What Are Pressure Ulcers?
Pressure ulcers, also known as bedsores, pressure sores, or decubitus ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure on the skin. They typically develop on skin that covers bony areas of the body, such as the heels, ankles, hips, and tailbone.
People most at risk for pressure ulcers include those who have a medical condition that limits their ability to change positions, requires them to use a wheelchair, or confines them to bed for extended periods.
Understanding the Stages
Pressure ulcers are classified in four stages based on their severity:
- Stage 1: The skin is intact but appears red and doesn't blanch (turn white) when pressed. The area may be painful, firm, soft, warmer, or cooler than surrounding tissue.
- Stage 2: The skin has broken open, worn away, or formed an ulcer. The wound is shallow and pink or red. It may look like a blister or a shallow crater.
- Stage 3: The ulcer has extended into the tissue beneath the skin, creating a deep crater. Fat may be visible, but muscle, tendon, and bone are not exposed.
- Stage 4: The most severe stage, involving extensive tissue damage. The wound reaches into muscle and bone, and can cause infection in the bone (osteomyelitis) or joints (septic arthritis).
Key Prevention Strategies
1. Repositioning
Regular repositioning is the cornerstone of pressure ulcer prevention:
- Reposition bedridden patients at least every 2 hours
- Wheelchair users should shift weight every 15 minutes
- Use the 30-degree lateral position rather than lying flat on the back or directly on the hip bone
- Keep a repositioning schedule and document each turn
- Use pillows or foam wedges to keep bony areas from touching
2. Skin Care
Proper skin care helps maintain skin integrity:
- Keep skin clean and dry—moisture from sweat or incontinence increases risk
- Use gentle, pH-balanced cleansers
- Apply moisturizer to dry skin, but avoid areas that stay moist
- Avoid massaging over bony prominences, as this can cause additional tissue damage
- Inspect skin daily, especially over pressure points
3. Nutrition and Hydration
Good nutrition is essential for maintaining healthy skin and healing wounds:
- Ensure adequate protein intake (needed for tissue repair)
- Provide sufficient calories to maintain healthy weight
- Encourage adequate fluid intake
- Consider zinc and vitamin C supplements if deficiency is suspected
- Consult with a dietitian for patients at high risk
4. Pressure-Relieving Surfaces
The right mattress and cushions can significantly reduce pressure:
- Use pressure-redistributing mattresses for high-risk patients
- Consider alternating pressure mattresses for very high-risk individuals
- Use appropriate wheelchair cushions
- Avoid donut-shaped cushions, which can concentrate pressure
- Elevate heels off the bed using pillows or specialized devices
High-Risk Areas
Pay special attention to these common pressure points:
- Back of head: Especially in patients who can't turn their head
- Ears: From lying on the side or from oxygen tubing
- Shoulders and shoulder blades: When lying on back
- Elbows: Common when using arms to reposition
- Tailbone (sacrum): One of the most common sites
- Hips: Particularly when lying on the side
- Knees: Inner knees when lying on side
- Heels: Very vulnerable due to small surface area
Warning Signs
Watch for these early indicators of developing pressure ulcers:
- Unusual changes in skin color or texture
- Swelling
- Pus-like drainage
- An area of skin that feels cooler or warmer than other areas
- Tender areas
- Skin that doesn't blanch when pressed
Managing Incontinence
Moisture from incontinence significantly increases pressure ulcer risk:
- Use absorbent products and change them frequently
- Clean skin promptly after episodes of incontinence
- Apply barrier creams to protect skin from moisture
- Consider a bowel and bladder management program
- Keep bedding dry and wrinkle-free
When to Seek Professional Help
Contact a healthcare provider immediately if you notice:
- Any open wound or area of broken skin
- Signs of infection (fever, spreading redness, warmth, swelling, or foul odor)
- Worsening of an existing pressure ulcer
- A wound that isn't healing despite proper care
- New pressure ulcers developing despite prevention efforts
Our mobile wound care team can assess wounds in the home or facility setting, providing expert treatment without the need for patient transport.
