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Pressure Ulcer Prevention: Using Preventive Dressings in the Operating Room Whitney Ashley, BSN, RN, CNOR - Operating Room Patients are sicker and require more advanced health care and longer admissions which places them at risk for decubitus from decreased mobility. The operating room is one of the many places in a hospital where patients are in the same position for a long period of time, putting them at risk for skin and tissue damage. Surgeries are more complex and require longer time spent in the surgical suite. There are many interventions for positioning of patients during surgeries, such as preventive dressings for pressure points when lying supine or laterally. This evidenced-based literature review explores the efficacy of silicone dressings to prevent the development of pressure ulcers during surgery. The use of these dressings could reduce the risk of compromised skin integrity that could lead to infection, increased length of stay or readmission, and risk for multiple surgical debridements. Review of Literature Standard Practice Pressure ulcer prevention is a Joint Commission National Patient Safety Goal1. Most hospitals have a standard pressure ulcer prevention protocol, or policy, in place. Within the literature, the phrase “SKIN Bundle� is used in combination with preventive dressings. This phrase refers to surface, keep moving, incontinence, and nutrition2. Current pressure ulcer prevention measures include frequent turning or repositioning, managing moisture and incontinence, selection of an appropriate mattress, managing a proper nutritious diet, reducing friction or shear injuries, and providing education on prevention3. Even with these standards, pressure ulcers still develop in all areas of the hospital. Perioperative nurses should always perform a thorough skin assessment. Intraoperatively, the focus is on positioning prior to the upcoming surgery. The nurse should always have appropriate support surfaces available to help with pressure redistribution. The intraoperative nurse should be aware of how long the surgery will be, and that a pressure ulcer could develop from extended surgical time up to 72 hours after surgery4. Other risk factors that should be known are the type of surgery, anticipated blood loss, chance of hypothermia, and types of anesthetic agents used during the surgery5. Standard operating room tables come with a tempur-pedic type mattress, and there are also pillows made of the same material that can be used to pad the knees and legs during prone positions. Other interventions include the use of approved headrest devices made of foam, gel pads, and the Pink PadŽ positioning system that is made of a material to contour to the patient and help prevent slipping when placed in steep Trendelenburg positions which could cause shear and friction injuries6.
