“What is the Impact of Sub Epidermal Moisture Measurement and Targeted Pressure Ulcer Prevention Versus Visual Skin Assessment and Usual Care on Mean Sub Epidermal Moisture Deltas and Early Pressure Ulcer Development?”

Background: Pressure Ulcers (PU) are a significant healthcare problem with a sizeable negative impact on quality of life and costs. It is widely recognised that early and effective risk assessment and PU detection is important. Evidence indicates that decreased mobility/excess movement and the presence of pressure/s hear are central to PU formation. However, existing risk assessment tools include several risk factors, all weighted the same, diluting the importance of immobility as a risk factor. This poses a challenge in the clinical battle to prevent PU in the first place. Furthermore, visual skin assessment, the gold standard, is unable to detect damage, which is manifesting beneath the skin, which if left unnoticed can progress to irreversible visible tissue damage. Elevated Sub Epidermal Moisture (SEM) has been shown to be an indicator of early-stage PU damage and when detected can direct staff to an atomical areas of the patient which are at risk, thus enabling the targeting of interventions to combat this risk. For the first time, this study sought to examine if identifying elevated SEM in patients at risk of PU, and correspondingly implementing enhanced skin care interventions, reduces the incidence of PU when compared to a control group receiving usual care. Aims: The aim was to investigate the impact of SEM measurement and targeted pressure ulcer prevention, versus visual skin assessment and usual care, on mean SEM delta scores and early pressure ulcer development in acute hospital patients. Methods: A quantitative quasi-experimental observational approach was employed. A total of 149 at risk acute hospital patients took part, 78 treatment and 71 control. SEM deltas were recorded daily for a maximum of five days using the SEM Scanner TM (Bruin Biometrics LLC, Los Angeles, CA, USA), on three sites: the sacrum, the right heel, and the left heel, with enhanced and targeted skin care interventions occurring in those with an elevated SEM score in the treatment group. Intention to treat analysis was used to guide the final composition of results. Results: The mean number of days completed by participants was just under 4 days, with participants having different comorbidities, with the most common being: hypertension, cancer, and chronic obstructive pulmonary disease. In relation to the primary outcome, findings show that following the introduction of SEM guided targeted treatments, participants in the treatment group yielded a statistically significant reduction in mean SEM delta scores (MD:0.49;95%CI:0.59,0.39;p Conclusion: Pressure ulcer risk assessment represents an ongoing clinical challenge as services seek to drive down the number of patients experiencing this avoidable problem. Considering this, and for the first time, this study sought to ascertain if elevated SEM with subsequent enhanced skin care can prevent the development of PU in at risk acute hospital patients. Based on all the results, the following is concluded,(1). There was a greater reduction in mean SEM delt as amongst those cared for using SEM measurement and targeted PU prevention, versus those cared for using visual skin assessment and usual care, and (2). the mean SEM delta was statistically significantly lower at study end for those who received targeted treatments based on abnormal SEM readings. More research is now needed in other and larger at-risk groups to further validate what was found in this study.