Bedsores

Definition

Bedsores are also called decubitus ulcers, pressure ulcers, or pressure sores. These tender or inflamed patches develop when skin covering a weight-bearing part of the body is squeezed between bone and another body part, or a bed, chair, splint, or other hard object.

Description

Each year, about one million people in the United States develop bedsores ranging from mild inflammation to deep wounds that involve muscle and bone. This often painful condition usually starts with shiny red skin that quickly blisters and deteriorates into open sores that can harbor life-threatening infection.

Bedsores are not cancerous or contagious. They are most likely to occur in people who must use wheelchairs or who are confined to bed. In 1992, the federal Agency for Health Care Policy and Research reported that bedsores afflict:

• 10% of hospital patients

• 25% of nursing home residents

• 60% of quadriplegics

The Agency also noted that 65% of elderly people hospitalized with broken hips develop bedsores and that doctors fees for treatment of bedsores amounted to $2,900 per person.

Bedsores are most apt to develop on the:

• ankles

• back of the head

• heels

• hips

• knees

• lower back

• shoulder blades

• spine

People over the age of 60 are more likely than younger people to develop bedsores. Risk is also increased by:

• atherosclerosis (hardening of arteries)

• diabetes or other conditions that make skin more susceptible to infection

• diminished sensation or lack of feeling

• heart problems

• incontinence (inability to control bladder or bowel movements)

• malnutrition

• obesity

• paralysis or immobility

• poor circulation

• prolonged bed rest, especially in unsanitary conditions or with wet or wrinkled sheets

• spinal cord injury

Causes and symptoms

Bedsores most often develop when constant pressure pinches tiny blood vessels that deliver oxygen and nutrients to the skin. When skin is deprived of oxygen and nutrients for as little as an hour, areas of tissue can die and bedsores can form.

Slight rubbing or friction against the skin can cause minor pressure ulcers. They can also develop when a patient stretches or bends blood vessels by slipping into a different position in a bed or chair.

Urine, feces, or other moisture increases the risk of skin infection, and people who are unable to move or recognize internal cues to shift position have a greater than average risk of developing bedsores.

Other risk factors include:

• malnutrition

• anemia (lack of red blood cells)

• diuse atrophy (muscle loss or weakness from lack of use)

• infection

Diagnosis

Physical examination, medical history, and patient and caregiver observations are the basis of diagnosis. Special attention must be paid to physical or mental problems, like incontinence or confusion, that could complicate a patient's recovery.

Bedsores usually follow six stages:

• redness of skin

• redness, swelling, and possible peeling of outer layer of skin

• dead skin, draining wound, and exposed layer of fat

• tissue death through skin and fat, to muscle

• inner fat and muscle death

• destruction of bone, bone, infection, fracture, and blood infection

Treatment

Prompt medical attention can prevent surface pressure sores from deepening into more serious infections. For mild bedsores, treatment involves relieving pressure, keeping the wound clean and moist, and keeping the area around the ulcer clean and dry. Antiseptics, harsh soaps, and other skin cleansers can damage new tissue, so a saline solution should be used to cleanse the wound whenever a fresh non-stick dressing is applied.

The patient's doctor may prescribe infection-fighting antibiotics, special dressings or drying agents, or lotions or ointments to be applied to the wound in a thin film three or four times a day. Warm whirlpool treatments are sometimes recommended for sores on the arm, hand, foot, or leg.

In a procedure called debriding, a scalpel may be used to remove dead tissue or other debris from the wound. Deep, ulcerated sores that don't respond to other therapy may require skin grafts or plastic surgery.

A doctor should be notified whenever a person:

• will be bedridden or immobilized for an extended time

• is very weak or unable to move

• develops bedsores

Immediate medical attention is required whenever:

• skin turns black or becomes inflamed, tender, swollen, or warm to the touch.

• the patient develops a fever during treatment.

• the sore contains pus or has a foul-smelling discharge.

