When you or a loved one develops bedsores, there may be many questions running through your mind. We answer the most frequently asked questions regarding this injury.
What are Bedsores?
Bedsores are injuries to skin and underlying tissue resulting from prolonged pressure on the skin.
You can take steps to help prevent bedsores and help them heal, but some never heal completely.
Who is at greatest risk of getting bedsores?
Those who have medical conditions that limit their mobility.
Anyone who struggles to change positions or spends most of their time in a bed or chair is at greatest risk. The most common risk factors for developing pressure ulcers are:
- Immobility. This might be due to poor health, spinal cord injury and other causes. A patient’s inability to move will often result in more pressure on the skin for extended periods of time, therefore putting them at greater risk.
- Incontinence. Also described as a problem with the bladder and sphincter control, incontinence can cause a patient’s skin to become more vulnerable, as it can often be exposed to urine and stool for a longer period of time. Dry and clean skin is a key to bedsore prevention.
- Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of warning signs and the need to change position.
- Poor nutrition and hydration. People need enough fluids, calories, protein, vitamins and minerals in their daily diets to maintain healthy skin and prevent the breakdown of tissues.
- Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, can increase the risk of tissue damage such as bedsores.
Are there other names for bedsores?
Yes, bedsores go by many names, which can sometimes cause confusion. Other common names are:
- Pressure ulcers
- Decubitus ulcers
- Pressure sores
What causes pressure sores?
Pressure sores can develop over hours or days and for many reasons.
The majority of causes have to do with one thing – pressure and contact with the skin. From friction to failure to reposition a patient, Decubitus ulcers appear due to a failure to take the necessary precautions.
For this reason, nursing homes have to be particularly vigilant in their care of patients at a high risk for developing bedsores, or those who had pre-existing pressure sores when starting their care.
For a more in-depth look at the causes of pressure ulcers, please read our article on the causes and liability for bedsores.
Where can pressure ulcers develop?
Pressure sores can develop anywhere on the body that comes in contact with pressure or friction.
This is particularly true where the patient has some form of pre-existing condition that limits their blood flow, or makes the skin weak.
For residents who use wheelchairs, or are mostly chair bound, bedsores often appear on the:
- Tailbone or “coccyx”
- Shoulder blades
- Backs of arms and legs where they rest against the chair
For people who need to stay in bed, pressure sores often develop on the:
- Back or sides of the head
- Shoulder blades
- Lower back
- Tailbone or “Coccyx”
- Heels of the feet
- Skin behind the knees
How are Pressure Sores Diagnosed?
Your healthcare provider will diagnose a pressure sore, into one of the four stages, by inspecting the skin.
They are then “staged” according to their appearance and the symptoms present within and on the patient.
What are the different stages of decubitus ulcers?
Pressure sores are categorized into 4 different medical stages:
Stage I bedsores
The mildest stage, as it is just the onset of a pressure sore. A Stage I ulcer only affects the upper layer of the skin.
Stage 1 symptoms:
- Pain, burning, and/or itching sensation
- Firmer or softer than the surrounding skin
- Warmer or cooler to the touch, compared to the surrounding skin
- Visibly red skin
Stage 2 bedsores
At stage 2, the skin starts to die and peel away due to a lack of oxygen, as the blood that would provide the oxygen has been cut off by the pressure.
Stage II pressure ulcers are open wounds and the risk for infection is great if left untreated.
Stage 2 symptoms:
- Resembles a blister, sometimes pus-filled
- Broken skin
- The area is swollen, warm, and/or red
- May ooze clear fluid or pus
Stage 3 bedsores
Once a pressure ulcer reaches stage III, it has now gone through the second layer
of skin and into the fat tissue.
This stage is identified by the tissue loss accelerating and ligaments and tendons now beginning to deteriorate.
Stage 3 symptoms:
- Resembles a crater
- May have a bad odor
- Shows signs of infections
- Red edges
- Dead tissue may appear black
- May also see body fat in the crater.
Stage 4 bedsores:
These sores are the most serious. At this point, the pressure sore has reached the bone. Stage four ulcers can affect the bones, muscles, ligaments, tendons, and joints.
Stage 4 symptoms:
- The sore is deep and big.
- Skin has turned black
- Shows signs of infection
- Red edges
- Tendons, muscles, and bone may also be visible
What are the treatments of bedsores?
