How to help your patients prevent and treat pressure sores

Pressure sores (or bedsores) are areas of damage to the skin and underlying tissue ultimately resulting in lesion and ulceration. They are commonly formed over the bony areas on the back, hips, heels, sacral area, or ankles and they’re much easier to prevent than to treat. Their main causes include:

  • Unrelieved pressure: skin and tissue directly compressed between the bone and a hard surface such as a chair.
  • Friction: occurring when skin rubs against a surface, for example heels rubbing against the sheets of a bed.
  • Shear: occurring when skin and tissue are pulled in opposing directions, for example when a person slips down or is dragged along a bed.

The 4 stages of pressure sores

  • Stage I - The most superficial, indicated by redness that does not subside after pressure is relieved. The skin may be hotter or cooler than normal, have an odd texture, or perhaps be painful to the patient. Although easy to identify on a light-skinned patient, ulcers on darker-skinned individuals may show up as shades of purple or blue in comparison to lighter skin tones.
  • Stage II - Damage to the epidermis extending into, but no deeper than, the dermis. In this stage, the ulcer may be referred to as a blister or abrasion.
  • Stage III - Involves the full thickness of the skin, extending into, but not through, the subcutaneous tissue layer. This layer has a relatively poor blood supply and can be difficult to heal. At this stage, there may be undermining damage that makes the wound much larger than it may seem on the surface.
  • Stage IV - The pressure ulcer is the deepest, extending into the muscle, tendon or even bone.
  • Unstageable - This means caregivers cannot decide the stage because dead tissue or scabbing covers too much of the wound.

Advice to prevent and treat pressure sores

    The best cure for pressure sores is prevention. Some advice you can give your patients includes:

    1. Skin care

    • Clean the affected skin. Your patients should use moisturising, unscented soaps and warm (not hot) water to clean their skin. They shouldn’t use excessive force as this causes friction and should only pad the site dry.
    • Protect the skin. Make sure your patient’s skin is dry. Use talcum powder sparingly. Apply lotion or cream to dry skin. Change soiled bedding and clothing as required.
    • Inspect skin daily. Check for red or broken skin regularly.
    • Keep skin dry. If your patient has urinary or bowel incontinence, counsel how to reduce the skin’s exposure to moisture and bacteria. Care may include frequently scheduled help with urinating, changing of pads or soiled clothing or using protective lotions on healthy skin.
    • Change soiled bedding and clothes: Change sheets, pads, and bedclothes if soiled.

    2. Nutrition

    • Maintain a healthy diet. Foods that are high in protein may help prevent skin breakdown. Examples are meat, beans, and milk. Nutritional shakes and dietary supplements may also provide extra calories, vitamins and protein if deficient in the diet.
    • Drink enough to keep the skin hydrated. Good hydration is important for maintaining healthy skin. Patients should drink at least eight glasses of fluids each day, unless there is a medical reason not to. Healthy liquids include water, skimmed milk, and juice.

    3. Lifestyle

    • Change position often: Patients should change their position every 2 hours if in bed all day or every 15-30 minutes if they’re in a wheelchair all day. Set up a regular turning schedule. If you are helping a person move in bed, lift them. Do not slide them. An alternative is to use lifting equipment or an overhead trapeze. This may help prevent damage to the skin from sliding down in bed.
    • Staying active. Limited mobility is a key factor in causing pressure sores. Daily exercise matched to the patient’s abilities can help maintain healthy skin. A physiotherapist can recommend an appropriate exercise program that improves blood flow, maintains vital muscle tissue, stimulates appetite and strengthens the body.
    • Quit smoking. Suggest your patients quit smoking. It reduces the amount of oxygen in the blood. Smokers tend to develop more severe wounds, and their wounds heal more slowly.

    4. Products & Equipment

    • To protect skin over bony areas: Use pillows or foam wedges to keep bony areas from touching one another. Put a foam pad or a pillow under your patient’s legs to keep their heels from touching the bed. Remove extra sheets or bedding from underneath them.
    • Special equipment and pads: A slide and turn sheet may help patients move around in bed. An overhead trapeze can help change positions. Special mattresses and overlays may relieve pressure. Examples include a foam mattress pad, or special air or water mattresses.
    • Cushions that relieve pressure. Cushions help ensure the patient’s body is well positioned in the chair. Various cushions available include such as foam, gel, water-filled and air-filled. An occupational therapist or physiotherapist can advise on placement and their role in regular repositioning. Cushions can also relieve pressure between the knees and ankles.

    Independence Australia offers over 2000 wound care products to help, including dressings, skin care, tapes and compression.

    For more product advice, contact our Customer Service Representatives on 1300 788 855. Alternatively, click here to select your home state and locate your nearest wound clinic through the Australian Wound Management Association (AWMA).