Pressure Ulcers – A Summary Guide

Bedsores, also called pressure sores or decubitus ulcers, are areas of damage to the skin and underlying tissue ultimately resulting in lesion and ulceration. They most commonly occur over bony areas or prominences in the body such as under the ischial tuberosities (buttocks) or on the shoulders, hips or heels. Pressure sores can be difficult to treat, extremely painful and even life threatening in extreme cases.

The main causes of pressure ulcers include:

• pressure: skin and tissue directly compressed between the bone and a solid surface
  such as a chair.
• friction: occurring when skin rubs against a surface, for example heels
  rubbing against a bed.
• shear: occurring when skin and tissue are pulled in opposing directions, for
  example when a person slips down or is dragged along a bed.

RISK FACTORS
The following factors can significantly increase a person’s risk of developing pressure ulcers:

Impaired mobility
People with decreased mobility often have difficulty moving to relieve pressure. They may be unable to reposition themselves in a chair, increasing pressure over prolonged periods of time, or may slump, causing a shearing effect.
Neurological / sensory impairment
People with sensory impairment may not feel the discomfort of pressure building and therefore not reposition themselves accordingly.

Temperature / humidity
Sweating adds to the risk of skin breakdown as does extreme changes in temperature.
Decreased nutrition and circulation
People with low body fat may have little padding in high risk areas.
People with high body fat have increased padding, but this tissue is poorly vascularised making the person more vulnerable to shear forces. Good nutrition & hydration are essential when attempting to maintain healthy skin.

Incontinence
Bladder and/or bowel incontinence increases dampness in high risk areas, making the skin more likely to lesion.
Body fluids also contain substances that cause skin to deteriorate more quickly and can increase the risk of infection in open sores.

REDUCING THE RISK OF PRESSURE ULCERS
Good pressure care should be viewed as a holistic issue and practised across all activities of daily living. Correct pressure care equipment is an important component of any planned prevention programme, but should not be recommended in isolation

A prevention programme for people at risk of pressure ulcers may include some or all of the following:

Appropriate seating / equipment
It is important that any equipment provided, such as seating or beds, give good support to all areas of the body – spreading load evenly.

Relieving pressure from areas at risk
Pressure should be relieved from the body at regular internals – especially over bony prominences or areas of concern.
It is important to allow time for blood to flow normally to pressure areas so that skin cell oxygen levels can be restored. If a person cannot change positions independently, they will need to be assisted by a carer. People at risk of sores should be regularly repositioned throughout the day.

Appropriate manual handling techniques
To reduce the effect of friction and shear on the skin, appropriate manual handling
techniques and equipment need to be used. Slide sheets and hoists can be
useful to reduce shear when transferring or repositioning although a thorough risk assessment should be completed.

Using pressure relief equipment
Pressure relief equipment may include mattresses, cushions, bed cradles and joint
protectors. Some products may have a pressure relief rating to assist health
professionals choose the correct products for their client. These
ratings have been provided by the product’s suppliers, and are intended as a
guide only. A full assessment by an appropriate health professional in conjunction with product suppliers as required is strongly advised.

For more information on how an occupational therapist could help you avoid pressure sores then please visit www.inclusion.me.uk We can also provide a range of disability consultation services such as free advice around the disability discrimination act. Inclusion, 64 Norman Road, Tunbridge Wells, Kent. TN1 2RP. 07812034533. www.inclusion.me.uk.