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Real World

Earlier is better in the prevention of Pressure Injuries/Ulcers (PI/PUs), where a timely intervention can potentially reverse the damage and prevent the wound from breaking through the skin.


To find out more, download our most recent real world publication presented at EWMA 2020 Virtual Congress here:

Reducing Pressure Injury/Ulcer (PI/U) Ulcer through the Introduction of Technology

Or select from our real world evidence detailed below.

Community Care

Striving for Perfect Care – Preventing skin breakdown in the community setting in the UK

Logo for NHS Mersey Care NHS Foundation Trust Community and Mental Health Services

Nicky Ore. et al., Head of Clinical Governance, Mersey Care NHS Foundation Trust EPUAP, Lyon, France, 2019

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Aim to prevent and reduce the numbers of pressure injuries/ulcers (PI/PUs) developed within the community care setting

A total of 445 PI/PUs were reported by Mersey Care NHS Foundation Trust Community Services during Q1 2019/20

This included:
Present on admission
Developed whilst on the caseload
Deterioration whilst on the caseload


2 pilot district nursing sites identified for a 12-week PURP with a focus on palliative care patients

Patients scanned 4 - 5 days per week

Intervention was implemented depending upon the results of the SEM Scanner readings


16.1% PI/PU incidence in the pre-study pilot period

11.8% PI/PU incidence achieved during study pilot period

Incidence during the study period reduced by 26.9%


Trust Executive Team agreed to procure SEM Scanners for every District Nursing Team and Ward 35 (Intermediate Care)

SEM Scanner implemented into clinical practice across all District Nurse Bases

Click here to download in PDF format

Results from a New Pressure Ulcer Prevention Bundle A Community Facility

EWMA, Bremen, Germany 2016

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To develop a holistic risk assessment as part a prevention strategy to support a zero-tolerance policy for avoidable Hospital Acquired Pressure Injuries/Ulcers (HAPI/Us)


6 month pilot on 2 wards at a community facility during 2016. This was to develop a new pressure injury/ulcer (PI/PU) prevention strategy termed the Pressure Damage Prevention Bundle. The development of the matrix was to provide clinicians with a focused visual tool to aid clinical decision making.

Patients were scanned on admission then 2 and 3 days post admission. Patients are classed into one of the 4 quadrants based on their risk assessment and SEM Scanner values and the treatment protocols were applied based on which quadrant the patient was assessed into.


Following the 6 month pilot on the 2 clinical ward areas Hospital Acquired Pressure Injury/Ulcer (HAPI/U) incidence reduced to below 0.1%

Previously patients would have been allocated a special mattress regardless based on an elevated risk assessment score


The results of the SEM Scanner pilot at a community facility demonstrated that using the SEM Scanner (in combination with traditional standards of visual skin assessment) led to more sensitive and specific patient diagnosis. When acted on, these combined evidences resulted in a dramatic drop in PI/PU incidence

Click here to download in PDF format

Pressure Ulcer Reduction Evaluation

Danielle Nation, Matron, Athlone Rehabilitation Unit
Central London Community Healthcare

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The Athlone rehabilitation unit was identified by Director of Quality for Central London Community Healthcare (CLCH) to evaluate the SEM Scanner from 11th November 2019 to 3rd January 2020


PI/PU incidence for 12 month prior to the Pressure Ulcer Reduction Programme (PURP) period obtained:

  • 6 Hospital Aquired Pressure Injuries/Ulcers (HAPI/Us) in 233 ward admissions
  • Overall PI/PU incidence 2.6% pre PURP
  • 44 patients scanned daily on heels and sacrum


2207 SEM Assessments conducted

Patients were scanned on average for 17 days

• PI/PU incidence during PURP 0/44 = 0% (95% CI: 0, 8%)
• Relative reduction in HAPI/U incidence: 100%
• 43% of all SEM readings were ≥ 0.6
° Visual discolouration, indicating developing pressure damage, was noted at 88% of assessments
• 10 patients were admitted with PI/PUs (n=1 had 2 PI/PUs)
• For 100% of patients, healthcare practitioners reported that the SEM Delta value had changed their clinical decision making
• 100% of patients received additional interventions on the basis of SEM delta values


