Safe Patient Handling to
Prevent Pressure Ulcer
Development
Linda Norton MSCH, OT Reg. (ONT)
lnorton@shoppershomehealthcare.ca
Jared Bespalko
JBespalko@shoppershomehealthcare.ca
What is a Pressure Ulcer?
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A pressure ulcer is localized injury to the
skin and/or underlying tissue usually over
a bony prominence, as a result of
pressure, or pressure in combination with
shear and/or friction.
National Pressure Ulcer Advisory Panel
(www.npuap.org)
Skin Tear
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“traumatic wounds due to separation of
epidermis from the dermis (partialthickness wound) or of the epidermis and
dermis from underlying structures” (fullthickness wound ). (Payne et al 1993)
1 .5 million skin tears occur in the United
States each year, (Bryant 2001)
Where the cause is known 25% were
caused by transfers (LeBlanc, 2008)
The Burden of Pressure Ulcers
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In 2003, the CAWC funded a study to determine
the extent of chronic wounds in Canada.
Results of the study indicated the prevalence of
pressure ulcers was:
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25% in acute care,
30% in non-acute care,
22% in mixed health-care settings, and
15% in community care
The mean prevalence overall was 26%.
1 in 4
- Woodbury MG, Houghton PE. Prevalence of pressure ulcers in Canadian health-care
settings. Ostomy/Wound Management. 2004;50(10):22-38.
Prevention
Front line caregivers are essential in the
effort to prevent pressure ulcers.
Pathway to Assessment/Treatment of
Pressure Ulcers
Keast DH, Parslow N, Houghton PE, Norton L, Fraser C. Best practice recommendations for the
prevention and treatment of pressure ulcers: Update 2006. Wound Care Canada. 2006;4(1):31-43.
How do I inspect the skin?
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www.epuap.org
Head to toe
Look for tears,
scraps, areas of
discoloration,
redness, or patches
where the skin
looks or feels
different
Why are skin checks so important
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Redness/changes in the skin are usually
stage 1 pressure ulcers
Immediate implementation of preventative
measures e.g. pressure management
devices, turning schedules etc. have been
shown to resolve the skin changes, and
prevent the progression of the ulcer
Reference: VanderweeK., Grypdonck M., Defloor T. Non-Blanchable erythema as an indicator for
the need for pressure ulcer prevention: a randomized-controlled trial. J Clin Nurs 2005 Aug
30;(16):325-35)
What is pressure?
What is friction?
What is shear?
Pressure
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Use pressure management surfaces
Encourage frequent repositioning
Blood Flow
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When external pressure exceeds the mean
arterial pressure blood flow ceases
If this is true, why is there an inverse
relationship between pressure and
time?
Slow tissue deformation is due to
interstitial fluid flow…tissues can creep
for several hours causing increased
deformation around bony
prominences
What do we know for sure?
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Minimize the use of incontinence pads. Use of
an incontinence pad was shown to increase peak
pressure values by 20 – 25%. (Fader M, 2004)
Leg elevation at 10 degrees in the 30-degree
head-up position is effective for reducing body
displacement at the acrominon; it was not
effective for reducing sacral interface pressures.
(Harada C, 2002)
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Any pressure management surface is better than
a “standard hospital mattress” (Callum et al 2006)
What else do we know?
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Nothing replaces good client care
Consider the impact of the support surface on
bed mobility and transfers. The greater the
immersion in the surface, the more difficult bed
mobility and transfers will be for the client
People are individuals, there is no one surface
which works for everyone
Friction and shear magnify the impact of
pressure
Friction and Shear
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Use devices which reduce friction and
shear
Lift, don’t drag the patient
Undermining
Courtesy of D. Keast
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Asymmetrical Undermining
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Symmetrical Undermining
Shear
Fluid
Health Care Worker Injuries

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The health care sector in British Columbia
accounts for more worker injuries than
any other sector, including forestry,
construction and transportation 14 .”
In British Columbia, “patient handling
activities account for almost 50% of MSK
injuries in acute care and long term care
settings 14 ”.
“Handle with Care: Patient Handling and the Application of Ergonomics
(MSI) Requirements" from Worksafe BC.
Safe Patient Handling Program
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Safe Patient handling Programs are
typically composed of 5 key components.
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Policy & Procedure,
Assessment,
Equipment,
Training & Education, and
Program Monitoring.
How can safe patient handling
programs prevent skin injuries?
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Reduces friction and shear forces
Makes repositioning easier, so patients are
more likely to get repositioned more
frequently
Transfer Boards
Consider a more dependent transfer to
reduce friction and shear
Apply the sling without rolling the
patient
One-way glides for
repositioning
Repositioning Sling in bed
Multiglide
4-Way Bed Management
System
Ergo Slide LT
Final Thoughts
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Manage pressure, friction and shear forces
everywhere all the time
Encourage frequent changes in posture, to
promote weight shifting
Nothing replaces good client care
Questions and Thank You