Volume 26 Number 3

Key messages

• This article evaluates the effectiveness of silicone foam dressings in preventing MDRPUs in the head region.
• The project aimed to assess the reduction in MDRPU incidence following the introduction of silicone foam dressings and to gather healthcare professionals’ feedback on their usability and effectiveness.
• The implementation of silicone foam dressings led to a substantial decrease in MDRPU prevalence across two healthcare facilities, with healthcare professionals reporting ease of application, patient comfort and improved prevention of skin damage.

Introduction

Pressure ulcers (PUs), also known as pressure injuries (PIs), remain a substantial healthcare challenge globally, impacting patient quality of life and healthcare systems. These injuries arise from sustained pressure on the skin, often exacerbated by immobility, sedation and medical device use, particularly in intensive care settings.^1,2 The financial burden of PUs is immense, with treatment costs amounting to approximately A$983 million annually in Australia (2015), US$2.1 billion in the Unied States (2014), and £2.1 billion in the United Kingdom (2004).¹ Recent studies in Czechia demonstrate that the cost of care for hospitalised patients with PUs increases with the PU category.³ These figures underscore the urgent need for robust prevention and management strategies.

Medical device-related pressure ulcers (MDRPUs) represent a growing concern within this spectrum, contributing to the overall prevalence of hospital-acquired pressure ulcers (HAPUs). MDRPUs are typically associated with oxygen tubing, endotracheal tubes and other devices that induce localised pressure and friction on the skin.² It is, therefore, assumed that they are often localised on the head and facial part of the head, where the skin is more delicate compared to other areas of the body, and there is a risk of alteration of the microenvironment due to secretion and excretion. Studies have shown that patients using medical devices are 2.4 times more likely to develop pressure ulcers than those without such devices.⁴ This increased susceptibility highlights the importance of understanding the mechanisms, risk factors and prevention strategies specific to MDRPUs.

Despite advancements in pressure ulcer management, MDRPUs remain underreported and understudied. The prevalence and incidence of MDRPUs vary widely, with reported rates ranging from 0.9% to 41.2%, depending on the population, healthcare setting and study methodologies.¹ These variations are partly due to inconsistencies in data collection and staging methods, emphasising the need for standardised guidelines.⁵ Common anatomical sites for MDRPUs include the nose, ears and oral cavity, with injuries frequently caused by nasogastric tubes, continuous positive airway pressure devices, and cervical collars (see Figures 1 and 2).⁶

 

 

Figure 1. MDRPU – nasal dorsum

 

Figure 2. MDRPU – nasal septum

 

Recent evidence suggests that silicone foam dressings are a promising innovation in MDRPU prevention, particularly in the head and facial regions.^7–9 Silicone foam dressings offer multiple benefits, including pressure redistribution, moisture management and friction reduction, which are critical for mitigating the forces leading to MDRPUs. These dressings feature a soft, adhesive silicone layer that provides a protective interface between the device and the skin, reducing localised tissue deformation and minimising the risk of injury. Their protective effect is primarily mechanical, achieved through redistribution of pressure, reduction of shear and friction and maintenance of a stable skin microclimate. The silicone layer allows for gentle adherence and minimises trauma during repositioning, while the foam structure supports moisture balance and cushioning.⁴

The use of silicone foam dressings for MDRPU prevention is supported by recent clinical practice guidelines, including the 2019 International Guideline by EPUAP, NPIAP, and PPPIA,¹⁰ as well as the SECURE consensus statement,⁴ both of which endorse their prophylactic use in high-risk anatomical areas, such as the head and face. The effectiveness of silicone foam dressings in preventing ulceration on the ears and nose when applied beneath oxygen cannulas has been demonstrated.¹¹ Similarly, silicone dressings during nasal intubation have been shown to reduce nasal-alar pressure injuries.¹²

Furthermore, clinical evidence supports the efficacy of silicone dressings in high-risk patient populations.¹³ Prophylactic use of multilayer silicone dressings on the sacrum and heels has been associated with a significant reduction in MDRPU incidence in critical care settings.¹⁴ Although the primary focus was on regions other than the head, the findings highlight the broad potential of silicone-based interventions in pressure ulcer prevention. The importance of considering biomechanical factors when selecting dressings has also been emphasised, particularly for their ability to alleviate shear and pressure forces in vulnerable areas.¹⁵

