Use Of Microclimate Manager (Mcm) Over Pressure Redistribution Surface (Jean M de Leon, MD; Michelle Fudge, PT; Stazny Duckworth, RN; Betty Garcia; Gina Kahakua, RN; Adora Lucius, RN, CWON; Melody Nagel, PT; Kristina Yarbrough, PA-C)

The rental or leasing of low air loss (LAL) support surfaces can be a significant cost burden in any healthcare setting. They are often placed to treat pressure ulcers as well as to manage moisture, friction and related breakdown and rashes.

The introduction of recent microclimate management (MCM) technology into this facility has the potential to decrease rental costs while treating and preventing pressure ulcers and moisture related breakdown. The MCM reduces temperature and humidity of the skin. By using Negative Airflow Technology (NAT), excess moisture is drawn into the mattress and away from the skin surface.

Eight patients with rashes were placed on our standard foam pressure redistribution surface with a MCM coverlet and healed in an average of 9.6 days and remained healed for their entire length of stay. Five patients with moisture related partial thickness breakdown healed in an average of 13.4 days.

While the design is intended to decrease moisture, our facility also placed it under select patients with stage II, III, and IV wounds, unable to stage (UTS) wounds, and sacral post surgical wounds. Two patients with stage II sacral breakdown healed in an average of 7 days without a cover dressing. Four patients with Stage III, IV and UTS wounds had an average healing rate of 0.41cm2/day and 1.53cm3/day. In 2008 the pressure ulcer healing rate for sacral wounds at our facility was 0.48cm2/day and 0.99cm3/day with patients treated on LAL mattresses.

In 2009 the healing rates were 0.26 cm2/day and 0.23cm3/day. Two patients with sacral post surgical wounds had an average healing rate of 0.99cm2/day and 4.85cm3/day while on our standard foam pressure redistribution surface with a MCM coverlet.

In 2008 the healing rate for sacral post surgical wounds treated on a LAL surface was 0.43cm2/day and 1.18cm3/day. In 2009 the healing rates were 0.5cm2/day and 1.38cm3/day. Utilizing the purchased coverlet provided 60 days of better microclimate management and maximized the pressure redistribution properties of our standard mattress.

Discussion and Financial Impact – This series of case studies demonstrates that for some patient types, the use of a MCM cover is an effective tool for moisture management and the treatment of pressure ulcers. Patients with wounds and measurable healing rates had similar outcomes on the MCM as they did on a low air loss surface.

The pressure redistribution surface used at this institution is a self adjusting technology (SAT) foam mattress with nine cylinders. Before there was technology to address the microclimate, these pressure ulcers and patient cases of severe moisture would all have been treated with a low air loss surface. Once the microclimate was more effectively and affordably addressed, we found the pressure redistribution properties of our current standard mattress to be adequate for prevention and treatment.

At this institution, the length of stay averages 25-27 days. Rental of a low air loss surface is costly. Total hospital days of therapeutic support surface usage was 584 days for patients with rashes, partial and full thickness break down. The cost of LAL rental would have been $18,600 to this institution. The cost of the MCM cover purchase in the same population was $4095.

For patients with full thickness skin breakdown, the total hospital days of therapeutic support surface usage was 191 days at a potential cost of $6080 for LAL rental. The cost of MCM cover purchase in the same population was $1170. This is a potential 81% savings with the additional benefit of discharging the patient home with the cover.