How to Properly Use Sheepskin for Bedsores

Medical-grade sheepskin, placed directly under a patient’s body at pressure-prone areas, cuts the rate of new pressure ulcers roughly in half compared with standard hospital bedding. Multiple randomized trials using a product called the Australian Medical Sheepskin have demonstrated this effect in both hospital and nursing home settings. But the benefit depends on using the right type of sheepskin, positioning it correctly, keeping it clean, and understanding that it works for prevention rather than treatment of advanced wounds.

What the Clinical Evidence Actually Shows

The strongest evidence for sheepskin in pressure ulcer prevention comes from a series of trials conducted in Australia and the Netherlands. In a hospital-based trial of more than 400 patients, those lying on medical sheepskin overlays developed new pressure ulcers at a rate less than half that of control patients, with a cumulative incidence of about 10% in the sheepskin group versus roughly 17% in the control group.¹ A separate trial in Dutch nursing homes found a similar pattern: sacral pressure ulcers developed in about 9% of residents on sheepskin compared with roughly 15% of those on standard bedding, with the sheepskin roughly halving the odds of developing a new ulcer after adjusting for age, sex, and baseline risk.²

An earlier trial in elderly orthopedic patients reported an even larger gap, with pressure ulcer incidence of about 10% in the sheepskin group versus 30% in the control group.³ The difference in that older study was striking, though later trials with larger and more diverse patient populations found a meaningful but smaller effect. Taken together, the evidence is unusually consistent for a simple bedding intervention: sheepskin helps, and the benefit holds across different care settings and patient types.

How Sheepskin Reduces Pressure Ulcer Risk

Pressure ulcers form when sustained pressure on skin compresses the small blood vessels that feed the tissue, cutting off oxygen and nutrients. The sacrum, heels, elbows, and shoulder blades are common sites because bone sits close to the surface there and the tissue gets squeezed between the bone and whatever the person is lying or sitting on. Sheepskin works against this process through several overlapping mechanisms, none of which is dramatic on its own but together they shift the odds meaningfully.

The dense wool fibers create a large number of contact points with the skin, which spreads the load over a wider area rather than concentrating it at a few peaks. This redistribution does not eliminate pressure, but it lowers peak pressure at the most vulnerable spots. The fibers also reduce friction and shearing forces when a patient shifts position or is repositioned by caregivers, which matters because shear damage to deeper tissue layers is a major contributor to ulcer formation.

Temperature and moisture at the skin surface also play a role. Warm, moist skin is more vulnerable to breakdown, and research on skin microclimate has found that even small temperature increases at the skin surface appear to predict pressure ulcer development.⁴ Wool fibers can absorb a substantial amount of moisture vapor from the skin surface without feeling wet, then slowly release it into the surrounding air. This wicking action helps keep the skin drier than it would be against a flat synthetic sheet or a plastic-coated mattress cover. It also moderates the temperature at the skin-sheepskin interface by moving heat away along with the moisture.

Medical-Grade Versus Decorative Sheepskin

Not all sheepskin products are equivalent. The trials that demonstrated a clear benefit used a specific product, the Australian Medical Sheepskin, which is manufactured to meet standards designed for clinical use. Medical-grade sheepskins are tanned using processes that allow repeated washing at temperatures high enough to kill bacteria and other pathogens, typically at least 80°C (176°F), without the wool matting down, losing its loft, or shrinking significantly. The dense, uniform pile height is engineered to distribute pressure evenly.

A decorative sheepskin rug or a cheap fleece pad from a home goods store will not perform the same way. Decorative skins are usually tanned for appearance, not durability under repeated laundering. The wool may be thinner, less uniform, or treated with chemicals that make it less absorbent. After a few washes, a non-medical sheepskin can flatten out, losing the springy pile that creates the load-spreading effect. If you are purchasing sheepskin specifically for pressure ulcer prevention, look for products marketed as medical-grade and intended for hospital or nursing home use.

Synthetic fleece pads are sometimes sold as “sheepskin alternatives” and are much cheaper. They can provide some friction reduction and a degree of pressure redistribution, but they lack wool’s moisture-management properties. The clinical trials that demonstrated the halving of pressure ulcer incidence used real sheepskin, not synthetic substitutes, so the evidence does not automatically transfer. Synthetic pads may be better than bare sheets, but claiming they are equivalent to medical-grade natural sheepskin overstates what the data supports.

Placement and Positioning

Where you put the sheepskin matters as much as what type you buy. For a patient lying on their back, the sacrum (the flat area at the base of the spine, just above the tailbone) is the single highest-risk site. Position the sheepskin so that the wool-side-up surface sits directly under the sacrum and extends far enough to cover the buttocks. The skin must be in direct contact with the wool, so the sheepskin goes on top of any bottom sheet and underneath the patient, not under the bottom sheet where a layer of cotton separates the wool from the body.