The recommended treatment for bedsores depends on how far they have developed. Treatment at each stage can include:
- Stage 1: Stage I sores are easy to treat by removing the pressure on the surrounding area and allowing the area to heal itself. A gentle wash with mild soap and water can help keep the area clean to allow for self healing. If necessary, a moisture barrier may be applied to protect the area from bodily fluids.
- Stage 2: If a Stage II is caught in the early stages, the recovery can be simple. A gentle flush with salt water, or saline, is used to remove loose and dead tissue. Then, a special dressing is applied to help protect against unwanted agents that can cause an infection, as well as assisting in keeping the area moist enough to heal.
- Stage 3: The most important treatment involves cleaning and dressing the wound properly. With Stage III, debridement, or removal of the damaged tissue may be necessary. Stage three ulcers can be very painful, so a healthcare provider may also intervene with drugs to control the pain. The damage at this stage can be intense and even when healing does take place, it may be inconsistent. If natural healing does not take place properly, skin grafts may also be used.
- Stage 4: The same treatment used in all of the prior stages will also be used for a Stage IV ulcer. However, because of the extent of the damage, surgery may be required as well. One method of surgical repair is to use a pad of your muscle, skin or other tissue to cover the wound and cushion the affected bone (flap surgery).
Can decubitus ulcers be prevented?
Yes, bedsores can be prevented by frequently repositioning the patient to avoid stress on the skin.
Other strategies include taking good care of the skin, maintaining good nutrition and fluid intake, quitting smoking, managing stress, and exercising daily.
How should patients be repositioned?
Anyone at risk of bedsores should be taken care of with regular routines to l reposition them. This helps to encourage good blood circulation and air flow to all parts of the skin.
Bedridden patients should be repositioned on either side at least once every 15 minutes, while others should be repositioned about once an hour. Patients could be assisted or advised to lift themselves using their upper body strength, if possible.
Selecting cushions or a mattress that relieves pressure can also help prevent the development of bedsores.
Donut cushions should not be used, as they can focus pressure on surrounding tissue.
What skin care tips can prevent bedsores?
The basics of proper skin care are to keep the skin clean and dry, but moisturized and healthy enough to promote proper healing and skin nutrition:
- Skin should be washed with a gentle cleanser and pat dry. Do this cleansing routine regularly to limit the skin’s exposure to moisture, urine and stool.
- A patient may also protect the skin using moisture barriers to protect from urine and stool.
- Changing bedding and clothing frequently will help the skin stay clean, but also can help avoid friction with debris.
- Watch for buttons on the clothing and wrinkles in the bedding that irritate the skin.
- Inspect skin daily for warning signs of a pressure sore.
Are decubitus ulcers contagious?
No. While an open wound may seem like something that can spread easily, bedsores themselves are not contagious.
However, it is critical to note that the infection caused by these pressure ulcers can very easily spread throughout the patient’s body.
Can pressure sores be left untreated?
No. While the treatment for a pressure sore in its early stages is relatively simple, it cannot be to heal without treatment.
If left untreated, pressure sores will advance through the stages, becoming extremely difficult to treat and can even lead to death. If a pressure sore does develop, it is important to begin treatment immediately.
There are a variety of treatments available to manage pressure sores and promote healing, depending on the severity of the pressure sore.
Speaking to a specialist can help reduce the risk and severity of infection. For more information, read our article: What Happens When Bedsores are Left Untreated?
What treatment technology is available?
- Pressure relieving devices: Special mattress, foam or pressure-redistributing cushions to assist in reducing or removing the pressure on a bedsore.
- Transcutaneous O2 measurements (TCOM)– is a non-invasive method of measuring the oxygen level of the tissue below the skin. This helps the doctor to determine the best treatment option.
- Radial shock wave therapy: An acoustic wave promotes regeneration and reparative processes of soft tissues.
- Negative pressure wound therapy: Also known as vacuum-assisted therapy, this procedure involves the attachment of a suction tube to the bedsore. The tube draws moisture from the ulcer, drastically improving the healing time and reducing the risk of infection.
- Hyperbaric Oxygen Therapy (HBOT) – enhances the body’s natural healing process by inhalation of 100% oxygen in a total body chamber, where atmospheric pressure is increased and controlled. This increases tissue oxygen availability and promotes healing.
What should you do if you’re worried about bedsores?
The information available about bedsores is vast and sometimes overwhelming. But for those that have been impacted by maltreatment that caused or aggravated a pressure ulcer, this information can be vital.
If you or a loved one is a victim of this kind of maltreatment, neglect, or abuse, call Thompson Law Firm today for a case consultation.