What is a pressure sore?
A pressure sore, also known as a bedsore or decubitus ulcer, is a type of injury that occurs when constant pressure is applied to a specific area of the body, typically the tailbone or heels. This pressure can reduce blood flow to the area, causing tissue damage and the development of a sore. People who are bedridden or have limited mobility, such as those with severe disabilities or advanced illnesses, are more likely to develop pressure sores. They can be painful and difficult to treat, and if not managed properly, they can lead to serious complications.
"A literature review done in Canada in 2004 found that the overall prevalence of pressure ulcers across all institutions studied was 26 per cent." - Healthcare Excellence Canada
The Four Stages of Pressure Sores
There are four stages of pressure sores, each representing a different level of severity. Here is a more detailed description of each stage:
Stage 1: The pressure sore appears as a red, painful area of skin that does not break open at this stage. The skin may be hot and swollen, as well as stiff or firm to the touch. If the pressure is relieved and the sore is properly treated, this stage is frequently reversible.
Stage 2: The pressure sore has developed into an open wound or sore that has not yet penetrated the underlying tissue at this point. The wound could be shallow and covered by a thin layer of skin, or it could be deeper and visible as a crater-like hole in the skin. At this stage, the sore may produce a small amount of clear or slightly bloody drainage.
Stage 3: The pressure sore has developed into a deep wound that has penetrated the underlying fat or muscle tissue. The wound could be quite large, with a foul-smelling discharge. The wound's edges may be sloping, and some dead tissue may be present.
Stage 4: At this point, the pressure sore has developed into a deep wound that has penetrated the bone. The wound may be large and cause significant swelling, redness, and pain. This is the most serious stage of a pressure sore and can result in severe infection and even death if not treated promptly and properly. The wound may be filled with dead tissue and drain a lot of foul-smelling fluid.
It's important to note that pressure sores can progress quickly from one stage to the next, so if you suspect you or a loved one has a pressure sore, seek medical attention as soon as possible. Early treatment can help prevent the sore from worsening and increase the chances of complete recovery.
What should you do to check for bed sores?
To check for bed sores, follow these steps:
Examine your skin for redness or discoloration: Bed sores frequently begin as red or discoloured patches on the skin. This could be a sign of skin irritation or damage.
Examine the skin for swelling or blistering: Swelling or blistering on the skin may indicate bed sores.
Check for warmth or tenderness in the skin: Bed sores can cause the affected area of skin to feel warm or tender to the touch.
Examine for open wounds or ulcers: Bed sores can progress to open wounds or ulcers in the later stages. These can be painful and have a bad odour.
You must notify your healthcare provider immediately if you notice any of these symptoms. Bed sores can be serious and necessitate immediate treatment to avoid complications and promote healing. Based on the stage and severity of your bed sores, your healthcare provider can recommend the best treatment for you.
"The economic cost of treating a single pressure injury ranges from CAD $26,800 to $231,000 [in 2017] and treating pressure injuries can increase nursing care hours by up to 50%" - Registered Nurses Association of Ontario
How to treat pressure sores?
Pressure sore treatment differs depending on the stage of the sore and the underlying cause. The goal of treatment in general is to relieve pressure on the sore, promote healing, and prevent infection. Some common pressure sore treatments include:
Cleaning the wound: Cleaning the wound to remove any dead tissue or debris is the first step in treating a pressure sore. Typically, a saline solution or mild soap and water are used for this. The wound should be cleaned gently but thoroughly, being careful not to damage the healthy tissue surrounding the sore.
Protecting the wound: Once the wound has been cleaned, it must be protected from further injury. Keeping the wound clean and moist can be accomplished by using a special dressing or wound cover.
Pressure relief: It is critical to relieve pressure on the sore in order to promote healing. This can be accomplished by using special cushions or mattresses designed to distribute weight evenly, or by changing positions on a regular basis to relieve pressure on the affected area.
Pain management: Pressure sores can be extremely painful, especially in the later stages. Pain management is a critical component of treatment and can be accomplished through a combination of medication, physical therapy, and other pain management techniques.
Infection treatment: If the pressure sore becomes infected, antibiotics must be administered. Other treatments, such as debridement (the removal of dead tissue), may be recommended by your doctor to help the wound heal faster.
Surgery may be required in some cases to treat a pressure sore, particularly if the sore is deep or has become severely infected. Your doctor can advise you on the best treatment plan for your particular situation.
