Abstract
A randomised controlled trial was undertaken in the orthopaedic ward at two hospitals to estimate the efficacy of a newly developed Australian Medical Sheepskin overlay to prevent hospital acquired pressure ulcers relative to a standard hospital mattress or other low technological constant pressure supports. A total of 297 patients aged 60 years and above were randomised to receive the sheepskin overlay (experimental group) or the standard hospital mattress, with or without other low technological constant pressure supports (control group). At risk status for developing an ulcer was assessed daily using the Braden Scale. Patients were assessed for evidence of a pressure ulcer on a daily basis. The risk ratio for development of at least one pressure ulcer for the 155 patients in the experimental group and 142 control group was 0.30 (95% confidence interval 0.17 to 0.52). The hazard ratio for time to development of first pressure ulcer in the experimental group relative to control group was 0.31 (0.17 to 0.58). These results provide evidence that the Australian Medical Sheepskin is effective in preventing pressure ulcers in elderly orthopaedic patients. A more comprehensive investigation, concentrating particularly on the effect of the sheepskin on duration of stay in hospital, is indicated.

Abstract
Amorphous hydrogel products are commonly used in wound management practice in the treatment of shallow to full thickness open wounds. Whilst some of the products currently used in clinical practice are intended for single use only, they are often re-used in the interests of reducing costs and wastage, despite the potential risk of contamination in re-used products. In this study, packs of Intrasite GelTM, SolugelTM and Duoderm Hydroactive GelTM were re-used in the clinic over a 1 month period. Samples were qualitatively analysed for microbial contamination each week.
Flasks containing fluid casein soy lecithin polysorbate-20 (FCSLP-20) medium were inoculated with used hydrogel samples and incubated overnight. Flasks displaying ‘growth’ were subcultured onto selective media for preliminary identification of the contaminating organism(s). One ‘no growth’ flask from each product sample was subcultured onto nutrient agar to confirm the absence of contamination. Microbial contamination was absent in samples of each product during the 1 month period. Control strains were successfully grown in flasks and isolated on selective media. Negative control flasks showed ‘no growth’.
The ‘single use only’ packs of SolugelTM, IntrasiteTM Gel and Duoderm Hydroactive GelTM amorphous hydrogels were free of microbial contamination during product re-use in this study, despite use in an active wound clinic situation. This study highlights the need to review the use of these hydrogels and address the safety in the re-use of these products.

Abstract
As there is a paucity of literature on pressure ulcer incidence in the Australian context, this prospective cohort study was undertaken to determine the incidence of pressure ulcers in a group of orthopaedic patients in an acute care setting. All orthopaedic patients who were free of pressure ulcers on admission and who met the study criteria were invited to participate. Each patient then underwent second daily skin integrity assessments and Braden Scale reviews until discharge.
Ninety patients were invited to participate over a 6 week period, with 100 per cent recruitment achieved. The majority of patients underwent hip or knee surgery and the incidence of pressure ulcers for this group was calculated at 11 per cent (n=10). Fifty per cent of these patients developed a Stage one pressure ulcer that was present on at least two consecutive assessments, while the remainder of the sample developed Stage two pressure ulcers. Ninety per cent of pressure ulcers were located on the heel or sacrum, with the remainder found on the elbow. The majority of patients (n=7) developed their pressure ulcers between days 3-4 post-admission. All patients who developed a Stage two pressure ulcer were found to be on Vaperm mattresses rather than on alternating air mattress or static air overlay as recommended by hospital guidelines for use of therapeutic support surfaces.
Although the Braden Scale for the total group was found to have a high specificity (91 per cent), its sensitivity was low (40 per cent). Of the 10 patients who developed pressure ulcers, only one patient was assessed as being at high risk, three were assessed at a moderate risk, two patients at low risk and the remainder (n=4) were all assessed as being at no risk of developing a pressure ulcer. Subjects who acquired pressure ulcers were found to be significantly older when compared to the rest of the sample population (mean age 80 years, vs 68 years). Those with pressure ulcers stayed in hospital 2.1 times longer (13.5 days compared to 6.5 days) than the remainder of the study sample who had undergone similar surgical operation/procedures. In view of the lack of Australian data on the incidence of pressure ulcers in acute care settings, further studies using larger samples are warranted to establish national benchmarks and determine risk factors for pressure ulcer development.

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