With proper treatment, bedsores should begin to heal two to four weeks after treatment begins.

Alternative treatment

Zinc and vitamins A, C, E, and B complex help skin repair injuries and stay healthy, but large doses of vitamins or minerals should never be used without a doctor's approval.

A poultice made of equal parts of powdered slippery elm (Ulmus fulva), marsh mallow (Althaea officinalis), and echinacea (Echinacea spp.) blended with a small amount of hot water can relieve minor inflammation. An infection-fighting rinse can be made by diluting two drops of essential tea tree oil (Melaleuca spp.) in eight ounces of water. An herbal tea made from the calendula (Calendula officinalis) can act as an antiseptic and wound healing agent. Calendula cream can also be used.

Contrasting hot and cold local applications can increase circulation to the area and help flush out waste products, speeding the healing process. The temperatures should be extreme (hot hot and ice cold), yet tolerable to the skin. Hot compresses should be applied for three minutes, followed by 30 seconds of cold compress application, repeating the cycle three times. The cycle should always end with the cold compress.

Prevention

It is usually possible to prevent bedsores from developing or worsening. The patient should be inspected regularly; should bathe or shower every day, using warm water and mild soap; and should avoid cold or dry air. A bedridden patient should be repositioned at least once every two hours while awake. A person who uses a wheelchair should shift his weight every 10 or 15 minutes, or be helped to reposition himself at least once an hour. It is important to lift, rather than drag, a person being repositioned. Bony parts of the body should not be massaged. Even slight friction can remove the top layer of skin and damage blood vessels beneath it.

If the patient is bedridden, sensitive body parts can be protected by:

• sheepskin pads

• special cushions placed on top of a mattress

• a water-filled mattress

• a variable-pressure mattress whose sections can be individually inflated or deflated to redistribute pressure.

Pillows or foam wedges can prevent a bedridden patient's ankles from irritating each other, and pillows placed under the legs from mid-calf to ankle can raise the heels off the bed. Raising the head of the bed slightly and briefly can provide relief, but raising the head of the bed more than 30 degrees can cause the patient to slide, thereby causing damage to skin and tiny blood vessels.

A person who uses a wheelchair should be encouraged to sit up as straight as possible. Pillows behind the head and between the legs can help prevent bedsores, as can a special cushion placed on the chair seat. Donut-shaped cushions should not be used because they restrict blood flow and cause tissues to swell.

Prognosis

Bedsores can usually be cured, but about 60,000 deaths a year are attributed to complications caused by bedsores. Bedsores can be slow to heal. Without proper treatment, they can lead to:

• gangrene (tissue death)

• osteomyelitis (infection of the bone beneath the bedsore)

• sepsis (tissue-destroying bacterial infection)

• other localized or systemic infections that slow the healing process, increase the cost of treatment, lengthen hospital or nursing home stays, or cause death

For Your Information

Books

• The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time Life, Inc., 1996.

• International Association of Enterstomal Therapy. 27241 La Paz Road, Suite 121, Laguna Niguel, CA 92656. (714) 476-0268.

• National Pressure Ulcer Advisory Panel. SUNY at Buffalo, Beck Hall, 3435 Main St., Buffalo, NY 14214. (716) 881-3558. http://www.npuap.org

• "Bed Sores." American Health and Herbs Ministry. 15 Mar. 1998 http://www.healthherbs.com

• "Break the Connection Between the O.R. and Pressure Ulcers." SpringNet Page. 16 Mar. 1998 http://www.springnet.com/top.shtml

• "Pressure Sores." ThriveOnline. 14 Mar. 1998 http://thriveonline.oxygen.com

• "Preventing Pressure Ulcers." Health Pages.org. 15 Mar. 1998

• "Treatment of Bed Sores." U. S. Department of Health and Human Services. 15 Mar. 1998 http://www.os.dhhs.gov

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is Maureen Haggerty.

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