Bedsores: Prevention and Treatments

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Bedsores are a common problem for patients in the medical field. Also known as pressure ulcers, pressure sources, or decubitus ulcers, they happen when constant pressure on an area of skin breaks down the skin and causes an open wound. Usually, the areas of the body most at risk for bedsores are where bones stick out, like on elbows, heels, shoulders, or the back. 

If you work in a field where it’s fairly common for patients to be in bed or sitting down in wheelchairs for long periods of time, you’ll be on the lookout for bedsores and trying to prevent them from happening. Here are the basics of how to recognize, prevent, and treat bedsores.

How to Identify Bedsores

Understanding how bedsores form and progress helps you determine the best method of treatment. And to do that, you’ll need to remember and understand the layers of skin, muscle, and bones.

  • Epidermis. This is the top layer of skin that you can see.
  • Dermis. This layer of skin is right below the epidermis. 
  • Subcutaneous layer. This is a layer of fat and the third and bottom layer of skin. 
  • Muscle. Below the subcutaneous layer is the muscle.

Bedsores develop in stages. Being able to identify which stage a bedsore is can help you and other health care professionals determine the best treatment. 

  • Stage I. At this stage, signs are superficial. If the skin is over a bony prominence that’s under a lot of constant pressure, and it looks or feels different than the skin around it, it might be a stage one bedsore.
    • You’ll notice an area that’s red on white skin or purple or blue on dark skin. 
    • Sometimes, that area might be itchy, flakey, hard, or warm when you touch it. 
  • Stage II. This stage is when the skin starts to break down enough to form an open wound or a blister. Some skin is lost or damaged on either the epidermis or even down to the dermis layers, but the sore doesn’t go all the way through those two layers yet.
  • Stage III. At stage three, the sore opening has gone down to the subcutaneous layer. You’ll likely see fat in the wound.
  • Stage VI. This is the worst stage of a bedsore. The damage is down to the muscle and sometimes even down to the bone, and it can affect tendons or ligaments. Sores at this stage are difficult to heal and are at high risk for life-threatening infections. 
  • Deep tissue pressure injury. If the skin is deep red, maroon, or purple, it might be a deep tissue pressure injury. The skin can be intact or open

Your facility will likely use different methods for identifying different stages of bedsores. 

How to Prevent Bedsores

The best treatment is prevention. This is the responsibility and priority of all health care professionals involved in a patient’s care. Work prevention methods for bedsores into your daily shift practices.

  • Regular position changes. Bedsores happen when pressure is constant on that part of the body. So one obvious and important prevention method is to limit the pressure, or at least the amount of time there’s pressure on that body part, through regular position changes. 

Your facility likely has policies on how often bedridden or physically disabled patients have to have their positions changed, but that can often get pushed aside for other priorities. Make it your mission and priority to keep up on position changes for your patients at higher risk for bedsores. 

  • Constant inspections. Whenever you get the chance, especially during position changes or other activities of daily living, inspect any at-risk sites where pressure ulcers are most common. If areas of skin are wet or soiled, pay close attention to keeping them dry and clean, because damp, dirty skin makes the area more prone to bedsores.

If there are signs of skin breakdown, don’t wait for it to get worse. 

  • Adequate nutrition. Our bodies need proper nutrition to stay healthy and fight off health problems, and those problems include bedsores. Without proper nutrition, our skin isn’t as resistant to break down, and it’s more difficult for it to heal from injuries. 

If a patient isn’t getting proper nutrition during meals, act now to coordinate with other staff to find ways to troubleshoot and solve any issues.

  • Adequate hydration. Just like nutrition, hydration plays a vital role in healthy skin. Without proper hydration, our skin isn’t as elastic or strong, and it’s much more susceptible to breaking down.
  • Daily exercise. Many patients are limited in how much exercise they can do, but any activity that gets blood moving and helps relieve pressure can help prevent skin breakdown. 
  • Special equipment for support. Since the primary cause of bedsores is pressure, using equipment to help relieve pressure on bony areas that see a lot of pressure can be an excellent preventative measure. Some items that you could use for your patients are pillows or mattresses meant to help relieve pressure. 

How to Treat Bedsores

Bedsores can develop and progress from one state to another very quickly, so it’s important to start treating them as soon as they are recognized and to keep up on treatment until they’re healed.

  • Stage I treatment. Follow your facility’s preferred practices. This could mean using antibiotics to keep the area clean from bacteria and prevent infection as well as the use of certain cleaning solutions. This is also an important stage for using prevention methods.
  • Stage II and III treatment. Once the skin is broken, it’s important to have proper wound care depending on how advanced the open sore is. This could mean surgery, or it could mean debridement, which is a medical process of removing damaged and necrotic tissue to make sure the sore is clean enough to start healing. 

Patients will also likely be prescribed pain medications and antibiotics. Open wounds are painful, especially in areas that often brush up against furniture or clothing or support weight. And they create a worrying opening for bacteria to cause infection. 

  • Stage VI treatment. At this point, surgery is usually the best treatment. The patient might need to have a limb amputated or at the very least a procedure to remove dead skin and repair underlying damate. If an infection has already set in, they may need to be hospitalized depending on the severity of the infection. 
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