1.1 Mepilex Border Heel and Sacrum dressings show promise for preventing pressure ulcers in people who are considered to be at risk in acute care settings. However, there is currently insufficient evidence to support the case for routine adoption in the NHS.
1.2 Research is recommended to address uncertainties about the claimed benefits of using Mepilex Border Heel and Sacrum dressings. This research should also explore issues such as:
the incidence of heel and sacrum pressure ulcers in NHS acute care settings
criteria for patient selection to reduce pressure ulcer incidence with Mepilex Border Heel and Sacrum dressings in addition to standard care.
NICE will consider reviewing this guidance when substantive new evidence becomes available.
Why the committee made these recommendations
Standard care to prevent pressure ulcers in acute care settings includes risk assessment, skin assessment, regular repositioning and the use of special devices.
Pressure ulcers are most common on the heel and sacrum. Mepilex Border Heel and Mepilex Border Sacrum dressings are designed to prevent pressure ulcers in these areas by reducing pressure, friction, shear and humidity.
There is limited evidence for the clinical effectiveness of Mepilex Border Heel dressings compared with standard care. Evidence from clinical trials suggests that Mepilex Border Sacrum dressings may reduce the incidence of pressure ulcers but it is unclear if the results are generalisable to patients in NHS acute care settings. On the basis of the published evidence and expert advice it is uncertain how patients might be selected for Mepilex Border dressings for the potential clinical benefits to be realised.
Cost modelling shows that Mepilex Border dressings may be cost saving when used with standard care, but the savings are difficult to estimate because of limitations in the evidence and uncertainty about the incidence of pressure ulcers in NHS acute care settings. The incidence rate is likely to fall over time as a result of improvements in preventative care but it will still vary across NHS trusts and it may be affected by proposed changes to the reporting arrangements.
Because of these uncertainties the case for routinely adopting Mepilex Border dressings is not supported, but further research to reduce the clinical and cost uncertainties would be helpful.