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January 25, 2022  
WOUND NEWS: Wound Technology

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  • Risk factors for pressure ulcers

    January 22, 2002

  • Request information on pressure-relief surfaces

    Following each risk factor are steps for preventing bedsores from developing. Note: none of these tips are surefire ways to prevent pressure ulcers. Nor is it always advisable to prevent pressure ulcers. The overall health and comfort of the patient should be the primary concern. If the prevention of bedsores interferes with more important treatment measures, then the latter measures should take precedence.

    The primary risk factors are immobility and poor hygiene. The primary prevention techniques are changing position as frequently as possible, and washing regularly and properly.

    Risk factor

    The primary risk factor for pressure ulcers (bedsores) is immobility. All persons confined to a chair or bed, and their caretakers, should take special care to prevent pressure ulcers. Chair or wheelchair confinement is most conducive to bedsore development. Highest risk patients are those that cannot change positions without help.

    Prevention tips:

    For bed-bound individuals:

    • Change position at least every two hours.

    • If you cannot change position yourself, make sure your caregiver uses lifting devices instead of dragging you to change your position. Dragging causes friction that can injure skin.

    • Use pillows or foam wedges to keep knees and ankles from direct contact with each other.

    • Use a special mattress with foam, air, gel or water, designed to prevent pressure ulcers.

    • Raise the head of the bed as little as possible. When it is raised more than 30 degrees, the skin may slide over the surface, which can damage the skin and blood vessels.

    • Spread weight as evenly as possible. Avoid lying directly on hipbone when lying on your side. Support pillows may help.

    • Pillows can be placed under legs between mid-calf and ankle to keep heels off bed. Do not place pillows behind the knee.

    • Wash skin properly, as designated in the following section.

    For chair-bound individuals:

    • If you can change positions without help, try to do so every 15 minutes. If not, change position every hour. The increased frequency is necessary because sitting places more pressure on the skin than lying in a bed does.

    • If you cannot change position yourself, make sure your caregiver uses lifting devices instead of dragging you to change your position. Dragging causes friction that can injure skin.

    • Use foam, gel or air cushions to relieve pressure.

    • Avoid donut-shaped cushions. They reduce blood flow and cause tissue to swell, which increases risk of developing blood sores.

    • Maintain good posture and comfort.

    • Wash skin properly, as designated in the following section.

    Risk factor

    Incontinence: Urinary or fecal incontinence increases the moisture that collects around the areas that are already at highest risk—the lower back and hips. The moisture provides friction, and the lack of hygiene also further irritates the skin.

    Prevention tips:

    If possible, treat the root cause of incontinence. Treatable causes include urinary tract infections, some medications, confusion, fecal impaction, polyuria and restricted mobility. If treatment is impossible, proper skin care is extremely important:

    • Wear soft, absorbent material with a quick-drying surface to minimize contact between urine or fecal matter and skin.

    • Clean skin as soon as it is soiled.

    • You or your caregiver should inspect skin at least once a day to identify problem areas before they become serious. Pay special attention to pressure points and reddened areas that do not fade after you change position. You can use a mirror for hard-to-see areas.

    • Use a soft sponge or cloth to reduce friction.

    • Bathe with warm water and mild soap. Avoid moisturizers or soap with alcohol.

    • Keep skin moist with cream or oil, but minimize moisture from wounds, urine, stool or sweat.

    • Avoid cold or dry air.

    • You can use special ointments to protect skin from unwanted moisture. A thin layer of cornstarch can reduce friction damage.

    Risk factor

    Decreased sensory perception: Usually, an increase in pressure on tissue will cause a response, and a person will adjust his or her position accordingly. A loss of sensory perception, due to stroke or other neurological disorders, decreases a person’s ability to feel the signals. Sedative drugs can also limit sensory perception.
    Prevention tips:

    The caregiver will have to pay special attention to moving the patient, maintaining hygiene, and noticing irritated areas (see above).

    Risk factor

    Poor nutrition affects the entire body. Healthy eating means healthier skin and circulation.

    Prevention tips:

    Eat a balanced diet if at all possible. If not, talk to your health care provider about nutrition supplements. Protein and calories are particularly important.

    Risk factor

    Peripheral vascular disease: Peripheral vascular disease—a restriction of blood flow in any part of the body except the heart, due to hypertension, diabetes or smoking, for example—reduces the ability of arteries and capillaries to respond to pressure.

    Prevention tips:

    Treat the cause of the peripheral vascular disease, through medication or other means.

    Other prevention points

    • Avoid vigorously massaging red areas that may already be irritated from too much pressure.

    • Rehabilitation programs can help improve your ability to move.

    • Communicate with your health care provider about your needs, wants and concerns. Your participation in maintaining your comfort is crucial.

  • Request information on pressure-relief surfaces

    Last updated: 22-Jan-02

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