Bedsores are also called pressure ulcers or decubitus ulcers. While bedsores can develop at any age, including the very young, these most often form in an elderly, frail, and bedridden individual. They result from skin pulling, skin friction, and extended compression of the skin between a person’s bony prominence(s) and the underlying support – e.g. bed, chair, or wheelchair.

Areas where bedsores most commonly form are the mid-lower back (just above the tail bone), the outer ankles, the heels, the outer hips, the shoulder blades, the outside and back of the knees, and the back and sides of the head.

In as little as two hours, the process that leads to the development of a bedsore can become well-established. The interruption of the blood supply to the skin for this period often results in the death of tissue and the subsequent breakdown of the skin. Ultimately this devitalized tissue can become infected.

Bedsores are preventable and if they do develop they can be successfully managed, especially if discovered and treated early.

Risk factors for the development of bedsores

• Being bedridden
• Unconscious
• Quadriplegia or paraplegia
• Stroke
• Dementia
• Being elderly
• Cancer
• Diabetes
• Faecal or urinary incontinence
• Reduced or absent perception of pain
• Lying or sitting in one position for long periods
• An underlying surface that is minimally yielding or unyielding
• Poor nutrition
• Suboptimal skincare
• Poor circulation
• Being overweight
• Sickle cell anaemia
• Having a bedsore in the past
• Elderly with a hip fracture
• Kidney disease
• Liver disease
• Anaemia
• Multiple sclerosis
• Low blood oxygen levels
• Smoker
• Hospitalization
• Nursing home residents
• ALS

Stages of bedsores

• Stage I (early): The skin is not broken but there is discolouration. If the person can communicate they often report pain, stinging, itching, or burning in the area.
• Stage II: Broken skin, a blister, or a shallow open sore is present. This only involves the upper layer of skin.
• Stage III: The wound deepens with a crater-like lesion present. The subcutaneous fatty layer of skin is involved.
• Stage IV (advanced): Underlying ligaments, tendons, and or bone is exposed as a result of the depth of the bedsore.

Treatment options

• The treatment of bedsores is determined by their stage.
• There should be absolutely no pressure on the area with bedsore(s).
• The wound must be cleaned at least once daily. Normal saline is a highly recommended cleaning agent. Hydrogen peroxide, iodine, and antiseptics should be avoided.
• A barrier preparation such as zinc & castor oil reduces the chances of contamination with stool and urine.
• Water-based gels, alginate made from seaweed, or hydrocolloid can be used for dressing.
• The patient’s nutrition should be optimized.
• Damaged, dead and infected tissue needs to be removed (wound debridement).
• Antibiotics are prescribed if the bedsore is infected.
• A skin graft should be considered in advanced cases.

Complications that can arise from bedsores:

In many instances, a bed sore takes weeks to months to heal. Such an open lesion facilitates the development of infection. The bacteria infecting the bedsore can spread into the surrounding tissue resulting in cellulitis, or they can enter the bloodstream thus causing bacteremia or septicemia (sepsis). Sepsis can result in the affected person becoming extremely ill, having a fever, experiencing mental confusion, and in some cases, even death can occur. Especially if the infection spreads to the brain (meningitis), or heart (endocarditis). Bone infections (osteomyelitis) can also occur. In rare cases, a long-standing bedsore can develop skin cancer. In 2019 bedsores accounted for 24,400 deaths worldwide.

Reducing the chances of bedsores

• A water mattress or a mattress with a reactive air-filled topper is highly recommended for all protractedly immobile patients.
• Every two hours bedridden patients should be repositioned.
• Appropriately designed and placed padding should be used especially if lying on a regular mattress or sitting in a wheelchair.
• Inspect the skin in all the vulnerable areas daily.
• Skin in vulnerable areas should always be kept clean and dry. The skin should be patted (not rubbed) until dry.
• Apply a moisturising cream to areas of the skin prone to bedsores that may be exposed to stool and urine.
• Ensure that the patient has a balanced and nutritious diet.
• The patient should be kept well-hydrated at all times.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: clinic@familycaresvg.com, 1(784)570-9300, (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided