What to do to prevent bed sores and pressure ulcers?

According to the Cleveland Clinic, an estimated 2.5 million Americans develop pressure injuries, or bed sores, each year. Knowing exactly what to do to prevent bed sores is crucial for individuals with limited mobility and their caregivers, as these painful ulcers can lead to serious health complications if left unchecked.

Quick Summary

Frequent repositioning, meticulous skin care, proper nutrition and hydration, and the use of specialized pressure-relieving equipment are all essential strategies for preventing bed sores. Caregivers must also be diligent in daily skin inspections and managing chronic health conditions that increase risk.

Key Points

• Frequent Repositioning: Change a person's position regularly, every two hours in bed and every 15-20 minutes in a chair, to relieve pressure on vulnerable areas.

• Daily Skin Inspections: Conduct thorough daily skin checks for redness, discoloration, or warmth, especially over bony prominences, to catch early warning signs.

• Meticulous Skin Hygiene: Keep the skin clean and dry, particularly after incontinence, using a pH-balanced cleanser and moisture barrier creams.

• Optimize Nutrition and Hydration: Ensure a balanced diet rich in protein and adequate fluid intake to maintain skin integrity and promote healing.

• Utilize Pressure-Relieving Equipment: Use special mattresses, cushions, and other aids to distribute weight evenly and prevent sustained pressure.

Understanding Bed Sores and Risk Factors

Bed sores, also known as pressure ulcers, are localized injuries to the skin and underlying tissue, most often over a bony prominence. They occur when prolonged pressure restricts blood flow to the area, causing the tissue to break down. For many people, unconscious or conscious shifts in position prevent this from happening. However, individuals with limited mobility due to age, poor health, paralysis, or other conditions are at a significantly higher risk. Several factors increase the likelihood of developing these ulcers:

• Immobility: The primary risk factor, as the inability to frequently change position allows sustained pressure on certain body parts.
• Incontinence: Exposure to moisture from urine and stool can make skin vulnerable and lead to breakdown.
• Lack of Sensory Perception: Conditions that cause a loss of sensation, such as spinal cord injuries, prevent a person from feeling the discomfort that signals a need to move.
• Poor Nutrition and Hydration: Insufficient intake of protein, calories, vitamins, minerals, and fluids can compromise skin integrity and the body's ability to heal.
• Medical Conditions: Health issues that affect blood flow, like diabetes and vascular disease, can raise the risk of tissue damage.

Repositioning: The First Line of Defense

Regular repositioning is the single most effective way to prevent pressure ulcers. This action relieves pressure on vulnerable areas and restores blood flow, which is vital for skin health.

Repositioning in bed

1. For those confined to a bed, repositioning should occur at least every two hours. A turning schedule can help caregivers remember.
2. Use pillows, foam wedges, or other support surfaces to lift bony prominences, such as heels and ankles, completely off the mattress. Never place pillows directly behind the knees, as this can impede circulation.
3. When a person lies on their side, a 30-degree tilt can reduce pressure on the hips and sacrum.
4. Elevate the head of the bed as little as possible and for the shortest amount of time. Raising it more than 30 degrees can cause the patient to slide down, creating friction and shearing forces that damage the skin.

Repositioning in a chair or wheelchair

1. Individuals in a wheelchair should shift their weight or be repositioned at least every hour, and even more frequently (every 15-20 minutes) if possible.
2. Encourage wheelchair pushups, where the person uses their arms to lift their body off the seat.
3. Consider a specialized wheelchair that allows for tilting to relieve pressure.

Proper Skin Care and Hygiene

Maintaining skin integrity is fundamental to preventing bed sores. Good hygiene practices help keep the skin clean, dry, and resilient.

Key skin care practices

• Daily Inspection: Examine the skin daily, especially over bony areas like the hips, tailbone, shoulders, elbows, and heels. Look for redness, discoloration, warmth, or tenderness, which are early warning signs of pressure damage. Use a hand mirror for hard-to-see areas.
• Clean and Dry: Keep skin clean and dry, especially after episodes of incontinence. Use a pH-balanced cleanser and pat the skin gently with a towel; avoid rubbing, which can cause friction.
• Moisture Management: Apply moisture barrier creams to protect skin from prolonged exposure to urine and stool. Use absorbent pads or briefs that wick moisture away from the skin.
• Avoid Friction: When repositioning, use lifting sheets or devices instead of dragging the person across the bed. This prevents the shearing forces that can damage delicate skin.
• Smooth Surfaces: Ensure bed sheets are clean, dry, and wrinkle-free, as wrinkles can create pressure points. Avoid clothing with thick seams, zippers, or buttons that press against the skin.

