A pressure sore is an area of skin that becomes damaged over time when the blood supply to a particular part of the body is reduced or cut off. Pressure sores are often referred to as Bedsores, Pressure Ulcers or Decubitus ulcers.
Pressure sores are caused by three main things:
- pressure – the weight of the body pressing down on the skin
- shear – the layers of the skin are forced to slide over one another or over deeper tissues, for example when you slide down, or are pulled up, a bed or chair or when you are transferring to and from your wheelchair
- friction – rubbing the skin.
The first sign that a pressure sore may be forming is usually discoloured skin, which may get progressively worse and eventually lead to an open wound.
The most common places for pressure sores to occur are over bony prominences (bones close to the skin) like the bottom, heel, hip, elbow, ankle, shoulder, back and the back of the head.
Anyone can get a pressure sore, but some people are more likely to develop one than others. Most pressure sores occur when someone is admitted to hospital. They affect between 1 to 5 in every 100 people admitted to hospital. However, pressure sores can also develop in someone at home, or in a nursing or residential home.
People who :
- have problems moving, immobile and unable to change position by themselves without help
cannot feel pain over part or all of their body
- are incontinent
- have poor circulation
- are overweight
- are seriously ill or undergoing surgery
- have had pressure sores in the past
- have a poor diet and don’t drink enough water
- are very old or very young
- have damaged their spinal cord and can neither move nor feel their bottom and legs
- are older people who are ill or have suffered an injury, for example a broken hip.
- Have a disability or are rendered immobile through use of an epidural anaesthetic.
Pressure sores can be easy to treat early on, but if they are left untreated they do get worse, and can be extremely painful and in the most serious cases can be life threatening.
Pressure sores can develop very quickly in some people, sometimes within an hour. Without care, pressure sores can be very serious. They can damage not just the skin, but also deeper layers of tissue under the skin.
The most important care for a patient with pressure sores is the relief of pressure. Once a pressure sore is found, pressure should immediately be lifted from the area and the patient turned at least every two hours to avoid aggravating the wound.
Pressure sores can be very painful, or mean a longer stay in hospital. Severe pressure sores can destroy the muscle or bone underneath the skin, so they can take a very long time to heal. In extreme cases, pressure sores can become life threatening, as they can become infected, and sometimes cause blood poisoning or bone infections.
One of the most important ways of preventing a pressure sores is to keep moving and changing position as much as possible to reduce or relieve pressure on areas of the body that are vulnerable, particularly bony areas of the body.
Your healthcare professional should advise you and your carer on how pressure is best reduced or relieved on areas of skin that are vulnerable to pressure sores. This advice should include:
- correct sitting and lying positions
- how to adjust your sitting and lying position
- how often you need to move or be moved
- supporting your feet
- keeping good posture
- which equipment you should use and how to use it.
If you have a pressure sore you should change your position or be repositioned regularly to allow the sore to heal and avoid further damage. – This applies whether you are in bed, chair or wheelchair.
What prevented measures do hospitals and nursing homes have in place? Nursing homes and hospitals usually set programs to avoid the development of pressure sores in bedridden patients such as using a standing frame to reduce pressure and ensuring dry sheets by using catheters or impermeable dressings. For individuals with paralysis, pressure shifting on a regular basis and using a cushion featuring pressure relief components can help prevent pressure wounds.
There are many different types of mattress and cushion that can help reduce the pressure on bony parts of the body and help prevent pressure sores. Your healthcare professional should work with you to decide which types of pressure-relieving supports are best for you.
The skin, as the largest organ in the body, must be kept will hydrated. Patients should be encouraged or assisted to drink two litres of fluid per day. Good nutrition provides essential nutrients which in turn keeps the skin healthy and helps to prevent pressure sores.
Are there any supplements I can take to reduce the risk of pressure sores? Certain vitamins and supplements such as Vitamin C have been shown to reduce the risk of pressure ulcers. People with higher intakes of Vitamin C have a lower frequency of pressure sores in bed-ridden patients than those with lower intakes.
Pressure Sores are categorised into 4 stages of severity:
Grade 1 – reddened skin which persists for more than 30 minutes after pressure has been relieved.
Grade 2 – superficial skin damage. May present as a blister or as an abrasion.
Grade 3 – full thickness skin loss not extending to bone or muscle. This grade is not usually painful.
Grade 4 – full thickness skin loss with extensive tissue damage through muscle and bone