Pressure injuries (also known as bed sores) are injuries to the skin and tissues caused by pressure, friction, or shear. Pressure injury prevention is very important because once bed sores occur, they can be very difficult and slow to heal. They can also be very painful for the person in your care.
If you’re caring for someone who has poor mobility and spends a lot of time in a chair or bed, the following information will help you to understand why they may be at risk of developing pressure injuries. Keep reading to learn what you can do to help reduce that risk.
What Are pressure, friction, and shear?
Here is a brief overview of how pressure, friction, and shear can cause skin breakdown.
Pressure is created when the skin and soft body tissues become compressed or squished between the bone inside the body and an outer surface over a period of time. This outer surface could be a chair or even what we might consider to be a soft mattress. If the pressure is not removed or alleviated, the tissue and skin begin to die causing a wound or bed sore. This wound can be caused by a person sitting or lying for too long in the same position or even from the pressure of tubes (such as oxygen tubing or catheter tubing) against a person’s skin.
Friction is created when two surfaces rub across one another. For example, a person’s skin can rub against rough bed linen causing the skin to become damaged.
Shear is created when the bone moves one way but the skin does not. This results in tension and damage to the underlying tissues. For example, shear can be created if the tissue is accidentally dragged up the bed during repositioning or if the person slides down the mattress when the head of the bed is raised. Ultimately, the skin and tissue stay in position as the body moves downward. This drags the person’s bones and tissues in opposite directions resulting in pressure injuries.
As skin ages, it becomes dry and fragile with less collagen and fat layers. These skin changes contribute to an increased risk of developing a pressure injury.
Risk factors For developing pressure injuries
- Reduced mobility or inability to get out of a bed and/or chair
- Difficulty changing position easily and/or involuntary sliding down in a chair/bed
- Poor fluid and food intake
- Decreased ability to feel sensation
- Prolonged contact with moisture (sweating and/or incontinence of urine and/or stool)
- Fragile skin
Tips for preventing pressure injuries
- Encourage the person in your care to drink enough fluids (around 1.5-2 litres per day unless the doctor has instructed differently).
- Ensure that the person in your care has a balanced diet of protein, vitamins, and minerals to ward off skin damage and speed up the healing process.
- Ultilize special cushions and mattresses that reduce pressure for people who have mobility issues. An occupational therapist can help to determine which one is best suited to the person in your care.
- Encourage and help the person to reposition or move every 1-2 hours.
- Ask an occupational therapist or a physiotherapist about equipment that may help you transfer the person from one surface to another (such as bed to chair and vice versa) to avoid dragging the person across surfaces that may result in friction or shear.
- Avoid positioning the person completely on their side as this can put pressure on the protruding bones of the hips and shoulders. If needed, use a pillow to prop them over on a 30 degree angle instead. Also, avoid elevating the head of the bed above 30 degrees.
- Check tubing every couple of hours to ensure that it is not digging into the skin or trapped under the person’s body. For instance, check that the oxygen tubing isn’t putting pressure on the person’s ear or that the catheter tubing isn’t under the person’s leg.
- Use pads and incontinence products if urine/stool leakage is a concern. The products should be changed as soon as possible once soiled. Consider reading When Nature Won’t Stop Calling, an article about incontinence and how to manage it.
- Avoid scrubbing the person’s skin during bathing or washing. The water should be lukewarm or room temperature. Also, apply moisturizer to their skin after bathing or washing.
- Avoid massaging any areas of redness over bony body parts (like hips, elbows, shoulders, heels, or ankles) as this can increase problems of friction and shear.
- If you DO see redness in an area that does not go away when pressure is removed, inform a health care professional so that a proper skin assessment can be completed.
Occupational therapists and physiotherapists can help assess seating and surfaces to ensure that they are the most appropriate for those at risk. A Registered Dietician can provide assistance if there is a concern related to fluid or food intake.
This plan for pressure injury prevention and management is a great place to start but be sure to discuss any concerns with the doctor or nurse so that the most appropriate course of action or treatment can be initiated early to prevent further damage from occurring.