What Causes Bed Sores and How Can They Be Prevented?

Bed sores are pressure ulcers and are some of the most commonly encountered medical conditions in patients requiring long-term care. Up to 2.5 million pressure ulcers are treated each year in the US alone.  Studies vary but it is estimated that between 40% and 50% of hospitalized patients will develop pressure ulcers. One study demonstrated that the need for long term care in patients with pressure ulcers approached 50% while in those without pressure ulcers the need was only 16.2%.

Pressure ulcers that remain unhealed can lead to several serious medical complications including cellulitis (an infection of the skin), septic arthritis (a joint infection) and osteomyelitis (an infection of the bones); all of which can lead to Sepsis (a serious and potentially life threatening systemic infection when bacteria enter the blood stream). In some cases they can also lead to a type of squamous cell carcinoma (or cancer).

Pressure ulcers develop for several reasons which tend to lead to or cause increased risk with periods of prolonged pressure and are typically treated by reducing such factors.

1) Immobility:  Preventing periods of prolonged immobility is the most important step in preventing and healing pressure ulcers. This includes patient initiated activities such as making sure to change position while in bed and lift up off of a wheelchair at minimum every 2 hours; to caregiver based positional changes again at least every 2 hours.

2) Malnutrition:  Poor nutritional status can cause loss of fatty tissue which serves as a cushion over pressure sensitive areas, it also leads to decreased resilience of skin tissue and decreased exposure time to develop a pressure ulcer. Treatment is aimed at correcting any potential nutritional deficits.

3) Poor Skin Perfusion (or decreased blood flow):  Any reduction in blood flow to the skin can cause hypoxia (decreased oxygen) in skin tissues causing decreased exposure time to develop a pressure ulcer. Efforts to improve perfusion should be taken and include offloading to prevent pressure induced ischemia, interventional procedures and in some cases hyperbaric therapy is indicated.

4) Sensory Loss:  Poor sensation doesn’t allow patients to feel when pressure is building up.  Again, efforts aimed at increasing awareness in insensate patients are key.

“Bed sores” can also arise from several other etiologies that are not pressure-induced but are important to be aware of.

1) Moisture:  Increased Moisture over prolonged periods can lead to skin maceration and cause skin to be more prone to injury from pressure and other forces. In some cases moisture can be the primary cause of ulceration, even in the absence of any pressure.

2) Friction/Shear:  Friction or shear-induced ulcers or skin tears can be another potential etiology for a bed sore and comes from moving skin over the surface of a fixed object. This could be something as simple as pulling a sheet or mattress up to position a patient in bed, so special care should be taken when completing transfers.

The physicians at the Wound Center at Columbus Regional Hospital are all well-trained to treat pressure ulcers and wounds of all types. If you or a loved one has a non-healing wound and would like to be seen at the Wound Center, please call (812) 375-3516 to schedule an appointment.

Doctor Zachary Siegel, MD is a Physiatrist and Wound Care/Hyperbaric Medicine Physician at Columbus Regional Health

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