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Pressure Sores and How to Prevent Them

What is a pressure sore?
The Four Stages of Pressure Sores
What should you do to check for bed sores?
To check for bed sores, follow these steps:
How to treat pressure sores?
What cushion or mattress should I use if I have a bedsore?
How can occupational therapists help people with pressure sores?


What is a pressure sore?

A pressure sore, also known as a bedsore or decubitus ulcer, is a type of injury that occurs when constant pressure is applied to a specific area of the body, usually over a bony prominence such as the tailbone or heels. This pressure can restrict blood flow to the area, leading to tissue damage and the formation of a sore. Pressure sores are most common in people who are bedridden or have limited mobility, such as those with severe disabilities or advanced illnesses. They can be painful and challenging to treat and lead to severe complications if not properly managed.


"A literature review done in Canada in 2004 found that the overall prevalence of pressure ulcers across all institutions studied was 26 per cent." - Healthcare Excellence Canada

The Four Stages of Pressure Sores

There are four stages of pressure sores, each representing a different level of severity. Here is a more detailed description of each stage:

Stage 1: In this stage, the pressure sore appears as a red, painful area of skin that does not break open. The skin may be warm and swollen and feel stiff or firm to the touch. This stage is often reversible if the pressure is relieved and the sore is adequately treated.


Stage 2: In this stage, the pressure sore has developed into an open wound or sore that has not yet penetrated the underlying tissue. The wound may be shallow and covered by a thin layer of skin, or it may be more profound and appear as a crater-like hole in the skin. The sore may produce a small amount of clear or slightly bloody drainage at this stage.


Stage 3: In this stage, the pressure sore has become a deep wound that has penetrated the underlying fat or muscle tissue. The wound may be quite large and may have a foul-smelling discharge. The edges of the wound may be sloping, and some dead tissue may be present.


Stage 4: In this stage, the pressure sore has become a profound wound that has penetrated the bone. The wound may be large and accompanied by severe swelling, redness, and pain. This stage of pressure sore is the most serious and can lead to severe infection and even death if not treated promptly and properly. The wound may be filled with dead tissue and produce a large amount of foul-smelling drainage.


It's important to note that pressure sores can progress quickly from one stage to the next, so it's essential to seek medical attention as soon as possible if you suspect you or a loved one has a pressure sore. Early treatment can help prevent the sore from getting worse and can improve the chances of a full recovery.

What should you do to check for bed sores?


To check for bed sores, follow these steps:

  1. Look for redness or discoloration on the skin: Bed sores often start as red or discoloured areas on the skin. This may be a sign of irritation or damage to the skin.

  2. Check for swelling or blistering: Swelling or blistering on the skin can signify bed sores.

  3. Feel the skin for warmth or tenderness: Bed sores can cause the affected area of the skin to feel warm or tender to the touch.

  4. Check for open wounds or ulcers: In more advanced stages, bed sores can develop into open wounds or ulcers. These may be painful and may have a foul odour.

  5. If you notice any of these signs, you must report them to your healthcare provider immediately. Bed sores can be serious and require prompt treatment to prevent complications and promote healing. Your healthcare provider can recommend the appropriate treatment based on the stage and severity of your bed sores.


"The economic cost of treating a single pressure injury ranges from CAD $26,800 to $231,000 [in 2017] and treating pressure injuries can increase nursing care hours by up to 50%" - Registered Nurses Association of Ontario

How to treat pressure sores?

Treatment for pressure sores varies depending on the stage of the sore and the underlying cause. In general, the goal of treatment is to relieve pressure on the sore, promote healing, and prevent infection. Some common treatments for pressure sores include:

Cleaning the wound: The first step in treating a pressure sore is to clean the wound to remove any dead tissue or debris. This is typically done using a saline solution or mild soap and water. The wound should be cleaned carefully but gently, taking care not to damage the healthy tissue around the sore.

Protecting the wound: After cleaning the wound, it's essential to protect it from further injury. Protecting the wound can be done by using a special dressing or wound cover to keep the area clean and moist.

Relieving pressure: Relieving pressure on the sore is essential for promoting healing. This can be done by using special cushions or mattresses designed to distribute weight evenly or by regularly changing the position to reduce pressure on the affected area.

Managing pain: Pressure sores can be quite painful, especially in the later stages. Pain management is an important part of treatment and can be achieved through a combination of medication, physical therapy, and other pain management techniques.


Treating infection: If the pressure sore becomes infected, it must be treated with antibiotics. Your doctor may also recommend other treatments, such as debridement (the removal of dead tissue), to help the wound heal more quickly.


In some cases, surgery may be necessary to treat a pressure sore, particularly if the sore is deep or has become severely infected. Your doctor can recommend the best treatment plan for your specific situation.



