Definition and Overview
Pressure ulcers are commonly known as bedsores. They are injuries that occur when the bone squeezes the skin against an outside surface (such as a bed or wheelchair) for an extended period. They are very common in people who are bedridden and wheelchair-bound. Pressure ulcers can appear on any part of the body. But they are more common in bony areas, such as the tailbone and spine.
Bedsores can be mild, moderate, or severe. Mild cases can cause skin inflammation and discolouration. The skin may look reddish or bluish. It may also be sensitive to the touch and very itchy. Mild cases respond to treatment very well. If not treated promptly, they are more likely to progress. The skin may become so thin and break open. This can cause a painful wound or deep crater to occur. The wound can affect not just the deeper layers of the skin but the underlying bones and muscles as well. This increases the risk of abscess and infections.
Advanced cases of pressure ulcers are known to be very difficult to cure. They also take a lot of time to heal. Thus, the best approach is to prevent them from occurring. They can be avoided by changing the patient’s position at least every two hours or every 15 minutes if they are sitting in a wheelchair. This relieves pressure and improves blood circulation.
Causes of Condition
Pressure ulcers occur due to prolonged pressure on the skin. They are a common problem in paralysed and comatose patients. Body parts at most risk are those that are in direct contact with a supporting surface, such as a wheelchair or bed.
Bedsores occur when the blood supply to a part of the body is interrupted. Without enough supply of oxygen and nutrients, the skin tissue becomes more prone to damage. The affected skin can also become infected because of an inadequate supply of white blood cells.
Some people are more prone to these ulcers than others. These include those who have diseases that disrupt normal blood flow as well as serious mental disorders. Others who have an increased risk are bedridden elderly patients in long-term care facilities.
Other causes are prolonged contact with urine as well as friction of the skin with adjacent skin or with clothing.
The symptoms depend on the grade or severity of the condition. Grade 1 pressure ulcers are marked by skin discolouration. The skin appears blue or purple in people with darker skin and red in people with lighter skin. Grade 1 is the mildest form. The affected skin is intact and not infected. When left untreated, the ulcer can become a painful blister or an open wound. Stage 2 is marked by skin loss and damage to deeper layers of the skin. Grade 3 pressure ulcers, on the other hand, are marked by damage to underlying tissue. The wound appears like a deep crater. Grade 4 ulcer is the most severe form. It is marked by bone and muscle damage as well as tissue death.
The complications of pressure ulcers can be very serious. These include bone and joint infection. There is also an increased risk for sepsis, amputation, and skin cancer.
Who to See and Types of Treatments Available
Bedsores are diagnosed by visual examination. Healthcare providers specialising in wound care and pressure ulcer management can determine the stage of the condition through a physical exam.
Grade 1 pressure ulcers are cleaned with a gentle cleanser. They are then covered with dressings to prevent infection and promote faster healing. The special dressings used ensure that the surrounding healthy skin is kept dry. They also encourage the growth of new skin cells. Topical preparations, such as ointments and creams, are also used to prevent further tissue damage. They also help relieve itchiness. It is important that the patient’s position is changed frequently. Healthcare providers have to make sure that there is no direct pressure on the existing ulcer until the affected skin is completely healed.
If the skin is broken, doctors will focus on preventing infections from occurring. Antiseptic creams and antibiotics are used to prevent or treat existing infection. Patients are also given medications to relieve pain.
In advanced cases, removing dead tissue is needed to allow the wound to heal. This can be done by using high-pressure water jets or low-frequency energy waves. The dead tissue can also be removed with laser energy or through surgical debridement. If the wound is too big, it is sealed through surgery. It can be closed by bringing together its edges. It can also be closed using tissue taken from another part of the patient’s body. Surgery comes with risks and possible complications because many patients are already in a poor state of health.
Early-stage pressure ulcers respond to treatment very well. In patients without underlying medical conditions, they can heal after a couple of weeks. The outlook is even better if the patient is able to eat a healthy, well-balanced diet because this promotes faster wound healing. The prognosis for more severe cases depends on many factors. These include whether they received timely and appropriate treatment and if they do not have any underlying medical conditions. Peripheral artery disease, diabetes, and malnutrition can make treatment more challenging. If these are not treated or properly managed, the long-term outcome is poor.
Pressure ulcers are known to cause serious complications. As such, the preferred approach is to prevent them from occurring. Patients or their carers are taught how to shift the patient’s weight as often as possible. They are also advised to use specialty cushions or mattresses that can help relieve pressure.
It is important for patients to keep their skin clean and dry all the time. This reduces the risks of pressure ulcers and infections. They must also inspect their skin on a daily basis for early signs of bedsores.
National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. National Pressure Ulcer Advisory Panel. Available at http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury.
Bergstrom N, Bennett MA, Carlson CE, et al. Treatment of Pressure Ulcers. Clinical Practice Guideline Number 14. Agency for Health Care Policy and Research, Public Health Service. Rockville, MD: US Department of Health and Human Services; 1994. AHCPR Publication No. 95-0642.:
Pham B, Teague L, Mahoney J, Goodman L, Paulden M, Poss J, et al. Early prevention of pressure ulcers among elderly patients admitted through emergency departments: a cost-effectiveness analysis. Ann Emerg Med. 2011 Nov. 58(5):468-78.e3.