Preventing Pressure Ulcers

Over one million Americans develop pressure ulcers (skin breakdown) each year. Pressure ulcers used to be called bedsores. The most common areas of the body for pressure ulcers are the tailbone, top of pelvis, side of hip joint, back of the heel, ankle, knee, and elbow.

After pressure ulcers develop, medical treatment includes antibiotics and enzyme agents. Surgical techniques include closing the wound, skin grafts, and, in severe cases, amputation. It is much better to prevent pressure ulcers than to treat them. Ways to reduce the risk of pressure ulcers include:

• Do skin checks in the morning and the last thing at night. Look for redness, dark areas, cracks, bruises, and blisters. Note any white spots or areas. The skin may turn white before it reddens. Watch for red, tender, or swollen areas on the skin. Pay special attention to any areas that stay red after the pressure has been relieved. The goal is to find and correct problems before skin breakdown occurs.
• Feel for lumps, soft areas, or unusual warmth (use the back of the hand). Do not massage a reddened area.
• Clean when incontinent (wetting or soiling the bed) as soon as possible. Use a soft cloth or sponge to reduce injury to skin.
• Minimize moisture from urine or stool, perspiration, or wound drainage. Use pads or briefs that absorb urine and have a quick drying surface that keeps moisture away from the skin.
• When bathing or showering, use warm (not hot) water and a mild soap.
• To prevent dry skin, use creams, ointments, or oils on the skin. Don't use alcohol or other drying agents on the skin.
• Avoid cold or dry air.

• Limit pressure over bony parts by changing positions.
  • If in bed, change position at least every 2 hours.
  • If in a wheelchair, change position every 15 to 60 minutes.
• Be careful not to scrape sensitive areas when changing positions. Bed sheets or lifters can be used to help lift the body. A thin layer of cornstarch on the skin may help reduce damage from friction.
• Avoid lying directly on the hip bone when lying on your side. Also, choose positions that spread weight and pressure more evenly.
• Massage may help. Do not massage bony areas of the body such as knees and elbows.
• Exercise to relieve pressure, such as "push-ups" from the wheelchair or bed and shifting weight.

• Use a foam, gel, or air cushion or mattress to relieve pressure. Ask your health care provider which is best. Avoid donut-shape cushions because they reduce blood flow and cause tissue to swell, which can increase the risk of getting a pressure ulcer.
• The head of the bed should be raised as little and for as short a time as possible depending on the medical condition. When the head of the bed is raised more than 30°, skin may slide over the bed surface, damaging skin and tiny blood vessels.
• Use pillows or wedges to keep knees or ankles from touching each other. If completely immobile, put pillows under the legs from mid-calf to ankle to keep the heels off the bed.
• Keep sheets wrinkle-free.
• Wear clothing without thick seams.
• Never put a heating pad where there is no sensation.

• Eat a balanced diet. Protein and calories are very important. Healthy skin is less likely to be damaged.
• Drink plenty of liquids.
• If unable to eat a normal diet, talk to your health care provider about nutritional supplements.
• Some studies show zinc and Vitamin C help promote healing of large wounds.