The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding), and by indirectness (participants were at very high risk of pressure ulcer development, so results may not be generalsable to all hospitalized patients).
A Cochrane review [Abstract] 1 included 9 studies (one of which was a cluster RCT) with a total of 1 501 subjects. The studies explored the impact of dressings (4) or topical agents (5) on the incidence of pressure ulcers. Dressings applied over bony prominences reduced pressure ulcer incidence (table T1). No overall beneficial effect of the topical agents was found. When the cluster randomized trial was omitted from the analysis, use of topical agents reduced the pressure ulcer incidence by 36% (RR 0.64, 95% CI 0.49 to 0.83; 4 studies, n=879).
| Intervention | Participants (studies) | Assumed risk (control) | Corresponding risk (intervention) | Relative effect (95% CI) |
|---|---|---|---|---|
| Dressing versus no dressing | 561 (4) | 93 per 1000 | 19 per 1000(8 to 47) | RR 0.21 (0.09 to 0.51) |
| Topical agent versus placebo | 940 (5) | 251 per 1000 | 195 per 1000(118 to 328) | RR 0.78 (0.47 to 1.31) |
Three types of dressings were used, the composition of each was quite different. Two studies used soft silicone, self-adherent, bordered foam dressing; one study used PPD (pressure ulcer preventive dressing) consisting of a skin adhesive layer (hydrocolloid) containing an intercellular lipid-ceramide, a support layer (urethane film) and an outer layer of multi-filament nylon fibres; and one study used a polyurethane film and foam dressing (Hang' huier transparent strip and foam dressing).
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