4.1 The Smith and Ingram (2010) study described in section 3.6 provides information on the incidence of pressure ulcers in an NHS hospital and on lengths of stay in hospital. During the selection of Parafricta Bootees and Undergarments, the Committee heard expert advice, based on this study and from 3 years' clinical use, that the routine management of washing the garments, educational support, and ensuring that appropriate decision‑making protocols are used to identify the correct piece of equipment for at‑risk patients were issues in the adoption of Parafricta garments.
4.2 Additional information on the impact of introducing Parafricta Bootees into another NHS hospital trust was provided by an audit at St. Helen's and Knowsley Teaching Hospitals NHS trust, described by Gleeson (2014; see section 3.8). Expert advisers who used Parafricta garments confirmed that locally developed pressure ulcer risk protocols were used to identify at‑risk patients who could most benefit. An example of patients at risk of heel pressure ulcers as developed at St. Helen's and Knowsley Teaching hospital NHS Trust was presented to the Committee.
4.3 The Committee recognised that pressure ulcers are an important problem facing the NHS, both in hospitals and in the community.
4.4 The Committee was advised that recent progress in pressure ulcer care has focused on the use of pressure‑reducing and pressure‑redistributing devices, but that many patients remain at risk of a pressure ulcer caused by friction and shear. Experts who use Parafricta garments both in the community and in hospitals informed the Committee that they use locally developed protocols to identify people at high risk of developing pressure ulcers due to friction and shear. The Committee considered that there needs to be a way of clearly identifying patients who would benefit from the use of Parafricta Bootees and Undergarments and this should be considered in designing further research.
4.5 The Committee heard from expert advisers about their experiences of using Parafricta garments in both hospital and community care. The experts described the positive effect of the technology on the prevention and management of pressure ulcers in certain patients, and good levels of acceptance among staff and patients.
4.6 A reduction in the length of stay was the key driver of the cost saving identified by the sponsor's model, but the Committee was unconvinced that this was the most reliable way to capture the benefits of Parafricta garments in a cost analysis. It considered that many patients who use Parafricta garments are likely to have comorbidities, which may indirectly influence the length of stay. Experts also advised the Committee that the pressure ulcers that are generally associated with longer hospital stays (grade 3 or 4) are relatively uncommon, and it is less likely that the development of more common grade 1 or 2 ulcers would prolong the length of hospital stay. The Committee concluded that collection of detailed resource use information on managing pressure ulcers in hospital was needed to inform a more appropriate cost analysis.
4.7 The Committee considered the logistics of providing Parafricta garments in hospital. It heard expert advice that the garments can be easily managed in this setting: patients are identified using a locally developed protocol before being issued with the garments from a central pool. Parafricta garments are cleaned in the same way as hospital mattresses and have proved to be very durable; in some cases, the garments have withstood more than 100 washes. A small number of Bootees are disposed of every month, based on an inspection by a clinician, usually because of worn non‑slip soles or fraying at the seams. The Committee concluded that the estimates in the cost model of using each Parafricta garment only 6 times were likely to be conservative.
4.8 In response to questions about the possibility of cross‑infection, the Committee heard expert advice based on experience of using Parafricta Bootees in an NHS hospital trust over 2 years. There had been no occurrences of infection attributable to the Bootee.
4.9 With regard to use in the community, the Committee was told by an expert about a locally defined protocol used to identify people at risk of developing a pressure ulcer caused by friction and shear in a community setting. Having received the garments on prescription, patients are responsible for their own laundry. The Committee heard expert advice that people are happy to use these garments as a long‑term care strategy to prevent and manage pressure ulcers. The Committee considered that if further research confirms the effectiveness of Parafricta garments in decreasing incidence and severity of pressure ulcers in hospital, the technology could have a positive effect on patients in the community.