Bedsores, also known as pressure ulcers and pressure sores, are skin lesions which can be caused by a number of factors, including friction and unrelieved pressure.
Healthy and mobile individuals constantly change position throughout the day, these subtle movements are not possible for patients who are paralyzed, injured, ill, or very old and frail. For them, pressure ulcers are a constant risk.
Any part of the body may be affected; bony or cartilaginous areas, such as the elbows, knees, and ankles are most commonly affected.
If discovered early, bedsores are treatable. However, they can sometimes be fatal.
Contents of this article:
Fast facts on bedsores
Here are some key points about bedsores. More detail and supporting information is in the main article.
- Elderly people are particularly at risk of developing bedsores
- If left unchecked, bedsores can be fatal
- Where bedsores are concerned, prevention is better than cure
What are bedsores?
Pressure ulcers can be a serious complaint if they remain untreated.
Pressure ulcers are much more common among patients who are unable to move because of paralysis, illness, or old age.
Sustained pressure can cut off circulation to vulnerable parts of the body, especially the skin of the buttocks, hips, and heels - the affected tissue dies if it does not receive an adequate flow of blood.
Injured tissue is always at risk of developing infections, which can spread and lead to serious illness.
An estimated 5 percent of all hospitalized patients develop at least one pressure ulcer.
Experts say that even with excellent medical and nursing care, bedsores can be hard to prevent, especially among vulnerable patients.
Anyone who cannot change position without help can develop bedsores; they can develop and progress rapidly and are often difficult to heal.
Risk factors for bedsores
Pressure ulcers are more common among:
- Patients who are immobilized because of injury, illness, or sedation
- Individuals with long-term spinal cord injuries - compression of certain areas can be constant; damaged skin as well as poor circulation increases the risk of damage and lowers the chances of healing
Also, patients with long-term spinal cord injuries, or neuropathic conditions including diabetes, have reduced sensation, so they often do not feel a developing bedsore and lie on it, making it worse.
Patients who cannot move specific parts of their body unaided have a greater risk of developing pressure ulcers; they include:
- Elderly people - they can have thinner, more vulnerable skin. If they are underweight, there will be less padding around their bones.
- Nursing home residents - the incidence of bedsores in nursing homes is significantly higher than in hospitals or at home.
- Coma patients - they cannot move unaided and do not respond to or acknowledge pain.
- Reduced pain perception - some diseases, including most spinal cord injuries, can reduce or eliminate the patient's sensation of pain.
- Losing weight in hospital - people who are hospitalized often lose weight because of their condition.
- Not eating properly - especially those whose diets are poor in protein, vitamin C, and zinc.
- Incontinence (urine or feces) - if a patient urinates uncontrollably there will be areas of permanently moist skin, resulting in a greater risk of skin breakdown.
- Existing medical conditions - patients with diabetes and vascular diseases that affect circulation may have problems with proper blood flow to certain tissues, resulting in a higher risk of tissue damage.
- Smoking - nicotine affects circulation and can slow healing. Mental awareness - if the patient is not fully aware, perhaps because of a disease, injury, or medication, they will not be able to take action to prevent pressure ulcers.
Symptoms of pressure ulcers
Bed-bound patients are most at risk of developing bedsores on their:
- Back of the head
- Breasts (female patients)
- Genitals (male patients)
- Rims of the ears
- Shoulder blades
Patients who use a wheelchair have a higher risk of developing pressure sores on their:
- Shoulder blades
- Back of arms
- Back of legs
Causes of pressure ulcers
Pressure ulcers, are usually caused by:
- Continuous pressure - if there is pressure on the skin on one side, and bone on the other, the skin and underlying tissue may not receive an adequate blood supply.
- Friction - for some patients, especially those with very thin and frail skin, as well as poor circulation, turning and moving may damage the skin, raising the risk of bedsores.
- Shear - if the skin moves one way while the underlying bone moves in the opposite direction. For instance, if a patient slides down a bed or a chair, or raises the top half of a bed too much, there is a risk of shearing - cell walls and minute blood vessels may stretch and tear.
Diagnosing pressure ulcers and ulcer management
Predicting and preventing bedsores is a priority.
Diagnosis of a pressure ulcer is made by visual examination. Doctors also try to predict who is most likely to develop bedsores. To do this, the medical team will assess the patient's:
- State of health
- Signs or symptoms that may point to an infection
- Mental health
- Personal history of pressure ulcers
- Blood circulation
To better assess the patient's risk, the doctor may order urine and blood tests.
Self-checking - if the patient is not in care, a doctor may teach them how to carry out regular daily checks for pressure ulcers.
Treatment of pressure ulcers
Treating pressure ulcers is not easy. If it is an open wound, it most likely will not heal rapidly; even when healing does take place, it may be patchy because the skin and other tissues have already been damaged.
Less severe pressure ulcers often heal within a few weeks if treated properly. However, serious wounds may require surgery.
The first step in treating any sore, regardless of its severity, is to remove the pressure that is causing it. This can be done by:
- The patient's positions - the patient needs to be turned and repositioned regularly
- Support surfaces - special beds, pads, cushions, and mattresses may all help reduce pressure on a sore, as well as protect likely areas from further breakdown
The following non-surgical treatments for pressure ulcers are also possible:
- Clean wound - if it is minor, it may be gently washed with water and a mild soap. Open sores, however, need to be cleaned with a saline solution each time the dressing is changed.
- Continence must be controlled as much as possible.
- Debridement - a wound does not heal well if dead or infected tissue is present, so it must be removed.
- Dressings - these protect the wound and accelerating healing.
- Oral antibiotics - if the pressure ulcers are infected.
- Nutrition - wound healing may be enhanced if the patient eats properly.
Some bedsores may become so severe that surgical intervention is necessary, regardless of treatment received. Surgery aims to improve the appearance of the sore, clean it up, treat or prevent infection, reduce fluid loss, and lower the risk of subsequent cancer.
Typically, a pad of muscle, skin, or other tissue from the patient's body is used to cover the wound and cushion the affected bone (flap reconstruction).
Prevention of pressure ulcers
Experts all agree that it is far easier to prevent bedsores than to treat them. However, easier does not necessarily mean easy. With the appropriate measures, patients and medical staff can significantly reduce the risk of developing pressure ulcers.
Some experts recommend that patients and medical staff develop a plan that all can follow:
- Position changes - change every 15 minutes for wheelchair users and at least once every 2 hours for people in bed
- Best positions in bed - a qualified physical therapist can advise
- Skin inspections - daily
- Diet - maintain good nutrition
- Smoking - quit
- Exercise - exercise helps circulation, builds muscle, improves overall health and stimulates a healthy appetite
Complications of pressure ulcers
- Cellulitis - a bacterial infection of the deepest layer of skin - as well as the subcutaneous tissues (fat and soft tissue) that are under the skin. Cellulitis can result in life-threatening complications, including septicemia (blood poisoning), and the spreading of infection to other parts of the body.
- Bone and joint infections - if a pressure ulcer makes its way into the joints or bones, there is a serious risk of infection, resulting in damage to cartilage and tissue and a reduction in limb and joint function.
- Sepsis - bacteria can enter through sores, especially advanced ones, and infect the bloodstream. There is then a serious risk of shock and organ failure, a life-threatening condition.
- Cancer - there is a higher risk of developing an aggressive carcinoma in the skin's squamous cells if the patient has bedsores.