More than skin deep

Billions of pounds are ploughed into treating problems created by life-supporting and essential devices every year. There’s a real juxtaposition between hospital devices supporting life but also causing chronic skin damage and scarring. It’s an issue that a multidisciplinary team from Health Sciences and Engineering is tackling, bringing benefits to both patients and purses.

Through addressing device design, materials and patient monitoring, the Skin Health Group is pioneering new methods that could change the lives of people living with the long-lasting effects of pressure ulcers and scarring.

The team from Health Sciences, comprising Professor Dan Bader, Professor Lisette Schoonhoven and Dr Peter Worsley, led the EPSRC-NIHR funded Medical Device and Vulnerable Skin Network from 2014 to 2019. This brought together academics, industry and clinicians to address two key challenges: optimising medical device designs and creating intelligent monitoring to promote self-management.

Peter, Associate Professor within Health Sciences, explained: “Pressure ulcers have traditionally been associated with people who are relatively immobile, but there is also a problem with skin damage resulting from using medical devices. Over one third of hospitalacquired pressure ulcers are caused by devices such as ventilation masks, support collars and prosthetics – anything that touches the skin. These devices are mostly generic in design and use stiff, non-breathable material that can be detrimental to skin health.”

Technology for healthy skin.

The team, based in a Clinical Academic Facility on the hospital site, has partnered with Engineering colleagues Professor Liudi Jiang and Dr Alex Dickinson to address a range of healthcare issues. They have a number of projects addressing skin health, for example for individuals using prosthetic and orthotics.

Alex, Associate Professor in the Bioengineering Science Research Group, said: “We are lucky to have a close relationship with Health Sciences. Our biomechanical modelling and simulation tools are clever but useless if they aren’t designed with clinical issues in mind, and trained with clinical data. Peter’s unique clinical and bioengineering experience is key to this multidisciplinary collaboration, and means our students and researchers have exposure to the full range of stakeholders in the care pathway, enhancing their experience, and ensuring our work is valuable to patients.”

Peter outlined the cost to the NHS and to patients themselves: “Chronic wounds, many of which are pressure ulcers, cost the NHS £5 billion a year. There is significant impact from having these types of wounds. Often wounds from medical devices can occur on the face or neck, such as skin damage forming on the bridge of the nose from a respiratory mask. These painful wounds diminish the individual’s quality of life and can cause social consequences when long term scarring is present. And now, with COVID-19 patients, there are a lot of issues with patients lying in a prone position for a long time and even with healthcare professionals getting skin damage from personal protective equipment.”

Breathing tubes can leave neonatal babies with longterm facial scarring

Collaborating with industry has been key to the Skin Health Group’s success.

“We have done a lot of work with industry, in particular with prosthetics and support services companies, where we have established a sustainable funding model from industry,” said Peter. “We have worked with them to co-develop new devices and products that have gone out into patient care, resulting in wound prevention.”

One example of this is the group’s work with Hillrom, one of the world’s largest providers of medical devices. The research included embedding sensors to establish the most effective mattress composition according to an individual’s body mass index. The group has also supported the integration of 3D spacer fabric materials to keep the skin cool and hydrated. Hillrom adopted the research to manufacture mattresses with sensors providing patient-specific care. By the end of 2020, Hillrom had sold 20,000 of these mattresses around the world.

“Enterprise and embracing industry collaboration is a fantastic thing for us,” added Peter. “At the School of Health Sciences, there is great opportunity to increase the amount of work we do with industry, creating the means to translate our research into medical products.”

Temperature and humidity sensing at the device interface to monitor local microclimate

Intelligent sensing

Another strand of the Skin Health Group’s work is intelligent sensing technologies.

The group collaborated with the Cornwall Partnership NHS Foundation Trust on a project called PROMISE (Pressure Reduction through Continuous Monitoring in the Community Setting). The project used a commercial pressure monitoring system in mattresses and chairs to help patients and carers better understand the risks of pressure ulcers.

“We developed bespoke sensors that can tell us when a problem could occur,” said Peter. “We use pressure mapping and intelligent algorithms to determine how often people move and how likely it is they will get a problem. Monitoring patients over 72 hours provides a unique opportunity to learn how people move and what posture they are in. We can give that additional information to carers and clinicians to help them to manage patients.”

The PROMISE system is now being used by the community teams from four hospitals in Cornwall, Devon and Somerset.

Radii Devices uses AI to improve prosthetic fit

Sampling sebum from the skin surface to monitor biomarkers indicative of tissue health

“It means district nurses have a means to monitor individuals remotely and, perhaps more importantly, when the patients see the pressure mapping information it helps them better understand why certain postures and positions might be causing problems – it empowers patients to do a bit of their own skin health care,” explained Peter.

Spinout success

The success of the interdisciplinary research between the Skin Health Group and Engineering colleagues led to spin-out company Radii Devices being set up.

Alex said: “I’m proud of Radii Devices as an example of a valuable research outcome of our multidisciplinary working with two of our PhD students, Joshua Steer and Jennifer Bramley.”

Joshua Steer was awarded a Royal Academic Enterprise Fellowship to continue the research and commercialise it through the spin-out which currently employs six staff.

Radii Devices tackles the issue of discomfort and scarring caused by external medical devices such as prosthetics. The World Health Organisation estimates there are about 40 million people who require a prosthetic limb – a figure that is expected to grow due to diabetes, which is on the rise, being a leading cause of amputation.

Joshua, Founder and Director of Radii Devices, said: “Our technology supports designers of external medical devices with artificial intelligence to analyse optimal device fit across the population, and biomechanical modelling to predict potential areas of pain. By bringing data and simulation into the design of these devices, our aim is to reduce the number of fittings required and increase comfort for patients. Whilst the technology was originally developed for prosthetics, collaboration with the Skin Health Group has already led to implementation of new applications of our technology in other devices, such as respiratory masks.”

Changing NHS policy

The strength of all this research has led to changes to NHS policy and informing new international standards for support surface manufacture.

Working with NHS Improvement, the group successfully changed reporting policy in England in 2019 to include device-related skin damage. This is now part of routine reporting practice in more than 200 care facilities in acute, community and mental health services.

The group also worked with NHS Improvement to create educational videos for clinicians to support best practice for medical device selection and application as part of the NHS Stop the Pressure campaign last year.

For further information, visit: www.southampton.ac.uk/fcs