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  1. Did you know ...

    Never rub reddened areas - it may create more damage.

  2. Did you know ...

    Never use sheepskin or ordinary pillows for padding - they don't work.

  3. Did you know ...

    Never ignore reddened skin - they are your warning sign.

  4. Did you know ...

    Never wear sanitary belts - they can lead to pressure sores.

  5. Did you know ...

    Never use a doughnut shape cushion for pressure sores - they just relocate the pressure.

  6. Did you know ...

    With proper treatment, most pressure sores will heal.

  7. Did you know ...

    Pressure sores can develop in only 20 minutes and many take up to 6 months to heal.

  8. Did you know ...

    Christopher Reeve, aka Superman, died because of infected pressure sores.

  9. Did you know ...

    95% of all pressure sores are preventable.

  10. Did you know ...

    Inadequate nutrition increases the chances of developing pressure sores.

  11. Did you know ...

    Pressure sores are a serious health issue and can be a life-threatening situation.

What are pressure sores?

Pressure sores are areas injured skin and tissue.  They usually are
caused by sitting or lying in one position for too long.  This puts
pressure on certain areas of the body.  The pressure can reduce the
blood supply to the skin often enough and the blood supply get too
low, a sore may form. Pressure sores are aslo called bed sores,
pressure ulcers and decubitus ulcers.
Pressure sores can develop in some people with just a few hours of constant pressure and range from mild reddening to severe craters that extend into the muscle and bone.  They're quite a nuisance and ofter painful. Anyone who must remain in a bed, chair, or wheelchair for extend periods can develop these sores.

Most pressure sores affect patients over 70 years old who are bedridden in hospitals and long-term care facilities.

In Canada, about 25% of people in acute-care settings (e.g., hospitals)   develop pressure sores. In non-acute care settings (e.g., nursing homes), the prevalence of pressure sores is even higher (about 30%).

What are the symptoms of pressure sores?

Pressure sores can range from a discolouration of the skin to an open sore that goes all the way in the bone. Pressure sores are classified into 4 stages, depending on their severity.  Symptoms of each stage include the following:

STAGE 1.  The affected skin looks red and may feel warm to the touch.  The area may also burn, hurt or itch. In people who have dark skin, the pressure sore may have a blue or purple tint.

What to do:
     - Stay off area and remove all pressure.
     - Keep the area clean and dry.
     - Eat adequate calories high in protein, vitamins

       (especially A & C) and minerals (especially iron
       & zinc).
     - Drink more water.
     - Find and remove the cause.
     - Inspect the area at least twice a day.
     - Call your doctor if it has not gone away in 2-3 days.

Approximate Healing Time:

A pressure sore at this stage can be reversed in about three days if all pressure is taken off the site.

STAGE 2.  The affected skin is more damaged in a stage 2 pressure sore, which can result in an open sore that looks like an abraison or a blister.  The skin around the wound may discoloured. The area is very painful.

What to do:
     - Get the pressure off.
     - Follow steps in Stage 1.
     - Call your doctor right away.

Approximate Healing Time:
Three days to three weeks.

STAGE 3.  These types of pressure sores usually have a crater-like appearance due to increased damage to the tissue below the skin's surface.  This make the wound deeper.

What to do:
     - If you have not already done so, get the pressure off and
       see your doctor right away.
     - Wounds in this stage frequently need special wound care.

Approximate Healing Time:
More than one to four months.

STAGE 4.  This is the most serious type of pressure sore.  The skin and tissue is severely damaged, causing a large wound. Infection can occur at this stage.  Muscles, bones, tendons and joints can be affected by stage 4 pressure sores.

What to do: 

     - Always consult your doctor right away.
     - Surgery is frequently required for this type of wound.

Approximate Healing Time:
Anywhere from three months to two years.

Where on the body can you get pressure sores?

Pressure sores usually develop over parts of the body that don't have much fat to pad them.  Pressure sores are most common on the heels and on the hips.  Other areas at risk for pressure sores include the base of the spine (tailbone), the shoulder blades, the backs and sides of the knees, and the back of the head.

What causes pressure sores?

Pressure sores usually are caused by sitting or lying in one position for too
long.  This puts pressure on certain areas of the body.  The pressure can
reduce the blood supply to the skin and the tissues under the skin. When a
change in position doesn't occur often enough and the blood supply gets
too low, a sore may form.

Pressure sores, especially for immobilized individuals, are usually caused by three main reasons such as continuing pressure, friction and shear.