In oncology and palliative care, where patients often have compromised skin integrity, soft silicone dressings have proven effective in preventing MDRPUs associated with prolonged oxygen therapy and other medical devices.¹¹ The inherent flexibility and adaptability of these dressings make them suitable for the head and facial regions, ensuring comprehensive protection without compromising device functionality or patient comfort. The inclusion of these dressings as part of a standardised MDRPU prevention protocol represents an essential step forward in mitigating the prevalence and severity of these injuries.

This study retrospectively evaluated the impact of implementing silicone foam dressings as a preventive measure for MDRPUs in the head region, aiming to contribute to understanding their role in clinical practice. The primary objective was to assess the change in prevalence of MDRPUs following the introduction of silicone foam dressings. The secondary objective was to gather healthcare professionals’ perceptions of the usability and effectiveness of these dressings in clinical care.

Methods

This study employed a retrospective analysis of MDRPUs in the head region across two major university hospitals in the Czech Republic during 2023 and 2024. The data covered both full calendar years, and analysis was carried out in early 2025 once all records from the year 2024 were complete. The primary objective was to evaluate the prevalence of these injuries and assess the impact of implementing silicone foam dressings as a preventive measure. The dressings used were commonly available materials used in public hospitals. Additionally, the study aimed to gather healthcare professionals’ perceptions of the effectiveness and usability of the dressings in clinical practice.

Data on pressure ulcers in the head region were extracted from hospital records, with a total sample encompassing 354 PUs across both facilities over the two-year study period. These records were analysed to identify trends in MDRPU prevalence before and after the introduction of silicone foam dressings. Particular attention was given to patients undergoing non-invasive ventilation (NIV), high-flow nasal oxygen (HFNO), prone positioning or rigid cervical collar use, as these scenarios present the highest risk of pressure injuries due to prolonged device use and increased skin vulnerability (see Figures 3 and 4). As this was a retrospective, non-interventional study using anonymised data from routine care, no ethics approval or patient consent was required beyond the general consent provided at hospital admission.

 

Figure 3.High-flow nasal oxygen

 

Figure 4. Non-invasive ventilation with protective dressing application

 

To complement the retrospective data, informal verbal feedback was gathered from healthcare professionals involved in MDRPU prevention and management, including nurses, physicians and physiotherapists. Two formal training sessions were conducted at the workplace to support the implementation of silicone foam dressings and provide staff with guidance on correct application procedures. In addition to these sessions, hospital-based wound care consultants provided ongoing methodological guidance and support to the nursing staff during the implementation phase. This feedback was collected during educational sessions and through observations of dressing applications in clinical practice. While not collected via standardised forms, this approach allowed for the capture of spontaneous and context-specific insights. Informal feedback methods are recognised in healthcare research for their ability to provide authentic, nuanced information that can inform quality improvement efforts and enhance understanding of clinical practices.^16–18 The insights focused on the perceived effectiveness, usability and challenges associated with silicone foam dressings. Clinical guidelines on MDRPU prevention¹⁰ were used as the foundation for this evaluation, ensuring consistency in the interpretation of findings.

Data from hospital records were analysed to compare the prevalence of MDRPUs before and after the implementation of silicone foam dressings. Informal verbal feedback gathered during educational sessions and dressing application was reviewed descriptively to provide insights into practical challenges and the perceived benefits of this intervention. By integrating retrospective data with these informal insights from healthcare professionals, the study aimed to present a comprehensive evaluation of silicone foam dressings as a preventive strategy for MDRPUs in the head region. As this was a full-population, descriptive analysis without formal group comparisons, no statistical testing was applied. The intent was to observe changes over time in routine clinical conditions.

Results

The implementation of silicone foam dressings was associated with a noteworthy reduction in the incidence of MDRPUs in the head region across both studied healthcare facilities. Data from 2023 and 2024 highlight a substantial decrease in MDRPU prevalence following the introduction of silicone foam dressings in January 2024 as a preventive measure (see Table 1).