Introducing SEM assessments into the care pathway has reduced PI/PU incidence during the evaluation by 100%.
During the evaluation the Registered Nurse undertook the assessments however the Healthcare Assistants are keen to adopt the assessment activity as it fits well into the personal care process

Acute Care

Evaluation of Novel Sub-Epidermal Moisture (SEM) Technology in Early Pressure Ulcer Detection Versus Conventional Techniques

Cork University Hospital Logo (CUH)

Sharon O’Keeffe, CNS Tissue Viability & Pat McCluskey Advanced Nurse Practitioner, Cork University Hospital, Ireland

Tissue Viability Conference, Southampton, UK, 2019

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To compare the clinical utility of using a SEM Scanning device versus subjective visual skin inspection in the early detection of Category 1 Pressure Injury/Ulcer (PI/PU)

To observe whether SEM data triggers the allocation of preventative interventions

To compare the rate of Hospital Acquired Pressure Injury/Ulcer (HAPI/U) before and during the SEM Scanner evaluation


32 orthopedic/plastic surgery patients

Waterlow ≥ 10 (at risk to very high risk)

12 week duration

3 consecutive readings taken from sacrum, heels and ischial tuberosities

SEM Delta of ≥0.6 = increased risk of PI/PU


Pre-evaluation HAPI/U incidence rate = 12%

No patients developed a HAPI/U during the evaluation

72% (n=23) patients showed evidence of incipient tissue damage

15 subjects with no visible signs of damage 33% (n=5) had positive scan results indicative of underlying damage


SEM Scanning presents an exciting innovation... a method of objectively assessing tissue health before damage becomes visible

Delta readings prompted front line staff to implement targeted interventions

5 patients potentially receiving preventative measures that they may not have had otherwise

Click here to download in PDF format

Utility of a sensor-based technology to assist in the prevention of pressure ulcers: A clinical comparison

Scarborough Health Network logo

Rose Raizman. et al., Scarborough Health Network, Canada

International Wound Journal, 2018, 1-12

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A two-phased study designed to evaluate the clinical utility of the SEM Scanner and to see if the Hawthorne effect played a part in the results


Phase 1 - patients provided with a standard of care risk assessment and interventions and scanning by SEM Scanner but the resulting SEM scores were not used to determine interventions

Phase 2 - identical to phase 1 except that the resulting SEM scores were used in conjunction with risk assessment to determine appropriate interventions and care planning


284 patients evaluated in the 2 phases
On 3 inpatient wards
Over a 7-month period

Phase 1 results:

12/89 patients developed pressure injuries/ulcers (PI/PUs) (4 category 1, 6 Category 2, 1 Category 3 and 1 Deep Tissue Injury (DTI).

Phase 2 results:

2/195 patients developed PI/PUs (1 Category 1 and 1 Category 2).

This illustrated a 93% reduction in Hospital Acquired Pressure Injury/Ulcer (HAPI/PUs) compared to phase 1.


93% decrease in HAPI/U rate following interventions using the SEM Scanner scores

A strategic approach to PI/PU management with the use of SEM Scanner for identification of PI/PU improves patients outcomes

SEM Scanner made non-visible damage identifiable by providing a numerical readout, alerting clinicians to implement stronger prevention strategies.

No Hawthorne effect noted

Click here to download in PDF format

Improved clinical outcomes in pressure ulcer prevention using the SEM Scanner

NHS Isle of Wight logo

Glenn Smith, Formerly Clinical Nurse Specialist, Nutrition & Tissue Viability, St Mary’s Hospital, Isle of White

Journal of Wound Care, 2019, Vol 28:5

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Evaluation of a sub-epidermal moisture (SEM) Scanner to detect non visible pressure damage, allowing appropriately targeted pressure injury/ulcer (PI/PU) prevention interventions


Evaluation on a medical-surgical inpatient ward over a period of 2 months

35 patients included in the evaluation

Heels and sacrum scanned on admission and daily thereafter


91% of patients had delta values ≥0.6 indicating inflammatory changes that without intervention may have progressed to a PI/PU

Zero Hospital Acquired Pressure Injuries/Ulcers (HAPI/Us) developed during the evaluation in this patient group


The inclusion of SEM Scanner as part of the patient examination informed clinicians about early damage