  • Continuous pressure - If there is pressure on the skin on one side, and bone on the other, the skin and underlying tissue may not receive an adequate blood supply.  Oxygen and other key nutrients may be lacking, resulting in possible skin and tissue damage.  Areas most susceptible are those, which are not well padded with flesh (muscle) and fat; areas just over a bone, such as coccyx (tailbone), shoulder blades, hips, heels, ankles and elbows.  Some causes of circulation loss may seem unlikely, but they do exist, such as crumbs on the patient's bed, wrinkles in the sheets and clothing, thick seams in pants, a sightly tilting chair.  Even sweating can moisten the skin and raise the risk of pressure sores.

  • Friction - For healthy and mobile people making bodily adjustments - shifting around - prevents the development of pressure sores.  However, for some patients, especially those with very thin and frail skin, as well as poor circulation, turning and moving may damage the skin, raising the risk of pressure sores.

  • Shear - If the skin moves on one way while the underlying bone moves in the opposite direction, this is known as shear.  If a patient slides down a bed or a chair, or raises the top half of a bed too much, there are a risk of shearing - cell walls and minute blood vessels may stretch and tear.  The tailbone, especially if the skin is already very thin, is especially susceptible to pressure sores from shear.

Who gets pressure sores?

Anyone who sits or lies in one position for a long time might get pressure sores.  You are more likely to get pressure sores if you are paralyzed, use a wheelchair or spend most of your time in bed.  However, even people who are able to walk can develop pressure sores when they must stay in bed because of an illness or an injury.  Some chronic diseases, such as diabetes and hardeling of the arteries, make it hard for pressure sores to heal because of poor blood circulation.

What are the risk factors associated to pressure sores?

                                           People are at risk of developing pressure sores if they have difficulty moving and                                              are unable to easily change position while seating or lying in bed.  Immobility                                                  may be due to:

  • Generally poor health or weakness
  • Paralysis
  • Injury or illness that requires bed rest or wheelchair use
  • Recovery after surgery
  • Sedation
  • Coma

Other factors that increase the risk of pressure sore include:

  • Age. The skin of older adults is generally more fragile, thinner, less elastic and drier than the skin of younger adults.  Also, older adults usually produce new skin cells more slowly.  These factors make skin vulnerable to damage.

  • Lacking of sensory perception.  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 pressure sores or the need to change position.

  • Weight loss.  Weight loss is common during prolonged illness, and muscle atrophy and wasting are common in people with paralysis.  The loss of fat and muscle results in less cushioning between bones and a bed or a chair.

  • Poor nutrition and hydration.  People need enough fluids, calories, proteins, vitamins and minerals in their daily diet to maintain healthy skin and prevent the breakdown of tissues.

  • Excess moisture or dryness.   Skin that is moist from sweating of lack of bladder control is more likely to be injured and increases the friction between the skin and clothing or bedding.  Very dry skin increases friction as well.

  • Bowel incontinence.  Bacteria from fecal matter can cause serious local infections and lead the lifethreatening infections affecting the whole body.

  • Medical conditions affecting blood flow.  Health problems that can affect blood flow, such as diabetes and vascular disease, increase the risk of tissue damage.

  • Smoking.   Smoking reduces blood flow and limits the amounts of oxygen in the blood.  Smokers tend to develop more severe wounds, and their wounds heal more slowly.

  • Limited alertness.  People whose mental awareness is lessened by disease, trauma or medications may be unable to take the actions needed to prevent or cure pressure sores.

  • Muscle spasms.  People who have frequent muscle spasms or other involuntary muscle movement may be at increased risk of pressure sores from frequent friction and shearing.

How are pressure sores treated?

There are several things you can do to help pressure sores heal:

     - Relieving the pressure that caused the sore.
     - Treating the sore itself.
     - Improving nutrition and other conditions to help the sore heal.

What can be done to reduce pressure on the sore?

Don't lie on pressure sores.  Use a bed pad to take pressure off the sore.  A bed pad can help support you in bed or in a chair to reduce or relieve pressure. Try to avoid resting directly on your hip bone when you're lying on your side.  Use a bed pad under one side so that your weight rests on the fleshy part of buttocks instead of on your side.  Also, use pillows to keep you knees and ankles apart.  When lying in bed, change your position at least every 2 hours.

