What is a pressure sore?
Pressure sores, also known as decubitus ulcers, are damage to the skin and subcutaneous tissue caused by prolonged pressure on the local tissues. They can range from localized redness of the skin to deep musculoskeletal holes. Pressure acts on the skin and squeezes the small blood vessels that supply nutrients and oxygen to the skin. If the local skin is deprived of oxygen and nutrients for too long, this leads to tissue necrosis and pressure sore formation. If the red color of the local skin fades after the pressure is removed, the pressure sore is not a pressure sore.
The prevalence of pressure sores ranges from 9% (general patients) to 66% (high-risk patients). The prevalence is 50% for patients who are not admitted to the hospital but are treated at home. Pressure sores are therefore a serious problem that can lead to pain, longer hospital stays, and slower recovery from illness. Thankfully, however, most pressure sores can be prevented, and even those that do occur can be cured. This brochure describes where pressure sores occur; identifies whether you are at high risk for pressure sores; and outlines steps to prevent and protect against the progression of pressure sores.
Pressure Sore Prevalence
Pressure sores often occur on skin and tissue protruding from bones that are under maximum pressure. For patients lying in bed, most pressure sores develop in the caudal sacral area of the back, the trochanter, or the heel. For patients in wheelchairs or chairs, the formation of pressure sores is related to the seating position. Pressure sores can also occur in the knees, ankles, shoulders, scapulae, back of the head, and spine.
Pressure sore staging and treatment.
SubspectedDeepTissueInjury (SDTI): Damage to the subcutaneous soft tissues by pressure or shear forces, where the local skin is intact but may show color changes such as purple or maroon, or blisters that cause congestion. These damaged areas of soft tissue may be painful, hard, with mucoid exudate, moist, warm or cold compared to the surrounding tissue.
Stage I (Stage I): Complete skin at the bony augmentation is accompanied by limited erythema that does not discolor when pressed. The dark skin may not have significant pale changes, but its color may differ from the surrounding tissue.
Recommendations for the management of Stage I pressure ulcers: overall pressure reduction, local protection, Braden scoring and reporting, prevention of pressure ulcers in other areas, dynamic observation of the effect, and adjustment of measures according to the results (overall intervention + early warning + zero defects).
Stage II (Stage II): partial absence of the dermis, manifesting as a shallow open ulcer with a pink wound bed (trabeculae), without putrefied flesh, which may also manifest as an intact or ruptured serous blister.
Recommendations for the management of Stage II pressure ulcers: Braden scoring and reporting, identification of high-risk factors and factors affecting healing, pressure-reducing measures and shift handover, saline wound cleaning, iodophor disinfection of surrounding skin, and selection of red wounds with foam dressings/hydrocolloid dressings
Stage III (Stage III): full skin tissue loss, visible exposure of subcutaneous fat, but bones, tendons, and muscles are not exposed, and rotting flesh is present, but the depth of tissue loss is unclear and may contain subterranean and tunneling.
Recommendations for management of Stage III pressure ulcers: Braden scoring and reporting, identification of high-risk factors and factors affecting healing, decompression measures and shift handover, professional treatment of the wound, assessment of measurements, debridement: combination of autolysis and CSWD, selection of dressing according to the amount of exudate and wound color, and dynamic adjustment until healing.
Stage IV (Stage IV): Total tissue loss with exposed bone, tendon or muscle, with rotting flesh or scorched crust in some parts of the wound bed, often with subterranean or tunneling.
Recommendations for the management of Stage IV pressure ulcers: assessment of measurements: area, depth, amount of exudate, color, odor, selection of cleaning solution and method, selection of debridement method: autolytic debridement, CSWD, combined debridement, selection of dressing and proper use, evaluation of adjustment, monitoring of nutritional indicators, improvement of nutrition, preparation of wound bed, and referral to surgery if necessary.
Unspecified staging Unstageable: total tissue loss with carrion covering the base of the ulcer (yellow, yellow-brown, gray, green, or brown), or scorched crust attachment to the wound bed (carbon, brown, or black). Only if enough of the carrion or scorched crust is removed to expose the base of the wound bed can the true depth of the pressure ulcer be accurately assessed and the staging determined. Stable scoria (dry, tightly adherent, intact but without a sense of redness or fluctuation) at the heel can serve as the body’s natural (biological) cover without being removed
Finding your risk factors
Pressure sores are caused by: 1) pressure; 2) shear; 3) friction; and 4) moisture.
Therefore confinement to a bed or chair, immobility, incontinence, poor nutrition, or unconsciousness can all increase your risk of developing pressure sores. The level of risk depends on the number and severity of your risk factors. If you have any of the following conditions, please pay attention to pressure sore prevention
1. Bed-bound or wheelchair-bound: If you have to lie in bed or sit in a chair or wheelchair, you are at high risk of developing pressure sores.
2. Inability to move: If you cannot change your position on your own without help, you are at the greatest risk. Those patients who are in a coma, paralyzed or have a broken hip are at high risk. If you can move on your own, the risk of pressure sores is much lower.
3. Incontinence: If your skin is constantly impregnated with urine, feces or sweat. These factors that cause moisture can irritate your skin. This puts you at a higher risk of developing pressure sores.
4. Poor nutrition: If you are not eating a balanced diet, your skin may be undernourished. Pressure sores are more likely to occur if your skin is not healthy.