 

Table 1: Incidence of MDRPUs in the head region (2023–2024)

 

At University Hospital 1, a total of 244 cases of PUs in the head region were recorded over the two years, with 119 cases in 2023 and 125 cases in 2024. Of these, MDRPUs accounted for 73 cases in 2023 (61%) but dropped to 38 cases in 2024 (30%). At University Hospital 2, 110 pressure ulcers were reported over the same period, with 61 cases in 2023 and 49 in 2024. MDRPUs comprised 25 cases in 2023 (41%), decreasing to 16 cases in 2024 (33%). These findings, summarised in Table 1, underscore the marked improvement in MDRPU prevalence following the integration of silicone foam dressings into routine clinical practice.

By January 2024, the use of silicone foam dressings had been formally adopted as a standard of care for high-risk patients in both facilities. This intervention was particularly impactful in scenarios involving non-invasive ventilation (NIV), high-flow nasal oxygen (HFNO), prone positioning and rigid cervical collars—contexts known to elevate the risk of pressure injuries in the head region. The reduction in MDRPU incidence in 2024 reflects the preventive potential of silicone foam dressings in these high-risk scenarios. Examples of dressing application in practice is shown in Figures 5 and 6.

 

Figure 5: Protective dressing application – child

 

Figure 6: Protective dressing application – adult

 

Feedback from healthcare professionals further reinforced the retrospective incidence analyses. During educational sessions and dressing application, professionals expressed appreciation for the dressings’ ease of application, adaptability and patient comfort. Many professionals emphasised noticeable reduction in skin damage and attributed this improvement to the early application of silicone foam dressings, ideally prior to device placement. They also highlighted the dressings’ role in minimising shear and friction forces, which are key contributors to MDRPUs.

Discussion

The findings of this study confirm the substantial benefits of integrating silicone foam dressings into routine preventive care for medical device-related pressure ulcers (MDRPUs) in the head region. The reduction in MDRPU prevalence across both healthcare facilities demonstrates the efficacy of this intervention, particularly in high-risk settings involving non-invasive ventilation (NIV), high-flow nasal oxygen (HFNO), prone positioning, and rigid cervical collars.

The most notable outcome of this research is the decrease in MDRPU incidence from 2023 to 2024. The marked improvement aligns with evidence from previous studies emphasising the role of silicone foam dressings in redistributing pressure and reducing friction and shear forces. Silicone foam dressings have been shown to protect vulnerable areas such as the ears and nose during oxygen therapy,¹¹ while similar benefits have been reported in preventing nasal-alar pressure injuries during intubation.¹² These findings reinforce the conclusion that silicone foam dressings are effective across diverse clinical contexts.

Informal verbal feedback from healthcare professionals further supports the practicality of silicone foam dressings in real-world settings. During educational sessions and dressing application, professionals consistently highlighted the dressings’ ease of application, adaptability and patient comfort. These advantages are particularly valuable in high-pressure clinical environments, where effective and user-friendly interventions ensure consistent adoption. This aligns with findings emphasising the role of usability in the successful implementation of MDRPU prevention strategies.¹⁹

These results underscore the importance of integrating silicone foam dressings into routine care for MDRPU prevention, particularly in the head region. The combination of reduced incidence rates and positive feedback from healthcare providers highlights their role as an evidence-based intervention to enhance patient outcomes. Despite these positive findings, this study also highlights areas requiring further exploration. Limited data exist on the long-term cost-effectiveness of silicone foam dressings in reducing MDRPUs, an essential consideration for scaling this intervention across healthcare systems. Previous research has advocated for more comprehensive economic analyses to support the widespread adoption of such innovations.¹⁵ The silicone foam dressing used in this study was procured at both participating university hospitals at a price of approximately 710 CZK (about €28) per pack of five dressings (approximately €5.60 per piece). Prices may vary by country and procurement context, but this representative figure can help readers better interpret the cost-effectiveness and practical feasibility of using such dressings.

