Bedsores (pressure sores)


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Prevention

By Mayo Clinic staff

Bedsores are easier to prevent than to treat, but that doesn't mean the process is easy or uncomplicated. And wounds may still develop with consistent, appropriate preventive care.

Your doctor and other members of a care team can help develop a strategy that's appropriate whether it's personal care with at-home assistance or professional care in a hospital or residential setting.

Position changes are key to pressure sore prevention. These changes need to be frequent, repositioning needs to avoid stress on the skin, and body positions need to minimize the risk of pressure on vulnerable areas. Other strategies include skin care, regular skin inspections and good nutrition.

Repositioning in a wheelchair
Repositioning in a wheelchair includes the following recommendations:

  • Frequency. People using a wheelchair should change position as much as possible on their own every 15 minutes and should have assistance with changes in position every hour.
  • Self-care. If you have enough strength in your upper body, you can do wheelchair push-ups — raising your body off the seat by pushing on the arms of the chair.
  • Specialized wheelchairs. Pressure-release wheelchairs, which tilt to redistribute pressure, provide some assistance in repositioning and pressure relief.
  • Cushions. Various cushions — including foam, gel, and water- or air-filled cushions — can relieve pressure and help ensure that the body is appropriately positioned in the chair. A physical therapist can advise on the appropriate placement of cushions and their role in regular repositioning.

Repositioning in a bed
Repositioning for a person confined to a bed includes the following recommendations:

  • Frequency. Repositioning should occur every two hours.
  • Repositioning devices. People with enough upper body strength may be able to reposition themselves with the assistance of a device such as a trapeze bar. Using bed linens to help lift and reposition a person can reduce friction and shearing.
  • Special mattresses and support surfaces. Special cushions, foam mattress pads, air-filled mattresses and water-filled mattresses can help a person lie in an appropriate position, relieve pressure and protect vulnerable areas from damage. Your doctor or other care team member can recommend an appropriate mattress or surface.
  • Bed elevation. Hospital beds that can be elevated at the head should be raised no more than 30 degrees to prevent shearing.
  • Protecting bony areas. Bony areas can be protected with proper positioning and cushioning. Rather than lying directly on a hip, it's best to lie at an angle with cushions supporting the back or front. Cushions should also be used to relieve pressure against and between the knees and ankles. Heels can be cushioned or "floated" with cushions below the calves.

Skin care
Protecting and monitoring the condition of the skin is important for preventing pressure sores and identifying stage I sores before they worsen.

  • Bathing. Skin should be cleaned with mild soap and warm water and gently patted dry. Or a no-rinse cleanser can be used.
  • Protecting skin. Skin that is vulnerable to excess moisture can be protected with talcum powder. Dry skin should have lotion applied.
  • Inspecting skin. Daily skin inspection is important for identifying vulnerable areas of skin or early signs of pressure sores. Care providers usually need to help with a thorough skin inspection, but people with more mobility may be able to inspect their skin with the use of a mirror.
  • Managing incontinence. Urinary or bowel incontinence should be managed to prevent moisture and bacterial exposure to skin. Care may include frequently scheduled assistance with urinating, frequent diaper changes, protective lotions on healthy skin, urinary catheters or rectal tubes.

Nutrition
Your doctor, dietitian or other members of the care team can recommend dietary changes that can help improve the health of your skin.

  • Diet. You may need to increase the amount of calories, protein, vitamins and minerals in your diet. Your doctor may also prescribe dietary supplements, such as vitamin C and zinc.
  • Fluids. Adequate hydration is important for maintaining healthy skin. Your care team can advise on how much fluid to drink and signs of poor hydration, such as decreased urine output, darker urine, dry or sticky mouth, thirst, dry skin, or constipation.
  • Feeding assistance. Some people with limited mobility or significant weakness may need assistance with eating in order to get adequate nutrition.

Other strategies
Other strategies that can help decrease the risk of pressures sores include the following:

  • Quit smoking. If you smoke, quit. Talk to your doctor if you need assistance quitting.
  • Stay active. Limited mobility is a key factor in causing pressure sores. However, daily exercise that is appropriately matched to a person's abilities is an important step in maintaining healthy skin. A physical therapist can recommend an appropriate exercise program that improves circulation, builds up vital muscle tissue, stimulates appetite and strengthens the body overall.
Coping and support
References
  1. Bluestein D, et al. Pressure ulcers: Prevention, evaluation, and management. American Family Physician. 2008;78:1186.
  2. Dealey C. Skin care and pressure ulcers. Advances in Skin & Wound Care 2009;22:421.
  3. Black J, et al. National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Dermatology Nursing/Dermatology Nurses' Association 2007;19:343.
  4. Pressure ulcers. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec10/ch126/ch126a.html. Accessed Jan. 25, 2011.
  5. Abrams GM. Chronic complications of spinal cord injury. http://www.uptodate.com/home/index.html. Accessed Jan. 28, 2011.
  6. Dorner B, et al. The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Advances in Skin & Wound Care 2009;22:212.
  7. Langemo DK, et al. Pressure ulcers in individuals receiving palliative care: A National Pressure Ulcer Advisory Panel white paper. Advances in Skin & Wound Care. 2010;23:59.
  8. Jaul E. Assessment and management of pressure ulcers in the elderly: Current strategies. Drugs & Aging. 2010;27:311.
  9. Garcia AD. Assessment and management of chronic pressure ulcers in the elderly. The Medical Clinics of North America. 2006;90:928.
  10. Tleyjeh I. Infectious complications of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2011.
  11. Berlowitz D. Treatment of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2011.
  12. Berlowitz D. Prevention of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2011.
DS00570 March 19, 2011

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