Hydrocellular Foam Versus Hydrocolloid Plate in the Prevention of Pressure Injuries

Fabiana da Silva Augusto, MS, RN; Leila Blanes, PhD, RN; Paula Zhao Xiao Ping, RN; Celina Mayumi Morita Saito, MS, RN; Lydia Masako Ferreira, PhD, MD


Wounds. 2019;31(8):193-199. 

In This Article

Abstract and Introduction


Introduction: Pressure injury is one of the most prevalent skin injuries and a great challenge in the hospital environment. The implementation of preventive measures contributes to reducing its occurrence.

Objective: This study compares the protective effect of 2 adhesive dressings used in the prevention of pressure injuries in at-risk patients.

Materials and Methods: This case series was conducted at a university hospital in southeastern Brazil with 80 hospitalized adult patients at risk for pressure injuries, as per the Braden Scale for Predicting Pressure Sore Risk. Patients were randomized to preventive intervention with either hydrocellular foam (n = 40) or hydrocolloid plate (n = 40) dressing, which was applied to the intact skin over the sacrum and trochanters and changed weekly over 8 weeks.

Results: Of the patients, 56.5% were women, 64.5% were 60 years of age or older, 58.1% were admitted to an intensive care unit, and 63.9% were at high risk for pressure injuries. None of the patients developed a pressure injury. However, the presence of blanchable erythema, desquamation, pruritus, discomfort during dressing removal, and skin damage caused by the strong adhesiveness of the dressings were observed in both groups. In the hydrocolloid plate group, patients reported significantly more discomfort during dressing removal due to its strong adhesion to the skin (P = .004) than those in the hydrocellular foam group.

Conclusions: Standard preventive measures combined with the use of either hydrocellular foam or hydrocolloid plate contributed to the prevention of pressure injuries in at-risk patients, with hydrocolloid plate being associated with significantly more discomfort during dressing removal.


Pressure injury is defined as a skin damage usually located over a bony prominence or under a medical or another device that occurs as a result of pressure or pressure in combination with shear.[1] It is a serious complication caused by multiple factors that has an important social and economic impact, negatively affecting a patient's quality of life.[2–4] In the United States, the estimated cost of pressure injury treatment for the health care system is about $11 billion annually.[5] Pressure injury is the second most prevalent lesion in the hospital environment.[6] The incidence of pressure injuries ranges from 0.4% to 39.8%, and its prevalence ranges from 10% to 18% worldwide, with intensive care units (ICUs) showing the highest incidence rates.[6–9]

International organizations focused on the study of skin injuries consider the early identification of the at-risk population, continuous assessment of the skin, and development and implementation of preventive measures to be the main pillars in preventing these injuries.[10] Given the major impact of pressure injuries, other preventive alternatives have been developed, such as the use of topical agents and prophylactic dressings.[11–14] Several studies[14–20] on the use of essential fatty acids, foams, barrier creams, hydrocolloids, transparent films, and dressings containing ceramide 2, among others, to prevent pressure injuries are found in the literature.

Hydrocolloid and foam dressings have physical properties that help prevent pressure injuries.[21] Modeling studies[21,22] showed these dressing materials redistribute mechanical forces, such as pressure, shear, and friction. Investigations using animal and human models also have identified the protective effects of prophylactic dressings applied to regions at risk for developing pressure injuries.[18,23,24] Another study[25] found foam dressings, in addition to preventing pressure injuries, have a protective effect against excessive moisture when applied to the sacral region. Other authors[26,27] also observed a reduction in the incidence of pressure injuries in ICUs after the implementation of standard preventive measures, training of the nursing team, and the application of silicone foam dressings in the sacral region. However, despite their use in clinical practice, few studies have assessed the efficacy of these products in Brazil.

Thus, the aim of this study was to compare the protective effect of hydrocellular foam and hydrocolloid plate dressings on the prevention of pressure injuries in at-risk patients.