A bed sore, also known as a pressure injury or pressure ulcer, is damage to the skin and underlying tissues resulting from prolonged pressure, friction, or shear forces. These injuries often develop in individuals with limited mobility who remain in a bed or chair for extended periods. Pressure sores commonly form over bony prominences, such as the heels, hips, tailbone (sacrum and coccyx), elbows, shoulder blades, and the back of the head, where less natural padding makes these areas more susceptible to damage.
Preparing the Area
Effective care for a bed sore begins with preparing the affected area to prevent complications and facilitate healing. Before touching the wound, thorough hand hygiene is necessary. This involves washing hands with soap and water or using an alcohol-based hand sanitizer before and after changing dressings. This practice significantly reduces the risk of introducing bacteria and causing infection.
Once hands are clean, gently clean the bed sore and surrounding skin. Mild soap and warm water or a sterile saline solution are appropriate choices. Saline solution, a salt and water mixture, effectively cleans the wound without causing irritation. Avoid harsh antiseptics like hydrogen peroxide or alcohol, as these can damage healthy skin cells and impede the natural healing process. After cleaning, gently pat the area dry with a soft, clean cloth, avoiding any rubbing or scrubbing.
Topical Applications
Applying the correct topical agents can protect the skin and support its healing. Barrier creams containing ingredients like zinc oxide or dimethicone are beneficial for protecting intact skin around the bed sore, especially areas susceptible to moisture from incontinence. These creams form a protective layer that shields the skin from irritants and helps maintain its natural moisture balance. Dimethicone is particularly effective at creating this barrier and improving skin softness.
For open bed sores, specialized wound care creams or ointments might be prescribed by a healthcare professional, depending on the wound’s specific characteristics and stage. These products are formulated to promote a moist healing environment, aid in tissue regeneration, and sometimes incorporate antimicrobial properties to manage potential infection. Always consult with a healthcare provider before applying any medicated creams.
Certain substances should not be applied to bed sores because they can hinder healing or cause further damage. Perfumed lotions, talcum powder, or strong disinfectants like iodine are generally not recommended. Perfumed lotions can irritate sensitive or broken skin, while talcum powder can clump and become a breeding ground for bacteria or cause respiratory issues if inhaled. Adhering to recommended topical treatments helps create an optimal environment for recovery.
Choosing the Right Dressing
Selecting an appropriate wound dressing is crucial for managing bed sores, as different types offer distinct benefits tailored to the wound’s condition. Hydrocolloid dressings are commonly used for shallow bed sores that produce light to moderate amounts of fluid, known as exudate. These dressings create a moist healing environment and form a gel-like substance upon contact with wound fluid, which helps protect the wound and encourages autolytic debridement. They are also self-adhesive and provide a protective barrier against external contaminants.
Foam dressings are another option, particularly useful for cushioning the wound and absorbing moderate to heavy levels of exudate. The soft, absorbent material of foam dressings helps to manage moisture while providing a protective barrier and reducing pressure on the wound site. Their cushioning property makes them suitable for areas prone to friction and pressure.
Transparent film dressings are ideal for superficial bed sores or as a secondary dressing to secure other wound products. These thin sheets allow for visual inspection of the wound without removal, provide a barrier against bacteria and water, and maintain a moist environment. However, they are not suitable for heavily exuding wounds due to their limited absorptive capacity.
For wounds with heavy exudate or those requiring packing of deeper cavities, alginate dressings are often chosen. Derived from seaweed, these highly absorbent dressings interact with wound fluid to form a soft, gel-like mass that conforms to the wound bed and helps manage excessive moisture. This gel also helps maintain a moist environment conducive to healing and can be beneficial for controlling minor bleeding. Alginates typically require a secondary dressing to secure them in place.
Knowing When to Get Medical Help
Recognizing when a bed sore requires professional medical attention is important for preventing serious complications. Individuals should seek medical help if they observe signs of infection, which can include increased redness, warmth, or swelling around the sore. Other indicators are new or worsening pain, the presence of pus, a foul odor, or systemic symptoms such as fever and chills. These symptoms suggest that bacteria may have entered the wound, requiring antibiotic treatment or other medical interventions.
Medical consultation is also necessary if the bed sore shows no improvement within a reasonable timeframe, typically 7 to 10 days of consistent home care. A sore that appears to be deepening, enlarging, or developing black, necrotic tissue signals a need for immediate evaluation by a healthcare provider. Black tissue, also known as eschar, often indicates significant tissue death and may require debridement to promote healing. Any bed sore classified as Stage 3 or 4, indicating full-thickness tissue loss or exposed bone or muscle, requires urgent professional care due to the high risk of severe infection and systemic complications.