What do you wear in bed? According to a national sleep survey, 92% of us sleep in bed wearing some form of clothing. However, caring for patients ‘inbed’, both in health and social care, this figure is more likely to be nearer to 100%.
Through our ongoing research into ‘inbed’ care systems, we’ve identified that the wearing of bed clothes has been totally disregarded in the research and recommendations made in the NPUAP-EPUAP-PPPIA Pressure Ulcer Treatment & Prevention, 2014 Quick Reference Guide Reference Guide DIGITAL NPUAP-EPUAP-PPPIA-Jan2016.pdf, published by the European and US National Pressure Ulcer Advisory panels. Discussing Mattress and Bed Support Surfaces for Pressure Ulcer Prevention, the report says, “Pressure redistributing support surfaces are designed to either increase the body surface area that comes in contact with the support surface (to reduce interface pressure) or to sequentially alter the parts of the body that bear load, thus reducing the duration of loading at any given anatomical site.”
This does not take into account that patients’ skin is not directly in contact with the bed mattress surface. However, a 2009 study in Japan showed there were significant differences between patients with and without clothing in relation to tissue integrity on the coccygeal bone site and the scapular bone site.
Leading fabric manufacturers state that for preventative pressure care, stretch fabrics should be used “that will fit the contours of both the device and body giving the required level of support’ and that the “support surface should also have sufficient slip, as excess surface friction can add to the risk of patients developing ulcers”. However, by nature ‘inbed’ clothing is not stretchable, can have surface creasing and can cause ‘hammocking’. Furthermore, the construction and materials used in ‘inbed’ clothing is relatively ‘adhoc’ in nature regarding its ability to slide.
‘Inbed’ clothing also means patients’ skin is not directly next to the support surface as recommended EPUAP Reference Guide which in essence is a contradiction and negates the correct interface when looking at patients and their resting surfaces.
So whilst all the above requirements have good intentions, surely ‘inbed’ care needs to take account of the actual interface between a patient and their bed surface – their ‘inbed’ clothes?