and governments is large enough that this issue cannot be ignored.

In the US, pressure injuries impact about 2.5 million people.(2) These injuries often result in lengthy hospital stays, increased pain, and in some cases, death. Approximately 50 percent of Stage 2, and 95% of Stage 3 and 4 pressure injuries do not heal within 8 weeks.(3)  Roughly 60,000 patients die each year as a direct result of pressure injuries.(4) Hospitals and insurance providers also face numerous issues. In the US alone, pressure injuries cost between 9.1 and USD11.6 billion annually.(5) The Society of Actuaries believes that the cost of treating an average pressure injury is more than $10,000.(6) That cost can rise to over $150,000 in severe cases involving hospital stays.(7) Additionally, the costs of legal proceedings related to pressure sores add significantly to the overall costs to society. More than 17,000 malpractice lawsuits are filed every year due to pressure injuries. On average, these lawsuits paid out close to $250,000, with some cases reaching as high as $300 million. Roughly 87% of the verdicts favoured the plaintiff.(8) Meanwhile, in the United Kingdom, the cost of pressure injuries falls directly onto the government-funded National Health Service, NHS. It is estimated that while the majority of pressure injuries could be avoided with proper equipment and care, pressure injuries cost the NHS between USD2 billion and USD3 billion dollars every year.(9)

One area in which the toll of pressure injuries can be significantly reduced is for individuals who are normally seated, such as wheelchair users. While these individuals may use their wheelchairs for most of the day, the need for other equipment, such as shower commode chairs, may expose them to risks that have been avoided in their wheelchairs.  Since many who use wheelchairs also use shower commode chairs and because these individuals can spend as many as 3 hours in their bowel / hygiene routines, Raz Design has developed a range of rehab shower commodes with seats designed to solve two critical issues regarding seating: The first is the reduction of peak pressures on high risk areas by locating the aperture (commode opening) near the rear of the seating area in order to avoid contact with the user's IT's, sacral and coccyx area. The second is the reduction of average pressure achieved by contouring the seat and constructing it with soft molded / visco foam to maximize seating contact and user comfort.

Raz Design's rehab shower commode chairs can be configured and adjusted to address an individual's unique seating, positioning and pressure management needs. Raz offers 25 different commode seat configurations (not including custom) with apertures that are optimally sized and located so the user's Ischial Tuberoscities (IT's), which are typically the high risk areas for pressure injuries, can be safely suspended in the aperture.  To address different body shapes, sizes and postures, Raz offers the Ischial Pelvic Alignment System (IPAS) which features 2" of fore/aft adjustment to accommodate the user's pelvic rotation/position and allows the aperture to be centered around the user's IT's.

This is a crucial detail as each individual can use the 2" margin in movement to adjust the chair to optimize their posture and seating based on personal traits such as height, weight, posture, etc.  Contouring further optimizes distribution of loading by mimicking an emersion effect and better matching body contours. This prevents excessive, localized loading that is inherent with flat seating surfaces. Additionally, the front surfaces that support the thighs (low risk area) are elevated slightly in order to bear a higher proportion of the loading. Footrest adjustment is critical; the underside of the thighs must be load bearing.

For users who are at greater risk of pressure injuries due to skin conditions, their inability to do independent weight transfers and extremely long bowel / hygiene routines, Raz offers two tilting models that redistribute the user's weight for lower average pressures. The Raz-AT model tilts to 40 degrees which significantly transfers pressure from the user's seat area onto the back area, typically a much lower risk area for pressure injuries.  A chair that is able to tilt to 40 degrees is significant because a 2011 study found that patients tilting at 40 degrees while reclining at 100 degrees decreased peak pressure on the ischial tuberosities and sacrum by 40%. Use of seat functions, such as tilting, is known to improve postural alignment which in turn improves visual orientation, speech, alertness, arousal, respiration, and eating, as well as help carry out bowel and bladder programs. Furthermore, seat functions can also improve biomechanical positioning which can reduce the possibility of injury to the client's shoulders, and to caregivers.(10)

(1)  Thomas, DR. Prevention and treatment of pressure ulcers: what works? What doesn't? Cleveland Clinic Journal of Medicine 2001;68:704-22.

(2)  "Preventing Pressure Ulcers in Hospitals". Agency for Healthcare Research and Quality, Rockville Maryland.

(3)  Bergstrom N, Horn SD, Smout RJ, et al. "The National Pressure Ulcer Long-Term Care Study: Outcomes of Pressure Ulcer Treatments in Long-Term Care." Journal of American Geriatrics Society. 2005:1721-1729.

(4)  "Preventing Pressure Ulcers in Hospitals". Agency for Healthcare Research and Quality, Rockville Maryland.

(5)   "Preventing Pressure Ulcers in Hospitals". Agency for Healthcare Research and Quality, Rockville Maryland.

(6)  "The Financial Impact of Pressure Ulcers" Leaf Healthcare White Paper. 2014. Pleasanton, California.

(7)  "Preventing Pressure Ulcers in Hospitals". Agency for Healthcare Research and Quality, Rockville Maryland.

(8)  "Preventing Pressure Ulcers in Hospitals". Agency for Healthcare Research and Quality, Rockville Maryland.

(9)  "Pressure Ulcers". National Health Services Website. UK.

(10)  Dicianno, Brad, et al. "RESNA Position on the Application of Tilt, Recline, and Elevating Legrests for Wheelchairs Literature Update" Rehabilitation Engineering & Assistive Technology Society of North America, Arlington, VA.  2015.