Pressure Injuries

Causes of Pressure Injuries

As our population ages, pressure wounds or “bedsores” are becoming a serious issue. These painful and potentially life-threatening wounds develop on the skin when a person is left in one position for too long or is unable to move. Pressure injuries can ulcerate and reach the muscle or bone if not treated properly.
Pressure injuries are caused when the blood supply to the skin is cut off for more than 2-3 hours. This occurs when a person is bedridden, unconscious, or unable to sense pain in the affected area. The elderly, people in wheelchairs, or those with diabetes or neuropathy are also at risk. Pressure injuries are common in bony areas of the body where there is little padding between the skin and bone. Areas of concern are:
  • Tailbone
  • Heels
  • Elbows
  • Back of the head
  • Back of the knees

Contributing Factors

There are four primary contributing factors of pressure injuries, especially in parts of the body that are bony or at the ends of limbs (“distal”) because of limited circulation and movement.
When the skin is pressed between the bone and an outer surface for more than one or two hours, a pressure wound can begin to develop. The heels, hips, and tailbones are at particular risk because they are often pressed against hard surfaces, but any hard surface will cause this pressure. Movement and padding can reduce the risk.
Friction occurs when the skin is rubbed back and forth across a rough or coarse surface, the opposite of prolonged pressure. Sliding down in bed can cause friction injuries in older patients with thin or dry skin. The lower back (“sacrum”) is often a site for friction injuries as patients attempt to change position in bed.
This occurs in tandem with friction and is the result of one body part moving up and down, while another moves side to side. A blister in an ill-fitting shoe is a type of shear injury. In bedridden patients, sliding down in bed and attempting to reposition themselves can cause this type of pressure injury.
Moisture attracts bacteria and mold and can cause skin damage by itself. If sweat, urine, or feces are trapped in skin folds it can cause irritation and skin breakdown. Wounds heal from the outside edges, and excessive moisture can cause breakdown of the skin, impeding the healing process.

These four contributing factors often work together when a pressure wound is formed. Once a wound has developed, it must be kept dry and immobile to prevent it from growing larger until it has fully healed.

Stages of Pressure Injuries

Pressure injuries appear in four recognizable stages. If they can be caught early and treated, the outcome is usually better.
The area looks red and feels warm to the touch. The patient may complain of pain, tenderness, or itching. The skin may have a dark or purple appearance.
The area may have an open or raw appearance. The skin may appear bruised or discolored. There is significant pain.
The wound takes on a pitted or cratered appearance due to tissue damage below the skin. The wound may have opened.
Significant tissue loss. Muscle and bone may be exposed. The wound may become infected or gangrenous.
A pressure sore is called “unstaged” if there is full-thickness tissue loss and conditions known as “slough” or “eschar.” These conditions are dead skin and discharge that is yellow, tan, green, or brown, accompanied by a foul smell.

Preventing Pressure Injuries

The best way to avoid pressure injuries is to keep the skin healthy and intact. People who are bedridden or have health issues should be monitored regularly in areas where pressure sores are likely to develop. Some things to do for healthy skin:
  • Stay hydrated. Dry skin is more likely to develop Stage 1 pressure sores, so ensuring the patient gets plenty of water helps keep the skin moist.
  • Monitor their nutrition. Healthy skin heals faster and improves circulation. Eating right means a good balance of nutrients to heal any wounds that develop.
  • Keep skin clean and dry. Dirt and moisture break down the outer keratin layer of the epidermis, which helps Stage 1 pressure sores start.
People who can move should change position often and rotate their feet and legs to keep circulation in their lower limbs.

Treatment for Pressure Injuries

Treating pressure injuries requires time and care. It can take two to three weeks to heal a Stage 2 pressure sore and longer for a Stage 3 or 4 injury. The sooner treatment begins, the better the outcome for the patient.
  • For Stage 1 injuries, clean the area with mild soap and water. Cover with a gauze bandage, foam dressings or other even more advanced dressings. Advanced dressings possess different components that help control excessive moisture, minor bleeding, excessive bioburden, decrease inflammation, etc. All of these objectives promote healing.
  • Stage 2 injuries can be cleaned with saline to remove dead tissue. Different dressings can be used to keep the area properly moist and protected while it heals.
  • A doctor or skincare specialist should clean
    Stage 3 and 4 wounds to remove all dead tissue (“debride”). This procedure may need to be repeated several times.
  • Your doctor may prescribe products to control biofilm in the wound while using certain dressings that have particular properties that help the wound heal.