Bed sores (also known as pressure injuries and decubitus ulcers) are common ailments for nursing home residents, but that doesn't mean that they aren't serious or preventable. Pressure injuries and bed sores are different terms to describe the same problem - the formation of a wound as a result of a particular part of the body being put under prolonged pressure. Bed sores can develop while the resident is lying in bed, sitting in a wheelchair or being otherwise immobile. Bed sores can be exacerbated by friction or excess moisture on the skin.
Once formed, bed sores are very painful, can take months to heal (if they heal at all) and can complicate existing health problems. It is not unusual for nursing home residents to die as a result of infections that develop from bed sores.
What Are The Risk Factors?
The following are common risk factors that the nursing home MUST take into account when assessing and caring for a resident:
- immobility (often as a result of fractures sustained during falls)
- poor nutrition and hydration
- peripheral vascular disease
What Causes Bed Sores?
Simply stated, bed sores develop on the bony prominences of the body when there is continuous pressure on that area. Areas most at risk for pressure injuries include the coccyx, hips, and heels, although other areas with unrelieved pressure are at risk as well. Immobile nursing home residents will likely develop bed sores if those charged with their care do not take consistent measures to reposition the resident and relieve the pressure.
Cleanliness is also a key factor in preventing and healing pressure injuries as well. When a resident is forced to lie in her own waste for hours, the acidity of the urine tends to break down the skin. This breakdown can lead to the development of a bed sore or worsen an existing pressure injury. If a nursing home resident with one or more bed sores is forced to lie in their own urine or feces for hours on end (which, sadly, is a common event at nursing homes), there is the added danger of infection. Once a bed sore becomes infected, the resident is in grave danger of developing a systemic infection throughout her body known as sepsis. Sepsis is very difficult to treat and often results in death.
Another key factor in the prevention and healing of pressures injuries is hydration and nutrition. When a nursing home is understaffed or the staff is poorly trained, some of the most basic necessities of life are overlooked. For example, many immobile residents rely entirely upon the nursing home staff for the most basic of care, including giving them a drink of water or assisting with meals. When those basic staples are not accomplished, residents are at risk for becoming dehydrated and malnourished. Dehydration and malnourishment weaken the body. When a person is dehydrated, their skin becomes less supple and more brittle, making it more prone to the development of bed sores. A person who is malnourished has less fat and muscle, making it easier for bed sores to develop and to worsen at a faster rate.
How Are Pressure Injuries Diagnosed?
Pressure injuries are classified according to stages and each stage of a bed sore represents a greater degree of tissue and skin damage than the stage before it. Pressure injuries can develop quickly and can become a serious problem very quickly.
There are four classifications of pressure injuries which indicate the severity of the ulcer:
Stage 1: Presents as an area of persistent defined redness of intact skin, usually over a bony prominence.
Stage 2: Presents as an abrasion or ruptured fluid filled blister involving partial skin loss.
Stage 3: The wound is open where subcutaneous fat is visible; however bone, muscle and tendon are not visible.
Stage 4: Wound is deep with full thickness tissue loss. Muscle, tendon and bone are visible.
What Should Nursing Homes Be Doing To Prevent Pressure Injuries?
Without a doubt, pressure injuries are easier to prevent than they are to treat and nursing homes have many practices at their disposal to prevent pressures injuries and to stop an existing pressure injury from worsening. For example:
- Residents should be well fed, well hydrated and kept clean and dry
- Change the position of residents who are bed-ridden or in wheelchairs regularly. Bed-bound patients should be moved at least once every two hours.
- Special mattresses can help alleviate the threat of pressure injuries; however these mattresses do not take the place of repositioning the patient every two hours.
- The use of special heel protectors and boots which can help alleviate pressure to the affected areas.
If you believe that a loved one may be the victim of nursing home neglect or abuse you should take action quickly and contact us online or call us at 214-563-7539 to set up a free consultation.