Bedsores or decubitis is defined as any form of tissue death caused by the action on the body of pressure, shearing and friction forces or a combination thereof. People who have to lie down a lot, for example because they are bedridden, or have to sit a lot, for example because they are confined to a wheelchair, can especially suffer from bedsores. Preventing pressure sores is crucial for maintaining comfort and quality of life. Caring for bedsores or decubitus consists of a number of measures, such as removing dead tissue and activating tissue repair through special wound care. Fast and adequate treatment is essential for proper healing of pressure ulcers. Complications of bedsores or pressure ulcers include bone and joint infection, inflammation of mainly loose connective tissue, and rapidly spreading bacterial skin infection and blood poisoning.
- Synonyms for pressure sores
- What is bedsores?
- Medical term and explanation
- Definition
- Preventing pressure ulcers: especially in the elderly
- Pressure sores cause
- Preferred places
- Are bedsores contagious?
- Risk factors
- Overview
- Prolonged immobility
- Decreased sensation
- Altered level of consciousness
- Shift
- Friction
- Humidity
- Incontinence
- Poor nutrition
- Age
- Pressure ulcer symptoms
- Stages of pressure ulcers
- Consequences and complications
- Examination and diagnosis
- Treating bedsores
- Preventive measures: prevent pressure sores
- Wound treatment: treating pressure sores
- Cure pressure ulcers
- Forecast of bedsores
- Prevention of bedsores
- Tips for sitting or lying down differently
- Skin care tips
Synonyms for pressure sores
There are several synonyms for the term pressure sores:
- bed sores;
- bed sores;
- pressure ulcers;
- bedsores;
- bedsores;
- pressure pain;
- pressure points;
- pressure sores; and
- pressure sores.
What is bedsores?
Medical term and explanation
Patients who have to lie down a lot (for example because they are bedridden) or sit a lot (in a wheelchair) may at some point suffer from bedsores, especially if they have difficulty changing their position themselves. The skin pinches in the areas where the body rests and persistent pressure can cause red spots, blisters and wounds. The medical term for this is ‘ decubitus ‘.
Definition
The definition of bedsores or decubitis is:
Any form of tissue death caused by the action on the body of pressure, shearing and friction forces or a combination thereof.
Preventing pressure ulcers: especially in the elderly
In the general population, pressure ulcers or bedsores mainly occur in the elderly aged 65 years and older, and especially in people over 75 years of age. In general practice, 0.4% of patients present with pressure ulcer complaints every year. In hospitals the prevalence is 9.6% per year and in the chronic care sector 6.1% per year.
Pressure sores cause
Bedsores or decubitus are caused by the action of pressure, shearing and friction forces on the body. Sustained pressure and/or shearing forces on the skin cause damage to the skin and/or the tissue under the skin. It often occurs at the site of a protruding bone.
Risk areas for pressure ulcers / Source: BruceBlaus, Wikimedia Commons (CC BY-SA-4.0)
Preferred places
Risk areas for bedsores or decubitus are:
- the rump;
- sitting tuberosities;
- heels;
- elbows;
- shoulders;
- Hips;
- back of head.
Are bedsores contagious?
Bedsores or decubitus are not contagious. This could be a secondary bacterial infection.
Risk factors
Overview
There are a number of factors that increase the risk of developing bedsores or pressure ulcers:
- inactivity;
- immobility;
- moist skin (for example due to incontinence or sweating);
- disturbances in blood circulation or in the sensory senses, where pain stimuli are felt less well;
- a higher age; and
- poor nutritional status (insufficient food and drink);
- in poorer health (in diseases such as diabetes, heart failure or COPD, Alzheimer’s disease, cardiovascular disease, hip fracture and hip surgery, deep vein thrombosis, paralysis of the limbs, edema in the legs, malignancy, Parkinson’s disease, rheumatoid arthritis and urinary tract infections).
Prolonged immobility
People at greatest risk of developing bed sores or pressure ulcers are those who do not exercise. Once a person loses the ability to move and becomes inactive, the risk of developing pressure sores increases.
Decreased sensation
Patients who have loss of sensation due to spinal cord injury or neurological disorders are at increased risk of developing pressure ulcers or pressure sores. A person without sensory loss may feel pain and will generally feel uncomfortable after spending a lot of time in a particular position. When sensory loss occurs, a person may not feel discomfort or the need to be moved.
