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Maintaining skin health to improve pressure ulcer prevention in vulnerable patients

Published: 7 February 2024

The Skin Health Group in collaboration with Cornwall Partnership NHS Foundation Trust has developed a quality improvement initiative, Pressure Reduction through Continuous Monitoring in the Community Setting (PROMISE). 

Skin damage, in the form of chronic wounds, is a major global healthcare challenge, resulting in pain and reducing quality of life in vulnerable patients. 

Despite national and international directives, the incidence of chronic wounds such as pressure ulcers (PUs) remains unacceptably high. 

PUs can occur when immobile individuals spend prolonged periods in a bed or chair. They also occur in critical care environments where therapeutic medical devices are attached to the skin. This can cause skin damage to people of all ages and result in longer hospital stays and greater care requirements.

Chronic wounds are associated with an estimated annual cost of £5bn in the UK alone.

Changing national policy

The Skin Health Group explored the mechanisms of skin damage to develop novel sensing technologies to reduce the incidence of skin damage in vulnerable patient groups. 

This was achieved through a multidisciplinary approach, involving nursing scientists (Schoonhoven), allied health professionals (Worsley) and bioengineers (Bader, Jiang, Dickinson). 

Technology innovation is playing a critical role in patient care, our approach is to undertake inter-disciplinary research to tackle fundamental care issues in skin health.

Our research recommended a modification in the range of internal air pressures associated with a fluid immersion mattress system. The project deployed the intelligent pressure monitoring sensors that we optimised for patient safety. 

The Group worked with NHS Improvement to successfully change reporting policy in England.  Device-related pressure ulcers can now be documented by clinicians as part of routine reporting practice across 200 NHS sites. 

We also influenced the design of new international device standards and played a leading role in developing international guidelines published by:

  • National Injury Ulcer Advisory Panel (NPIAP)
  • European Pressure Ulcer Advisory Panel (EPUAP)
  • Pan Pacific Pressure Injury Alliance (PPPIA) 

The Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline is available in 14 languages and represents the leading international consensus to standardise and improve pressure ulcer prevention. 

We have used our understanding of skin health to inform new medical device design, which has created an international impact.

Professor Pete Worsley

Commercial success

This has generated revenues of £500,000 for a UK company with the sale of 20,000 therapeutic mattress products by a US company across 20 countries. The creation of a spinout company has created three jobs and attracted external investment.

The spin out company, Radii Devices Ltd, adopts cutting-edge engineering to support socket fitting, through the introduction of novel software. 

Since March 2019, three staff members have been employed and attracted £240,000 of external investment from a University Dragons’ Den event. The software includes a point-of-care tool for aiding socket design for prosthetic limbs and architecture for storing clinical data to evaluate patient outcomes. 

A large part of this work was conducted with Emeritus Professor Dan Bader and Dr Josh Steer.

Related publications

C.Y. Chai,
O. Sadou,
& D.L. Bader
, 2017 , Journal of Tissue Viability , 26 (3) , 180--188
Type: article
B. Parsons,
& D.L. Bader
, 2016 , Clinical Biomechanics , 40 , 28--32
Type: article
Piotr Laszczak,
Michael Mcgrath,
Jianliang Gao,
Dan Bader,
David Moser,
& S. Zahedi
, 2016 , Medical Engineering & Physics , 38 (7) , 695--700
Type: article
George Prudden,
George Gower,
& Dan L. Bader
, 2016 , Medical Devices Evidence and Research , 1--26
Type: article