Preventing Pressure Ulcers

Over 1 million Americans develop pressure ulcers each year. A pressure ulcer is a breakdown of an area of skin and underlying tissue caused by constant pressure on the skin. Pressure ulcers are sometimes called bedsores. The medical term is decubitus ulcers.

Pressure ulcers can happen to anyone with enough pressure for enough time. People with thin, frail skin have the most problems with pressure ulcers, so they need to pay attention to prevention. The thinner your skin is, the higher your risk.

The most common areas of the body for pressure ulcers are the tailbone, top of the pelvis, side of the hip joint, back of the heel, ankle, knee, and elbow. They may develop anywhere on the body where there is constant pressure.

Once a pressure ulcer develops, it can be hard to heal. It is much better to prevent pressure ulcers than to treat them. Ways to reduce the risk of pressure ulcers include:

• taking care of your skin--be extra careful about parts of your body where the skin is thin and you are bony.
• changing positions often
• using devices to relieve pressure
• reducing or eliminating swelling in the skin (ask your healthcare provider about how to do this)
• avoiding rubbing, chafing, or sliding across sticky or rough, harsh surfaces
• eating well.

Take care of your skin

• You or someone who cares for you needs to "keep watch" over your skin.
• Check your skin in the morning and before you go to bed at night. Look for redness, dark areas, cracks, bruises, and blisters. Note any white spots or areas. Injured skin may turn white before it reddens. Watch for red, tender, or swollen areas on the skin. Pay special attention to any areas that stay red even when you are no longer putting pressure on the area. The goal is to find and correct problems before the skin breaks down.
• With the back of your hand, feel for lumps and areas that are soft or unusually warm. Do not massage a reddened area.
• Clean the skin right away if it is exposed to urine or bowel movement. Wash the skin gently with a soft cloth or sponge. If you have problems controlling urine or bowel movements, use pads or briefs that absorb urine and have a quick drying surface that keeps moisture away from the skin.
• When bathing or showering, use warm (not hot) water and a mild soap.
• To prevent dry skin, use creams, ointments, or oils on the skin. Don't use drying agents on the skin, including alcohol wipes or disinfectant lotions, drying powders, or the chemical called aluminum hydroxide used in many deodorants.

Change positions often

• Limit pressure on bony parts of the body by changing positions often. You may need someone to help you do this if you are weak or disabled.
  • In bed, change your position at least every 2 hours. More often is better, if possible.
  • In a wheelchair, change your position every 15 to 20 minutes.
• Be careful not to rub sensitive areas when changing positions. Someone helping you to change position can use a sheet to lift you so you don't have to slide on the bed. A thin layer of cornstarch on the skin may help reduce damage from friction.
• Avoid lying directly on the hip bone when lying on your side. Choose positions that spread weight and pressure more evenly.
• Massage may help, but do not massage reddened areas, sores, or bony areas of the body such as knees and elbows.
• Do exercises to relieve pressure, such as push-ups from the wheelchair or bed and shifting of your weight.

Use devices to relieve pressure

• Use a foam, gel, or air cushion or mattress to relieve pressure. Ask your healthcare provider which is best. Avoid doughnut cushions because they reduce blood flow and cause tissue to swell, which can increase the risk of getting a pressure ulcer.
• The head of the bed should be raised as little and for as short a time as possible depending on your medical condition. When the head of the bed is raised more than 30°, skin may slide over the bed surface, damaging skin and tiny blood vessels.
• Use pillows or wedges to keep knees or ankles from touching each other. If you are unable to move easily, pillows may be placed under your legs from midcalf to ankle to keep your heels off the bed. Try to avoid pillows under your knees because it puts too much pressure on your heels. If you must support your knees, then also support your lower legs and protect your heels.
• Keep sheets free of wrinkles.
• Wear clothing without thick seams.
• Never put a heating pad on an area where you are unable to feel anything.

Eat well

• Eat a healthy diet to keep your skin healthy. It's very important to get enough protein and calories. Healthy skin is less likely to be damaged.
• Drink plenty of liquids.
• If you are unable to eat a normal diet, talk to your healthcare provider about nutritional supplements or get advice from a registered dietician.
• Some studies show zinc and vitamin C help the healing of large wounds. Ask your provider about this.

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Published by RelayHealth.
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