The prevention of pressure ulcers (which are sometimes called pressure sores or bed sores) is an essential part of caring for people who have to spend long periods of time in bed or sitting in a chair or a wheelchair. This is common in health care settings, making pressure relief a priority.
Without effective pressure relief measures in health care settings, pressure ulcers can seriously affect the health and well-being of patients.
How pressure ulcers can develop
Pressure ulcers most commonly develop on the parts of the body that are in contact with the surface of the hospital bed or chair and are therefore under the most pressure. These also tend to be the parts of the body that are most bony and include the hips and base of the spine as well as the heels and elbows.
The earliest signs of a pressure ulcer are discolouration of the skin (red or blue patches), a warm feeling and discomfort.
Unfortunately, the situation can deteriorate quite rapidly, and the ulcer can become an open wound. In time, the wound can extend to the deeper layers of skin and in very severe cases can even reach the muscle and bone. In the worst cases, there is a risk of blood poisoning.
There are treatments for pressure ulcers including dressings and surgery to remove damaged tissue. However, it is always best to prevent ulcers from developing in the first place if at all possible.
Who requires pressure relief in the health care setting?
Anyone can develop a pressure ulcer but some patients are more likely to get them than others. The patients most at risk are:
- Over 70 years of age. They are more likely to have mobility problems and their skin gets damaged more easily.
- Suffering from paralysis. These are patients who are not able to move some or all of their body
- Obese. Patients who have a larger build.
- Incontinent. This includes urinary incontinence and bowel incontinence.
- Have a poor diet. Their bones will be more prominent and their skin in a poor condition.
- Suffering from certain medical conditions. These are conditions that affect the blood supply and skin and include diabetes and heart failure.
Preventing pressure ulcers in health care
Some of the preventative measures for pressure ulcers can also be used as part of the treatment.
Equipment to relieve pressure
There is a range of pressure relieving equipment that can be effective in both preventing and treating pressure ulcers. These include foam or pressure-redistributing cushion pads, heel boots and troughs. Some pads come with air pumps that alter the shape of the cushion so that no one area of skin is constantly under pressure.
For more serious ulcers, a sophisticated mattress or bed system may be required where the mattress is connected to a pump that delivers air to change the shape of the mattress at set intervals.
Before selecting the appropriate equipment for a particular patient, a thorough risk assessment should be carried out. Also, the patient’s preferences should be taken into account.
Pressure relief can be achieved with manual turning but this uses up a lot of staff time and can be undignified and uncomfortable for the patient. Mechanical turning aids are also available for this procedure.
A balanced diet
By maintaining a healthy body weight and ensuring that the patient has all the nutrients that they need, the risk of pressure ulcers can be reduced. There needs to be enough protein and a variety of vitamins and minerals in the diet. A poor diet can result in skin that is vulnerable to damage and that cannot heal quickly. Drinking plenty of water is also important as dehydration can affect the quality of the skin.
Daily skin checks are needed to look for signs that a pressure ulcer may be developing. Any changes in skin colour, sensation, temperature or texture need to be noted and acted upon. By providing treatment early on, the ulcers can be cured quicker.
Giving up smoking
It is known that smoking reduces the levels of oxygen in the blood. This has the effect of weakening the immune system and this makes pressure ulcers more likely to develop. There are many other health issues that can be caused by smoking.
Incontinence can increase the likelihood of pressure sores developing. Care needs to be taken with toilet routines to ensure that faecal matter and urine is not left in contact with the skin for long periods. This causes irritation and makes the skin more vulnerable.
Cleanliness and hygiene
All areas of skin need to be clean and dry at all times. However, only non-drying skin cleansers that are very gentle on the skin should be used. The same is true for skin moisturisers which must be applied with great care.