Bed Sores – Treatments and Prevention

Bed sores, or pressure ulcers are caused by the skins constant contact with a wheelchair or bed.  They usually occur on the skin where there are boney areas such as the heel, knees, tailbone, hips and elbows.  Another precipitating factor that contributes to the development of bedsores is the individual’s inability to move freely in the bed or wheelchair.

Pressure is the main reason for bedsores.  As we age our skin will naturally thin and bruises more easily.  Combined with limited physical movement the pressure applied to the skin reduces the circulation of blood flow to the skin thereby causing it to break down and develop into a bed sore.  These sores can range from skin redness to deep muscle and or bone infection.

Pressure or bedsores are described in 4 Stages:

  • Stage 1 Redness of the skin, painful to touch but no tears.  The area will also feel warmer to the touch.  The area can feel either harder or softer than the area around it.
  • Stage 2 The skin will be open and is painful.  The sore has now deepened into the layers of the skin and may look like a blister or scratch.  Skin may be damaged or die at this stage.
  • Stage 3 The bedsore has stretched through the skin into the tissue.  It is exceedingly painful and very difficult to heal.  This stage of bedsores can indicate lasting tissue damage.
  • Stage 4 This level of bedsore is deep within the tissue down to the bone and muscle level and will bring about widespread damage.  These bedsores are very serious.

Bedsore and Pressure Ulcer Treatments

There are several treatments for Pressure Ulcers/Bed Sores.  Treatment is determined by physicians, nurses, aides, social workers, physical therapists, occupational therapist and nutritionists.  They will evaluate the situation and the causes of the development of the sores and determine the proper treatment to help with the healing.  The first thing to do is to lessen the pressure on the skin and reduce the friction that caused the bedsore to develop in the first place.

  • Stage 1 Treatment – generally consists of making absolutely sure that the patient’s position is changed on a regular and consistent schedule.  This is called repositioning and needs to be done every couple of hours if the patient is bed ridden or every 15 – 20 minutes if they are in a wheelchair.  It is imperative that caretakers follow the physician’s orders on repositioning in order to heal the affected area.  This is not an easy or convenient task for the caregiver or the patient who may not want to be disturbed every few hours but it should be used as the first step in either avoiding the development and or treatment of these types of wounds.
  • Stage 2 Treatment – this is the time that a number of professionals develop the plan to begin the treatment process.  They begin by figuring out what caused the sores to develop.  Then they provide a variety of options for treatment.  These can include special pads made of sheepskin or foam to place under the patient to reduce the pressure and friction causing the sore.  A bed mattress filled with air pockets that aids in reducing the pressure and friction may be needed.  You need to make sure that the area is cleaned and dried gently.
  • Stage 3 Treatment – since the skin has opened at this stage it is important to clean and debride the wound.  A saline/saltwater solution is used as a means to clean the wound and the removal of the dead skin.  It can be necessary to cut out the dead skin depending on the damaged tissue.  This will be done by a physician and will be painful.  Generally, medicine to reduce the pain will be given prior to the procedure.  These wounds can also be treated with topical antibiotic creams and should always be covered.  Covering the area allows the wound to remain moist and promote healing.
  • Stage 4 Treatment – Since the damage at this stage stretches further than the visual tissue damage shows, treatments for this stage encompasses all of the above treatments along with the possibility of surgery and the use of oral or intravenous antibiotics.  

Prevention of Pressure Ulcers/Bedsores

  • A healthy diet rich with vegetables and high protein intake is needed for healing the skin.  Foods rich with vitamin C and Zinc are also needed.
  • Look for the development of a pressure sore especially on those who are bedridden or wheelchair bound.  It may be uncomfortable to look at someone so closely but it is necessary to be proactive rather than reactive.
  • Take care of your skin or the skin of your loved ones.  Keep it clean and dry especially if there is an incontinence issue involved. You can use a diaper rash cream to create a moisture barrier and in doing so protect the skin in that area.  Body lotion is helpful as it keeps the skin smooth and hydrated thereby avoiding drying and cracked skin.
  • Avoid staying in one position too long.  Plan repositioning movements frequently this helps to alleviate the pressure put on the skin.
  • If you smoke STOP! Smoking reduces blood flow and dry’s the skin.
  • Exercise helps promote blood flow and supports muscle development and strength.

Summary

With Stages 1-4 it is important to avoid positioning the patient on body parts that are   boney such as hips, knees, elbows and tailbones.  Positioning pillows, sheepskin, foam padding in-between the legs and directly under these pressure points will help in diminishing the development of bedsores/pressure ulcers. Heel pads made of sheepskin can also be used to protect the patients heels from constant rubbing on sheets.  

These proactive treatments won’t always eliminate the development of sores but cushioning and frequent repositioning of the patient is the first step.  

It can take several weeks for the wounds to heal depending on the stage.