If heels are also at risk, separate heel pads or sheepskin booties can be used. The heel is the second most common site for pressure ulcers, and because it is a small, bony area bearing a significant amount of weight when a person lies supine, it benefits from the same pressure-redistribution and friction-reduction properties. Some facilities use full-length sheepskin overlays that cover the entire bed surface from shoulders to feet, but the trials primarily studied sacral placement and that is where the evidence is strongest.

For patients in wheelchairs or seated for extended periods, a sheepskin pad cut to seat size can be placed on the chair cushion. The same principle applies: wool side against the skin or clothing, with the pad centered under the ischial tuberosities (the bony prominences you sit on). Wheelchair users tend to generate more heat and moisture in the seat area because of sustained contact and the enclosing shape of the cushion, so the moisture-wicking property of wool is especially useful here. However, a seated sheepskin pad should not replace a proper pressure-relieving wheelchair cushion for someone at high risk.

Cleaning and Hygiene

A sheepskin that is not washed regularly becomes a problem rather than a solution. Bodily fluids, sweat, and skin cells accumulate in the wool, and a soiled sheepskin is unhygienic and loses its ability to manage moisture. Medical-grade sheepskins are designed to withstand machine washing at high temperatures, and most manufacturers provide specific laundering instructions that maintain the wool’s properties over many wash cycles.

The general approach is to machine wash on a wool or gentle cycle using a detergent approved for sheepskin or wool, then tumble dry on low heat or air dry. High-heat drying can damage the leather backing and cause the wool to felt. After drying, brushing the wool with a wire pet brush or a sheepskin-specific comb restores the pile’s loft and springiness, which is critical for maintaining its pressure-distributing function. A flat, matted sheepskin is not doing much more than a folded towel.

In clinical settings, sheepskins are typically laundered between patients and at regular intervals during a single patient’s stay, often every few days or sooner if soiled. For home use, a practical guideline is to wash at least weekly, or immediately after any contamination with urine, feces, or wound drainage. Having two medical-grade sheepskins allows you to rotate them, keeping one in use while the other is being washed and dried. This also extends the useful life of each pad.

What Sheepskin Cannot Do

Sheepskin is a preventive measure, not a treatment for an existing wound. If a patient already has a Stage 2 or higher pressure ulcer, placing a sheepskin over the open wound is not appropriate. Wool fibers can shed into the wound bed, the surface is not sterile, and an active wound requires specific dressings, offloading strategies, and often clinical wound management. The trials showing sheepskin’s benefit measured its ability to stop new ulcers from forming in intact skin, not its ability to heal existing ones.

Sheepskin also does not replace the single most important intervention in pressure ulcer prevention: regular repositioning. A person who is turned every two hours has vastly lower pressure ulcer risk than one who lies in the same position for six or eight hours, regardless of what surface they are lying on. Sheepskin helps between repositionings by reducing friction during movement and moderating pressure, but it cannot substitute for the relief that comes from completely unloading a pressure point. Think of sheepskin as one layer in a prevention strategy that also includes repositioning, adequate nutrition, moisture management, and regular skin assessment.

It is worth noting that for patients at very high risk, such as those who are immobile, malnourished, incontinent, and critically ill, sheepskin alone is unlikely to be sufficient. These patients typically need specialized pressure-redistributing mattresses (alternating-pressure or low-air-loss systems) and intensive nursing protocols. Sheepskin can complement those interventions, but it was tested primarily in patients at low to moderate risk and its effect size should be interpreted accordingly.¹

The Antibacterial Question

You will sometimes see sheepskin marketed as having natural antibacterial or antimicrobial properties, the idea being that wool itself resists bacterial growth and therefore stays cleaner between washes. The reality is more nuanced than the marketing suggests. Laboratory testing has shown that while bacteria do not grow freely in the space around wool fabric (they adsorb tightly onto the fibers rather than floating off into the surrounding area), the bacteria are not actually being killed. They continue to multiply on the wool surface, forming a firmly attached biofilm.⁵

What this means in practice is that wool may give a superficial impression of being cleaner because bacteria are bound to the fibers rather than transferring easily to other surfaces. But the bacteria are still there and still alive. This is why regular washing is non-negotiable. If you are relying on wool’s supposed antimicrobial properties to extend the time between laundering, you are building a biofilm colony under your patient. The wool fiber structure may help manage odor somewhat, since volatile compounds produced by bacteria are partly absorbed by the fibers, but odor management is not the same as disinfection.

