The Complete Guide to Pressure Ulcers

Pressure ulcers continue to be a concerning and mainly avoidable harm within healthcare settings.

What is a pressure ulcer?

A pressure ulcer, also referred to as a pressure sore or bed sore, is damage caused to the skin and underlying tissue, primarily caused by prolonged pressure on the skin. Pressure ulcer development can happen to anyone, however typically they usually affect those who are confined to a bed or sit for long periods of time in a chair or wheelchair.

Early signs of a pressure ulcer – category 1

Pressure ulcers will develop over time, but this can be as little as a few hours. They can affect any part of the body that’s exposed to pressure. The most common areas of the body for pressure ulcers are bony provinces such as heels, elbows, hips and base of the spine/ sacral region.

In the early stage of a pressure ulcer part of the skin will start becoming discoloured, those with pale skin will have red patches while those with dark skin often get purple or blue patches on their skin. These discolorations on the skin won’t turn white when pressed and the patches will feel warm, spongy or hard to touch.

It's common for pain or itchiness to occur in this area, all of the above are commonly referred to as a category 1 pressure ulcer in which recovery time is around 2-3 days.

Older signs of a pressure ulcer

If a pressure ulcer is left untreated, it will worsen and has the potential to seriously affect a person’s health, wellbeing and delay their recovery/wound healing. Even if the skin is not broken at first, when a pressure ulcer gets worse it can form into a higher category which become more painful and a longer recovery.

Category 2
• An open wound or blister, sometimes can look like filled with clear liquid
• Painful to touch and tender
• Can look like a scrape (abrasion), blister, or a shallow crater in the skin
• Partial thickness skin loss
• Recovery time: 3 days to 3 weeks

Category 3
• Full thickness skin loss
• A deep wound that reaches the deeper layers of the skin
• Wound tunnelling and odour
• Recovery time: 1 month up to 4 months

Category 4
• Very deep wound that may expose tendons, muscle, or bone
• Skin has turned black and shows signs of infection
• Red edges, pus, odour, heat, and/or drainage
• Recovery time: From 3 months and possibly longer

Who is likely to get a pressure ulcer?

Anyone who puts prolonged pressure on the skin can develop a pressure ulcer. However, as we briefly mentioned earlier pressure ulcers usually affect those who are confined to a bed or spent long periods of time sitting.
People over the age of 70 are at a higher risk of developing a pressure sore due to being more likely to have mobility problems. Meanwhile, their skin can be damaged more easily through dehydration and other factors.
Those who are spending more time in bed perhaps due to illness or after surgery could lead to pressure ulcer development.

Medical conditions that affect the bloody supply also put people at risk of pressure ulcers as they make the skin more fragile, these include diabetes, kidney failure, MS and Parkinson’s disease. There are also other factors that can increase the risk of developing a pressure ulcer such as obesity, paralysis, poor diet and nutrition, and urinary/bowel incontinence.

How do you prevent pressure ulcers?

Pressure care is a complex issue which means it can be difficult to completely prevent, however there are methods and pressure care products that are designed to reduce the risk of pressure ulcer development.

Skin care
• Keep skin clean and dry
• Avoid scented soaps which can dry out the skin
• Moisturise after washing

Lifestyle
• Eat a well-balanced diet
• Keep hydrated (at least 2L per day)
• Ensure bedsheets are smooth and not wrinkled when lying in bed, sheets should be cotton or silk like fabric
• Stop smoking, smoking damages blood circulation which increases risk

Pressure Care Products

With care environments pressure care products are used to help keep pressure off the delicate areas of the skin and prevent further damage occurring such as:

Pressure care mattresses

Pressure care mattresses can be an effective way to relieve and redistribute pressure amongst areas of the skin. They are designed to make the user comfortable whilst ensuring effective pressure relief. There are different types of pressure care mattresses which work differently.

Static Pressure care mattresses (Foam)
Static mattresses, also known as reactive mattresses, are made up of either a single or multiple pressure relieving foams. The surface of these types of mattresses is static which is designed to relieve pressure.

Static mattresses spread the weight of the user over a larger surface area to reduce the pressure on any single point of the body. Static pressure care mattresses respond to the users body shape, heat and movement allowing for more comfort and pressure relief. Additional pressure relief is provided by the castellations as well as the air cells within the foam layer/s. Static mattresses are suitable for use in the home or care environments.

 Learn more about our static pressure care mattresses

Alternating or Dynamic Mattresses (Air)
Also referred to as air-flow mattresses, alternating air mattresses relieve and redistribute pressure through a dynamic lying surface. Within their construction is a row of lateral air cells that alternative and inflate and deflate. The inflated air cells are designed to provide support to the user whilst the deflated cells provide relief for the skin. The air-flow is controlled through a pump unit that is connected to the mattress and is normally clipped onto the foot end of the bed.

Alternating pressure mattresses are often used to treat already developed pressure ulcers, whilst preventing pressure ulcers for those unable to move by themselves. Many care establishments use alternative air mattresses as they provide constant relief to the user, whilst the lying surface is effective in relieving pressure.

Explore our range of dynamic air mattresses

Hybrid
Hybrid mattresses use a combination of static and alternating mattress systems into one mattress. The most common construction of hybrid mattresses have alternating air cells are within the foam mattress with a soft upper part of the mattress. In doing so they provide the optimum pressure relief which ensuring high levels of comfort for the user. Hybrid mattresses are designed for the user by those who are at a high/ very high risk of developing a pressure ulcer.

See our Opera Impulse Hybrid Mattress

If you are unsure which mattress is right whether its within the home or care environment, read our pressure care mattress buying guide

Automatic Lateral Turning Systems

Within pressure care management, user turning, position and repositioning plays a key role in the prevention of pressure ulcers and their treatment.
A turning plan is essential for the well-being of persons who are cared for around the bed, especially for those with a high risk of pressure damage or who have limited mobility. Effective positioning should be carried out every 2 to 4 hours depending on the nature of the circumstances such as skin condition, mobility, and other factors.

Automatic lateral turning systems are a highly effective way in the management and treatment of pressure ulcer development. Turning systems allow the user to be automatically repositioned for effective pressure relief and eliminate the need for manual turning. They ensure users are turned safely and correctly, which contributes to improves wellbeing and esteem and greater efficiency within care settings.

As there is no need for manual turning, care givers are not at risk of injury to their neck, back or shoulders. Meanwhile, users are not being disrupted during the night to be turned.

Discover the Opera AutoTurn Lateral Turning System

Our pressure care range at Opera includes pressure care for low/medium up to very high risk users who are subject to developing pressure ulcers. Our dedicated team are able to take you through our consultation process to ensure the most appropriate pressure care equipment is selected for the user’s needs.

References:

• Excellence, N. I. f. H. a. C. (2014) Costing statement: Pressure ulcers (Implementing the NICE guideline on pressure ulcers, CG179).
• Wood, J., Brown, B., Bartley, A., Batista, A.A., Cavaco, C., Roberts, P.A., Santon, K., Cook, S (2019) 'Reducing pressure ulcers across multiple care settings using a collaborative approach', BMJ Open Quality, 8.