Pressure Sores: Causes, Risk Factors And Prevention

A pressure sore/pressure ulcer generally starts off as an area of skin that gets damaged due to extra pressure in that particular area. The persistent pressure hampers blood flow to the skin. The oxygen and nutrient starved skin begins to break down and becomes progressively worse, often developing into a painful open wound. This can happen due to several different reasons but is more commonly seen in people with mobility issues. Pressures sores take a long time to heal. In severe cases they can infect the bone, requiring an amputation of the affected area.

Causes And Risk Factors Associated With Pressure Sores

There are a number of risk factors associated with pressure sores. Some of these are:

• Lack of mobility – Sitting or sleeping in one place for long periods of time puts excessive pressure on certain areas of the skin, which are more susceptible to injury. Those who are unable to reposition their body are at higher risk of developing pressure sores.
• Advanced age – As we get older, new skin cells take longer to form and our skin tends to become more delicate, because of this an untreated skin injury is more likely to progress into a pressure sore.
• Medical conditions – Some medical conditions obstruct circulation to the skin. When this happens, skin injuries take longer to heal, putting the person at risk of pressure sores.
• Extreme weight loss – This is often seen in individuals who have eating disorders such as bulimia or anorexia nervosa. The extreme weight loss leaves little or no cushioning between the skin and bone, increasing the risk of injury to the skin. This injury could then progress into a pressure sore.
• Dehydration – Dehydrated skin is more fragile and likely to tear when any pressure is applied.
• Poor nutrition – The skin requires proper nutrition to stay healthy and elastic. Poor nutrition leaves the skin weak and unable to prevent the breakdown of skin tissue, so it is more vulnerable to injury.
• Incontinence – Skin that is continually moist, whether due to urinary or faecal incontinence, it tends to break down more easily.

Although anyone can be afflicted by pressure sores, regardless of age or any other factors, seriously ill patients in hospital and old age pensioners living in nursing homes are at higher risk.

Once they develop, pressure sores can take a very long time to heal, as the wound has to heal from the inside out. If no treatment is provided, the necrotic tissue will keep spreading over a larger surface area. In more severe cases, it can infect the bone causing gangrene, which may require amputation of the affected area.

Symptoms Of Pressure Sores

An area of skin that looks red and feels tender to touch is the first indication that a pressure sore may develop. If the person is not repositioned and treatment is not provided at this stage, the area starts to turn purple and becomes more painful. If the area continues to be subjected to pressure without any treatment, it could progress into an open wound and later into a more serious infection.

Areas most susceptible to pressure sores include heels, inner knees, hips, buttocks, lower back, elbows, shoulders, and the back of the head.

Can Pressure Sores Be Prevented?

In most cases, yes they can be prevented. Since constant pressure on the skin is the primary cause of pressure sores, the key to keeping these sores at bay is to prevent excessive pressure on any one area of the skin. This can be done by avoiding extended periods of remaining in one position.

If the person can change their position on their own, they should be encouraged to do this regularly throughout the day. If they are unable to reposition themselves on their own, they must be helped to a different position every hour for those sitting down, and every two hours for those lying down in bed.

Today, there are several types of devices such as air filled mattresses and cushions that are especially designed for this purpose. These redistribute pressure evenly so there is less pressure on highly sensitive areas that are more prone to skin damage.

Inspecting high risk areas is equally important. It helps identify early signs so that prompt medical care can be provided before the injury worsens.

Keeping the skin clean, dry and healthy also goes a long way in preventing pressure sores.

In hospitals and nursing homes, nurses and carers use the Waterlow Assessment. This is a risk assessment tool that helps carers determine which patients or residents are at highest risk of developing a pressure ulcer depending on their age, height, weight, build, mobility, and continence. They also take into consideration whether the patient has undergone any major surgery in the recent past. Special care is taken to ensure that high-risk patients are repositioned regularly.

How To Treat Pressure Sores

Once pressure sores develop, they heal slowly and require consistent treatment to heal completely. The exact treatment depends on various factors, primarily the severity of the condition. Common ways to treat pressure sores include:

• Changing the patient’s position regularly is the first course of action. This helps reduce the pressure on that area.
• Applying special medicated creams and ointments and dressing the wound speeds up the healing process.
• Nutritional supplements including Vitamin C, protein and zinc are often prescribed to boost the patient’s help the skin heal faster.
• Using an air-filled mattress can also help distribute the patient’s weight more evenly, giving the injured area a chance to heal faster.
• The doctor may prescribe antibiotics if infection has set in.

Pressure sores are graded from 1 to 4. Grade 1 and 2 are relatively less severe and can be treated locally. Grade 3 involves tissue damage and is more severe. Grade 4 is the most severe and involves serious tissue damage or tissue death. Surgery is the only option to treat Grade 4 pressure sores.

If you or a loved one has suffered pressure sores as a result of negligence or sub-standard care you may wish to refer to the following page as you may be eligible to make a claim for compensation.