Preventing Pressure Sores
What Are Pressure Ulcers?
A pressure ulcer is an injury usually caused by unrelieved pressure that damages the skin and underlying tissue. Pressure ulcers are also called bed sores and range in severity from mild (minor skin reddening) to severe (deep craters down to muscle and bone).
Unrelieved pressure on the skin squeezes tiny blood vessels, which supply the skin with nutrients and oxygen. When skin is starved of nutrients and oxygen for too long, the tissue dies and a pressure ulcer forms. Skin reddening that disappears after pressure is removed is normal and not a pressure ulcer.
Other factors cause pressure ulcers too. If a person slides down in the bed or chair, blood vessels can stretch or bend and cause pressure ulcers. Even slight rubbing or friction on the skin may cause minor pressure ulcers.
Purpose of This Article
Pressure ulcers are serious problems that can lead to pain, a longer stay in the hospital or nursing home, and slower recovery from health problems. Anyone who must stay in a bed, chair, or wheelchair because of illness or injury can get pressure ulcers.
Fortunately, most pressure ulcers can be prevented, and when pressure ulcers do form, they do not have to get worse. This article describes where pressure ulcers form and how to tell if you are at risk of getting a pressure ulcer. It also lists steps to take to prevent them or keep them from getting worse, and suggests how to work effectively with your health care team.
Where Pressure Ulcers Form
Pressure ulcers form where bone causes the greatest force on the skin and tissue and squeezes them against an outside surface. This may be where bony parts of the body press against other body parts, a mattress, or a chair. In persons who must stay in bed, most pressure ulcers form on the lower back below the waist (sacrum), the hip bone (trochanter), and on the heels. In people in chairs or wheelchairs, the exact spot where pressure ulcers form depends on the sitting position. Pressure ulcers can also form on the knees, ankles, shoulder blades, back of the head, and spine.
Nerves normally tell the body when to move to relieve pressure on the skin. Persons in bed who are unable to move may get pressure ulcers after as little as 1-2 hours. Persons who sit in chairs and who cannot move can get pressure ulcers in even less time because the force on the skin is greater.
Confinement to bed or a chair, being unable to move, loss of bowel or bladder control, poor nutrition, and lowered mental awareness are risk factors that increase your chance of getting pressure ulcers. Your risk results from the number and seriousness of the risk factors that apply to you.
Fortunately, you can lower your risk. Following the steps in this article can help you and your health care provider to reduce your risk of pressure ulcers.
The following steps for prevention are based on research, professional judgment, and practice. These steps can also keep pressure ulcers from getting worse. Some steps apply to all prevention efforts; others apply only in specific conditions. It may help to talk to a nurse or doctor about which steps are right for you.
Take care of your skin
Your skin should be inspected at least once a day. Pay special attention to any reddened areas that remain after you have changed positions and the pressure has been relieved. This inspection can be done by yourself or your caregiver. A mirror can help when looking at hard-to-see areas. Pay special attention to pressure points. The goal is to find and correct problems before pressure ulcers form.
Your skin should be cleaned as soon as it is soiled. A soft cloth or sponge should be used to reduce injury to skin.
Take a bath when needed for comfort or cleanliness. If a daily bath or shower is preferred or necessary, additional measures should be taken to minimize irritation and prevent dry skin. When bathing or showering, warm (not hot) water and a mild soap should be used.
To prevent dry skin:
Minimize moisture from urine or stool, perspiration, or wound drainage. Often urine leaks can be treated.
When moisture cannot be controlled:
Protect your skin from injury
Avoid massage of your skin over bony parts of the body. Massage may squeeze and damage the tissue under the skin and make you more likely to get pressure ulcers.
Limit pressure over bony parts by changing positions or having your caregiver change your position.
Reduce friction (rubbing) by making sure you are lifted, rather than dragged, during repositioning. Friction can rub off the top layer of skin and damage blood vessels under the skin. You may be able to help by holding on to a trapeze hanging from an overhead frame (see cover). If nurses or others are helping to lift you, bed sheets or lifters can be used. A thin film of cornstarch can be used on the skin to help reduce damage from friction.
Avoid use of donut-shape (ring) cushions. Donut-shape cushions can increase your risk of getting a pressure ulcer by reducing blood flow and causing tissue to swell.
If you are confined to bed:
If you are in a chair or wheelchair:
Eat a balanced diet. Protein and calories are very important. Healthy skin is less likely to be damaged.
If you are unable to eat a normal diet, talk to your health care provider about nutritional supplements that may be desirable.
Improve your ability to move
A rehabilitation program can help some persons regain movement and independence.
Be Active in Your Care
This article tells how to reduce your risk of getting pressure ulcers. Not all steps apply to every person at risk. The best program for preventing pressure ulcers will consider what you want and be based on your condition.
Be sure you:
You can help to prevent most pressure ulcers. The extra effort can mean better health.
National and international organizations provide a variety of resources for people concerned with pressure ulcers.
For More Information
The information in this article was taken from the Clinical Practice Guideline on Pressure Ulcers in Adults: Prediction and Prevention. The guideline was developed by an expert panel of doctors, nurses, other health care providers, and a consumer representative, and it was sponsored by the Agency for Health Care Policy and Research. Other guidelines on common health problems are being developed and will be released in the near future. For more information about the guidelines or to receive more copies of this booklet, call toll free 1-800-358-9295 or write to:
Table 1. Care by Risk Factors
Source: Agency for Health Care Policy and Research, Pub. No. 92-0048: May 1992
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