The authors wanted to compare the performance and skin environment provided by a recently introduced reusable underpad (Test Group underpad) to an underpad already well established in the absorbent products market (Reference Group underpad). A controlled, prospective, randomized multi-centered clinical trial was conducted in 18 facilities (6 hospitals, 7 home health agencies, and 5 skilled nursing facilities) and completed by 107 patients. The majority of the patients had a Braden score near 13, were 70 to 80 years of age, and weighed 130 to 138 lbs. The Test Group underpad ranked more favorably overall and in all eight categories of daily assessment. These differences were statistically significant (p < 0.05) in the Total Score and in four of the eight individual categories: Keeping Skin Dry, Keeping Clothing Dry, No Pooling of Fluid, and Patient Comfort. The Test Group underpad also ranked more favorably with statistical significance (p < 0.05) in three of the assessment categories at the conclusion of the study: Pad Absorbency, Pad's Ability to Wick Moisture, and Pad's Ability to Keep Skin Dry. Investigators also noted that 57 patients (53%) exhibited some measure of improvement by the end of the study. Of these, 45 (79%) had been assigned to the Test Group. The Test Group underpad demonstrated better absorbency, kept patients' skin, clothing and bed linens drier, exhibited less pooling of fluid and resulted in higher patient comfort. As a result, it may have contributed to a more beneficial skin environment, allowing for prevention of preexisting skin integrity problems and enhancement of healing.