Pressure sores

Pressure sores, sometimes referred to as bed sores or decubitus ulcers, are sores that develop as a result of continuous pressure on one area of the body for some time. The sore develops because of pressure on the capillaries, cutting off the blood flow to that area. It takes two hours for a pressure sore to develop on an elderly person. The risk is greater with a person who is always in bed or sitting in a chair (“chair-bound”) or very inactive and is increased with an elderly person.  Their skin is thin and has little fat to protect the tissues underneath it. It is therefore very important to ensure that you check the person for signs of a pressure sore developing every time you wash or dress them. The first sign of a pressure sore is a red patch on the skin that does not go away after a few hours.

Causes and prevention of pressure sores:

The causes of pressure sores are pressure, scraping the skin (known as shearing), friction and moisture. The best way to prevent the sores is to get rid of the causes.

This is a diagram showing the most common areas where pressure sores develop. Note that they are the areas that come into contact with the bed or chair. The bony areas such as the shoulders, shoulder blades, hips and ankles and over the sacrum are more likely to develop sores.

              upper arm     elbow      hip       thigh     lower leg    heel

Adapted from “Wound Care Education” manual, 2003. Johnson & Johnson, RSA

Shearing happens when the person is dragged up the bed instead of being lifted up.  Make sure that you do lift the person.  Two people should always lift together.  This prevents the friction and the shearing and also prevents injury to you.  Refer to the section on ‘mMoving and lifting’.

F r i c t i o n

Forward-backward friction

Adapted from “Wound Care Education” manual, 2003. Johnson & Johnson, RSA

Prevent the person from slipping down the bed by using a bolster (a pillow rolled up in a sheet and placed at the person’s feet, with the ends of the sheet tucked under the mattress). Do not raise the head of the bed more than 30° unless required.

Creases in the bed linen and seams on the clothing can also cause pressure. Check to make sure that the sheets are pulled straight.  If the seams of the clothing are rough, put the clothes on inside out.

The person should be encouraged to get up during the day and to move around as much as possible, with or without help. If the person is chair-bound, encourage them to change their position in the chair, to relieve the pressure on one area. Rocking from side to side, or standing up holding the arms of a chair, are ways in which pressure sores can be prevented.  Changing the person’s position should be done as often as possible.

Moisture makes the skin “spongy”, increasing the risk of sores. Moisture can be due to incontinence, not being dried properly after washing, being too hot and sweating, or from having liquids spilt in the bed. Ensure that the person is never left in a wet bed or wet clothes. When drying the skin, pat it; do not rub, for the underlying tissue will be damaged if rubbed too hard, resulting in a pressure sore. Make sure that the person is dried in the folds of skin.  If the skin is dry and flaky, apply a lotion such as Ebes or Elizabeth Anne’s, or aqueous cream.

Avoid tucking the bedlinen in too tightly around the feet or the person. S/he must be able to move freely in the bed.

There are things that can be used to help prevent pressure sores and these include sheepskins for the person to sit/lie on, “egg box” mattresses“, “Tempur” mattresses, pillows or rings made out of a pressure-relieving material originally developed by NASA for the US Space Programme.

Try to encourage the person to eat a balanced diet as good nutrition means the skin will be healthier, decreasing the risk of sores developing.

Exercise will improve the circulation.

Stages and treatment of a pressure sore

Stage 1: the skin is intact but is red. The redness does not go away.  Do not rub or massage the area as the rubbing causes further damage to the tissue under the skin. Place a transparent film dressing (looks like “Glad Wrap”) on it to protect the skin from direct contact with any form of friction and to prevent the skin from drying and cracking. Do ensure that you remove the dressing correctly by loosening the ends and then pulling both ends at the same time, thus stretching the dressing.

Stage 2: the skin has now broken, with the pressure sore deeper, extending into the skin. Place a hydropolymer dressing on it (e.g. ‘Tielle Lite’ by Johnson & Johnson). This dressing may be left in place for seven days.

Stage 3: the ulcer is now through the skin and into the fat. Place a more absorbent hydropolymer dressing on it (e.g. ‘Tielle’ by Johnson & Johnson). This dressing may be left in place for seven days.

Stage 4: the ulcer is now deep and involves the muscle and the bone. It is advisable that professional advice be obtained as there is a high risk of infection spreading throughout the person’s body and the type of dressing required will depend on the how bad the ulcer is and what else is involved.

Reference:  “Wound Care Education”, 2003. Johnson and Johnson, Midrand, South Africa