How to Prevent Bed Sores

Bed sores can be prevented with techniques like frequent repositioning and having your loved one lay on a special surface such as an egg-crate mattress. Check the person early and often for signs of developing bed sores and treat them as soon as they appear.

Bed sores are also called pressure ulcers. They are areas of damaged tissue that develop when pressure reduces the blood flow to specific parts of the body. The key to preventing them is to reduce the amount of friction and pressure between the person's skin and the bed. This means helping them move often as well as looking after their overall health.

This article discusses bed sores, how they develop, and some of the ways they can be prevented and treated.

Causes of Bed Sores

Bed sores are a common problem in palliative care patients. They form when constant pressure between the skin and the bed or other surfaces reduces blood flow to specific points on the body.

Bed sores can develop quickly, often after only two or three hours of reduced blood supply. They can become deep enough to penetrate muscle and bone and can heal very slowly, sometimes taking months or years depending on a person's physical health.

Decreased mobility, increased time spent in bed, and altered nutrition can all make a person more vulnerable to developing bed sores.

How to Prevent Bed Sores

Pressure ulcers are painful. As a caregiver, one of the most important things you can do to keep your loved one comfortable is to prevent one from developing. This involves lifting and moving the person regularly. Make sure to ask for help with these tasks if you need it.

Relieve Pressure

Turning a patient who is bed-bound is the most important thing you can do to prevent pressure ulcers from occurring. Frequent turning alternates areas of pressure on bony parts of the body such as the lower back, hips, elbows, and heels.

Plan on turning your loved one every two hours, alternating between their right and left sides and their back. You don't need to disturb your loved one or wake frequently at night to maintain this schedule, however. If they do call for you late at night, take that opportunity to turn them.

Use pillows to help position your loved one. Pillows add comfort and can reduce pressure on bony areas. For example:

• Place a pillow under their back to prop them on their side.
• Place one between the knees when they're laying on their side.
• Use one under the ankles to “float” their heels off the bed.

If your loved one is spending most of the day in a recliner chair, repositioning is still important. Small adjustments in seating position are often effective enough at relieving pressure.

Special surfaces can also help reduce or relieve pressure. Some of these include:

• Egg crate mattresses and chair pads: Many hospice and home health agencies provide these free of charge but they are relatively inexpensive at your local department store. An egg crate surface helps distribute pressure more evenly, helping minimize the amount of pressure on one area.
• Air mattress overlay: This type of surface is placed on top of a mattress and typically alternates air pressure in various columns.
• Fluidized air mattresses: These special mattresses contain silicone-coated glass beads that become fluid when the air is pumped through them. A downside is the frame, which makes transferring a person to and from bed difficult. If the person wants to sit up in bed, they may need a foam wedge to help support their back. This mattress is best suited for palliative care patients who are fully bed-bound, have severe pressure ulcers, and are in a lot of pain.

Even when using an egg crate mattress or an air mattress overlay, it’s still important to maintain the turning schedule. These devices don’t replace frequent repositioning.

Reduce Friction

Friction is the rubbing of skin on an external surface, usually bed sheets. Friction to the most commonly affected areas can be reduced with protective devices. Heel and elbow cradles are typically made of egg-crate material. They are usually attached with Velcro.

Skin-protecting dressings, such as films (Tegaderm) and thin hydrocolloid bandages (Duoderm) can protect the skin from repeated friction but won’t help reduce pressure.

Avoid Shearing

Shear is created when the deeper fatty tissues and blood vessels are damaged by a combination of friction and gravity. The best way to avoid this type of injury is to avoid placing your loved ones in certain positions. The most important positions to avoid are:

• Semi-Fowler, where the head is raised less than 30 degrees
• Upright positions of more than 30 degrees

You won't be able to avoid these positions all of the time. Many patients need to be semi-Fowler to help ease shortness of breath or prevent gastric reflux. All patients need to be in an upright position to eat safely.

