Can acute care facilitates reduce pressure injury incidence by 90%?
Pressure injuries (also known as pressure ulcers), are a major global healthcare problem occurring in both acute, long stay and community healthcare settings1,2,3. These injuries have a significant humanitarian and economic impact4,5,6, but are largely considered to be a preventable7 ‘Never Event8’. For prevention to be successful, it is essential that patients at risk of a pressure injury are identified, and that appropriate interventions are initiated early. International expert guidelines for pressure injury prevention recommend patient assessment on admission, and daily thereafter9.
Risk Assessment Tools (RATs) and a visual skin and tissue inspection by the clinician, to assess for early signs of skin damage, have been the standard of care for many years with over 200 risk assessment tools currently available to the clinicians. Despite this however, many of the RATs in clinical use, are subjective assessments10, not anatomy-specific, subjective, and reported to have low predictive value11. Visual Skin and Tissue Assessments (STAs) also lack reliability and are based upon the subjective interpretation of the individual assessing the skin12.
”Visual skin inspection lacks reliability and is based upon subjective interpretation”12
One major deficiency with the current risk assessment processes is that they do not alert the clinician to the biological changes which occur beneath the skin surface. Tissue changes may occur beneath the observable skin level days before tissue breakdown and ulceration are visible at the surface13. These tissue changes that may lead to pressure injury development are caused by inflammation, triggered by prolonged pressure, shear forces, tissue deformation and ischaemia. The inflammation is stimulated over time, varying from minutes to hours and leads to a number of pathological changes. One early change is increased permeability of blood vessels which allows leakage of fluid from the vessels into the extracellular space. The leaked fluid accumulates as localised oedema also known as Sub-Epidermal Moisture (SEM)13 and is therefore an early sign that tissue damage is happening which may lead to pressure injury development. This highlights the importance of early identification and the need for early intervention in pressure injury prevention.
An innovative and clinically proven technology – the Provizio® SEM Scanner, which provides an assessment of sub-epidermal moisture content, as an early indicator of pressure injury risk, is increasingly being adopted into clinical practice14–16.
”Reduction in pressure injury incidence of 90.5% in acute care”17
The Provizio SEM Scanner is a handheld, wireless, objective medical device that uses biocapacitance to identify increased risk of pressure injury to provide insight to the clinician that a patient without visible external signs of tissue damage is at risk of pressure injury development on the heel or sacrum. The Provizio SEM Scanner has been demonstrated as an effective tool supporting the prevention of pressure injury when used as an adjunct to standard of care with a weighted average reduction in pressure injury incidence of 90.5% in acute care facilities17. Economic modelling studies based on a conservative range of assumptions also suggest that the implementation of the SEM technology, as part of a prevention protocol are a dominant strategy compared to standard of care, since it lowers cost and increases QALYs (Quality Adjusted Life Years)6.
The Science of Sub-epidermal Moisture (SEM) clinical evidence summary
Elevated levels of SEM is a biomarker of early tissue damage that can lead to pressure injury development. SEM can be identified by assessing the biocapacitance of tissue. This non-invasive technology enables early and objective assessment of increased pressure injury (PI) risk, empowering you to take decisive action to minimize PI incidence and to help reduce overall cost and time to care.
Download our Science of SEM clinical evidence summary and learn about:
- The challenge of preventing pressure injuries
- Effects of prolonged pressure on tissue
- The Provzio SEM Scanner hand-held wireless, non-invasive device
- Foundational clinical studies
Talk to an Arjo Expert
Learn more about the Provizio SEM Scanner by speaking with an Arjo Expert, who will respond to your request in a timely manner.
- Vowden KR, Vowden P. The prevalence, management, equipment provision and outcome for patients with pressure ulceration identified in a wound care survey within one English health care district. J Tissue Viability. 2009;18(1):20
- Gardiner JC, Reed PL, Bonner JD, haggerty DK, Hale DG. Incidence of hospital-acquired pressure ulcers-a population based cohort study. Int Wound Journal 2016; 13:809-820
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- Dealey C, Posnett J, Walker A (2012). The cost of pressure ulcers in the United Kingdom. Journal of Wound Care; 21(6):261-266.
- Brem H, Maggi J, Nierman D et al. High cost of stage IV pressure ulcers. Am. J. surg. 2010; 200:473-477
- Padula WV, Malaviya S, Hu E, Creehan S, Delmore B, Tierce JC (2020). The cost effectiveness of sub-epidermal moisture scanning to assess pressure injury risk in U.S. Health Systems. Journal of Patient Safety and Risk Management. 0(0):1-9. DOI:10.1177/2516043520914215Add in new reference
- AHRQ. Never Events. 2017. https://psnet.arhq.gov/primers/primer/3/never-events. Accessed August 2017
- Centre for Medicare and Medicaid Services (CMS) (2013)
- European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel & Pan Pacific Pressure Injury Alliance. Prevention and Treament of pressure ulcers/injuries:Clinical Practice Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPIA:2019
- Fletcher J (2017). An Overview of Pressure Ulcer Risk Assessment Tools. Wounds UK, Vol 13
- Moore ZEH, Patton D. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews 2019, Issue 1. Art No.:CD006471.DOI:10.1002/14651858.CD006471. Pub4
- Samuriwo R. & Dowding D (2014)Nurses’ pressure ulcer related judgements and decisions in clinical practice: A systematic review. Int J Nurs. 51(12):1667-85
- Ross G, Gefen A (2019). Assessment of sub-epidermal moisture by direct measurement of tissue biocapacitance. Medical Engineering and Physics. Vol 73:92-99
- Smith G (2019) Improved clinical outcomes in pressure ulcer prevention using the SEM scanner. Journal of Wound Care. Vol 23(5)
- Raizman R, MacNeil M, Rappl (2018). Utility of a sensor-based technology to assist in the prevention of pressure ulcers: A clinical comparison. Int Wound Journal. https://doi.org/10.1111/iwj.12974
- Ore N, Carver T (2020) Implementing a new approach to pressure ulcer prevention. Journal of Community Nursing, 34,4
- Bryant RA, Moore ZE, Iyer V. Clinical profile of the SEM Scanner - Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning. Expert Rev Med Devices. 2021 Sep;18(9):833-847. doi: 10.1080/17434440.2021.1960505. Epub 2021 Sep 3. PMID: 34338565