How to prevent pressure sores?

There are several steps that can be taken to prevent the development of pressure sores, including:

  • Maintaining good hygiene: Regularly washing the skin with soap and water, especially in areas that are prone to pressure sores, can help to keep the skin clean and healthy.

  • Using a good-quality mattress: A mattress that provides adequate support and helps to distribute the body's weight evenly can help to prevent the development of pressure sores. Specialized mattresses designed for this purpose are available.

  • Repositioning the body frequently: Changing position frequently, at least every two hours, can help to reduce pressure on the skin and prevent the development of sores.

  • Using cushions and padding: Using cushions and padding to support the body and distribute pressure evenly can help to prevent pressure sores.

  • Eating a healthy diet: A diet rich in vitamins and minerals can help maintain the skin's health and prevent the development of sores.

  • Exercising regularly: Regular exercise can help to improve circulation and promote healthy skin, which can help to prevent the development of pressure sores.

  • Keep your skin clean and dry: Regularly wash your skin with soap and water, and dry it thoroughly to prevent moisture from accumulating on your skin.

  • Use a pressure-relieving mattress or cushion: A pressure-relieving mattress or cushion can help to distribute your weight evenly and reduce the pressure on your skin.

  • Avoid rubbing or massaging the affected area: Rubbing or massaging the affected area can damage your skin and increase your risk of developing bed sores.

  • Check your skin regularly: Look for signs of redness, swelling, or blistering on your skin, and report any changes to your healthcare provider.

By following these tips, you can help to prevent bed sores and maintain the health and comfort of your skin. It's important to remember that bedsores can be serious, so if you have any concerns, be sure to talk to your healthcare provider.


"In Canada, approximately 1 in 8 patients in acute care hospitals, 1 in 11 nursing home residents, and 1 in 50 home care clients experience pressure ulcers." - Registered Nurses Association of Ontario

What cushion or mattress should I use if I have a bedsore?


If you have a bed sore, it's important to use a cushion or mattress that will help to relieve pressure on the affected area. A pressure-relieving cushion or mattress can distribute your weight evenly and reduce the pressure on your skin. Some common types of pressure-relieving cushions and mattresses include:

Air-filled cushions: Air-filled cushions are made of a flexible, air-filled chamber that can be adjusted to provide the right level of support and pressure relief.

Foam cushions: Foam cushions are made of a soft, supportive foam material that can help to distribute your weight evenly and reduce pressure on the skin.

Gel-filled cushions: Gel-filled cushions are made of a gel material that can provide a soft, supportive surface for your body. The gel can help to distribute your weight evenly and reduce pressure on your skin.

Alternating pressure mattresses: Alternating pressure mattresses are designed to relieve pressure on the skin by periodically inflating and deflating different sections of the mattress. This can help to redistribute your weight and prevent bed sores.



Using a pressure-relieving cushion or mattress (as pictured above) can help prevent the development of bed sores and promote the healing of existing sores.

How can occupational therapists help people with pressure sores?

Occupational therapists can help prevent pressure sores by working with patients to develop and implement a plan to regularly change their position and move around to reduce pressure on their skin. This can include using specialized equipment such as pressure-relieving mattresses and cushions, and helping patients with activities of daily living such as bathing and dressing to reduce the risk of developing pressure sores.


In addition to prevention, occupational therapists also play a key role in the treatment of pressure sores. This can include providing wound care to help promote healing, and working with patients to develop and implement a plan to prevent further sores from developing. Occupational therapists may also provide education to patients and their families about how to prevent and manage pressure sores, and may work with other members of the healthcare team to provide comprehensive care for patients with pressure sores.



References:


Best Practice Guideline Implementation to Reduce Hospital-Acquired Pressure Injuries. Registered Nurses Association https://rnao.ca/sites/rnao-ca/files/FINAL_Evidence_Boosters_-_Spring_2017_HAPU_May_25_17_FINAL.pdf


How to Care for Pressure Sores: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/patientinstructions/000740.htm Accessed 15 Dec. 2022.

Maklebust, J., Sieggreen, M. (2000). Pressure Ulcers: Guidelines for Prevention and Management. United Kingdom: Springhouse Corporation.

Pressure Ulcer: Introduction. https://www.healthcareexcellence.ca/en/what-we-do/all-programs/hospital-harm-is-everyones-concern/hospital-harm-improvement-resource/pressure-ulcer-introduction/. Accessed 15 Dec. 2022.


“Pressure Ulcers (Pressure Sores).” Nhs.Uk, 23 Oct. 2017, https://www.nhs.uk/conditions/pressure-sores/.

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