A Pilot Study of the Envision® Surface

In June of 2007, researchers initiated a study to test the effectiveness of the Envision surface with regards to bedsores. According to the study’s description, it evaluated the safety and the effectiveness of the Envision surface. They placed the Envision surface on the TotalCare Frame and observed its effects on ulcer prevention and management and patient comfort. They also queried the staff about their acceptance of the Envision surface in the critical care environment.

It was an observational study with 30 participants. There was no age limit and both sexes served as participants in the study. To be included, the subjects had to meet the following criteria:

• Subject weighs between 70 and 400 pounds
• Subject to remain on Envision surface for at least 3 days
• Subject at risk for pressure ulcers or has existing ulcer of any stage
• Subject is able to provide voluntary consent

Betsy Fisher, RN, was the study director. She conducted the study at Sinai Hospital in Baltimore, Maryland under Gordon MacFarlane, PhD, Director of Clinical Research at Hill-Rom. Hill-Rom was the sponsor of the study, which concluded in October of 2007.

What is a Bedsore?

A bedsore, also known as a pressure ulcer, pressure sore, or decubitus ulcer, is an open wound on the surface of the skin that has formed due to constant pressure on an area of the body. The pressure has cut off circulation and deprived the area of oxygen. The skin and tissue of the area begin to die and the wound eventually opens up and gets gradually worse if no treatment is applied.

There are four stages of a bedsore based on severity.

• Stage I. The initial stage of the bedsore sees a reddish color to the skin. No wound has opened up, but the surface of the skin may be hard and warm to the touch. There may also be swelling. Towards the end of this stage the area may turn purple.
• Stage II. A wound begins to open up and abrasions appear. Blisters may also be present. The infection risk is elevated due to the open wound on the skin.
• Stage III. The skin has died off and revealed the tissue underneath. The lack of oxygen and direct pressure contact damages the tissue. The infection risk is high as a crater-like wound develops.
• Stage IV. The final stage is life-threatening. A deep wound is now present, penetrating the tissue and revealing muscle and bone underneath. Infection is a near certainty without intervention.

Can Caregivers Prevent Bedsores?

Caregivers can prevent bedsores, but they need to be vigilant. Immobility is the key element, as bedsores require continued pressure against a surface to cut off the blood flow. Most patients who develop bedsores are either incapable of moving or too weak to move with enough frequency. Caregivers must perform this function for them.

Any patient confined to a bed or wheel chair needs someone to shift or turn him or her into new positions several times each day and night. This redistributes the weight-bearing duties to other parts of the bodies and gives a rest to areas that need it.

Apart from turning patients, nurses can practice “off-loading”. This is a short exercise to get the patient off his or her pressure bearing spots for at least a minute. Frequent off-loading is especially good for patients in wheelchairs, since caregivers cannot turn them as readily as patients in a bed.

Nurses and other caregivers also need to keep their patients clean and dry. Filth is an infection risk and moisture on the skin is a risk factor for developing pressure sores. They must keep the sheets of the bed strictly dry and clean. A colostomy bag may be necessary for incontinent patients.

There are also pressure-relieving devices which can be a useful aid in preventing pressure sores. The Envision surface was under study to see if it could function in that respect.