BEST PRACTICES

Five-layer foam dressing: how this innovative technology helps you care for wounds

Learn how a layered wound care dressing helps fight friction and shear for patients at risk for skin breakdown

When it’s cold outside, it’s common sense to dress in layers, each addressing a specific need, whether moisture, warmth or water-resistance. A similar theory provides the basis for a five-layer foam wound care dressing. Each layer has a purpose in helping the body’s natural healing process. “These dressing can be used as part of pressure injury prevention protocol specifically for the patient’s sacrum and heels, two of the most common areas to find stage 4 pressure injuries.1

Pressure injuries at the sacrum and heels can develop through a number of interrelated contributing factors, but two major causes are friction and shear, which often go hand in hand.

Effects of friction…

In terms of skin breakdown, friction is defined as “the mechanical force exerted when skin is dragged across a coarse surface such as bed linens” in an article by Cathy Thomas Hess, BSN, RN, CWOCN, in Advances in Skin & Wound Care.2 Although some friction is required for a patient to comfortably sit up in bed, gravity soon causes problems. As gravity pulls on the upper torso, skin resists the movement because of the friction with the surface. Hess goes on to explain that this extra stress on the body, particularly on the sacral area and heels, “can cause damage to the inner layer of connective tissue and limits blood flow to the region, resulting in tissue necrosis.”2

…and shear

Differentiated from friction, shear is described as the “mechanical force that acts on an area of skin in a direction parallel to the body’s surface.”2 In the case of a sacral pressure injury, this would occur when the bones of the pelvis are pulled in one direction and the skin in the opposite. Tissue may be damaged due to both of the forces of friction and shear working together, combined with pressure.2 This is often a risk for older people, but also for critical care patients and newborns.1

The internal damage caused by shear is not often visible, but friction can cause surface damage on the skin and lead to tears and fissures. Often exacerbating the decline in skin integrity is a less-than-optimal microclimate between the body and the surface.3

Why use a multilayer dressing?

As a clinician, you have many options to help control friction and shear and manage microclimate. One of those is the five-layer foam dressing. “The material is unique in that it can compress and redistribute shear across the dressing and beyond,” says Dr. Kevin Woo, PhD, RN, NSWOC, FAPWCA, Medline consultant and associate professor, Queen’s University, School of Nursing, School of Rehabilitation Therapy in Kingston, Ontario, Canada.

“The five-layer foam dressing helps manage the frictional forces associated with pressure injury development, which will also help to lower the potential for shear,” emphasizes Medline Clinician Patricia Turner, BSN, RN, CWOCN, CWS, adding, “These dressings also manage microclimate, which is the temperature and humidity of the skin and the dressing interface.”

Purposeful layers

Read about the technology behind Medline’s five-layer Optifoam:

  1. Silicone layer minimizes trauma to the wound with gentle adhesion.
  2. Foam layer absorbs exudate to minimize pooling at wound surface.
  3. Transfer layer helps move fluids and moisture into super absorbent layer and helps prevent leakage.
  4. Super absorbent layer absorbs and retains exudate.
  5. Highly breathable film acts as a waterproof barrier to seal out germs and dirt.

Is there a cost-savings?

“For pressure-injury prevention, it’s not a single intervention approach but a bundled approach—and you can add multi-layer foam dressing to the bundle cost-effectively,” Dr. Woo notes.

As Turner points out, “Preventing a pressure injury helps save the overall cost of developing a PI and having to take care of it.”

A study to examine the effectiveness and value of five-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings found that facilities could, not only reduce HAPIs, but could also save money. Up to $600,000 in expenses associated with pressure injuries.5  The study also stated that using a specific product to address pressure injuries called attention to prevention needs and opportunities to reduce risk: “Investment in a tangible product as part of a pressure injury prevention bundle results in staff who are more aware of this concerning issue and feel supported in their efforts to prevent pressure injuries.”5

As an added benefit, Dr. Woo also points out that patients and families can learn how to use the five-layer foam dressings at home without specialized help.

“Using a five-layer dressing as part of an overall pressure injury prevention protocol can help prevent and treat skin breakdown”

— Medline Clinician Patricia Turner, BSN, RN, CWOCN, CWS

When to use it

Turner stresses that a five-layer dressing is not needed on every patient and is best for bony prominences on patients at specific risk for developing pressure injuries. She encourages staff to develop a decision tree or internal guidelines based on patient condition.

“Each facility should empower nurses to use critical thinking or risk factor assessments to determine which patients will benefit from a five-layer foam dressing and which patients should receive a different option,” Turner says. “Using a five-layer dressing as part of an overall pressure injury prevention protocol can help prevent and treat skin breakdown,” she adds.

“It’s a matter of the right product for the right patient at the right time.”

Studies have shown that Sacral performed better than other dressings, demonstrating lowest average shear force, transferring less shear to the skin when external shear force was in place under compression and, when the force was removed, relieving residual shear better.3, 5 Another benefit Turner points out: “Medline’s Optifoam Gentle dressing stays on the skin for the desired time and is easy to remove when changing.”

What to look for in a wound dressing1
  • Potential benefit of dressing
  • Ability to manage microclimate
  • Ability to maintain the dressing in place
  • Individual’s preference
  • Comfort and allergies
  • Cost effectiveness and accessibility to dressing
  • Appropriateness of size and shape
  • Ease of application and removal
  • Ability to regularly assess the skin under the dressing
  • Coefficient of friction at the skin-dressing interface

In closing

You’ve heard the statistics: 2.5 million patients are affected each year by pressure injuries.6 Using a five-layer dressing as part of an overall pressure injury prevention protocol can help prevent skin breakdown that leads to PIs. As Turner notes, “It is an added tool in nurses’ toolbox of wound care.” Learn more strategies and products to help manage your patients’ skin health.

Sources:

1. NPIAP, Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline, The International Guideline 2019, pages 145-150
2. https://journals.lww.com/aswcjournal/Fulltext/2004/06000/DID_YOU_KNOW__The_Difference_between_Friction_and.6.aspx (Accessed March 1, 2020)
3. Call, Evan, MS, CSM-NRM, “Friction and Shear Displacement Analysis of Sacral Foam Dressings: Optifoam Gentle SA, Mepilex and Allevyn Life” Data on file
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592987/ (Accessed March 1, 2020)
5. “Biomechanical Evaluation of Wound Dressings Based on their Ability to Mediate the Transmission of Shear Loads That May Lead to Decubitus Ulcers.” Data on File
6. https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu1.html (Accessed March 1, 2020)