Pressure Injury Prevention: Choosing the Right Underpad for LTC
An LTC nurse in Hamilton told us about a resident who developed a sacral pressure injury after three nights on a worn-out reusable pad that no longer wicked moisture away. The injury set the resident back weeks, added dressing costs, and triggered a documentation review. The pad had been in service long past its effective life — and nobody had a replacement standard.
Pressure injury prevention is one of the most documented quality indicators in Canadian long-term care. The right underpad is a core part of that program because it manages the two things that drive skin breakdown: moisture and friction. This article walks through what to look for when choosing underpads for pressure injury prevention.
How Underpads Affect Pressure Injury Risk
Underpads sit between the resident and the mattress. Their job is to absorb moisture, protect the mattress, and keep the skin dry. When a pad fails — because it is saturated, worn, or not absorbent enough — the skin stays wet, and wet skin is weaker skin. Moisture-associated skin damage (MASD) and pressure injuries share the same precursor: prolonged moisture exposure at the interface.
That is why absorbency is the first spec to evaluate, not the last. A pad that holds more fluid per square centimetre keeps the resident drier longer, which directly supports skin integrity.
The Five-Layer Structure That Works
Modern underpads designed for pressure injury prevention use a multi-layer construction. The five-layer format has become the standard in Canadian LTC procurement:
- Surface layer — soft, fluid-passing layer that wicks moisture away from the skin
- Distribution layer — spreads fluid across the pad so one spot does not saturate
- Absorbent core with SAP — super absorbent polymer locks fluid into a gel, keeping it away from the surface
- Leak-proof backing — a polyethylene or similar barrier that protects the mattress
- Grip or anti-skid layer — keeps the pad from shifting under the resident
The super absorbent polymer core is the key differentiator. SAP locks fluid into a gel rather than letting it pool — that is what keeps the surface dry enough to protect skin.
Sizing: 60x90cm vs 30x36 Inch
For pressure injury prevention in bed-bound residents, size matters more than most buyers assume. A pad that is too small leaves exposed areas of the mattress and allows skin to contact moisture that migrated beyond the pad. The 60x90cm format covers the sacral and torso area for most adult residents, which is why it is the dominant choice in Canadian LTC.
Facilities serving bariatric residents or managing heavy output may prefer a larger format or double-pad placement for night shifts.
ISO and Canadian Guidance
There is no single Canadian standard that rates underpad absorbency, but procurement guidance in Canadian LTC consistently points to three references: ISO 15621 for absorbent incontinence aids (test methods), CSA Group guidance on pressure injury prevention in care settings, and provincial quality frameworks such as Ontario's Fixing Long-Term Care Act expectations around skin integrity. A pad that claims "high absorbency" should come with a testable mL rating, not just a marketing phrase.
Vacuum-Compressed Format: Storage Without Compromise
Pressure injury prevention programs consume underpads at a steady rate — often several per resident per day. That volume creates a storage problem in homes where supply rooms are small. Vacuum-compressed underpads shrink the same absorbent product into roughly one-third of the space, which lets facilities keep an adequate supply without building extra shelving.
CliniEco Medical supplies 60x90cm five-layer underpads with SAP, vacuum-compressed in 50-packs — sized for the Canadian LTC standard and built for moisture management at the skin interface. Homes commonly pair them with 3,000mL adult briefs and nitrile gloves so the full incontinence care station comes from one supplier.
CliniEco Medical is a licensed medical device establishment (MDEL #35334).
Related reading
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Frequently Asked Questions
What underpad should I choose for preventing pressure injuries?
Look for a multi-layer pad with a super absorbent polymer core that locks moisture away from the skin, a soft wicking surface layer, and a leak-proof backing. The five-layer 60x90cm format with SAP is the standard choice in Canadian LTC. CliniEco Medical's vacuum-compressed five-layer underpads meet this specification.
How often should underpads be changed for pressure injury prevention?
Change frequency depends on output, but the clinical principle is simple: the pad must not remain saturated against the skin. For heavy-output residents, that may mean every 2–4 hours or with each repositioning. A higher-absorbency pad extends the window between changes without letting moisture pool.
Are PLA underpads suitable for pressure injury prevention?
PLA surface-layer underpads offer a biodegradable surface layer while still functioning as an absorbent product. They are a reasonable choice for facilities with sustainability goals, but the absorbency core and SAP performance remain the deciding factors for skin protection. Compare the mL rating and layer structure, not just the material label.
Related Reading
Explore more guides in this category:
- Disposable Underpad Cost per Pad: A Budget Calculator for LTC
- Disposable Underpad Standards: ISO and Canadian Guidance
- What Is a Medical Underpad? Layers, Absorbency and Sizing Explained
Related reading: explore our long-term care and home care resources.
start with our underpad buying guide for absorbency, sizing and cost.
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