Factors Implicated in Bedsore Causation

Most people who want to prevent or deal with bedsores (pressure sores) wrongly believe that the only factor to consider is pressure. In fact there are several other factors to consider when looking at the efficient prevention and management of bedsores.

Pressure

Pressure is a key factor contributing to decubitus ulcers. This is particularly pronounced amongst either very heavy patients or those who are very thin. This problem is further exacerbated amongst the aged as the skin tends to be more fragile and therefore easily traumatised. Patients with reduced sensitivity and those neurological compromiesd are also at higher risk because of their inability to sense and respond to the pain stimuli caused by the pressure.

It is important to relieve the particularly vulnerable points of pressure when dealing with this problem. See picture of likely points already shown on main page.

The most efficient way to deal with bedsores is to relieve pressure by constantly adjusting the position the patient is in. This is the rationale of turning protocols that require  a patient to be turned every 2 hrs, the minimum frequency. This is based on clinical studies that have shown that bedsores can be formed on almost anyone who does not relieve pressure for that period of time. Normal individuals will not allow that pressure to build up because we will feel the discomfort and naturally move to relieve it, even in our sleep.

The interphase pressure (pressure on the skin) that we are tryng to alleviate is a distinct value of 32 mmHg which is known to be the capillary closing pressure in humans. Antibedsore systems are configured to go below this pressure, as an average, over a period of time.

Heat

Heat causes all reactions to speed up and that includes skin breakdown. Also, heat causes sweating that moistens the skin and if not managed properly will add to the problem.

Patients should be clothed in light breathable clothing to beat our tropical heat and when necessary further cooled by fans or air-conditioning. 

Moisture

Our skin sweats to cool our body, but if left to soak our skin, it can effect the skin's integrity. The skin should ideally be moist but should not be wet. In the tropical heat, the sweating is unavoidable especially for the overweight patient. Appropriate clothing and keeping cool will help reduce the excessive sweating.

For incontinent patients, this is a further challenge because constant urination and poor diaper quality can result in the pelvic area to suffer from excess moisture. The sacral area is also one of the most vulnerable spots that can lead to persistant ulcers.

Patients should have frequent diapers changes if they are on it to reduce wetness and skin breakdown.

Sheer Forces

Sheer forces are the forces experienced when the skin is dragged over a surface. This can lead to bruising and then skin breakdown if not managed. Coupled with the other factors mentioned, ulcers can form quickly.

That is why why it is imperative that immobile patients be moved with care because the subtle brusining of sheer forces are not immediately perceptible. Proper technique or tools are therefore required to avoid such bruising in heavy patients when moving them.

Also see Kinetibed - The automatic turning bed.