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24 November, 2009

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Pressure sores

Pressure sores are areas of damage to the skin and underlying tissue caused by constant pressure or friction. This type of skin damage can develop quickly in anyone with reduced mobility, such as older people or those confined to a bed or chair. Pressure sores can be difficult to treat and can lead to serious complications. Prevention includes regular position changes, good hygiene and skin care, and a healthy diet.

Other names for this type of damage include bed sores, pressure ulcers and decubiti (‘lying down’) ulcers. The skin over bony areas such as the heels, elbows, the back of the head and the tailbone (coccyx) is particularly at risk. Lack of adequate blood flow can cause the affected tissue to die if treatment is not available.

Degrees of severity
If a person is bedridden for long enough, the areas of skin in constant contact with the mattress or chair will start to discolour. This shows that the skin is in danger of ulcerating.

Pressure sores are graded to four levels, including:

Grade 1 – skin discolouration, usually red, blue, purple or black.
Grade 2 – some skin loss or damage involving the top-most skin layers.
Grade 3 – necrosis (death) or damage to the skin patch, limited to the skin layers.
Grade 4 – necrosis (death) or damage to the skin patch and underlying structures, such as tendon, joint or bone.

Added complications
Untreated pressure sores can lead to a wide variety of secondary conditions, including:

Sepsis (bacteria entering the bloodstream)
Cellulitis (inflammation of body tissue, causing swelling and redness)
Bone and joint infections
Abscess (a collection of pus).

Risk factors
A pressure sore is caused by constant pressure applied to the skin over a period of time. The skin of older people tends to be thinner and more delicate, which means an older person has an increased risk of developing a pressure sore during a prolonged stay in bed.

Other risk factors for a pressure sore include:

Poor physical condition
Poor mental condition
Immobility
Being restricted to either sitting or lying down
Incontinence
Malnutrition
Level of care needed.

People who use a wheelchair are most likely to develop a pressure sore on the parts of the body where they rest against the chair. These may include the tailbone or buttocks, shoulder blades, spine and the backs of arms or legs.

When a person is bedridden, pressure sores can occur in a number of areas: the back or sides of the head, the rims of ears, shoulders or shoulder blades, hipbones, lower back or tailbone, the backs or sides of knees, heels, ankles and toes.

Prevention
If you are caring for someone confined to a bed or chair for any period of time, it’s important to be mindful of the risk of pressure sores. To prevent skin damage, you need to relieve the pressure, reduce the time that pressure is applied and improve skin quality.

Develop a plan which the person and any other caregivers can follow. This plan will include position changes, supportive devices, daily skin care, a nutritious diet and supportive lifestyle changes.

Position changes and supportive devices
Experts advise shifting position about every 15 minutes when you’re in a wheelchair and at least once every two hours, even during the night, if you spend most of your time in bed.

Other strategies include:

Use pillows as soft buffers between the skin and the bed or chair.
Avoid lying directly on your hipbones.

Daily skin care
Strategies include:

Check the skin at least daily for redness or signs of discolouration.
Keep the skin at the right moisture level, since damage is more likely to occur if skin is either too dry or too moist.
Use moisturising products to keep skin supple and prevent dryness.

Bony areas should never be massaged because the skin is too delicate.

Diet and lifestyle
Strategies include:

Make sure the person eats a healthy and nutritious diet.
Be aware of using good hygiene practices.
Maintain activity levels where appropriate.
Quit smoking.

If a pressure sore develops
There are a variety of treatments available to manage pressure sores and promote healing, depending on the severity of the pressure sore. These include:

Regular position changes
Special mattresses and beds that reduce pressure
Dressings to keep the sore moist and the surrounding skin dry
Light packing of any empty skin spaces with dressings to help prevent infection
Regular cleaning with appropriate solutions, depending on what stage the sore is at
Specific drugs and chemicals applied to the area, if the infection persists
Surgery to remove the damaged tissue
Operations to close the wound, using skin grafts if necessary
Continuing supportive lifestyle habits such as eating a healthy and nutritious diet.

Where to get help

Your doctor
Hospital staff
Domiciliary care staff
Nurse-on-Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)

Things to remember

Anyone confined to a bed or chair for a long time is at risk of developing a pressure sore.
Pressure sores can be difficult to treat.
Prevention includes regular changes of position, good hygiene and skin care, and a healthy diet.

You might also be interested in:
Leg ulcers.
Osteomyelitis.
Paraplegia (spinal cord injury).
Septicaemia.
Spina bifida explained.
Wounds - how to care for them.
Wounds - lower leg ulcers.

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