Comprehensive Guide to Pressure Ulcers
Everything About Bedsores: Causes, Prevention, and Treatment
What Is a Pressure Ulcer?
Pressure ulcers, also known as bedsores, are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. People who are immobile for long periods, such as those confined to bed or using a wheelchair, are at higher risk.
These painful sores can enlarge and become infected. In severe cases, pressure ulcers can be life-threatening.
Pressure ulcers often occur in individuals with limited mobility who cannot change their position for extended periods. Sitting or lying in one position for too long reduces blood flow to the affected area. Prolonged pressure and friction can damage the skin and underlying tissues, starting from mild discoloration and progressing to deep, infected wounds that may involve muscles and bones.
The most common sites for pressure ulcers are areas where bone is close to the skin, including the back, hips, buttocks, elbows, heels, and ankles.
Common Sites of Pressure Ulcers
In patients who are bedridden for long periods or use a wheelchair for extended durations due to mobility problems.
Pressure ulcers can also develop where a device is in prolonged contact with the skin or causes friction. For example, casts, bandages, nasal tubes, or oxygen masks can lead to these types of sores.
What Does a Bedsore Look Like?
At first, a bedsore may appear as a discolored patch of skin. For example, the skin may look red, purple, or blue. As the condition progresses, the skin breaks open, forming a shallow, crater-like wound with a pinkish-red base. The wound may become infected. Without proper and timely treatment, the ulcer can deepen, extending from the skin into the muscle or even the bone. Sometimes a scab forms over the sore, hiding its true depth, and in some cases, the sore may look like a blister.
Who Is at Risk of Developing Pressure Ulcers?
People with thinner skin or those who have limited (or no) mobility are more likely to develop pressure ulcers. These individuals include:
- ✓Those who are in a coma or vegetative state.
- ✓Those experiencing paralysis.
- ✓People who use a wheelchair.
- ✓Individuals who use a cast, splint, or prosthesis.
Which Diseases Increase the Risk of Pressure Ulcers?
Children and adults with certain medical conditions are more likely to develop pressure ulcers. These conditions include:
- ✓Cancer
- ✓Cerebral palsy
- ✓Chronic venous insufficiency
- ✓Dementia
- ✓Diabetes
- ✓Heart failure
- ✓Kidney failure
- ✓Malnutrition
- ✓Peripheral arterial disease (PAD)
- ✓Spinal cord injury or spina bifida
What Are the Complications of Bedsores?
Bedsores increase the risk of potentially life-threatening bacterial infections such as cellulitis and sepsis. In severe cases, amputation may be required. Worldwide, pressure ulcers cause the death of more than 24,000 people each year. Sometimes, the infection spreads to deeper tissues and may lead to the following complications:
- ✓Bacteria entering the bloodstream (bacteremia), which can lead to bacterial meningitis or endocarditis.
- ✓Bone infections (osteomyelitis) or joint infections (septic arthritis).
- ✓Group A Streptococcal infections, ranging from cellulitis to necrotizing fasciitis (flesh-eating disease).
How Are Bedsores Diagnosed?
You can visit a wound care specialist for diagnosis and treatment. Healthcare providers diagnose and stage pressure ulcers based on their appearance. Your provider may also take photographs of the wound to monitor healing progress.
You may need specific tests to check for infections, such as:
- ✓Biopsy of the wound and affected tissues.
- ✓Blood culture, wound culture, and other laboratory tests.
- ✓X-ray imaging or MRI scan.
Can Bedsores Be Prevented?
Yes, with a few simple measures, you can prevent the development of bedsores.
If your patient spends long periods in bed
You can reduce the risk of pressure sores by doing the following:
- ✓Reposition the patient at least every 2 hours — for example, turn from lying on the back to one side and then to the other side.
- ✓While slightly elevating the upper body, position the patient on their side — this reduces pressure on the hip bones.
- ✓Place foam pillows or cushions between the patient's ankles and knees — you can also place them under the ankles.
- ✓Use an air, foam, gel, or water mattress (anti-decubitus mattress).
- ✓Use special mattresses with automatic pressure-relief systems that adjust surface pressure while lying down.
The 30-Degree Rule – Correct Positioning for Long-Term Bedridden Patients
- •Raise the patient’s upper body about 30 degrees using pillows.
- •Tilt the patient’s upper body about 30 degrees to one side with a pillow placed underneath.
- •Bend the hips approximately 30 degrees.
- •Bend the knees about 30 degrees.
- •Always place a pillow between the lower legs.
If you spend long periods sitting or use a wheelchair
You can reduce the risk of pressure sores by doing the following:
- ✓Remember the areas most at risk for pressure sores when using a wheelchair.
- ✓Do the 'chair push-up' — use your arms to lift yourself off the seat and then lower back down. Try to do this at least once every hour.
- ✓Lean forward or to the sides to lift your buttocks off the chair — do this for at least one minute every hour.
- ✓Use a special wheelchair cushion — these cushions can be filled with air, gel, or foam.
Good skin care is also essential to prevent bedsores
To help maintain your skin’s health as much as possible, you should:
- ✓Regularly check the patient’s skin for early signs of pressure sores — ask someone to check areas you can’t see or feel (if you have nerve damage, you might not feel sore formation).
- ✓Clean your skin regularly with mild soap — avoid hot water. Gently pat dry instead of rubbing with a towel.
- ✓Use moisturizing cream — this helps prevent dryness and flaking.
- ✓If you have urinary incontinence, use absorbent pads or briefs — even for minor leakage, they help keep skin dry. Change them as soon as they become soiled.
How Are Pressure Sores Treated?
Treatment may include the following:
- ✓Pain relief medications as prescribed by your doctor.
- ✓Antibiotics prescribed by your physician in case of wound infection.
- ✓Specialized wound dressings designed to accelerate the healing process.
- ✓Surgery or other procedures to remove infected or dead tissue from the wound (not all patients require this).
⚠️When Should I Contact a Doctor?
Contact your doctor or nurse if any of the following occur:
If a new pressure sore develops or an existing sore gets worse.
Signs of infection, which may include:
- ✓Fever of 38°C (100.4°F) or higher, or chills.
- ✓Swelling, discoloration, or warmth around the sore.
- ✓Yellow, green, or bloody discharge from the wound.
- ✓Foul odor coming from the sore.
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