Pressure Ulcers: Prevention

What is a pressure ulcer?

A pressure ulcer is a breakdown of an area of skin and the tissue under it. It is caused by constant pressure on the skin.

Pressure ulcers are sometimes called bedsores. The medical term is decubitus ulcer.

Pressure ulcers can happen to anyone with enough pressure for enough time. People with thin, frail skin have the most problems with pressure ulcers, so they need to do what they can to prevent them.

What do pressure ulcers happen?

Where people get pressure ulcers depends on the type of problems they have. People with diabetes who are able to walk may have foot or ankle sores. People confined to wheelchairs may have problems where their pelvic bones carry the constant weight of their sitting. People confined to bed may have pressure sores around the tailbone, on the side of the hip joint, at the back of the heel, or at the elbow. Pressure sores may develop anywhere on the body where there is constant pressure.

Once a pressure ulcer develops, it can be hard to heal. It is much better to prevent pressure ulcers than to treat them.

How can I help prevent pressure ulcers?

Ways to reduce the risk of pressure ulcers include:

• Take care of your skin. Be extra careful about parts of your body where the skin is thin and you are bony.
• Change positions often.
• Use devices and take other cautions to relieve pressure.
• Reduce swelling.
• Avoid rubbing, chafing, or sliding across sticky or rough, harsh surfaces.
• Eat well.

Take care of your skin

• You or someone who cares for you needs to regularly check your skin.
  • Check your skin in the morning and before you go to bed at night.
  • Look for redness, dark areas, cracks, bruises, and blisters. Note any white spots or areas. Injured 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 even when you are no longer putting pressure on the area.
  • The goal is to find and fix problems before the skin breaks down.
• Use the back of your hand to feel for lumps and areas that are soft or unusually warm. Don’t massage a red area.
• Clean the skin right away if urine or bowel movement gets on it. Wash the skin gently with a soft cloth or sponge. If you have problems controlling urine or bowel movements, use pads or underwear that absorbs urine. The pads or underwear should have a quick drying surface that keeps moisture away from the skin.
• When bathing or showering, use a mild soap and warm water. Don’t use hot water.
• To prevent dry skin, put creams, ointments, or oils on the skin. Don't use substances that can dry the skin. Don’t use alcohol wipes or disinfectant lotions, drying powders, or deodorants with the chemical aluminum hydroxide.

Change positions often

• Limit pressure on bony parts of the body by changing positions often. You may need someone to help you do this if you are weak or disabled.
  • In bed, change your position at least every 2 hours. More often is better, if possible.
  • In a wheelchair, change your position every 15 to 20 minutes.
• Be careful not to rub sensitive areas when you change position. Someone helping you can use a sheet to lift you so you don't have to slide on the bed. A thin layer of cornstarch on the skin may help lessen damage from friction.
• Avoid lying directly on your hip bone when you are lying on your side. Choose positions that spread weight and pressure more evenly.
• Massage may help, but don’t massage reddened areas, sores, or bony parts of the body such as knees and elbows.
• Do exercises to relieve pressure, such as push-ups from the wheelchair or bed and shifting of your weight.

Use devices and take other cautions to relieve pressure

• Use a foam, gel, or air cushion or mattress to relieve pressure. Ask your healthcare provider which is best. Avoid doughnut 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 your medical condition. When the head of the bed is raised more than 30 degrees, 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 it’s hard for you to move, pillows may be placed under your legs from midcalf to ankle to keep your heels off the bed. Try to avoid putting pillows under your knees because it puts too much pressure on your heels. If you must support your knees, then also support your lower legs and protect your heels.
• Keep sheets free of wrinkles.
• Wear clothing without thick seams.
• Never put a heating pad on a place where you cannot feel anything.

Reduce swelling

• Swelling causes most problems at the feet, ankles, and heels. If you have swelling there, work with your healthcare provider to reduce it. People with bad veins or with congestive heart failure often have this problem.
• Raise your feet above your heart several times a day. Keep your feet up at least 15 minutes each time, if you can.
• Talk to your provider about compression stockings. You may need special-order, fitted stockings. Some people need just light-compression stockings. The stockings can be bought without prescription at most drugstores or medical supply stores.

Avoid chafing, rubbing, or sliding

• When changing your position, try to lift off the bed or furniture surface, change your position, and settle down again. If you have helpers, ask them to lift and turn and to avoid sliding you around.
• Sometimes a protective pad or covering helps, such as a soft boot over the heel. The boot takes the friction of the sliding, preventing the skin from being rubbed.

Eat well

• Eat a healthy diet to keep your skin healthy. It’s very important to get enough protein and calories. Healthy skin is less likely to be damaged.
• Drink plenty of liquids.
• If you are unable to eat a normal diet, talk to your healthcare provider about nutritional supplements or get advice from a registered dietician.
• Some studies show zinc and vitamin C help the healing of large wounds. Ask your provider about supplements. Ask about taking a multivitamin if your overall diet is restricted for some reason.