Pressure ulcers (also known as bedsores or decubitis ulcers) is an area of skin and tissue that becomes injured or broken down. Pressure sores develop when the skin and underlying tissue is squeezed between a bone and an external surface, such as a bed or chair. The most common places for pressure ulcers are over bony prominences (bones close to the skin), such as the elbow, heels, hips, tailbone, ankles, shoulders, back, and the back of the head. Generally, pressure ulcers occur when a person is in a sitting or lying position for too long without shifting his or her weight. Thus, Anyone confined to a chair or bed is at risk. Incontinence and decreased sensory perception (due to a stroke, for example) also increase the likelihood of developing bedsores. The constant pressure against the skin squeezes the blood vessels that supply nutrients and oxygen to the skin and nearby tissue, causing a decreased blood supply to the area. Subsequently, the skin can no longer survive and dies. Left untreated, nearby tissue begins to die, eventually resulting in an ulcer that reaches the bone, leaving an open cavity with resulting secondary infections that can cause death.

Risk Factors

Factors that increase the risk for pressure ulcers include:

• Age -- elderly people are at higher risk
• Inability to move certain parts of the body without assistance, such as with spinal or brain injury patients, and patients with neuromuscular diseases
• Malnutrition
• Being bedridden or in a wheelchair
• Having a chronic condition such as diabetes or artery disease that prevents areas of the body from receiving proper blood flow and nutrition
• Urinary incontinence or bowel incontinence (moisture next to the skin for long periods of time can cause skin irritation that may lead to skin breakdown)
• Fragile skin
• Mental disability from conditions such as Alzheimer’s (some patients may not be capable of taking the proper steps toward prevention and may not seek appropriate treatment when an ulcer has formed)

Preventing Pressure Ulcers

Education of at-risk patients and their families is the most productive way to prevent pressure ulcers. Steps toward prevention include:

• Identifying individuals at high risk for pressure ulcers.
• Ensuring that immobile patients change their position at least every two hours to relieve pressure.
• Using items that can help reduce pressure caused by bedsheets and wheelchairs (e.g., use pillows, sheepskin, foam padding, and powder to relieve pressure).
• Making sure patients eat healthy, well-balanced meals.
• Encouraging daily exercise, including range-of-motion exercises for immobile patients.
• Following good skin care, including inspecting the skin every day and keeping skin clean and dry. Incontinent people need to take extra steps to limit areas of moisture.

Bed-bound individuals should be moved at least every two hours. Chair-bound individuals should change positions every 15 minutes if possible. The patient or the caretaker should take care to wash the patient properly, especially if the patient is incontinent. Over-washing, and certain types of cleansers, can irritate the skin, and should be avoided.

A variety of pressure-reducing beds and cushions are available, as are lifting devices that help minimize friction when moving chair- or bed-bound individuals. These include lift sheets, belts, sliding boards and hydraulic lifts.

Staging a Pressure Ulcer

The National Pressure Ulcer Advisory Panel (NPUAP) created a process for evaluating pressure sores based on a system that spans from Stage I (earliest signs) to Stage IV (most advanced):

• Stage I: A reddened area on the skin that when pressed is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.
• Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
• Stage III: The skin breakdown now looks like a crater, where there is damage to the tissue below the skin.
• Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

Treating a Pressure Ulcer

The protocol for treating a pressure ulcer is based upon the ulcer’s stage,. In the early stages (Stage 1 and 2), characterized by redness (Stage 1), and blistering and cracking (Stage 2), the area is generally kept exposed, free from pressure, and dry. Gentle massage may facilitate healing. By Stage 3, when the ulcer is a crater-like sore and bacterial infection may be present, treatment may focus on draining and dressing the wound, and using topical ointments to promote healing.

Legal Options

If you or someone you love have suffered from a stage 3 or stage 4 Pressure Ulcer due to the neglect of a caregiver (such as a hospital, nursing home, or assisted living provider), you should immediately contact a competent attorney. The attorney will work with you to determine the legal options that may be available.