I was concerned to read Peter Cave and Leonora Descombe's article ('Slow on the uptake', pages 30-31, 30 April), and even more so when they claimed it to be hypothetical.

Where is the data for their claims and are they responsible for negotiating these contracts? My experience of a well-managed trust has been that there is close scrutiny of the contracting process, staff are accountable for bed use and efforts are made to reduce waste, misuse and costs.

A regional contract with major hospitals throughout the North East exists, and I have the current pricing schedule.

My hospital and any other on this contract can obtain a specialised bed (low air loss, air fluidised) at a daily rate well below the 114 quoted. If the hospital's use of it is sufficient, the price continues to fall.

But the most pressing requirement is not price but good disinfection control.

I also want technical support, expert advice, prompt delivery and a larger range of products and devices. I would not personally want to be nursed on a standard hospital mattress, and it makes sense to have a replacement purchasing programme for low to medium-risk patients.

The prevalence of pressure ulcers is such that up to 20 per cent of the hospital population need preventive treatment, 6 per cent for treatment of stage one and two, and 2 per cent for stages three and four.1

Prevention is not cheap and has been estimated as 150 per person, with treatment at 320.2

There is an ethical (and practical problem) in testing every new product, in that we can assume any improvement will be superior to the standard mattress. There is now some data to allow us to evaluate the value of low to medium-risk products as well as more sophisticated beds.3,4,5,6

In critical care, where more than 90 per cent of these expensive products are used, there are many therapeutic benefits.

The costs form only a small part of intensive care unit costs and equate well with daily antibiotic or inotrope use.

DW Ryan

Clinical director

General intensive therapy unit

The Freeman Hospital

Newcastle

REFERENCES

1 Ryan D, Haalboom J, Colin D. Pressure ulcers in the critically ill. Intensive Care Medicine 1998 (in press).

2 Clough N. The cost of pressure area management in an intensive care unit. J Wound Care 1994. 3; 33-35.

3 Bliss M. Preventing pressure ulcers in the elderly patients: a comparison of seven mattress overlays. Age and Ageing 1995. 24; 297-301.

4 Gebhardt K, Bliss M, Winwright P, Thomas J. Pressure-relieving supports in an ICU. J Wound Care 1996. 3; 116-121.

5 Allman R, Paprade C, Noel L. Pressure ulcers among hospitalized patients. Ann Intern Med 1986. 105; 337-342.

6 Inman K, Sibbald W, Rutledge F, Clark B. Clinical utility and cost- effectiveness of an air suspension bed in the prevention of pressure ulcers. JAMA 1993. 269; 1139-1143.