Cost and Practical Trade-Offs

Medical-grade sheepskin is not cheap. An economic analysis of the nursing home trial found that using sheepskin for all patients added roughly €2 per patient per day in costs, with each prevented case of sacral pressure ulcer costing about €2,974 in sheepskin investment when given to every patient regardless of risk level.⁶ The cost dropped substantially when sheepskins were targeted only to higher-risk patients: about €2,479 per prevented case for those already at pressure ulcer risk, and roughly €1,847 per prevented case for patients with the most severe limitations in daily activities.⁶

Those numbers might sound like the investment does not pay for itself, and in a strict accounting sense the study found that the sheepskin’s purchase and laundering costs exceeded the savings from fewer pressure ulcers. But that calculation depends heavily on what you count as a cost of pressure ulcers. Treating an established ulcer can involve weeks of specialized wound care, expensive dressings, extended hospital stays, and in severe cases surgery. The economic analysis focused on direct care costs within the nursing home; it did not fully capture the pain, reduced quality of life, and potential for serious complications like sepsis that come with advanced pressure ulcers.

For home caregivers, the math is simpler. A medical-grade sheepskin overlay costs anywhere from $80 to $200 depending on size and supplier. If it lasts a year or more with proper care and prevents even one round of wound treatment, the return is obvious. The challenge is sourcing genuine medical-grade products rather than decorative alternatives that will not hold up to repeated laundering.

Skin Microclimate and Why the Surface Matters

The concept of skin microclimate has become increasingly recognized in pressure ulcer research. It refers to the temperature and humidity conditions right at the skin surface, in the tiny space between the body and whatever it rests on. Even when overall pressure is managed, a hot and damp microclimate accelerates skin breakdown because warm, moist skin is weaker, more permeable, and more susceptible to friction damage.

Research measuring skin temperatures at pressure sites has found that even modest increases in the temperature difference between a pressure point and surrounding skin seem to predict who will go on to develop an ulcer.⁴ This is relevant to sheepskin because wool’s ability to transport moisture vapor away from the skin helps moderate that microclimate. A flat cotton sheet traps moisture between the body and the mattress, and a waterproof mattress protector underneath makes the problem worse. Sheepskin provides an air-permeable, moisture-buffering layer that vents heat and humidity more effectively than flat woven fabrics.

That said, the microclimate benefit depends on the sheepskin not being covered. Placing a cotton draw sheet over the sheepskin, or tucking a waterproof pad between the patient and the wool, defeats the purpose. The patient’s skin or a single thin layer of clothing should be the only thing between the body and the wool surface. In incontinence situations, this creates a tension between microclimate management and the need for waterproof protection. Some caregivers resolve this by using a waterproof layer beneath the sheepskin (between the sheepskin and the mattress) rather than above it, keeping the wool-to-skin interface unobstructed while protecting the mattress.

Sheepskin for Heels and Other Bony Prominences

While the sacrum gets the most attention in the literature, heels are actually the second most common site for pressure ulcers and can be harder to protect. Heel ulcers develop quickly in immobile patients because the heel has very little subcutaneous fat padding the calcaneus bone. Standard flat sheepskin overlays do not extend all the way down to the heels in most configurations, so separate products are needed.

Sheepskin heel protectors typically come as booties or wraps that enclose the heel in wool while leaving the toes free for circulation monitoring. When using heel protectors, make sure the boot does not create a tourniquet effect around the ankle. It should fit snugly enough to stay in place but loose enough that you can slide a finger between the boot edge and the skin. Check the heels at least twice a day by removing the protectors and inspecting for redness, warmth, or early skin changes.

Elbows, shoulder blades, and the backs of the ears in patients with nasal cannulas or oxygen masks are other at-risk sites. Small sheepskin pads can be positioned under elbows, and strips of medical sheepskin can be placed under tubing that presses against the skin. These uses are less well studied in formal trials, but the mechanical principles are the same: spreading load, reducing friction, and managing moisture at the skin-device interface.

When Sheepskin Becomes Inappropriate

There are situations where sheepskin should not be used or should be discontinued. If a patient develops an allergic reaction to lanolin (the natural oil in wool), the sheepskin must be removed. Lanolin allergy is relatively uncommon but not rare, and it typically presents as contact dermatitis: red, itchy skin in the area of wool contact. Medical-grade sheepskins are washed extensively during processing, which removes much of the lanolin, but traces remain.

Patients with heavily draining wounds at the contact site should not use sheepskin over the wound area, as already noted. If a patient is on a specialized low-air-loss or alternating-pressure mattress, placing a sheepskin overlay on top can interfere with the mattress’s pressure-cycling function. The added layer dampens the alternating pressure waves and may reduce the mattress’s effectiveness. In that situation, ask the wound care team whether an overlay is compatible with the specific mattress system in use.

Finally, in patients with severe incontinence that cannot be managed with catheterization or containment products, the sheepskin will become saturated faster than it can wick moisture away. At that point, the wool’s advantages are overwhelmed and the surface becomes another source of moisture-related skin damage. Adequate incontinence management must be in place before adding sheepskin to the care plan.