Altered level of consciousness
Likewise, a person with an altered level of consciousness may not experience discomfort or be lucid enough to physically reposition themselves.
Shift
The rubbing of skin and fatty tissue over the bones can be caused by the combination of gravity and friction. Shearing forces usually occur when a patient is in a more elevated position. The person’s skeleton can slide down the bed, while the skin and fatty tissue remain in place. This type of force causes damage to the underlying blood vessels, resulting in ulcers with a large area of internal tissue damage and less noticeable damage to the surface of the skin.
Friction
Friction occurs when two surfaces move over each other. This can happen when a patient slides down in bed or is placed in bed incorrectly.
Humidity
Moisture is a common problem in people who have become incontinent and have to wear diapers. Moisture from sweating can also be a problem. Moisture removes fatty substances from the skin that protect the skin and soften the skin’s connective tissues, making the effects of sliding and friction more damaging.
Incontinence
Fecal incontinence and urinary incontinence makes the skin moist and can cause softening of the skin. Fecal incontinence has the added risk of damage to the skin from bacteria and enzymes in the stool and also increases the risk of infection.
Poor nutrition
Poor nutrition can lead to weight loss, which can increase pressure on bony parts of the body. Good nutrition is also important for the healing of pressure ulcers.
Age
As a person ages, the skin becomes thinner and more fragile, increasing the risk of skin breakdown. Pressure ulcers mainly occur in elderly people aged 75 and over.
Pressure ulcer symptoms
Symptoms of bedsores include:
- Unusual changes in skin color or texture;
- Swelling;
- Pus-like discharge;
- An area of the skin that feels cooler or warmer than other areas;
- Sensitive areas.
Stages of pressure ulcers
Pressure sores can be divided into a number of phases or stages based on their depth, severity and other characteristics. The degree of skin and tissue damage varies from red, intact skin to a deep injury involving muscle and bone. Four stages are distinguished in bedsores or pressure ulcers:
|
Stage |
Phenomena |
|
Grade 1 |
Non-blanchable redness, where the skin is otherwise completely intact. This sometimes also causes discoloration of the skin, with heat, edema and hardening. |
|
Grade 2 |
Superficial skin defect such as a blister or excoriation of the epidermis and sometimes also of the layer underneath (dermis). |
|
Grade 3 |
Deeper skin defect with damage or necrosis (death of tissue) of the skin and subcutaneous tissue. The damage can extend to the underlying connective tissue. |
|
Grade 4 |
Extensive tissue damage or necrosis to muscle, bone or supporting tissues. This can also be done while the epidermis and dermis are still intact. |
Consequences and complications
Bedsores can have serious consequences. Complications that can occur mainly concern infections:
- Abscess formation under or adjacent to the pressure ulcer;
- Arthritis: joint inflammation in a deep pressure ulcer;
- Cellulitis: inflammation of mainly loose connective tissue;
- Erysipelas: a rapidly spreading bacterial skin infection;
- Osteomyelitis: inflammation of underlying bone tissue;
- Sepsis or blood poisoning.
For all complications: notify a doctor immediately.
Examination and diagnosis
The doctor can refer you to a wound care team, consisting of doctors, specialists and nurses who have experience in treating pressure sores. The team can assess the pressure ulcer based on several factors. These are:
- the size and depth of the spots;
- the type of tissue affected, such as skin, muscle or bone;
- the color of the skin that is affected
- the amount of tissue death that occurs;
- the possible presence of an infection, foul odor and bleeding.
The doctor may take samples of the fluids and affected tissue. Additionally, they can look for signs of bacterial growth and cancer.
Treating bedsores
Treatment of bedsores or decubitus consists of two parts or pillars:
- precautionary actions; and
- wound treatment.
Preventive measures: prevent pressure sores
You can prevent bedsores or decubitus by taking a number of measures. Change your position or position for 24 hours a day, keeping the wound exposed as much as possible. Ideally, the patient should be turned to a different side of the body after every 4 hours. This prevents someone from lying on one side for too long. The optimal posture is achieved by raising the head end and foot end 30° (= semi-Fowler). The pressure distribution is greatest this way. When lying on the side, the patient does not rise more than 30° in relation to the mattress with the side up. The patient can be supported with pillows in the back and under the arm and the buttock seam does not rest on the mattress. It is best to bend the legs slightly with a pillow between the knees. The optimal sitting position is in a chair that can tilt backwards, with the legs resting on a bench. In a chair that cannot tilt, the patient should sit as upright as possible, with the feet on the floor and the thighs resting on the seat. The heels must be free in both the lying and sitting position. You can use a pillow that you place under the lower leg, which fully supports the leg. When sitting, a change in posture can best be achieved by tilting the chair a little more or a little less. It is also wise to stand or walk for a while. You can also take 1 to 2 hours of bed rest in the afternoon.
