What is a Pressure Sore?
The Agency for Healthcare Research & Quality (AHRQ) estimates that more than 2.5 million people develop pressure sores annually. Pressure sores, also known as bed sores, pressure ulcers, or decubitus ulcers are an injury to the skin and underlying tissue. They are caused by unrelieved pressure built up on an area of the skin for a long period of time. They can range from mild reddening of the skin to severe tissue damage and sometimes infection that extends into muscle and bone. Pressure sores are often a sign of neglectful care at nursing homes, assisted living facilities, and hospitals. Due to the built up pressure, blood flow to the affected area will become restricted and the tissue may begin to die, usually starting with the skin. Pressure sores are most likely to develop in areas of the body with little to no muscle or fat for padding. These areas of the body are generally bonier and are more susceptible to the development of pressure sores. The most common places for pressure sores are the head, heels, back, and buttocks.
How do Pressure Sores Occur?
Simply put, pressure sores occur when a person lays or sits in one position for a very long period of time. The pressure of the body causes all of the blood to leave the area. The lack of blood flow causes tissue to die. The amount of time this takes will vary depending on the health of the person and the condition of their skin. There are several common ways pressure sores can occur. For example, after surgery or an injury a person may be bed-bound for a period of time. Another example involves elderly people that are bed-bound or wheelchair-bound. Both of these examples commonly occur in nursing homes and assisted living facilities. Additional factors that put nursing home and assisted living facility residents at risk for developing bedsores include being elderly, needing assistance to move, malnourishment, incontinence, chronic health problems, fragile skin, Alzheimer’s disease, and dementia.
What Are the Stages of a Pressure Sore?
Pressure sores develop in four stages, one being the least severe and four being the most severe. Each stage has different signs and different levels of treatment:
Stage One: There are no open wounds or tearing. Instead, the skin will appear red and maybe painful. In fact, it may look very similar to a rash. When you press on it the redness does not disappear. Skin temperature may be increased and the skin my feel softer or firmer than the skin around it.
- How to get rid of it: Take all pressure off the site of the wound. Keep the wound dry and clean. Make sure the diet is high in protein, vitamin A, vitamin C, zinc, and iron. Drink a lot of water to stay hydrated. Pressure sores at this stage can be reversed in about three days if these steps are followed.
Stage Two: The skin is broken and begins to wear away or form an ulcer. The wound is likely to be tender and painful. The sore has reached the deeper layers of the skin but does not go all the way through the skin. At this stage, the wound may look like a scrape or a blister filled with clear fluid. Some of the skin may be damaged beyond repair at this point.
- How to get rid of it: follow the same steps as a stage one pressure sore. The sore should go away within three weeks.
Stage Three: The sore will worsen and spread deeper to the tissue beneath the skin, although bone, muscle, or tendon will not be showing. Fat may be seen in the sore. Look for signs of infection: redness around the edges, pus, odor, fever, or a greenish drainage from the sore.
- How to get rid of it: Make sure all pressure is off the wound if this has not been done already. Go see a health care provider immediately. Pressure sores at this stage need special care from a medical professional. Healing time may be between one and four months.
Stage Four: The sore will be deep enough to cause damage to muscle, bones, tendons, and joints. There is a high risk of infections at this stage. Signs of infection are listed in the previous stage.
- How to get rid of it: Contact a health care provider immediately. Surgery is often required to treat such a severe pressure sore. Healing time can be from three months up to two years.
Are Pressure Sores Avoidable?
Minor pressure sores such as a stage I pressure sore and most stage II pressure sores can be unavoidable. However, with diligent care, the stage I and stage II pressure sores are easily treated. Furthermore, proper treatment should prevent them from becoming stage III and/or stage IV pressure sores. As a result, most medical professionals agree that severe pressure sores, especially in stages three and four, are easily prevented. In fact, developing a severe pressure sore in a nursing home is often considered nursing home neglect. Similarly, developing a severe pressure sore in an assisted living facility can be considered ALF neglect.
How to Prevent the Development of Pressure Sores
The most important intervention for the prevention of pressure sores is pressure relief. Standard pressure relieving techniques in nursing homes and assisted living facilities involves turning and re-positioning bed-bound and wheelchair-bound residents every two hours. For someone that is bed-bound, this means a staff member must help the person I just in their bed from left side to back to right side every two hours. For someone in a wheelchair, this means assisting the person to re-position in the wheelchair every two hours. It can also mean transferring the person out of a wheelchair into a bed or out of a bed and into a recliner. Other standard pressure relieving techniques involve using pressure relieving devices. For bed-bound residents this may mean a special pressure relieving mattress. For wheelchair-bound residents it may mean a special pressure relieving pad in the wheelchair. For people at risk of developing heel pressure sores, it may mean floating the heels with pillows or using special pressure relieving booties.
Another important pressure sore intervention involves dealing with a person’s underlying medical condition. For example, providing proper nutrition to malnourished individuals and providing proper hydration to dehydrated individuals gives the body the ability to help heal itself. Routinely cleaning people that are incontinent of bowel and/or bladder keeps the skin from breaking down and helps prevent skin irritations from becoming infected.
What Is the Number One Cause of Pressure Sores Developing in Long-Term Care Facilities?
The number one cause of pressure sores in nursing homes and assisted living facilities involves the staff not doing their job. Occasionally, the staff is not properly trained or the staff is too lazy to do their job. However most nursing home and ALF employees actually care about their residents and want to do a good job. The real culprit is the facility failing to provide enough staff. Under-staffing occurs when facilities cut down on the level of staff members in order to increase their profits. Under-staffing also occurs when one caregiver is responsible for too many patients that have too many needs. In either situation, there is simply not enough time for the staff members to provide all the care that each resident needs. Turning and re-positioning takes time and therefore is often the first thing skipped by an overworked staff member.