How to prevent pressure sores?
There are several steps that can be taken to prevent pressure sores from developing, including:
Maintaining good hygiene: Washing the skin with soap and water on a regular basis, especially in areas prone to pressure sores, can help to keep the skin clean and healthy.
Using a good-quality mattress: A mattress that provides adequate support and evenly distributes the body's weight can aid in the prevention of pressure sores. There are special mattresses designed for this purpose.
Changing positions frequently, at least every two hours, can help to relieve pressure on the skin and prevent the development of sores.
Using cushions and padding to support the body and evenly distribute pressure can help to prevent pressure sores.
Regular exercise can help to improve circulation and promote healthy skin, both of which can help to prevent the development of pressure ulcers.
Keep your skin clean and dry by washing it with soap and water on a regular basis and thoroughly drying it to prevent moisture from accumulating on your skin.
Make use of a pressure-relief mattress or cushion: A pressure-relieving mattress or cushion can assist in evenly distributing your weight and relieving pressure on your skin.
Rubbing or massaging the affected area can cause skin damage and increase your risk of developing bed sores.
Check your skin on a regular basis: Examine your skin for signs of redness, swelling, or blistering and notify your healthcare provider of any changes.
You can help prevent bed sores and maintain the health and comfort of your skin by following these tips. It's important to remember that bedsores can be dangerous, so talk to your doctor if you have any concerns.
"In Canada, approximately 1 in 8 patients in acute care hospitals, 1 in 11 nursing home residents, and 1 in 50 home care clients experience pressure ulcers." - Registered Nurses Association of Ontario
What cushion or mattress should I use if I have a bedsore?
If you have a bed sore, you should use a cushion or mattress to relieve pressure on the affected area. A pressure-relieving cushion or mattress can help to evenly distribute your weight and relieve pressure on your skin. Some examples of pressure-relieving cushions and mattresses are:
Air-filled cushions are made of a flexible, air-filled chamber that can be adjusted to provide the appropriate level of support and pressure relief.
Foam cushions: Made of a soft, supportive foam material, foam cushions can help to distribute your weight evenly and relieve pressure on your skin.
Gel-filled cushions: Gel-filled cushions are made of a gel material that can provide your body with a soft, supportive surface. The gel can help to evenly distribute your weight and relieve pressure on your skin.
Alternating pressure mattresses are designed to relieve pressure on the skin by inflating and deflating different sections of the mattress on a regular basis. This can aid in weight distribution and the prevention of bed sores.
Using a pressure-relieving cushion or mattress (as pictured above) can help prevent the development of bed sores and promote the healing of existing sores.
How can occupational therapists help people with pressure sores?
Occupational therapists can help patients avoid pressure sores by helping them develop and implement a plan to change their position and move around on a regular basis to relieve pressure on their skin. This can include using specialized equipment like pressure-relieving mattresses and cushions, as well as assisting patients with daily activities like bathing and dressing to reduce the risk of developing pressure sores.
Aside from prevention, occupational therapists play an important role in the treatment of pressure ulcers. This can include providing wound care to promote healing and collaborating with patients to develop and implement a plan to prevent the development of new sores. Occupational therapists may also educate patients and their families on how to prevent and manage pressure sores, and they may collaborate with other members of the healthcare team to provide comprehensive care for pressure sore patients.
References:
Best Practice Guideline Implementation to Reduce Hospital-Acquired Pressure Injuries. Registered Nurses Association https://rnao.ca/sites/rnao-ca/files/FINAL_Evidence_Boosters_-_Spring_2017_HAPU_May_25_17_FINAL.pdf
How to Care for Pressure Sores: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/patientinstructions/000740.htm Accessed 15 Dec. 2022.
Maklebust, J., Sieggreen, M. (2000). Pressure Ulcers: Guidelines for Prevention and Management. United Kingdom: Springhouse Corporation.
Pressure Ulcer: Introduction. https://www.healthcareexcellence.ca/en/what-we-do/all-programs/hospital-harm-is-everyones-concern/hospital-harm-improvement-resource/pressure-ulcer-introduction/. Accessed 15 Dec. 2022.
“Pressure Ulcers (Pressure Sores).” Nhs.Uk, 23 Oct. 2017, https://www.nhs.uk/conditions/pressure-sores/.