We all know the importance of exercise – it helps us physically and mentally. But do you know the dangers of immobility? Healthy people move throughout the day, even in their sleep. But for some patients, their illness makes it hard for them to move. And when people spend prolonged periods of time in one position, painful sores can develop. Pressure sores, also referred to as bedsores, decubitus ulcers, or pressure ulcers, can occur from the constant pressure or friction on one body part. Patients can develop these painful sores while at home or in a hospital or other healthcare facility. What do you need to know about pressure sores? Read on to learn what causes them and how you can reduce the risk for yourself or a loved one.
What causes pressure sores?
Pressure sores can occur when blood flow to the skin is limited by pressure against the skin. Blood flow is essential as it brings oxygen and other nutrients to tissue. Without adequate blood, the skin and nearby tissues are damaged and can eventually die.
Although any patient can develop a pressure sore, some medical issues make more skin vulnerable to damage which can contribute to the development of pressure sores.
There are 3 primary risk factors for pressure sores:
For people with limited mobility, there can be prolonged pressure on body parts from contact with a bed, wheelchair or other surface.
When skin rubs against clothing or bedding it can become fragile and vulnerable, particularly if the skin is moist.
Shear occurs when two surfaces move in the opposite direction. For example, if you slide down in a bed or chair, your tailbone moves down but the skin over your bone might stay in place.
What body parts are at risk?
Pressure sores commonly develop where bones are close to the skin, such as ankles, back, elbows, heels and hips. However, sores can develop on any body part under pressure, including the back of the head, buttocks, base of the spine, shoulders and toes.
How dangerous are pressure sores?
Unfortunately, pressure sores can cause serious infections, some of which are life-threatening. In fact, experts estimate that more than 60,000 patients in the US die each year as a direct result of pressure sores.
Cellulitis is an infection of the skin and connected soft tissues. It can cause warmth, redness and swelling of the affected area. Furthermore, those with nerve damage often don’t feel cellulitis related pain.
Bone and joint infections.
Infections from pressures sore can move into joints and bones. Joint infections can damage cartilage and tissue. And bone infections can reduce joint and limb function.
Some long-term, non-healing wounds can develop into a type of squamous cell carcinoma.
On rare occasions, a pressure sore can lead to sepsis, a very dangerous infection.
How common are pressure sores?
Researchers estimate that up to 23% of patients in long-term care and rehab facilities develop pressure sores. Additionally, an estimated 10% to 41% of ICU patients develop pressure sores. Finally, experts believe 600,000 – 700,000 hospitalized patients get sores every year in the US.
Finally, the US Agency for Healthcare Research and Quality (AHRQ) estimates that almost 2.5 million Americans develop pressure sores every year.
What are the symptoms?
Because these sores can cause serious infections, it’s important to know these warning signs of pressure sores:
- Unusual changes in skin color or texture – including sores, cracks, blisters, scales or broken skin.
- Pus-like drainage – look for yellow stains on sheets and clothing.
- Skin that feels cooler or warmer to the touch than other areas.
- Areas tender to the touch.
The depth, severity and other characteristics of bedsores varies. For instance, skin can become red and unbroken or there can be a deep injury involving muscle and bone.
When should you involve your doctor?
The Mayo Clinic suggests you contact your doctor if you see no improvement in any of the above warning signs 24-48 hours after changing positions to relieve pressure. However, you should seek immediate care for “any signs of infection, such as a fever, drainage from a sore, a sore that smells bad, or increased redness, warmth or swelling around a sore”.
What increases the risk of pressure sores?
There are many risk factors for pressure sores, including:
- An inability to move around easily, due to old age or illness.
- Weight loss, which can reduce padding over bony areas.
- Sliding down in a bed or chair, which increases pressure as the skin is pulled in different directions.
- Friction or rubbing of the skin, even against soft materials such as bed sheets.
- A poor diet.
- Moist skin, including from sweating or incontinence.
- History of previous pressure ulcer(s).
Additionally, an inability to feel pain or discomfort, due to spinal cord injuries, neurological disorders and other conditions, can make it hard to notice warning signs which can signal the need to change position. Lastly, medical conditions that impact blood flow, such as diabetes and vascular disease, can increase the risk of tissue damage.
Treatment for pressure sores.
Although there are a variety of treatments for pressure sores, advanced sores heal slowly. Therefore, early treatments are best.
If you, or a loved one, have a pressure sore, or think you might have a pressure sore, talk to your doctor. Treatment of sores may involve regular rinsing with water, bandages, ointments and creams. Additionally, it’s a good idea to protect the sore and the area around it with a foam wedge or pillow.
Importantly, don’t let a wound fester. And report any changes to your doctor.
Preventing pressure sores.
Clearly, it’s much better to prevent pressure sores than to treat them. Ask your doctor to assess your level of risk, or the risk of your loved one. Then ask for help creating a plan to prevent them. Additionally, if you or a loved one are in a hospital, rehab facility or other long-term care facility, ask the staff what steps they take to prevent pressure sores.
What can you do to reduce the risk of pressure sores?
Patients and family caregivers prevent pressure sores use these tips to reduce the risk of pressure sores:
Relieve direct pressure whenever possible.
- Change positions at least every 2 hours.
- For patients who can’t move on their own, caregivers should change the patients’ positions regularly.
- Patients should move as much as possible, including standing up.
- Avoid dragging heels and elbows when moving in a bed or chair.
Pay attention to skincare.
- Keep skin clean and dry.
- Don’t use scented soaps – they can dry the skin.
- Moisturize skin thoroughly after washing and throughout the day.
- Avoid talcum powder – it dries the skin.
- Don’t use hot water.
The bed and sheets matter.
- Use special pressure-relieving mattresses and cushions.
- Keep bed sheets smooth – avoid wrinkles.
- Use cotton or silk-like sheets.
- Keep the head of bed flat or no higher than a 30° angle – to reduce sliding down on the bed.
- Try sprinkling sheets with cornstarch to reduce friction.
Considerations for wheelchair-bound patients.
- Consider a chair that tilts, allowing a change of position.
- Use a special foam or gel seat cushion to reduce pressure.
- Quit smoking – it increases risk.
- Exercise – it improves blood flow. If exercise is difficult, talk to your doctor for suggestions.
- Avoid very tight clothing, but also avoid clothes so loose they bunch up under you.
- Eat a well-balanced diet.
- Drink at least 2 litres of fluid every day.
- Carefully check your body, or your loved ones, for signs of pressure sores.
- Tell your doctor or nurse if you notice any skin changes or discomfort as soon as possible.
Considerations for patients with bowel and bladder control issues.
Those with bladder and bowel control issues need special care. Since moisture increases the risk of sores, change undergarments (underwear or diapers) as soon as possible. Additionally, apply an ointment after cleaning to help keep the area dry. And sprinkle cornstarch over the ointment. Lastly, underpads can make clean ups easier and reduce the chance of soiling the mattress. Talk to your doctor for specific recommendations.