Pressure Ulcer Prevention and Management Guide

Pressure Ulcer Prevention and Management Guide

What are pressure ulcers?

Applying a large amount of pressure over a short period of time can result in pressure ulcers, which are a serious health risk. Pressure ulcers can range from patches of discolouration on the skin, to open wounds that expose bone or muscle. These ulcers tend to affect people with health conditions that limit a person’s movements, particularly those who are confined to lying down.

What are the causes of pressure ulcers?

There is a combination of causes that lead to pressure ulcers. Excessive pressure disturbs the blood supply to the affected area, and blood is crucial in keeping tissue healthy. Without it, tissue becomes damaged and will die. Disruption to the blood supply also prevents the skin from receiving white blood cells, which fight infection. Without these, the ulcer can be infected by bacteria. The time it takes for a pressure ulcer to form depends on the amount of pressure applied, and the vulnerability of a person’s skin to damage.

In terms of pressure, there are three types that can cause the development of pressure ulcers: Interface pressure, which is caused by the body pressure pressing the skin down onto a firm surface. Shear pressure, which occurs when layers of skin are forced to slide over one another or deeper layers of tissue. And friction pressure, which can be caused by something rubbing against the surfaced of the skin, such as a mattress.

What are the symptoms of a pressure ulcer?

The appearance of pressure ulcers varies depending on the severity of them. Healthcare professionals use a grading system to describe ulcers, depending on the severity and how deep the ulcers go. Grade 1 is when the skin is permanently red but not broken. Grade 2 refers to the ulcer looking similar to a blister or abrasion. Grade 3 is when the ulcer has damaged the tissue underneath the skin. And the final grade, grade 4, is the most severe form. This is when the ulcer is deep and has damaged the muscle or bone underneath the skin.

For those who are confined to a bed, these individuals are at risk of developing pressure ulcers on shoulders, elbows, the back of the head, around the ears, knees, ankles, heels, toes, the spine, and the tail bone.

How can pressure ulcers be prevented?

The treatment of pressure ulcers in the UK costs £1.4 - £2.1 billion each year, but most pressure ulcers are preventable. There is a Stop Pressure Ulcer Day that raises awareness of prevention techniques. Pressure relief is extremely important in preventing pressure ulcers, and a pressure relief mattress can greatly reduce the chances of them developing. Pressure relief mattresses are designed to produce active pressure relief, so that pressure is handled effectively, pain is eased, and the patient is comfortable.

Pressure relief mattresses cater for three levels of pressure relief risk: high risk, which is suitable for severe pain and pressure ulcers. Medium risk, which is suitable for slight pain and discomfort. And low risk, which is suitable for providing additional comfort. There are active and static pressure relief mattresses available.

In managing pressure ulcers, there are different ways to go about it. As well as pressure relief mattresses, it is important to make sure that the patient changes their position often; if in bed, changing position every 2 hours is recommended. For stage 1 and 2 ulcers, the area can be washed gently. For stage 1, ulcers can be washed using water and soap. For stage 2, pressure ulcers should be cleaned using salt water, and any loose or dead skin should be removed. All ulcers should be covered with a dressing, to prevent infection. Stage 3 and 4 ulcers should be treated by professional nursing staff, who may advice on homecare instructions.

Pressure relief is extremely important, particularly for the long-term health of a patient, but also in reducing the burden that pressure ulcers present to the care sector in terms of cost. Pressure ulcers are preventable and there are plenty of pressure relief products available.

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