Bedsores are easier to prevent than to treat, but that doesn't mean the process is easy or uncomplicated. And wounds may still develop with consistent, appropriate preventive care.
Your doctor and other members of the care team can help develop a good strategy, whether it's personal care with at-home assistance, professional care in a hospital or some other situation.
Position changes are key to preventing pressure sores. These changes need to be frequent, repositioning needs to avoid stress on the skin, and body positions need to minimize pressure on vulnerable areas. Other strategies include taking good care of your skin, maintaining good nutrition, quitting smoking and exercising daily.
Repositioning in a wheelchair
Consider the following recommendations related to repositioning in a wheelchair:
- Shift your weight frequently. If you use a wheelchair, try shifting your weight about every 15 minutes. Ask for help with repositioning about once an hour.
- Lift yourself, if possible. If you have enough upper body strength, do wheelchair pushups — raising your body off the seat by pushing on the arms of the chair.
- Look into a specialty wheelchair. Some wheelchairs allow you to tilt them, which can relieve pressure.
- Select a cushion that relieves pressure. Use cushions to relieve pressure and help ensure your body is well-positioned in the chair. Various cushions are available, such as foam, gel, water filled and air filled. A physical therapist can advise you on how to place them and their role in regular repositioning.
Repositioning in a bed
Consider the following recommendations when repositioning in a bed:
- Reposition yourself frequently. Change your body position every two hours.
- Look into devices to help you reposition. If you have enough upper body strength, try repositioning yourself using a device such as a trapeze bar. Caregivers can use bed linens to help lift and reposition you. This can reduce friction and shearing.
- Try a specialized mattress. Use special cushions, a foam mattress pad, an air-filled mattress or a water-filled mattress to help with positioning, relieving pressure and protecting vulnerable areas. Your doctor or other care team members can recommend an appropriate mattress or surface.
- Adjust the elevation of your bed. If your hospital bed can be elevated at the head, raise it no more than 30 degrees. This helps prevent shearing.
- Use cushions to protect bony areas. Protect bony areas with proper positioning and cushioning. Rather than lying directly on a hip, lie at an angle with cushions supporting the back or front. You can also use cushions to relieve pressure against and between the knees and ankles. You can cushion or ''float'' your heels with cushions below the calves.
Protecting and monitoring the condition of your skin is important for preventing pressure sores and identifying stage I sores early so that you can treat them before they worsen.
- Clean the affected skin. Clean the skin with mild soap and warm water or a no-rinse cleanser. Gently pat dry.
- Protect the skin. Use talcum powder to protect skin vulnerable to excess moisture. Apply lotion to dry skin. Change bedding and clothing frequently. Watch for buttons on the clothing and wrinkles in the bedding that irritate the skin.
- Inspect the skin daily. Inspect the skin daily to identify vulnerable areas or early signs of pressure sores. You will probably need the help of a care provider to do a thorough skin inspection. If you have enough mobility, you may be able to do this with the help of a mirror.
- Manage incontinence to keep the skin dry. If you have urinary or bowel incontinence, take steps to prevent exposing the skin to moisture and bacteria. Your care may include frequently scheduled help with urinating, frequent diaper changes, protective lotions on healthy skin, or urinary catheters or rectal tubes.
Your doctor, a dietitian or other members of the care team can recommend nutritional changes to help improve the health of your skin.
- Choose a healthy diet. You may need to increase the amount of calories, protein, vitamins and minerals in your diet. You may be advised to take dietary supplements, such as vitamin C and zinc.
- Drink enough to keep the skin hydrated. Good hydration is important for maintaining healthy skin. Your care team can advise you on how much to drink and signs of poor hydration. These include decreased urine output, darker urine, dry or sticky mouth, thirst, dry skin, and constipation.
- Ask for help if eating is difficult. If you have limited mobility or significant weakness, you may need help with eating in order to get adequate nutrition.
Other important strategies that can help decrease the risk of bedsores include the following:
Mar. 25, 2014
- Quit smoking. If you smoke, quit. Talk to your doctor if you need help.
- Stay active. Limited mobility is a key factor in causing pressure sores. Daily exercise matched to your abilities can help maintain healthy skin. A physical therapist can recommend an appropriate exercise program that improves blood flow, builds up vital muscle tissue, stimulates appetite and strengthens the body.
- Pressure ulcers. The Merck Manuals: The Merck Manual for Health Care Professionals. http://www.merck.com/mmpe/sec10/ch126/ch126a.html. Accessed Nov. 12, 2013.
- Berlowitz D. Treatment of pressure ulcers. http://www.uptodate.com/home. Accessed Nov. 12, 2013.
- Gestring M. Negative pressure wound therapy. http://www.uptodate.com/home. Accessed Nov. 12, 2013.
- AskMayoExpert. Pressure ulcer. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2013.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Nov. 12, 2013.
- How to manage pressure ulcers. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2013.
- Berlowitz D. Prevention of pressure ulcers. http://www.uptodate.com/home. Accessed Nov. 13, 2013.
- Tleyjeh I, et al. Infectious complications of pressure ulcers. http://www.uptodate.com/home. Accessed Nov. 13, 2013.
- Lebwohl MG, et al. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Nov. 13, 2013.
- Neligan P. Plastic Surgery. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2013. https://www.clinicalkey.com. Accessed Nov. 13, 2013.
- Gupta S, et al. Optimal use of negative pressure wound therapy in treating pressure ulcers. International Wound Journal. 2012;9(suppl 1):8.
- Lim JL, et al. Epidemiology and risk factors for cutaneous squamous cell carcinoma. http://www.uptodate.com/home. Accessed Nov. 15, 2013.
- Abrams GM, et al. Chronic complications of spinal cord injury. http://www.uptodate.com/home. Accessed Nov. 18, 2013.
- Mattison M, et al. Hospital management of older adults. http://www.uptodate.com/home. Accessed Nov. 18, 2013.
- Pressure ulcer prevention. Rockville, Md.: Agency for Healthcare Research and Quality. http://www.guideline.gov/content.aspx?id=43935&search=trapeze#Section420. Accessed Nov. 18, 2013.
- AskMayoExpert. Sepsis, severe sepsis and septic shock. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2013.
- AskMayoExpert. Skin and soft tissue infections. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2013.
- Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 21, 2013.