Decubitus pressure ulcers are a world wide health crisis, and their prevention has become a national priority. The National Pressure Ulcer Advisory Board estimates that as many as three million people in the United States have pressure ulcers yearly. The causes of pressure ulcers include both extrinsic and intrinsic risk factors. Patients are at high risk due to numerable intrinsic risk factors including mobility, age, nutrition, sensory perception, and disease. However, extrinsic risk factors which can be addressed with cotton, bed-sheeting systems include pressure, shear, and friction. The biophysical design of the mattress and sheeting must take into account, body temperature, moisture, water transport, and microbial contamination due to incontinence. The application of new woven, non-woven, and multifunctional finishing technologies to cotton products is required to address improvement of hospital bed-sheeting systems. Methods of testing these cotton products for their ability to decrease friction increase water transport away from the patient's body, and to work in tandem with pressure reducing mattresses are being developed.