The Role of Nutrition and Hydration

Healthy skin is less prone to damage and better equipped to heal. Proper nutrition and hydration are non-negotiable for anyone at risk of developing bed sores.

• Adequate Protein Intake: Protein is crucial for tissue repair and growth. A balanced diet should include protein-rich foods like lean meats, fish, eggs, and legumes. A healthcare provider or dietitian can recommend appropriate intake levels.
• Stay Hydrated: Drinking enough water and other fluids keeps skin elastic and resilient. Dehydration can lead to dry, brittle skin that is more vulnerable to injury.
• Balanced Diet: Ensure a well-balanced diet with adequate calories, vitamins, and minerals to support overall skin health and immune function.

Pressure-Relieving Equipment

Using specialized equipment can significantly reduce the risk of bed sores by redistributing pressure away from vulnerable areas.

Comparison of pressure-relieving surfaces

Equipment Type	How It Works	Best For	What to Avoid
Alternating Air Mattress	Features connected air cells that inflate and deflate cyclically, constantly shifting pressure points.	Individuals at high risk or with existing sores.	Relying solely on the automated cycle without manual repositioning.
Gel/Foam Cushions	Conform to the body's shape to provide support and evenly distribute weight.	Patients in wheelchairs or those sitting for extended periods.	Using donut-shaped cushions, which can concentrate pressure and restrict blood flow.
Heel Protectors	Elevate heels off the bed or surface to eliminate pressure on the ankle and heel bone.	Immobile patients, particularly those lying flat for long periods.	Tight-fitting devices that cut off circulation.
Support Wedges	Position the body at a supportive angle (like a 30-degree tilt) to relieve pressure on the tailbone and hips.	Bedridden patients who are being repositioned regularly.	Forgetting to reposition and check the skin after use.

Conclusion

Preventing bed sores requires a multi-faceted and proactive approach involving frequent repositioning, impeccable skin care, and adequate nutrition. Caregivers play a pivotal role in daily monitoring and risk assessment, ensuring early intervention for any warning signs. By consistently implementing these strategies, it is possible to reduce the risk and maintain the health and comfort of individuals with limited mobility. For more detailed information on preventing pressure ulcers, consult authoritative sources such as MedlinePlus, a reliable resource for patient health information.

Frequently Asked Questions

What are bed sores and why do they happen?

Bed sores, or pressure ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure on a specific area. This pressure reduces blood flow, causing tissue damage and potentially leading to the formation of an open sore.

How often should I reposition someone in bed to prevent bed sores?

For someone confined to bed, repositioning should be done at least every two hours. Using a structured turning schedule can help ensure consistency.

Are there special mattresses to help prevent bed sores?

Yes, specialized mattresses such as alternating air mattresses or gel overlays can help redistribute pressure and improve circulation. Foam cushions are also recommended for those who spend a lot of time in a chair.

How can I check for early signs of bed sores on someone with dark skin?

On darker skin tones, redness may not be as visible. Instead, check for changes in skin temperature (warm or cool areas), firmness (hard or boggy spots), and ask if they feel any tingling, itching, or pain.

What role does nutrition play in preventing bed sores?

Proper nutrition and hydration are vital. A diet rich in protein, calories, and essential vitamins helps maintain healthy, resilient skin. Dehydration and malnutrition can weaken the skin and hinder its ability to heal.

What is the correct way to position a pillow to prevent bed sores on the heels?

To prevent bed sores on the heels, place a pillow or foam support under the person's calves to lift the heels completely off the bed. Do not place it directly under the knees.

Should I massage red areas of the skin to prevent bed sores?

No, you should never massage or rub red areas or bony parts of the body. Massage can damage the delicate tissue underneath the skin and make it more susceptible to a pressure ulcer.