Pressure ulcers are painful, debilitating, and severely compromise an individual’s health by increasing morbidity and mortality in terms of increased length of stay, risk of infection, and the need for additional surgical procedures. They are also considered to be preventable and incidence is used to indicate quality of care. Numerous devices have been developed to prevent their occurrence and protocols that involve regular turning of patients is a standard of care. Despite the many interventions used to prevent pressure ulcers, there is still a high prevalence.

Research comprising this dissertation involved: identifying clinically relevant biomechanical factors likely to increase the risk of pressure ulcer formation in the sacral area, investigating bioimpedance measurements as a feasible method to detect or identify the onset of pressure ulcer formation or skin damage, monitoring the interface pressures of patients at risk for pressure ulcer formation to determine what pressure thresholds are experienced and how they are affected by body position, and to develop a protocol that is safest for patients by helping prevent pressure ulcers formation.

Results from healthy subject studies demonstrated that increasing the head of bed increased the interface pressures and the areas subjected to interface pressures of 32 mm Hg or greater. Additionally, lateral turning was not adequate in unloading areas at risk for pressure ulcer formation and these areas always remained at risk despite repositioning. The bioimpedance methods did not succeed as a reliable method to detect pressure ulcer formation. Patient studies confirmed what was observed in healthy subjects, and patients were shown to be at even greater risk by experiencing higher interface pressures and larger areas at risk for pressure ulcer formation. Tissue areas were also shown to be always at risk for several (5+) consecutive hours despite 2-hour turning protocols.

Solutions to reduce pressure ulcer incidences involve reducing or eliminating high interface pressures, improving patient positioning, and reducing or eliminating areas that are always at risk for pressure ulcer formation. These goals can be achieved through a number of methods: improved turning protocols, better support devices for lateral turning, providing feedback to caregivers, and continuous interface pressure monitoring.