Pressure ulcers

Pressure ulcers are common in people confined to bed for long periods, or immobilised due to a disease or accident. They are wounds which require frequent care, which can take several months to heal and which mainly affect elderly patients. 

What is a pressure ulcer?

A pressure ulcer is a chronic wound which appears when sitting or lying for a prolonged period. This is because long periods of inactivity create pressure on  weight-bearing areas. This pressure compresses the tissue between two hard surfaces, preventing blood from flowing normally, leading to reduced oxygen supply. The tissue then becomes damaged, and the wound eventually develops.

In many cases, pressure ulcers appear on the sacrum or the heel, which are primary weight-bearing areas in disabled patients or patients with reduced mobility. Pressure ulcers can also occur on the elbows, shoulder blades, or the back of the head. 

Pressure ulcers are classified by stage according to their severity.

  • Stage 1 : Persistent redness. Stage 1 of a pressure ulcer can be seen as redness which appears and which does not disappear when pressed. . The skin is not yet broken, and there is not yet a wound. Specific treatment must be started at this stage. In this case it is recommended to not massage the area as this may aggravate the condition.
  • Stage 2 : Erosion of the epidermis and the dermis. The wound is formed and the skin is broken.
  • Stage 3 : The epidermis, the dermis and the hypodermis are affected. There is necrotic (black) tissue and scabs can be seen. NB: pressure ulcers always appear smaller on the surface than they are deeper down.
  • Stage 4 : Deep pressure ulcer. Deep necrosis with possible involvement of the bones, tendons and muscles.

Factors promoting the appearance of pressure ulcers:

  • Immobility
  • Patient age. Even though pressure ulcers can sometimes occur in children, patients over the age of 70 are especially at risk
  • Malnutrition
  • The quality of the skin. The finer the skin, the higher the sensitivity to friction, shear stress and pressure
  • Incontinence, which causes permanent humidity and leaves the tissue fragile and macerated
  • Differences in sensitivity. Patients (sometimes with neurological disorders) may not feel the pain, and may not have the reflex to change position.

Pressure ulcer treatment

Regardless of the stage of the pressure ulcer, treatment must be started as soon as possible.

The type of treatment depends on the stage of the pressure ulcer (reversible or irreversible lesion). If there is a visible lesion, it should be protected by the appropriate dressing. Where both the epidermis and the dermis are involved,  nursing staff should oversee wound cleansing and healing.

Regardless of the severity of a pressure ulcer, the first step is to remove the pressure. The patients position should be changed every 2 to 3 hours. Setting up a specialised bed with a specific mattress (foam, water, air) and cushions will relieve and redistribute pressure in high-risk areas of the body. Treatment should be accompanied by appropriate nutritional management and management of any comorbidities.

And afterwards?

We know that two hours without moving is enough to create a pressure ulcer. The following prevention measures could help:

  • Always examine the areas of the body in which a pressure ulcer is likely to develop (weight-bearing areas)
  • Move the patient, even if it means calling on a nurse or physiotherapist
  • Fully wash the patient at least once a day and clean the perineal area each time the patient goes to the toilet
  • Avoid using rough fabric to dry the skin
  • Change bed sheets daily