A laboratory study examining the impact of linen use on low-air-loss support surface heat and water vapor transmission rates.

Layers of linens are frequently placed under patients to manage moisture and/or assist with positioning immobile patients, including persons placed on a therapeutic surface because they are at risk for developing pressure ulcers. Because skin microclimate is believed to affect pressure ulcer risk, some therapeutic surfaces are designed to manage skin temperature and humidity (microclimate management). The purpose of this study was to measure the effects of linens and underpads on a low-air-loss (LAL) surface's ability to disperse heat and evaporate moisture. Underpads and transfer sheet combinations (grouped by three common linen functions: immobility, moisture management, and immobility and moisture management) were tested using the sweating guarded hot plate method, which allows for the measurement of the evaporative capacity (g H2O/m2*hour) and the total rate of heat withdrawal (Watts/m2) associated with nine different linen configurations placed on the support surface. Total heat withdrawal and evaporative capacity of the LAL surface with a fitted sheet only was used for comparison (P <0.05) Compared with fitted sheet only, heat withdrawal was significantly reduced by five of eight combinations, and evaporative moisture reduction was significantly reduced by six of eight linen combinations (P <0.05). All combinations that included plastic-containing underpads significantly reduced the surface's ability to dissipate heat and evaporate moisture, and use of the maximum number of layers (nine) reduced heat withdrawal to the level of a static, nonLAL surface. The results of this study suggest that putting additional linens or underpads on LAL surfaces may adversely affect skin temperature and moisture, thereby reducing the pressure ulcer prevention potential of these surfaces. Additional studies to examine the effect of linens and underpads as well as microclimate management strategies on pressure ulcer risk are needed.