Small changes yield big impact

From easing bedsores to zapping bugs in hospitals, researchers find new ways to achieve better results, writes CLAIRE O'CONNELL

HAVE YOU ever looked how something is normally done and thought there could be a better way?

It could be as simple as positioning patients in bed differently, so they get fewer sores. Maybe it’s about fitting wheelchairs into cars more securely, so their occupants are better protected in a crash. Or possibly even using a burst of light to zap bugs on surfaces in hospitals.

Those are some of the questions that researchers in Ireland have asked, and they are included in a new publication launched yesterday.

Picture of Health 2010 highlights some of the recent projects funded by the Health Research Board (HRB), and this year many offer evidence for relatively small changes that could have big impacts on patients.

They include a finding that tilting patients in a bed, rather than turning them right over to lie on their side, can reduce the risk of developing bed sores almost fourfold.

“We know are very expensive to manage and they impact on a patient’s quality of life,” says researcher Zena Moore, a lecturer at the Royal College of Surgeons in Ireland who looked at the issue under a HRB fellowship.

“So we were looking for something that you could use in a clinical setting that would actually make a difference to the number of new pressure ulcers that would develop.”

Bed sores can arise when a person is in the one position for too long and the usual practice in the Republic is to move the patient at intervals, turning them right over onto their side, explains Moore.

However, there’s evidence to suggest this isn’t the optimal answer. “The international literature mainly from animal studies and healthy volunteers would show that lying in that 90- degree position actually cuts off the blood supply to the area that you are weight-bearing on.

“So the recommendation would be that you tilt the person with pillows, so they are not completely on their side but they are offloading weight from areas of their bodies.”

To see what kind of impact this 30-degree tilting rather than 90- degree turning would have, her team carried out month-long trials in 12 centres that care for elderly people.

Among more than 200 participants, they found that 3 per cent of patients in the group who were tilted developed bed sores compared with 11 per cent of those who were turned onto their sides.

Tilting also took half as long to do and cost significantly less than turning, adds Moore, who would now like to see the practice rolled out across the HSE.

Another source of concern in healthcare settings is antibiotic-resistant micro-organisms such as MRSA. A HRB-funded team from Athlone Institute of Technology and NUI Galway is working on a new approach: to zap them with pulses of light.

The short but intense pulses they deliver not only damage DNA in bugs such as MRSA and VRE, but they also affect other cellular structures and processes.

“What you illuminate is what you kill,” explains Dr Neil Rowan, director of the biomedical and health science research group at AIT, who would see the approach being used in a hand-held device to clean surfaces or in situ to decontaminate surgical theatres between operations.

He adds that the technology can also address contaminants in water such as Cryptosporidium and describes it as being a clean and green approach.

“You are not producing any chemicals that will affect the localised environment,” he says.

“And it’s nice to be able to offer possible new technologies where other things are dwindling.”

Wheelchair occupants in vehicles stand to benefit from another project the HRB highlights. Dr Ciaran Simms from Trinity’s Centre for Bioengineering has been looking at the kind of protection offered to passengers in wheelchairs during a rear impact car crash – and designing improvements of a new head restraint and hardware to attach the wheelchair to the car.

“We estimated that a minimum of 700 wheelchair users in Ireland take half a million road trips annually, remaining in their wheelchair,” says Simms. “And access to transport is a major part of quality of life – it’s not something that should be seen as a luxury, it’s a requirement.”

Working with Enable Ireland and University College Dublin, the project analysed how crash-test dummies fare in wheelchairs in a collision and also developed a computer model to take account of scoliosis, or spine deformity, which affects how a person is seated in the chair.

And what did they find? “The absence of a head restraint on a wheelchair where the user is in the wheelchair in a rear-end collision is very serious,” says Simms.

“And it’s possible to reduce these neck injuries by the provision of a head restraint, either commercially or of the type we have designed.”

The group is in discussions about commercialising its new head restraint and attachment hardware, and information from the study is feeding into best practice guidelines, he adds.

You can download Picture of Health 2010 at hrb.ie