Identification of pressure damage prior to it being visible would allow the most appropriate resource use

Click here to download in PDF format

A Quality Improvement Initiative in the Acute Setting

Ruth Ropper, Senior Nurse Project Support previously Lead Nurse Tissue Viability, NHS Lothian

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Lothian Health Board conducted a Pressure Ulcer Reduction Program (PURP) in 2 clinical settings: Western General Hospital (WGH) & Royal Infirmary of Edinburgh (RIE) in 2019/2020

Primary Aim:

• RIE - to determine if the addition of the SEM Scanner in the Pressure Injury/Ulcer (PI/PU) care pathway could reduce the incidence of Hospital Acquired Pressure Injuries/Ulcers (HAPI/U) where other initiatives had not achieved the Health Board goals

• WGH - to determine if their low HAPI/U rates were linked to high use of equipment or if decision making could be improved without affecting outcomes.

Secondary Aim:

• To assess if this project could impact on potentially inappropriate and excessive use of high cost intervention products, specifically dynamic mattress surfaces.


This project was split into 2 parallel paths:

1. PURP path to evaluate the use of SEM Scanning in the reduction of PI/PUs

2. Parallel path to test a decision pathway for equipment selection in clinical areas where there was high reporting of HAPI/U or high use of equipment.


Pre PURP information for the prior year 2018-2019 recorded a (HAPI/U) incidence rate in the SEM assessment wards:

• WGH - 0%, 259 admissions • RIE - 2.4%, 792 admissions WGH - 48 patients scanned - total 1212 readings

• 0% HAPI/U maintained

• 33% reduction in the use of dynamic system usage achieved

• 75% of patients, healthcare practitioners reported that the SEM Delta had changed their clinical decision making

• 75% patients received additional interventions on the basis of SEM delta readings. RIE - 78 patients scanned - total 1999 readings

• 100% HAPI/U reduction

• 11% reduction in the use of dynamic system usage achieved

• 79% of patients, nurses reported that the SEM Delta had changed their clinical decision making

• 79% patients received additional interventions on the basis of SEM delta readings.


Addition of the SEM Scanner into the care pathway impacted positively on both the HAPI/U incidence rates and resource usage.

In contrast the parallel path whilst a reduction in HAPI/Us was achieved, dynamic system usage increased.

Given the outcomes achieved the economic value has been fully reviewed compared to the reported cost of treatment of HAPI/U within the Health Board.

The introduction of SEM Scanner technology has been recommended to the Health Board for implementation to relevant wards within acute hospitals initially, with a view to widening the remit to the post-acute setting in the future.

Click here to download in PDF format

Is it time to re-evaluate the inevitability of SCALE ulcers?

Marie Curie yellow daffodil logo

Raine G. (2021). Lead Nurse, Marie Curie Hospice, Newcastle upon Tyne

International Journal of Palliative Nursing, Vol 27, No 9

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Hospice Care

Prevention, Prevention, Prevention - Tackling the No 1 Patient Safety Issue

Marie Curie yellow daffodil logo

Gillian Raine, Lead Nurse, Marie Curie, Newcastle upon Tyne, UK

Patient Safety Congress, Manchester, UK, 2018

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A quality drive for improvement to prevent damage occurring

Hospice Acquired Pressure Injuries/Ulcers (HAPI/Us) data for 34 patients developed 36 PI/PUs from Nov 2016 - Nov 2017

Overall HAPI/Us incidence rate = 9% prior to using SEM Scanner


6 Month pilot period

Focus on sacrum, buttocks & heels

All patients

Baseline scan performed as part of admission protocol, including Waterlow Risk Assessment & SSKIN check

Daily scan thereafter


Evaluation period of pilot incidence rate 4.8%

Pre pilot period incidence rate 9%

Reduction HAPI/U incidence rate 47%


Move to full implementation of SEM Scanner with the creation of own tools and guidelines for use

Click here to download in PDF format

Learn more about the

Provizio® SEM Scanner

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Are you ready to implement?

Contact Arjo, our exclusive distributors of the Provizio SEM Scanner here: – pressure injury prevention – pip

Alternatively, contact Bruin Biometrics LLC:

+1 310 268 9494
[email protected]