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Evidence to Improve Care

Turning for the Prevention and Management of Pressure Ulcers


Ontario Health Technology Advisory Committee Recommendations

  • For prevention of pressure ulcers in acute care, the Ontario Health Technology Advisory Committee recommends that a high-density foam mattress should be provided to all persons receiving acute care.

  • For prevention of pressure ulcers in the operating room, a high-quality support surface (foam or gel) should be used during surgical procedures longer than 90 minutes. Strong evidence exists for using a gel pad for this population.

Read the full OHTAC Recommendation report



Bedsores, also known as pressure ulcers, cause problems for many patients with limited mobility. They increase the risk of death and hospitalization, and decrease quality of life. They are also expensive to treat. Bedsores are caused by the pressure when bones under the skin meet support surfaces (like mattresses) and blood flow in that area is reduced.


Health Quality Ontario Reviews Frequency of Turning Patients

Bedsores are prevented by using support that spreads pressure out more evenly (high-density foam mattresses) and by turning people in their beds so they rest on the same spot for a shorter time. High-density foam mattresses reduce bedsores even when patients are turned less often. Less frequent turning could have other benefits, such as decreasing the number of times sleeping patients are disturbed and freeing up staff to do other work.


Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes
October 2014 (PDF)


Turning for Ulcer Reduction (TURN) Study: An Economic Analysis
October 2014 (PDF)


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The Ministry of Health and Long-Term Care endorses these recommendations.

The Ministry of Health and Long-Term Care has provided the following response: The Ministry agrees with these recommendations and supports their widespread dissemination. Currently, the Ministry has requirements through regulation as well as funding policies to support prevention of pressure ulcers. Through regulation the Ministry requires long-term care homes to have a wound treatment program as well as a repositioning plan for any resident who is dependent on staff for repositioning (repositioning is known to prevent pressure ulcers). No further regulation changes are currently planned. Through funding policies the Ministry supports the purchase of therapeutic surfaces such as high density foam mattresses which help in the prevention and care of pressure ulcers.




Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.



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