Design: Patients hospitalised in a university hospital were included. A series of one-day prevalence measurements was performed. Six hundred seventy four patients were included in this study before the implementation, 756 patients 4 months after the implementation, and 771 patients 11 months after the implementation .

Main Measures: Comparisons before versus after the implementation were made regarding (i) the care behaviour of nurses, (ii) the prevalence of pressure ulcers, (iii) the cost of illness of pressure ulcer care.

Results: Inadequate prevention and in inadequate treatment were reduced by 17% [11-23] to 19% [13-24] and 28% [11-45] respectively. Excluding the use of mattresses as a positive indicator for care behaviour, we found only a minor insignificant increase in adequate pressure ulcer prevention. In adequate treatment activities we found no significant difference. Overall we found a significant decrease in pressure ulcer prevalence from 21% to 16% (Pd=5% [1-9]) after 4 months and 13% (prevalence difference =8% [4-12]) after 11 months. In our study hospital a relatively small investment (€50,000) resulted in a decrease of the pressure ulcer prevalence that is associated with an estimated cost saving of €862,000.

Conclusion: Implementation of a hospital guideline on pressure ulcer care and a new visco-elastic polymer foam mattress results in a significant decrease in pressure ulcer care and cost savings. This was mainly due to the introduction of the new mattress and to a much lesser degree to the change in care behaviour of the nurses.