Pressure sores or decubitus ulcers are the result of a constant deficiency of blood to the tissues over a bony area such as a heel which may have been in contact with a bed or a splint over an extended period of time. The surface of the skin can ulcerate which may become infected.
Common pressure points on the body include the sacrum, hip bone areas, and the ankle and heel. Less common sites include the elbows, spine, ribs, and back of the head.
Pressure sores may also result from friction caused by your skin rubbing against another surface, or when two layers of skin slide on each other, moving in opposite directions and causing damage to the underlying tissue. This may happen if you are transferred from a bed to a stretcher, or if you slide down in a bed or chair.
Pressure sores are more likely to develop persons who are at higher risk due to one or more risk factors. Once a person is identified as being at increased risk for pressure sores, measures should be undertaken to reduce or eliminate those risks.
Confinement to bed, chair, or wheelchair. Persons confined to beds, chairs, or wheelchairs who are unable to move themselves, can develop pressure-induced injuries in as little as 1-2 hours if the pressure is not relieved;
Inability to change positions without help. (Eg, an individual in a coma, who is paralyzed, or recovering from a hip fracture or other mobility limitation.)
Loss of bowel or bladder control. Sources of moisture on the skin from urine, stool, or perspiration can irritate the skin.
Poor hygiene , not washing regularly or drying properly
Poor nutrition and/or dehydration. Bed sores are more likely to form when the skin is not properly nourished.
Friction and shearing can occur when a patient or resident is pulled up in bed or in the chair. These forces can make the skin irritated. They can cause the skin to break and develop a pressure ulcer.
Identifying individuals at high risk for pressure ulcers. Ensuring that immobile patients change their position at least every two hours to relieve pressure. Using items that can help reduce pressure caused by bed sheets and wheelchairs [ (e.g., low air-loss mattress system, Slidesheets, pillows, cushions, foam padding ). Making sure patients eat healthy, well-balanced meals. Encouraging daily exercise, including range-of-motion exercises for immobile patients. Following good skin care, including inspecting the skin every day and keeping skin clean and dry. Incontinent people need to take extra steps to limit areas of moisture.
Skin should be observed in good lighting and any areas of discoloration or redness should be reported. Areas with lack of sensation, areas of pain and fragile skin should be inspected.
RCN have guidelines on pressure area prevention. NICE also have guidelines.
Manual handling policy