When sitting in a chair or wheelchair, sit uptight and straight.  An uptight, straight position will allow you to move more easily and help prevent new sores.  You should change positions every 15 minutes when sitting in a chair or wheelchair.  If you cannot move by yourself, have someone help you shift your position.

How should the pressure sores be kept clean?

In order to heal, pressure sores must be kept clean and free of dead tissue.  Stage 1 sores can be cleaned with mild soap and water.  You can clean stage 2 sores by rinsing the area with a salt and water solution. The saltwater  removes extra fluids and loose material.  Your doctor or nurse can show you how to clean your pressure sore.

Pressure sores should be kept covered with a bandage or dressing.  Sometimes, gauze is used.  The gauze is kept moist and must be changed at least once a day.  Newer kinds of dressings include a see-through film and a hydrocolloid dressing.  A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore and helps promote healing and skin growth.  These dressings can stay on for several days at a time.

Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from a pressure sore.  Rinsing the sore every time your change the bandage is helpful.  

Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry.  The dead tissue sticks to the gauze and is removed when the gauze is pulled off.  For more severe pressure sores, dead tissue must be removed surgically.

Removing dead tissue and cleaning the sore can hurt.  Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressings is changed to help reduce pain.

Why is good nutrition important for healing pressure sores?

Good nutrition is important because it helps your body heal the sore.  If you don't get enough calories, proteins and other nutrients (especially vitamin C and zinc, which can help heal wounds like bedsores), your body won't be able to heal no matter how well you care for the pressure sore.  Your doctor, nurse or dietitian can give you advice about a healthy diet.  Be sure to tell your doctor if you have lost or gained weight recently.

How can I tell if the pressure sore is getting better?

As a pressure sore heals, it slowly gets smaller.  Less fluid drains from it.  New healthy tissue starts growing at the bottom of the sore.  This new tissue is like red or pink and looks lumpy and shiny.  It may take 2 to 4 weeks of treatments before you see these signs of healing.

If it doesn't hurt, why should I care?

Just because you can't feel it, doesn't mean it doesn't hurt.

A pressure sore can:
  • Limit moblity
  • Lead to a loss of work time
  • Interfere with recreational activities
  • Be costly to treat and require many visits to the doctor or clinic.
  • Smell bad
  • Small sores that are ignored can get worse
  • Cause infection, sometimes requiring antibiotics and even hospitalization and surgery
  • In extreme cases, a serious pressure sore can even cause death.
What if the pressure sores get infected?

Pressure sores that become infected heal more slowly and can spread a
dangerous infection to the rest of your body.  If you notice any of the signs
of infection listed below, call your doctor right away

Signs of an infected pressure sore include the following:

  • Thick yellow or green pus
  • A bad smell from the sore
  • Redness or warmth around the sore
  • Swelling around the sore
  • Tenderness around the sore.

Signs that the infection may have spread include the following:

  • Fever
  • Chills
  • Mental confusion or difficulty concentrating
  • Rapid hearthbeat.

How are infected pressure sores treated?

The treatment of an infected bed pressure depends on how bad the infection is.  If only the sore itself is infected, an antibiotic ointment and be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenously (through a needle put in a vein) or orally (by mouth).
How can pressure sores be prevented?

The most important step to prevent pressure sores is to avoid prolonged pressure in one part of your body, especially the pressure points mentioned previously.

It is alo important to keep your skin healthy.  Keep your skin clean and dry  Use a mild soap and warm (not hot) water,  Apply moisturizers so your skin doesn't get too dry,  If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, colors changes or other signs of sores.  Pay attention to the pressure points where sores are most likely to occur.

If you smoke, you should quit.  People who smoke are more likely to develop pressure sores.

Exercice can help improve blood flow, strengthen your muscles and improve your overall health.  Talk to your doctor if physical activity is hard for you.  He or she can suggest exercices that can work for you, or refer you to a physical therapist that can help.

Here are quick tips that can help preventing pressure sores?

  • Heat and moisture is bad! Stay away from products like memory foam and sheepskin pads.  These products, although soft and comfortable to the touch, can generate heat and friction causing the patient to sweat.  Heat and sweat can cause the skin to break.

  • Keep your skin hydrated with moisturizers, especially after a bath or shower.

  • Inspect your skin daily.  Look for redness or any skin breakdown.  Report any changes to your healthcare professional.

  • Skin should be washed with warm (avoid hot) water and use gentle cleansers to minimize dryness.

  • Avoid aggressive massage or massaging over bony areas such as hips.