Level 4

Force Related Tissue Damage: A White Paper

Damage to skin and tissue is an important and expensive issue for the NHS and other organisations providing care for those who are confined to their bed or chair for any period of time. The costs are not just financial; a lot of individual suffering and loss of quality of life occur when tissue breaks down. This white paper brings together existing research into skin and tissue damage associated with patient’s being cared for in bed.
The latest term being used for this is pressure injury (NPUAP 2016). This term replaces previous terminology used such as; pressure ulcers, pressure sores, bed sores /ulcers and decubitus ulcers. However, with our extensive review of the literature into the internal and external influences, we believe a more accurate description is force related tissue damage.
This paper investigates the observations regarding unobvious causes of force related tissue damage and the events linking both biomechanical and biological processes at several organisational (pathological) levels together with external in bed events. Over 22 internal marginal influences are identified which, as countless Cochrane reviews demonstrate, wound care science struggles to diagnose and cure; mostly due to the underestimation of the complexity and processes involved regarding tissue homoeostasis, damage and regeneration.
The paper explains how there are two major causal factors connected with all in bed force related tissue damage. The patient’s resting/support surface synergy and the way the person is moving/being moved and stabilised on that surface, regardless of whether this is by manual or mechanical means. We will explore how in bed force related tissue damage can be a direct result of both manual and/or mechanical handling and the incorrect synergetic interface layers of the resting/support surface with the patient’s skin and tissues.
We strongly suggest the major causal factors involved with all in bed force related tissue damage are external and within our control. This paper proposes that a preventative trajectory is both desirable and achievable by adopting a combined ergonomic and biomechanical approach to remove the risks to both patients’ skin/tissue and the carer’s muscular-skeletal system associated with in bed care and positioning.
Harm Smit and Phil Strong 2018


Here is the link to the paper: White Paper Force related tissue damage