Does placing multiple pads and linens under residents who are incontinent protect their skin?

Staff members in long-term care settings often seek guidance regarding the amount and type of linens and/or incontinence pads used under residents with support surface therapy. 

The latest guidelines on pressure ulcer prevention and treatment (NPUAP 2009) state “care must be taken to consider the patient’s condition and the types of support surface being utilized in order to determine the type and amount of linen to be used for each patient.” The general rule of thumb is “less is best.”

Recent laboratory studies have shown that incontinence pads and additional linen used between the patient and therapeutic support surfaces do, in fact, increase tissue interface pressure on both foam and low-air-loss support surfaces. There has been some evidence that smoothing the pad folds under the resident by hand does assist in reducing pressure.

Also, excessive use of linens and incontinence pads reduces the effectiveness of a low-air-loss support surface to dissipate heat and evaporate moisture. 

Wet pads and linen caused additional pressure on foam and low-air-loss support surfaces. Plastic-backed products can trap heat and moisture on the skin, contributing to skin irritation and breakdown. 

Based on these facts, the placement of multiple pads and linens under incontinent residents actually could jeopardize skin integrity.

While promoting the comfort and skin dryness of residents who are incontinent, the placement of multiple layers of linen and pads under residents vulnerable to pressure ulcers should be avoided so that the maximum benefit of the support surface can be achieved.