Getting pressured to purchase?

In this article, Professor Nick Santamaria highlights the need for clinicians and managers to always base their decisions about pressure injury prevention strategies on sound scientific and clinical evidence.
There is a compelling need for us to challenge the wound care industry to provide high quality evidence of not only the clinical efficacy but also the cost effectiveness of their products rather than marketing materials.
Our ultimate goal is to provide the best care and protection to our patients who are vulnerable to developing a pressure injury whilst in care.
Silicone Foam
An instructive example of this need for evidence is in the area of the use of silicone foam wound dressings for the prevention of pressure injuries. The use of wound dressings as a potential additional intervention for the prevention of pressure injuries has been investigated intermittently over the past 20 years.
More recently, however, work by Tod Brindle1, 2 in the USA and by our own group in Melbourne,3, 4 has clearly demonstrated that one particular dressing can reduce the incidence of hospital acquire pressure injuries by 80 percent when used prophylactically in large randomised controlled trials. Additionally our work showed that there was a 3.6 times cost benefit to using these dressings than not using them because wounds are much more costly to treat than to prevent.
These dressings have also undergone extensive laboratory based investigation 5, 6 that support and elucidate our clinical findings. One of the outcomes of our research is that more than 1000 hospitals around the world are using our approach to protect their patients using these dressings.
The disturbing trend emerging is that we are now seeing unsubstantiated claims being made by other manufacturers of silicone foam dressings that their products can provide the same level of protection. These claims are generally based on small case studies or case series that are mostly not published in the peer reviewed scientific literature.
Voodoo Science
I recently attended the European Wound Management Association meeting where one manufacturer was demonstrating the pressure redistribution capacity of their dressing by placing a large steel ball on the dressing and measuring the change in pressure under the dressing with a pressure mapping device. This is completely misleading with no clinical relevance (unless you are looking after steel balls at your facility) yet looks good on a display stand. We now refer to these displays as Voodoo science.
There is no way in the world that the pharmaceutical industry could get away with claims of comparable clinical efficacy without any meaningful data, yet the wound care industry does just that.
Whilst we may lack the necessary legislative controls to prevent the use of voodoo science in wound care marketing, we do have an even more powerful approach and that power resides in the wound care clinicians and their managers.
We need to ask for the evidence of clinical efficacy and cost benefit before committing to using a particular product. In the case of prophylactic dressings, ask for copies of the publications of the large well designed randomised controlled trials showing the effectiveness of the dressing in preventing pressure injuries. It’s simple, if this is not available don’t buy the dressing.

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Nick Santamaria
Nick Santamaria RN. B.App.Sc. M.Ed. St. Grad Dip Health ED. PhD, is the Professor of Nursing Research, Translational Research at the University of Melbourne. He has a long history of wound research and has published extensively. Nick has received more than $12 million in research funding. He is currently chief investigator in a number of pressure injury prevention clinical trials in Australia and the USA.
This article was originally published in the Australian Hospital & Healthcare Bulletin, Spring 2016 issue as Science Vs. snake oil in pressure injury prevention. You can read the Spring issue here.