5. Decreased awareness: When awareness decreases, individuals are unable to move effectively to prevent pressure sores.
Following the steps in this health education can help you reduce the risk of pressure sores and prevent them from occurring.
For pressure sore prevention.
1. Caring for your skin
(1) Observation: Have your skin observed by yourself or a caregiver at least once a day. This is especially true for areas that are no longer under localized pressure, but where the skin is still red. You yourself can use a mirror to observe those locations that are not easily visible. Give special attention to the marked spots shown on the picture.
(2) Keep the skin dry and clean: When the skin is impregnated with sweat, urine or stool, etc., wash it immediately. Use a sponge or a soft cloth to clean the skin to minimize damage to the skin. If wet conditions cannot be effectively controlled, diaper pads can quickly allow urine to be absorbed, thus providing a dry environment. Emollient lotions or oils can prevent the skin from coming into contact with urine, feces, or wound drainage fluid.
(3) Clean skin: Bathing will keep you comfortable and clean. Use warm water (40 degrees Celsius) and mild soap (avoid alkaline soap) for bathing. If daily bathing is required, use moisturizer to prevent dry skin.
(4) Prevent excessive dryness of the skin: Use skin moisturizer or emollient oil. Avoid cold or excessively dry air to irritate the skin.
(5) Prevent damage to the skin.
Avoid massaging the bony prominence of the torso. Massage can squeeze the subcutaneous tissue and cause damage, making you more likely to develop pressure sores. If you are lying in bed, you need to change positions at least every hour to reduce pressure on the bony prominence. If you are in a wheelchair, you will need to change positions every hour. (If you have the strength to move your body, elevate and move your body every 15 minutes while you are sitting.) See (Figures 6 and 7)
To prevent friction, care needs to be taken to completely lift the body empty when repositioning, without dragging or pulling. Friction can remove the surface skin and damage the blood vessels under the skin. An overhead hanger can be used to assist in lifting the body. (See Figure 8.) The nurse or someone else can use a sheet to lift you up. Skin protection films can be used to reduce injury from friction.
Avoid the use of ring-like air loops. This is because ring-shaped pads can reduce the blood supply to the surrounding tissues and cause pressure sores due to tissue swelling.
2. Precautions for bedridden patients.
(1) Observe the skin at least once a day
(2) Bathe when needed to keep comfortable and clean
(3) Prevent the skin from drying out too much
(4) Avoid using ring pads
(5) Participate in rehabilitation programs
(6) Reduce friction, lift the air when placing the body position not to drag or tug the local use of cornstarch (no talcum powder)
(7) Change position at least every 2 hours: use pillows or a chevron pad to keep the knee and ankle joints from touching each other. When lying in the lateral position, avoid lying directly on the point of the femoral trochanter. Whenever possible, choose a position that distributes weight and pressure more evenly, or use pillows to position yourself. If you are completely incapacitated you can place a pillow under your calf to keep your heels elevated in the air, do not place the pillow under the N fossa.
(8) Special pads containing foam, air, gel or water: These mattresses can help you prevent pressure sores (see Figure 9) You can consult a specialist to choose the best mattress for you.
(9) Moderate elevation of the head of the bed for as short a time as necessary: If there are no other contraindications, the head of the bed should not be raised too high because when the head of the bed is raised more than 30 degrees, it makes it easier for you to slide off the bed, damaging the skin and small blood vessels in the process and thus developing bed sores.
3. Precautions for patients in wheelchairs or chairs.
(1)-(6) Same as “Precautions for bedridden patients”.
(7) Change position every hour: Patients who cannot change their position on their own should be repositioned every hour, and patients in chairs who can lift themselves up should be lifted up every 15 minutes. It is also important to maintain good sitting posture and to keep a comfortable seat.
(8) Foam, gel or air cushions can be used to reduce pressure. Consult a professional to select the appropriate cushion. Avoid using ring-shaped cushions (such as air washers or tires) because they can reduce the peripheral blood supply and cause tissue swelling, increasing the risk of pressure sores.
4. Precautions for patients with urinary and fecal incontinence.
(1) Clean the skin as soon as possible once there is maceration
(2) Assess and treat urine leakage
(3) If wetness cannot be controlled
(4) Use absorbent pads for early absorption to dry the surface layer
(5) Use skin moisturizer or skin protection film to protect the skin
5. Precautions for patients with impaired consciousness.
Patient precautions should be developed according to the patient’s specific situation. For example, if the patient is incontinent, care should be provided according to the key points of “Precautions for Patients with Incontinence”.
Nutritional Enhancement.
(1) We all need a balanced diet. A balanced diet includes eating adequate amounts of carbohydrates (e.g., rice, noodles, etc.), proteins (e.g., meat, milk, eggs, etc.), fats (e.g., oils), and vitamins (e.g., various vegetables) every day. To promote the recovery of the organism and maintain the health of our skin. Healthy skin has a stronger ability to fight against harmful factors.
(2) If you can’t go on a regular diet, talk to your doctor about using nutritional supplements.
6. Promote your ability to move
Rehabilitation programs can help some people regain mobility and independence, and our rehabilitation physical therapy department can provide you with various rehabilitation treatment programs.
7.Actively participate in your care
This health education tells you how to reduce your risk of getting pressure sores. It is not necessary to use all preventive measures when preventing pressure sores in people at high risk. The best measure should be to choose the preventive measures you need based on your individual condition.