Bed Sores

Bed sores, pressure sores, or decubitus ulcers are the ulcers that occur in prolonged bedridden patients such as patients who are unable to move, unconscious, or unable to sense the pain. These happen in the areas of the skin under pressure. The pressure can be from lying on the bed, sitting in a wheelchair, or wearing a cast for a longer duration

Bed sores can cause a serious problem in older individuals, based on the quality of the care the patient has received. If the patient is bedridden maintaining the proper air circulation in the room, frequent turning of the body to the sides, good nutrition and skincare are necessary.

These occur on the pressure-dependent areas such as the buttocks, the tailbone or hips, heels of the feet, shoulder blades, back of the head, back and sides of the knees

Bed sores occur when the pressure over the soft tissue exceeds the normal capillary pressure causing occlusion and tearing of small blood vessels which reduces tissue perfusion leading to ischemic necrosis resulting in bed sore.

Bed Sores: Causes

The main causes of bed sores include −

• Pressure − A constant pressure on the body parts for a longer duration which reduces the blood supply and the required nutrients to the particular area resulting in damage to the normal tissue.

• Friction − This is when the skin over the body rubs against the bed, wheelchair, cast, or clothing making the damaged skin more susceptible to injury.

• Shear − it is the force that acts when the two surfaces move in an opposite direction like skin stays in place and muscles continue to move in the opposite direction.

Bed Sores: Symptoms

The common symptoms of bed sores include

• The 1st symptom is a change in skin color which usually becomes red at the beginning

• The pressure sores occur in four stages −

• Stage 1 − The skin is red, darkened, and becomes white when pressure is applied

• Stage 2 − Blister-like lesions appear and the skin may be damaged

• Stage 3 − The skin is destroyed and fatty tissue may be involved. Infection and blackening of the tissue can be seen

• Stage 4 − Skin and fatty tissue are destroyed and muscles and bone may be involved

• The areas are painful.

• Pus-like appearance.

• The temperature over the part of the skin is different to touch than the other areas

Bed Sores: Risk Factors

The most important risk factors for bed sores include the following −

• Immobility − Patients suffering from paralysis, spinal cord injuries, poor health, and other various causes

• Lack of Sensation Over the Skin − Spinal cord injuries, and neurological disorders can result in loss of sensation. Inability to feel the pain or discomfort can result in not being aware of the warning signs of the bed sore and the need to change position

• Poor Nutrition and Hydration − People need good nutrition and a balanced diet to maintain healthy skin and prevent the breakdown of the tissues

• Medical Conditions Affecting the Blood Flow − Chronic disorders such as diabetes, hypertension, and vascular diseases increase the risk of tissue damage

• Old age Group − Advanced age group people with associated co-morbidities are more prone to develop bed sores.

Excessive body heat can also be a risk factor.

Bed Sores: Diagnosis

Usually, laboratory investigations are not required to diagnose bed sores and these can be diagnosed based on the appearance of the skin and the condition of the patient

Some of the investigations which can be done include MRI, erythrocyte sedimentation rate, and bone biopsy to diagnose the extent of the wound and the bacteria present

Bed Sores: Treatment

Conservative treatment includes the following

• Changing the Positions often − Following the schedule for turning and repositioning approximately every 15 minutes if in a wheelchair and at least once every 2 hrs when in bed.

• Using Support Surfaces − these are special cushions, pads, mattresses, and beds that relieve pressure on an existing sore and help to protect susceptible areas from further breakdown

• Cleaning − keeping the wound clean to prevent infection. Stage 1 sore can be treated with water and mild soap, whereas open sores should be cleaned with salt water solution each time when the dressing is changed.

• Negative Pressure Therapy − this vacuum is used to clean the wounds with suction

• Controlling Incontinence − Unable to control the urine can still result in infection so should be managed

• Removal of Damaged Tissue − for healthy wound healing removing the dead and damaged skin should be done frequently

• Oral Antibiotics − To prevent the infection

• Pain killers such as nonsteroidal anti-inflammatory drugs to reduce the pain

Apart from these, a healthy diet, good dressings, and educating the caregiver play an important role in the treatment of bed sores.

Surgical Treatment includes −

• Surgical repair of the wounds

• Tissue flap

• Plastic surgery can be done to replace the tissue

Bed Sores: Prevention

Bed sores can be prevented by the following methods

• Positional Changes − changing the position frequently is crucial to prevent bed sores. Shifting the weight every 15 minutes if in a wheelchair, and at least once every 2 hrs if in bed. Adjust the elevation of the head; usually it should not be more than 30 degrees.

• Skin Inspection − Daily observing the skin for pressure is important.

• Nutrition − A healthy diet is important in preventing skin breakdown and in aiding wound healing.

• Adequate Hydration − To maintain the skin integrity

• Lifestyle Changes − avoid bad habits such as alcohol, and smoking. Daily exercise improves circulation.

• Pressure-relieving devices such as air mattresses, and water mattresses and ensure that the body is well-positioned.

Conclusion

Bed sores are pressure sores mainly occurring in bedridden patients for a prolonged duration. These lead to serious complications if not treated properly.

These can be prevented in the early stage itself with proper care, positioning, supportive special devices, hydration, and a healthy diet. If unnoticed leads to serious complications.