Foam Dressings to Prevent Pressure Injuries: Does Adding One Help?

Quick answer: a soft silicone foam dressing placed on the sacrum and heels can lower the risk of a new pressure injury, but only as an add-on to repositioning, pressure-redistributing surfaces and skin checks. In a randomised trial of 1,634 hospitalised patients at risk, the dressing group had about a third fewer pressure injuries of category 2 or worse. The dressing never replaces turning.

What is a prophylactic foam dressing?

It is a multilayer foam pad with a soft silicone contact layer, applied to skin that has not broken down yet. The usual sites are the sacrum (tailbone), the heels and the hips over the greater trochanter. The idea is that the layers absorb some of the shear and friction that happens every time a person is slid up the bed or shifts in a chair, and the silicone lets you lift the dressing to inspect the skin without tearing it.

This is different from using a foam dressing to treat an open wound. Here the skin is still intact, and the goal is prevention.

What does the research show?

The largest trial on this question is a multicentre randomised study run by the Belgian Health Care Knowledge Centre in 1,634 hospitalised adults judged to be at risk of pressure injury (NCT03442777, status: completed, with results posted). Patients received either standard prevention alone or standard prevention plus silicone adhesive multilayer foam dressings on the sacrum, heels and greater trochanter, and were followed for up to 14 days.

The primary outcome was a new pressure injury of category 2 or worse at those sites. The dressing arms combined showed a risk ratio of 0.64 compared with standard care alone, with a 95% confidence interval of 0.41 to 0.99 and a p value of 0.04. In plain terms: roughly a third fewer pressure injuries, with the upper end of the confidence interval sitting just under 1.0, so the benefit is real but modest rather than dramatic.

Two points matter for how you read that. First, every patient in the trial also received standard prevention, so this is evidence for adding a dressing, not for swapping one in. Second, it was a hospital population in Belgium over a short window, so it does not automatically translate to months of care at home.

Who is most likely to benefit?

The people at highest baseline risk tend to gain the most from any prevention measure. In practice that means someone who cannot reposition themselves, who is on bed rest after surgery or a fracture, who is in an intensive care setting, who has poor nutrition or low body weight, or whose skin is repeatedly damp from sweat, urine or wound fluid.

If a person is mobile, shifts position on their own and has intact, well-perfused skin, a preventive dressing adds cost without adding much protection.

How do you use one properly at home?

• Apply to clean, dry, intact skin. Do not put a preventive dressing over an existing open wound, that needs a wound dressing chosen for the wound.
• Centre it over the bony prominence with the whole silicone border in contact, and smooth it down without stretching the skin.
• Lift a corner at least once a day to inspect the skin underneath. This is the part people skip, and it is the whole reason silicone is used.
• Change it when it is soiled, lifting at the edges, or at the interval on the manufacturer's instructions. A dressing that has slid off the bone is doing nothing.
• Keep repositioning on schedule, keep the skin clean and dry, and keep protein and fluid intake up. The dressing is the smallest part of the plan.

When should you call a doctor or nurse?

Ask for a review if you see redness over a bony area that does not fade within about 30 minutes after pressure is taken off, any broken skin or blister, a purple or maroon patch (which can mean deeper tissue damage under intact skin), or if the area becomes hot, swollen, smelly or newly painful. Fever with any of these needs same-day attention.

What is still uncertain?

The trial above shows a reduction in incidence over 14 days in hospital. It does not tell us the best dressing brand, the ideal change interval, whether the benefit holds over months of home or nursing-home care, or whether it is cost-effective in a Singapore setting. Anyone who tells you prophylactic dressings prevent pressure injuries outright is overstating what the evidence supports.

This article is general information, not medical advice. Pressure injury risk and skin care should be assessed for the individual person. Please consult your doctor, wound care nurse or a qualified clinician before starting or changing any prevention plan.

EMIS+ supplies wound care, skin protection and continence products to homes, clinics and care facilities across Singapore. If you are not sure what suits the person you care for, browse www.emis.asia or ask us and we will point you to the right category.