Decubitus ulcer prevention; Bedsore prevention; Pressure sores prevention

Pressure ulcers are also called bedsores and pressure sores. They can form when muscles and soft tissue press against a surface such as a chair or bed. This pressure cuts off your blood supply to that area. Lack of blood supply can cause the skin tissue in this area to die. When this happens, a pressure ulcer may form.

You have a risk of developing a pressure ulcer if you:

• Spend most of your day in a bed or a chair
• Are overweight or underweight
• Are not able to control your bowels or bladder
• Have decrease feeling in an area of your body
• Spend a lot of time in one position

You will need to take steps to prevent these problems.

You, or your caregiver, need to check your body every day from head to toe. Pay special attention to the areas where pressure ulcers often form. These are:

• Your heels and ankles
• Your knees
• Your hips
• Your spine
• Your tailbone area
• Your elbows
• Your shoulders and shoulder blades
• The back of your head
• Your ears

Call your doctor or nurse if you see early signs of pressure ulcers. These are:

• Skin redness
• Warm areas
• Spongy or hard skin
• Erosion of the top layers of skin or a sore

Treat your skin gently to help prevent pressure ulcers.

• When washing, use a soft sponge or cloth. Do not scrub hard.
• Use moisturizing cream and skin protectants on your skin every day.
• Clean and dry areas underneath your breasts and in your groin
• Do not use talc powder or strong soaps
• Try not to take a bath or shower every day. It can dry out your skin more.

Eat enough calories and protein to stay healthy.

Drink plenty of water every day.

Make sure your clothes are not increasing your risk of developing pressure ulcers.

• Avoid clothes that have thick seams, buttons, or zippers that press on your skin.
• Do not wear clothes that are too tight.
• Keep your clothes from bunching up or wrinkling in areas where there is any pressure on your body.

After urinating or having a bowel movement:

• Clean the area right away. Dry well.
• Ask your doctor about creams to help protect your skin in this area.

Make sure your wheelchair is the right size for you.

• Have your doctor or physical therapist check the fit once or twice a year.
• If you gain weight, ask your doctor or physical therapist to check how you fit your wheelchair.
• If you feel pressure anywhere, have your doctor or physical therapist check your wheelchair.

Sit on a foam or gel seat cushion that fits your wheelchair. Do NOT sit on donut-shaped cushions.

You or your caregiver should shift your weight in your wheelchair every 15 - 20 minutes. This will increase blood flow and take pressure off certain areas:

• Lean forward
• Move side to side

If you transfer yourself (move to or from your wheelchair), lift your body up with your arms. Do NOT drag yourself. If you're having trouble transferring into your wheelchair, see a physical therapist to learn proper technique.

If your caregiver transfers you, make sure they know the proper way to move you.

Use a foam mattress or one that is filled with gel or air. Place pads under your bottom to absorb wetness to help keep your skin dry.

Use a soft pillow or a piece of soft foam between parts of your body that press against each other or against your mattress. Some common pressure areas are:

• When you are lying on your side, between your knees and ankles
• When you are lying on your back:
  • Under your heels. Or, place a pillow under your calves to lift up your heels, another way to relieve pressure on your heels.
  • Under your tailbone area
  • Under your shoulders and shoulder blades
  • Under your elbows

Some other tips are:

• Do NOT put pillows under your knees. It puts pressure on your heels.
• NEVER drag yourself to change your position or get in or out of bed. Dragging will cause skin breakdown. Get help if you need moving in bed or getting in or out of bed.
• If someone else moves you, they should lift you or use a draw sheet (a special sheet used for this purpose) to move you.
• Change your position every 1 - 2 hours to keep the pressure off any one spot.
• Sheets and clothing should be dry and smooth, with no wrinkles.
• Remove any objects such as pins, pencils or pens, or coins from your bed.
• Do not raise the head of your bed to more than a 30-degree angle. Being flatter keeps your body from sliding down. Sliding may harm your skin.

Call your doctor right away if

• You notice a sore, redness, or any other change in your skin that last for more than a few days or becomes painful, warm, or begins to drain pus.
• Your wheelchair does not fit.

US Department of Health and Human Services. Health care protocol: Skin safety protocol: Risk assessment and prevention of pressure ulcers. Institute for Clinical Systems Improvement. 2nd ed. 2007 March:1-31. Guideline summary: 2009 July.