Bed sores are injuries that result from unrelieved pressure on the skin. Also known as decubitus ulcer or pressure ulcers, bed sores are worsened by moisture and friction and can cause skin lesions and damage to underlying tissue. Pressure ulcers can affect any part of the body but areas of bony prominence like the elbows, ankles, knees, and sacrum are easily and commonly affected.
Individuals with medical conditions that limit their mobility such as those in wheelchairs and those who are confined to a bed for long periods, the elderly, and the terminally ill are at most risk of developing decubitus ulcer. Pressure ulcers tend to develop fast and treating it can be difficult once it reaches an advanced stage. Prompt bed sore treatment is necessary to prevent complications, especially given the fact that bed sores can be fatal and is one of the leading causes of unexpected death brought about by medical treatment in developed countries.
Causes of Bed Sores:
Decubitus ulcer is caused by three main elements, namely pressure, friction, and shear force. Pressure, especially unrelieved pressure, causes the tissues under the skin to be compressed between the bone and a surface. Shear force refers to the skin moving one way while the bone underneath moves in the opposite direction. This can cause damage to cell walls and blood vessels. Friction also worsens bed sores by causing the top layer of the skin to shed.
Stages of Pressure Ulcers:
According to the National Pressure Ulcer Advisory Panel in the U.S., there are four stages of bed sores. The more advanced the stage of the ulcer is, the longer it takes to heal.
Stage I decubitus ulcer is superficial damage to the skin. It is characterized by a non-blanchable redness meaning it the redness does not relieved even if the pressure is removed. In individuals with dark skin, stage I pressure ulcers may appear blue or purple in color.
Stage II bed sore is defined as damage to the epidermis, the skin’s uppermost layer, which may extend to the dermis. The ulcer is often called an abrasion or blister in this stage.
Stage III pressure ulcers involve all the layers of the skin and damage may extend up to the fatty tissue layer or subcutaneous layer. Subcutaneous tissue can make it difficult to carry out wound care due to poor blood supply.
Stage IV bed sores extend into deeper layers including the muscles and bones. In some cases, the ulcer is covered in wound exudates and dead cells, making it difficult to determine the actual depth of the wound.
Pressure Ulcer Treatment:
Pressure ulcer treatment depends on the stage of the wound. The important thing is to keep the wound clean and avoid conditions that can worsen the ulcer such as pressure, moisture, and friction. For stage I ulcers, bed sore treatment involves cleaning the wound with soap and water. For more advanced stages where there is an open sore, saline solution should be used instead of water and soap.
Debridement of the wound is also necessary if there is infected or dead tissue already. Debridement may be done in several ways through the use of a scalpel, irrigation device, topical enzymes, laser, and ultrasound to remove the dead or infected tissue. Antibiotics may also be needed to control infection. Nutritional support may also be implemented to help speed up healing of tissues in the body.
Prevention of Bed Sores:
Prevention of bed sores involves three major considerations namely limiting pressure, reducing pressure, and skin protection. An individual’s position must be changed every one to two hours regardless of whether he or she is on the bed or sitting on a wheelchair. Do not drag or pull when changing positions to avoid creating friction. Keeping one’s skin clean and dry can also prevent skin breakdown.
Prevention of bed sores is a main responsibility of the primary caregiver. Regardless of whether the patient is cared for at home or in the hospital, observing measures to prevent the development of pressure ulcers should be part of giving care.