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, a healthy diet, good hygiene and skin care.

Other names for this type of damage include bed sores, pressure ulcers and decubitus (‘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 I – skin discolouration, usually red, blue, purple or black.
• Grade II – some skin loss or damage involving the top-most skin layers.
• Grade III – necrosis (death) or damage to the skin patch, limited to the skin layers.
• Grade IV – necrosis or damage to the skin patch and underlying structures, such as tendon, joint or bone.

Added complications with pressure sores

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)
• Cancer (squamous cell carcinoma).

Risk of developing pressure sores

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. This 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 and paralysis
• Being restricted to either sitting or lying down
• Urinary and faecal incontinence
• Malnutrition and obesity
• Age
• Smoking
• 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 of pressure sores

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 and pressure sores

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, lifestyle and pressure sores

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

Depending on the severity of the pressure sore, there are a variety of treatments available to manage the sores and promote healing. 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, a healthy diet, good hygiene and skin care.

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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This page has been produced in consultation with and approved by:

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Joanna Briggs Institute

Last reviewed: November 2011

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<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pressure_sores?open">Pressure sores - Better Health Channel</a><br/>
Pressure sores can develop in anyone with reduced mobility, such as being confined to a bed or chair. This type of skin damage is difficult to treat and can lead to serious complications. Other names for this type of damage include bed sores, pressure ulcers and decubitus ('lying down') ulcers. Prevention tips include regular changes of position, a healthy diet, good hygiene and skin care.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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