The technology

Mepilex Border dressings (Mölnlycke Health Care) are self-adherent, multilayer foam dressings which include proprietary soft silicone technology (called Safetac). They are available in various sizes; the company also provides variants which are specifically designed for use on the heel and sacrum, areas where there is a high risk of pressure ulcers forming.

Mepilex Border dressings can be used for a wide range of wound types in people of all ages, but this briefing focuses specifically on their use for preventing pressure ulcers and on the 2 variants designed for this indication (Mepilex Border Heel and Mepilex Border Sacrum).

The dressings are made up of 5 layers. The layer closest to the skin is designed to reduce friction between the skin and the dressing itself. The Safetac technology is designed to allow the dressing to be easily peeled back and reapplied, thereby enabling multiple inspections of the skin site without needing to fully replace the dressing. The other 4 layers are variously designed to cushion, prevent stretch or tear, absorb moisture and allow moisture to evaporate.

Innovations

Wound dressings are not routinely used to prevent pressure ulcers, but Mepilex Border dressings have a non-woven redistribution layer which is designed to reduce the effect of shear forces. Moreover, the Safetac technology is designed to reduce pain and allow for the dressing to be peeled back and reapplied with minimal discomfort or trauma to the area.

Current care pathway

The NICE guideline on pressure ulcers recommends that a documented risk assessment for pressure ulcers should be done in certain adults. It recommends using a validated scale to support clinical judgement, and that risk be reassessed if there is a change in the patient's clinical status.

The guideline recommends various strategies for preventing pressure ulcers, including regular patient repositioning, foam mattresses and pressure redistribution cushions.

NICE medical technology guidance on Parafricta Bootees and Undergarments considers that they show potential to reduce the development and progression of skin damage in people with, or at risk of, pressure ulcers, but it ultimately recommends further research on their use.

Several dressings are available for treating pressure ulcers, but they are not usually intended for or used for prevention. This is because most dressings are not widely considered to be able to influence the effects of compression (that affects blood supply to the area) or shear forces (that stretch and tear the skin) that cause pressure ulcers to develop. Research on the role of dressings in pressure ulcer prevention strategies has emerged as interest in other factors that contribute to pressure ulcer development, such as the microclimate around the site of pressure ulcers, has increased.

NICE is aware of the following CE‑marked devices that appear to fulfil a similar function as Mepilex Border dressings for the prevention of pressure ulcers:

  • Askina DresSil Sacrum/Heel (Braun).

Population, setting and intended user

Mepilex Border dressings would be used in patients of all ages in acute care settings who are considered to be at risk of pressure ulcers. The dressings may also be used in the community in patients who are at risk of pressure ulcers through mobility issues. They would mainly be applied by nursing staff. No extra training is needed.

Costs

Table 1 Cost of Mepilex Border dressings

Description

Cost (per dressing)

Mepilex Border Heel

£6.61

Mepilex Border Sacrum 15×15 cm

£3.13

Mepilex Border Sacrum 18×18 cm

£4.45

Mepilex Border Sacrum 23×23 cm

£7.26

All dressings are sold in packs of 5. All prices exclude VAT. Note that several sizes of Mepilex Border are available at various costs; this table includes only the Heel and Sacrum variants (that is, areas at high risk of pressure ulcers).

The instructions for use recommend that Mepilex Border dressings are changed as needed. In a study by Kalowes et al. (2016) evaluating the prophylactic use of Mepilex Border dressings in an intensive care unit, dressings were changed every 3 days.

Costs of standard care

No estimate for the overall cost of existing standard care for preventing pressure ulcers could be identified, but the cost of treating a pressure ulcer increases with severity (Dealey et al. 2012).

The NICE guideline on pressure ulcers estimated costs for repositioning based on the staff time involved, depending on grade. The costs of repositioning equipment were also included; high-specification foam mattresses were estimated to cost £120 to £200 for adults and £50 to £200 for children; constant low pressure and alternating pressure mattress replacements were estimated to cost around £3,500 to £3,600, or daily hire of around £13 to £14. Once purchased, the equipment can be used over a number of years, so the cost per patient would be low.

Resource consequences

Using Mepilex Border dressings would represent an additional cost to standard care. This could be offset if using the dressings reduced the severity or incidence of pressure ulcers.

The NICE guideline on pressure ulcers states that the daily costs of treating a pressure ulcer range from £43 to £374 in addition to the costs of standard care. Resources needed include nurse time, dressings, antibiotics, diagnostic tests and pressure redistributing devices.

Santamaria et al. (2015c) did a cost–benefit analysis of Mepilex dressings for preventing pressure ulcers from an Australian health service perspective, using the results from a randomised controlled trial which compared the Mepilex Border Sacrum and Mepilex Heel dressings plus standard care with standard care alone (the Border trial; Santamaria et al. 2015a). Based on dressing and staff costs, the estimated average marginal cost per patient for Mepilex dressings was A$36.61 (£21.56; September 2017); this was offset by lower downstream costs for pressure ulcer treatment, meaning that the cost of using Mepilex dressings was lower than standard care alone (A$70.82 [£41.71] compared with A$144.56 [£85.14]).