Moreover, the results underscore the need for ongoing education and training to optimise the consistent application of silicone foam dressings. A lack of standardised guidelines and training can lead to inconsistent prevention practices, reducing the overall efficacy of even the most promising interventions.¹ This study’s findings reinforce the importance of equipping healthcare professionals with the knowledge and skills necessary to apply silicone foam dressings effectively.

This study has several limitations that should be acknowledged. First, the retrospective design limits the ability to establish a direct causal relationship between the implementation of silicone foam dressings and the observed reduction in MDRPU prevalence. The analysis relied on existing hospital records, which may contain inconsistencies or incomplete documentation. Second, the study was conducted in two healthcare facilities in the Czech Republic, potentially limiting the generalisability of findings to other healthcare settings. Third, while informal verbal feedback from healthcare professionals was gathered during educational sessions and dressing application, it was not systematically collected through a structured survey. This may introduce bias and limit the depth of qualitative insights. Finally, the economic impact of implementing silicone foam dressings was not assessed, leaving an opportunity for future research to evaluate cost-effectiveness and resource allocation.

Future research should expand on these findings by investigating the potential of silicone foam dressings in preventing MDRPUs in other anatomical regions and high-risk populations, such as pediatric and geriatric patients. The effectiveness of these dressings in preventing pressure injuries on the sacrum and heels has been demonstrated, suggesting that their utility extends beyond the head region.¹⁴ Additionally, efforts should focus on integrating complementary strategies, such as device redesign and improved risk assessment tools, to further enhance MDRPU prevention.

Conclusion

The integration of silicone foam dressings into routine nursing care has demonstrated potential to reduce the incidence of medical device-related pressure ulcers (MDRPUs) in the head region. By addressing key risk factors such as pressure, friction and shear forces these dressings offer a practical and effective solution for high-risk scenarios, including patients requiring non-invasive ventilation, high-flow nasal oxygen, prone positioning or rigid cervical collars. The marked reduction in MDRPU prevalence, along with positive feedback from healthcare professionals, underscores the importance of evidence-based innovations in clinical practice.

While the findings highlight the effectiveness of silicone foam dressings, they also point to the necessity of continued research and development. Future efforts should focus on expanding their application to other anatomical regions and high-risk populations while evaluating the long-term economic benefits of their use. Education and training for healthcare professionals remain critical to ensuring consistent and effective implementation.

By prioritising the integration of evidence-based interventions such as silicone foam dressings, healthcare systems can enhance patient outcomes, reduce the economic burden of MDRPUs, and set a new standard for preventive care. This study reinforces the importance of innovation and collaboration in addressing the challenges posed by MDRPUs in modern healthcare settings.

Authors contribution

LK and JH: conceptualisation, data collection and analyses, manuscript drafting

AP: methodological support, data analysis and manuscript supervision

All the authors approved the final version of the manuscript

Implications for clinical practice

• Routine use of silicone foam dressings in high-risk patients can reduce MDRPU incidence.
• Early application before device placement helps prevent skin damage and improves comfort.
• Healthcare professionals need training on proper dressing application for optimal prevention.
• Standardised guidelines should include silicone foam dressings for MDRPU prevention.

Further research

• Evaluate the cost-effectiveness of silicone foam dressings in MDRPU prevention.
• Investigate their efficacy in other high-risk populations, including pediatric and geriatric patients.
• Conduct structured studies on healthcare professionals’ experiences with silicone foam dressings.
• Explore complementary prevention strategies, such as device redesign and improved risk assessment.

Conflict of interest

The authors declare no conflicts of interest.

Funding

The authors received no funding for this study.

Author(s)

Lenka Krupová*¹, Jitka Hovorková², Andrea Pokorná^3,4
1Department of Dermatology, University Hospital Ostrava, Czech Republic
²Department of Otorhinolaryngology and Head and Neck Surgery, Faculty Hospital Motol, Czech Republic
³Department of Health Sciences, Faculty of Medicine, Masaryk University, Czech Republic
⁴Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Czech Republic

*Corresponding author email lenka.krupova@fno.cz

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