To minimize the risk of shear injury in a semi-Fowler or upright position, take precautions to prevent your loved one from sliding down in bed. You can do this by raising the foot of the bed and propping the knees up with pillows.

Shear injury can happen in chairs too. To keep your loved one from sliding in their chair, use footstools or ottomans to prop their feet and pillows or special devices to keep their hips at a 90-degree angle.

Early Treatment

Check your loved one often for early signs of bed sores. They will need to be treated before they develop into more serious sores.

Stage I bed sores on a light-skinned person look red. On darker skin, they may look blue or purple. They usually feel warm to the touch. They cause a burning or itching sensation and may also feel sore.

If you find early signs of a bed sore, immediately relieve pressure on the area. Consult your loved one's healthcare provider for instructions on how to care for the sore.

For stage I sores, care usually begins with washing the area with a gentle soap and water. It can also help to apply a moisture barrier, a specially formulated gel, cream, or ointment that can protect the area from moisture. Stage II pressure sores are open sores or blisters. These will need to be cleaned with a saline solution to remove dead tissue. 

Cover the sore with a dressing as instructed by your loved one's healthcare provider. This will help it heal and protect against infection.

Self-Care to Prevent Bed Sores

Bed sores can also be prevented with self-care techniques that can help make a person's skin less prone to developing a sore.

Skin Care

Moisture from sweat, urine, or feces can be damaging to the skin. It’s important to maintain the skin’s integrity by managing the moisture.

If a patient accumulates a lot of moisture from sweat, they will need their clothing and sheets changed often. Hospital gowns or other clothing that slips on and off easily can make this task easier. Using several layers of sheets can also help.

If your loved one has urinary incontinence, they will need frequent changing of their adult diapers or pull-ups. Check them at least every two hours and change them as soon as they become soiled.

If a pressure ulcer already exists or if there is a high risk of developing one, it may be helpful to place a Foley catheter. This is a small tube that is inserted into the urethra and into the bladder where it remains with the help of an inflated balloon. Once placed, urine drains out of the tube and into a collection bag, keeping the skin free from urine.​ A Foley catheter can only be placed by a nurse with a physician’s order.

A person who has bowel incontinence is at an increased risk of skin breakdown from the bacteria and digestive enzymes found in bowel movements. They will need to be cleaned and changed as soon as possible after every bowel movement.

It is also important to use a moisturizer to keep your loved one's skin from drying out. This can help make the skin less prone to damage.

Good Nutrition

There is a strong correlation between nutrition deficits and pressure ulcer risk. If your loved one has an appetite, try to maintain adequate nutrition with nutrient-rich foods including:

• Lean proteins
• Whole grains
• Fruits
• Vegetables

If their appetite is waning, offer supplements such as Ensure or Boost to help bolster nutrition.

Staying well-hydrated is another important way to improve the integrity of the skin. Hydration supports blood flow and can help prevent sores or keep them from getting worse.

Aim to give your loved one around 30 to 35 ml of water per kg of body weight. For a 150-pound person (68 kg), this works out to around 2 to 2.4 liters of fluid per day.

Choose the Right Sheets

The right kind of sheets are also important. Choose sheets made from a silk-like fabric and avoid sheets that feel stiff or have a rough or loose weave. Studies have found that a breathable, silk-like fabric can help reduce the incidence of pressure sores.

Pain Relief

Making sure your loved one has adequate pain relief may also help. Some people may avoid moving if it hurts to do so. Pain relievers can help make a person who is bed-bound more willing to reposition themselves or be repositioned.

Summary

Bed sores can develop when a person who needs to remain in bed for long periods of time doesn't change positions often enough. This can happen as a result of friction and pressure, which causes reduced blood flow to vulnerable parts of the body.

To keep bed sores from developing, it is important to make sure your loved one changes position every two hours. It can also help to make sure they are drinking enough fluids and getting the right nutrition. Make sure to check for developing bed sores often and treat them right away with help from your loved one's healthcare provider.