Bed Sores

What are bed sores?

Bed sores (also known as pressure sores or decubitus ulcers) can occur when a person is bedridden, unconscious, unable to sense pain, or immobile. Bed sores are ulcers that occur on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time. Bed sores can be a serious problem among frail older adults. Their occurrence can be related to the quality of care the person receives. If the person is not turned, positioned correctly, and provided with adequate nutrition and skin care, bed sores can develop. People with diabetes, circulation problems and malnutrition are at higher risk.  

Why does a bed sore develop?

A bed sore develops when blood supply to the skin is cut off for more than two to three hours. As the skin dies, the bed sore first starts as a red, painful area, which eventually turns purple. Left untreated, the skin can break open and become infected. A bed sore can become deep, extending into the muscle and bone. Once a bed sore develops, it is often very slow to heal. Depending on the severity of the bed sore, the person's physical condition, and the presence of other diseases (such as diabetes), bed sores can take days, months, or even years to heal. 

Bed sores often occur in the buttocks area (on the tailbone or hips), or on the heels of the feet. The shoulder blades, the back of the head, and the backs and sides of the knees are also frequent bed sore sites. 

Bed sore symptoms

Bed sores are divided into four stages, from least severe to most severe. These are:

Stage 1. The area looks red and feels warm to the touch. With darker skin, the area may have a blue or purple tint. The person may also complain that it burns, hurts, or itches.

Stage 2. The affected area looks more damaged and may have an open sore, abrasion, or blister. The person complains of significant pain and the skin around the wound may be discolored.

Stage 3. The area has a crater-like appearance due to damage below the skin's surface.

Stage 4. The affected area is severely damaged and a large wound is present. Muscles, tendons, bones, and  joints can be involved. Infection is a significant risk at this stage. 

A wound is considered unstageable when there is full-thickness tissue loss and the base of the ulcer is covered by slough or eshar is identified in the wound bed. Slough my be tan, grey, green, brown, or yellow in color and eschar is usually tan, brown or black.  

Preventing bed sores

Bed sores can be prevented by inspecting the skin for areas of redness (the first sign of skin breakdown) every day with particular attention to bony areas.  Other methods of preventing bed sores and preventing progression of existing bed sores include the following:

• Turning and repositioning every two hours

• Sitting upright and straight in a wheelchair, changing position every 15 minutes.

• Providing soft padding in wheelchairs and beds to reduce pressure

• Providing good skin care by keeping the skin clean and dry

• Providing good nutrition because without enough calories, vitamins, minerals, fluids, and protein, bed sores cannot heal--no matter how well you care for the sore

Treatment for bed sores

Specific treatment of a bed sore is determined by your physician and wound care team and based on the severity of the condition. Treatment may be more difficult once the skin is broken, and may include the following:

• Removing pressure on the affected area

• Protecting the wound with medicated gauze or other special dressings

• Keeping the wound clean

• Ensuring adequate nutrition intake

• Debriding the wound (removal of damaged, infected or dead tissue)

• Transplanting healthy skin to the wound area (skin grafts)

• Negative pressure wound therapy

• Medication (i.e., antibiotics to treat infections)

• On-going monitoring of the bed sore to document size, depth, and response to treatment