Anti-decubitus cushion / Source: –Xocolatl 14:44, 26 July 2007 (UTC), Wikimedia Commons (Public domain)
Also use prevention materials, such as specific anti-decubitus mattresses and cushions. A special mattress can reduce the pressure. Furthermore, make sure you have a smooth underlay. Creases in the sheet or a nightgown that is not completely smooth can contribute to redness and subsequent pressure sores. Ensure a good nutritional status, because poor nutritional status and reduced or complete absence of food intake promote the development of pressure sores. Pay extra attention to incontinence or sweating, as moisture can contribute to the problem. Finally, pain relief may be necessary. Firstly, this should focus as much as possible on controlling the cause of the pain:
- by covering the wounds;
- through the adjustment of supporting materials; and
- by changing attitude.
If necessary, painkillers can provide a solution.
Wound treatment: treating pressure sores
For healing of wounds of the first and second degree, it is generally sufficient to apply preventive measures consistently and strictly. There are three general principles for third and fourth degree wounds:
- Use the correct bandage:
- where the bandage keeps the edges dry while the wound remains moist;
- where you do not have to change too often and where the change is quick;
- There is a special pre-formed bandage for the area around your butt;
- In particular, do not use bandages that harden, as this promotes pressure ulcers.
- Remove necrosis (which must be done by a qualified person) so that a potential source of infection is removed. Moreover, this improves wound healing.
- Fight serious infection to prevent complications.
Treating grade 3 and 4 wounds requires a lot of time, patience and skill. However, pressure sores of grade 3 and 4 can be cured, although many patients are left with a permanent painful and/or vulnerable spot.
Cure pressure ulcers
Stage II pressure ulcers heal within one to six weeks, but stage 3 or 4 pressure ulcers often take several months to heal or fail to heal, especially in patients with ongoing health problems.
Forecast of bedsores
Pressure ulcers often heal slowly due to permanent adverse factors such as pressure or poor nutrition. It can spread to deep tissues and also cause local infection, including osteomyelitis and systemic infection. The presence of pressure ulcers or pressure ulcers is associated with a twofold to fourfold increased risk of death, but this is because pressure ulcers are a marker for the underlying severity of the disease and other comorbidities.
Exercise or exercise daily / Source: Oskylafon, Wikimedia Commons (CC BY-SA-3.0)
Prevention of bedsores
You can help prevent bedsores by moving regularly to avoid persistent pressure on the skin. Other strategies include taking good care of your skin, good nutrition and fluid intake, quitting smoking, stress management and exercising or exercising daily.
Tips for sitting or lying down differently
The following tips can help with this:
- Shift your weight regularly. If you use a wheelchair, try to shift your weight every 15 minutes. Ask for help to reposition about once an hour.
- Lift yourself up, if possible. If you have enough upper body strength, do push-ups in your wheelchair by lifting yourself onto the armrests of the chair.
- Choose a special wheelchair. Some wheelchairs can be tilted to relieve pressure.
- Use an anti-decubitus wheelchair cushion.
- Choose pillows or a mattress that relieves pressure. Use pillows or a special mattress to relieve pressure and ensure your body is properly positioned.
- Adjust the height of your bed. If your bed can be raised at the head end, don’t raise it more than 30 degrees. This helps prevent shearing.
Skin care tips
Consider the following skin care suggestions:
- Keep the skin clean and dry. Wash the skin with a gentle cleanser and pat dry. Perform this cleansing routine regularly to limit skin exposure to moisture, urine and feces.
- Protect the skin. Simply use talcum powder to protect the skin at friction points. Apply lotion to dry skin. Change bedding and clothing regularly if necessary. Watch out for buttons on clothing and folds in bedding that irritate the skin.
- Inspect the skin daily. Examine the skin carefully every day for warning signs of pressure sores and pressure ulcers.
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