The question of whether foam or gel is the better option in pressure injury prevention in the operating room is one that has been debated for years. Both options have points for and against as is often the case in such debates. Healthcare systems in countries such as Australia and New Zealand very much favour the use of disposable foams while Scandinavian countries like Sweden advocate the use of reusable gel devices in the OR.
Pressure injuries are defined as localised damage to the skin and/or underlying tissue that usually occur over a bony prominence. When pressure is applied to soft tissue it can obstruct the blood flow which over time can lead to the deterioration and even death of the tissue, what results is a pressure injury.
They often occur in persons of limited mobility who cannot move freely. The primary method of dealing with pressure injuries is prevention and using the best pressure relieving materials is a large part of that.
Before we examine the merits of using foam or gel to relieve pressure we first need to look at what the primary contributing factors are in the development of pressure injuries.
Constant pressure on any part of your body can lessen the blood flow to tissues. Blood flow is essential to delivering oxygen and other nutrients to tissues. Without these essential nutrients, skin and nearby tissues are damaged and might eventually die.
For people in an operating room setting, this kind of pressure build-up tends to occur due to poor positioning techniques coupled with immobility during surgery. In particular it can affect head, elbow, sacral, hip and heel areas.
Friction occurs when the skin rubs against clothing or bedding during patient transfer or repositioning. It can make fragile skin more vulnerable to injury, especially if the skin is also moist.
Shear occurs when two surfaces move in the opposite direction. For example, when a patient is operated on in the Trendelenburg position, the tailbone might move up while the skin over the bone stays in place — essentially pulling in the opposite direction.
While there exists a number of other factors that can contribute to pressure ulcer formation such as moisture, immobility or poor nutrition of the patient – pressure, friction and shear are the main causes. Luckily through proper positioning these risk factors can be greatly reduced.
What material to use remains a debate.
Foam has proven popular for years owing not only to its pressure relieving qualities but due to a number of other factors:
Disposable: Keeping hygiene standards to the highest possible level in the operating environment is of huge importance. Infection control is a key focus. The use of foam can help in this regard as each product can often be brand new, due to many products available on the market being one use only. This negates the cleaning time and gives time over to medical staff to perform other tasks. The fact that foam products are mostly one-use means that a stock of the products needs to be held at all times, this can prove expensive over a longer period of time adding to both storage and disposal costs.
Cost per unit: Foam positioners are cheaper per unit as the materials they are made from cost significantly less than their gel counterparts. While this is beneficial in the short term their costs can surpass gel products over time, particularly for products that are used in a high number of surgeries such as head positioners.
Ease of Use: Given its nature as an air-filled material, foam is quite light and therefore easy to handle when moving which can be important when positioning in trickier surgical positions. This is the case with the Trulife Foam Positioners range.
Gel support surfaces are the main rival of foam in pressure relief. While gel products perform the same job as foam, the benefits of using gel devices can differ:
Reusable: While disposable foam positioners may reduce the risk of spreading disease, the benefits of using reusable gel positioners are many. They offer the same protection, a reduction in costs over time and with the correct cleaning can negate any risk of contamination. The gel used in most pressure care devices stands up to repeated use extremely well, like the 100% silicone used in the Trulife Oasis pressurecare range.
Cost effective: As mentioned above, in the short-term, disposable devices cost less than their reusable counterparts when compared on a product to product basis. However reusable devices drastically reduce costs without the need for multiple repeat purchases as well as the reduced cost of storage.
Easy to Clean: Gel devices do require the extra step of cleaning after each use, it is however a simple process that is standard practice after operating room procedures. It often involves spraying, wiping and rinsing the device in question, and then repeating the process.
Having examined the factors that cause pressure injuries as well as looking at the benefits of using foam and gel, it is obvious that both are excellent pressure relieving materials. The fact that cost and durability are often important factors means that gel devices just shade the debate, as they ultimately benefit both the patient in terms of care and the hospital in terms of usability.
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