What is a bed sore?

Adverse Events in Hospitals
December 2, 2011
A Guide to Bedsores
September 7, 2012
NPUAP-Normal-150x150.jpg

Definition of Bed sore
Bed sore: A painful, often reddened area of degenerating, ulcerated skin caused by pressure and lack of movement, and worsened by exposure to urine or other irritating substances on the skin. Bed sores are a major problem for patients who are confined to bed or a wheelchair, but aren’t limited to the bedbound. These sores can affect anyone who spends long periods in limited positions and those who are overweight and have folds of skin that touch. Bed sores can be prevented by moving the patient frequently, changing bedding, and keeping the skin clean and dry. They are also called a pressure sore, decubitus sore, or decubitus ulcer.

4 Stages of a Bed Sore
The definitions of the four pressure ulcer stages are revised periodically by the National Pressure Ulcer Advisory Panel (NPUAP) in the United States.

Normal Skin Deep Tissue Injury Stage 1 Stage 2
 
Stage 3 Stage 4 Unstageable  
  • Stage I is the most superficial, indicated by non blanchable redness that does not subside after pressure is relieved. The skin may be hotter or cooler than normal, have an odd texture, or perhaps be painful to the patient. Although easy to identify on a light-skinned patient, ulcers on darker-skinned individuals may show up as shades of purple or blue in comparison to lighter skin tones.
  • Stage II is damage to the epidermis extending into, but no deeper than, the dermis. In this stage, the ulcer may be referred to as a blister or abrasion.
  • Stage III involves the full thickness of the skin and may extend into the subcutaneous tissue layer. This layer has a relatively poor blood supply and can be difficult to heal. At this stage, there may be undermining damage that makes the wound much larger than it may seem on the surface
  • Stage IV is the deepest, extending into the muscle, tendon or even bone
  • Unstageable pressure ulcers are covered with dead cells, or eschar and wound exudate,such that the depth cannot be determined.
  • Suspected Deep Tissue Injury  Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.
     

 Treatment
According to the Mayo Clinic, the first step in treating a sore at any stage is relieving the pressure that caused it.  A person with pressure sores needs to be repositioned regularly and placed in correct positions. People using a wheelchair should change position as much as possible on their own every 15 minutes and should have assistance with changes in position every hour. People confined to a bed should change positions every two hours.  Special cushions, pads, mattresses and beds can help a person lie or sit in an appropriate position, relieve pressure on an existing sore and protect vulnerable skin from damage. A healthy diet and proper hydration are also crucial to wound healing.

Sometimes for wounds to heal properly, it needs to be free of damaged, dead or infected tissue. There are several ways to remove these tissues called debridement:

 

  • Surgical debridement involves cutting away dead tissues.
  • Mechanical debridement uses one of a number of methods to loosen and remove wound debris, such as a pressurized irrigation device, a whirlpool water bath or specialized dressings.
  • Autolytic debridement, the body’s natural process of recruiting enzymes to break down dead tissue, can be enhanced with an appropriate dressing that keeps the wound moist and clean.
  • Enzymatic debridement is the use of chemical enzymes and appropriate dressings to break down dead tissues.

In order to promote healing, the wound must also be cleaned and dressed. It’s essential to keep wounds clean to prevent infection. A stage I wound can be gently washed with water and mild soap, but open sores are cleaned with a saltwater (saline) solution each time the dressing is changed. A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. A variety of dressings are available, including films, gauzes, gels, foams and various treated coverings. Pressure sores that fail to heal may require surgical intervention. The goals of surgery include improving the hygiene and appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer. In general, most pressure wounds are repaired using a pad of the person’s own muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).

Bed sores can also be extremely painful and the processes of debridement, cleaning and dressing the wound can further add to the pain level for the patient. The use of nonsteroidal anti-inflammatory drugs ” such as ibuprofen (Motrin, Advil, others) and naproxen (Aleve, others) as well as topical pain medications, such as a combination of lidocaine and prilocaine, can help the patient deal with the pain.  Pressure sores that are infected and don’t respond to other interventions may be treated with topical or oral antibiotics.

What should you do if a loved one develops a Bed sore?

Bedsores are not a minor skin irritation- as they can result in lasting injury, and even death. The Centers for Medicare & Medicaid Services (CMS) has defined pressure ulcers (bed sores) as œnever events “ errors in medical care that are clearly identifiable, preventable and serious in their consequences for patients. The occurrence of œnever events indicates there is a problem in the safety and credibility of a health care facility.  Additionally, dehydration and malnutrition do not just happen without someone acting in a negligent way.  It is important to protect the ones you love. Medical providers have a responsibility to provide basic levels of care as defined by the law and individual facilities’ policies and procedures. Do not hesitate to contact us if you suspect a loved one is the victim of nursing home abuse or medical malpractice. We will get to work immediately and investigate your claim. If negligence is found and evidence of abuse or malpractice exists, we will ensure that the facility is held responsible and your loved one is protected.  Contact one of our attorneys today for a free consultation.

 

Sources: http://www.npuap.org/resources.htm
http://www.mayoclinic.com/health/bedsores/DS00570
http://www.cms.gov/

1 Comment

  1. Attorney Blog: Guide to Bedsores: Never Events: Medical Malpractice | Jacksonville Personal Injury Lawyer: Medical Malpractice Law Firm: Edwards and Ragatz says:

    […] one has become bedridden due to illness or infirmity, it is important to take steps to prevent bedsores/pressure ulcers, which are areas of broken down skin caused by pressure of lying in one spot too long without […]

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