Alginate dressings for treating pressure ulcers

What are pressure ulcers, and who is at risk?

Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are wounds involving the skin and sometimes the tissue that lies underneath. Pressure ulcers can be painful, may become infected, and so affect people's quality of life. People at risk of developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as elderly people and people who are ill as a result of short-term or long-term medical conditions.

In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent to 4% of the total National Health Service expenditure. People with pressure ulcers have longer stays in hospital, and this increases hospital costs. Figures from the USA for 2006 suggest that half a million hospital stays had 'pressure ulcer' noted as a diagnosis; the total hospital costs of these stays was USD 11 billion.

Why use alginate dressings to treat pressure ulcers?

Dressings are one treatment option for pressure ulcers. There are many types of dressings that can be used; these can vary considerably in cost. Alginate dressings are a type that is highly absorbant and so can absorb the fluid (exudate) that is produced by some ulcers.

What we found

In June 2014 we searched for as many relevant studies as we could find that had a robust design (randomised controlled trials) and compared alginate dressings with other treatments for pressure ulcers. We found 6 studies involving a total of 336 participants. Alginates have been compared with hydrocolloid dressings, another type of alginate dressing, dextranomer paste dressing, silver-alginate dressing, silver-zinc sulfadiazine cream and treatment with a radiant heat system in these studies. There was no evidence from these studies to suggest that alginate wound dressings are more effective at healing pressure ulcers than other types of dressings or skin surface (topical) treatments, or other interventions.

Generally, the studies we found did not have many participants and the results were often inconclusive. Some study reports did not provide information about how they were conducted and it was difficult to tell whether the results presented were likely to be true. More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings or other treatments. This review is part of a suite of reviews investigating dressings for the treatment of pressure ulcers

This plain language summary is up-to-date as of June 2014.

Authors' conclusions: 

The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.

Read the full abstract...
Background: 

Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers. Each review will focus on a particular dressing type.

Objectives: 

To assess the effects of alginate dressings for treating pressure ulcers in any care setting.

Search strategy: 

For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.

Selection criteria: 

Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above).

Data collection and analysis: 

Two review authors independently performed study selection, risk of bias assessment and data extraction.

Main results: 

We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was of low or very low quality. Where data were available there was no evidence of a difference between alginate dressings and alternative treatments in terms of complete wound healing or adverse events.

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