Bed sores, also called pressure sores or decubitus ulcers, are areas of damage to the skin and underlying tissue ultimately resulting in lesion and ulceration.
Bed sores are the cause of death of several thousand Americans a year, however mortality rates have improved over the last several years due to improved prevention and treatment efforts.
Bedsores most commonly occur over bony areas or prominences in the body such as under the ischial tuberosities (buttocks) or on the shoulders, hips or heels. Bed sores can be difficult to treat, extremely painful and even life threatening in extreme cases.
The main causes of bedsores include:
Pressure: skin and tissue directly compressed between the bone and a solid surface such as a chair.
Friction: occurring when skin rubs against a surface, for example heels rubbing against 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.
Stages of Bedsores
Unstageable pressure ulcers are covered with dead cells, or eschar and wound exudate, so the depth cannot be determined.
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.
The following factors can significantly increase a person's risk of developing pressure ulcers:
Impaired mobility -People with decreased mobility often have difficulty moving to relieve pressure. They may be unable to reposition themselves in a chair, increasing pressure over prolonged periods of time, or may slump, causing a shearing effect.
Neurological / sensory impairment -People with sensory impairment may not feel the discomfort of pressure building and therefore not reposition themselves accordingly.
Temperature / humidity -Sweating adds to the risk of skin breakdown as does extreme changes in temperature.
Decreased nutrition and circulation -People with low body fat may have little padding in high risk areas. People with high body fat have increased padding, but this tissue is poorly vascularised making the person more vulnerable to shear forces. Good nutrition & hydration are essential when attempting to maintain healthy skin.
Incontinence -Bladder and/or bowel incontinence increases dampness in high risk areas, making the skin more likely to lesion.
Body fluids also contain substances that cause skin to deteriorate more quickly and can increase the risk of infection in open sores.
REDUCING THE RISK OF BED SORES
Good pressure care should be viewed as a holistic issue and practised across all activities of daily living. Correct pressure care equipment is an important component of any planned prevention programme, but should not be recommended in isolation.
A prevention programme for people at risk of bedsores may include some or all of the following:
Appropriate seating / equipment -It is important that any equipment provided, such as seating or beds, give good support to all areas of the body - spreading load evenly.
Relieving pressure from areas at risk -Pressure should be relieved from the body at regular internals - especially over bony prominences or areas of concern.
It is important to allow time for blood to flow normally to pressure areas so that skin cell oxygen levels can be restored. If a person cannot change positions independently, they will need to be assisted by a carer.
People at risk of sores should be regularly repositioned throughout the day.
Appropriate manual handling techniques -To reduce the effect of friction and shear on the skin, appropriate manual handling techniques and equipment need to be used. Slide sheets and hoists can be useful to reduce shear when transferring or repositioning although a thorough risk assessment should be completed.
Using pressure relief equipment -Pressure relief equipment may include mattresses, cushions, bed cradles and joint protectors. Some products may have a pressure relief rating to assist health professionals choose the correct products for their client.
These ratings have been provided by the product's suppliers, and are intended as a guide only. A full assessment by an appropriate health professional in conjunction with product suppliers as required is strongly advised.
TREATING BED SORES
Treating bed sores can be difficult. The open wounds of bed sores are slow to heal, and often the skin and other tissues have already been damaged or destroyed. Infected sores heal slowly and the infection can spread to other parts of the body.
The best cure for bed sores is prevention. Be sure to change your or the patients position often, at least every 15 minutes if you're in a wheelchair and at least once every two hours when you're in bed.
Use mild soap and apply moisturizer to prevent the skin from becoming dry and irritated, a factor that increases the chance of bed sores developing. You can clean the sore by rinsing the area with a salt-water solution. The salt water removes extra fluid and loose material from and around the sore(s).
Good nutrition is very important to help your body heal the sore(s). If you don't get enough calories, protein and other daily nutrients, your body won't be able to heal itself.
The methods for treating bed sores is based on individual cases. Various methods for treating bed sores include synthetic dressings, acetic acid compresses, saline dressings, and antibiotic dressings.
Signs of an infected bed sore include:
Bad smell from the sore
Redness and/or warmth around the sore
Swelling around the sore area.
Tenderness around the sore
Yellow or green pus
Signs that the infection may have spread or be spreading:
Fever or chills
General overall feeling of weakness
Mental confusion or difficulty concentrating