Preventing bedsores “Essential Care for bedridden patients”

Anjali Sharma, Aman Deep, Dr. Shruti Sharma

Treating bedsores is an emerging problem in today’s world. The term “bedsore” might seem misleading because it suggests they only happen to people who stay in bed. These sores, also called pressure ulcers, form when certain areas of the body are under pressure for too long. Bedsores are a serious concern for people in palliative care, as their health conditions and limited ability to move put them at a higher risk. As their illness gets worse, they become less active and more vulnerable to these sores.

Bedsores, commonly known as pressure ulcers or decubitus ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure on the skin. These sores often affect individuals who are bedridden, use wheelchairs, or are unable to change their position frequently. Bedsores can quickly develop into serious wounds, leading to infection, prolonged hospital stays, and even life-threatening complications
Who is most at risk of bedsores?
” Patientswith prolonged immobility- Individuals unable to move due to illness, injury, or surgery are among the most vulnerable. Without regular movement, pressure builds up on specific areas of the body, cutting off blood flow and damaging the skin.
” Elderly Patients- Aging naturally leads to thinner, more fragile skin. Combined with reduced mobility, elderly individuals are at a heightened risk for pressure ulcers.
” People with Chronic Illnesses- Conditions such as diabetes, cancer, vascular diseases, or spinal cord injuries compromise circulation and healing, making bedsores more likely.
” Malnourished or Dehydrated Patients- Poor nutrition weakens skin integrity, while dehydration reduces the body’s ability to maintain healthy tissues. Together, they significantly increase the risk of bedsores.
” Individuals with Sensory Impairments- Patients who have lost sensation due to nerve damage or conditions like multiple sclerosis, diabetic neuropathy, may not feel the early signs of pressure, allowing sores to develop unnoticed.
” Patients with Poor Circulation- heart disease and other conditions affecting blood flow reduce the body’s ability to deliver nutrients to the skin, leaving it more prone to skin damage.
” Patients with cancer- Cancer patients, particularly those undergoing treatments like chemotherapy, radiotherapy are at an increased risk of developing bedsores. These therapies can weaken the immune system, making the skin more vulnerable to damage.
Common Sites Bed sores commonly develop in bony prominence areas. These include the sacrum, which is the lower back area near the tailbone, elbow, backof thehead, shoulder, hips and the heels, where pressure builds when lying down.
Recognizing and managing bedsores by stages – Bed sores progress through four stages and their management includes:
” Stage 1:In this stage, the skin is red, warm, and painful without breaks. To manage stage 1, the area can be gently washed with mild soap and water. If needed, a moisture barrier (such as Zinc Oxide Cream) can be used to protect the area.
” Stage 2: Open sores or blisters affecting the top skin layers.Stage2 pressure ulcers should be cleaned with salt water(saline)rinse, to remove loose, dead tissues. Avoid using other chemicals without consulting a doctor.Keep the area clean, dry and covered with dressing.
” Stage 3: Deeper wounds resembling craters, possibly showing dead tissue.
” Stage 4: Severe wounds exposing muscle, bone, or tendons, often with infection signs like pus or a foul Odor.Stage 3 and 4 will be treated by the doctor.
How to Prevent Bedsores: –

1. Change Positions regularly: It is important to relieve pressure on the skin by changing position regularly. For bedridden patients, this should be done at least every two hours. If the person is in a wheelchair, they should shift their weight every 15 to 30 minutes.
2. Take Good Care of the Skin: Clean the skin gently every day, especially if it becomes sweaty or soiled. Use mild soaps and warm water, and always dry the skin thoroughly. Moisturizers can also be applied to prevent dryness and cracking.
3. Maintain a Balanced Diet: Nutrition is essential for preventing and healing bedsores. Foods high in protein, such as eggs, lean meats, fish, and beans, aid tissue repair. Including vitamin C-rich options like oranges, strawberries, and broccoli helps promote healing, while zinc-rich foods such as seeds, whole grains, and dairy products support skin recovery. Staying well-hydrated by drinking plenty of water is equally important to maintain healthy skin and speed up healing.
4. Use Special Cushions and Mattresses: Using support surfaces like air mattresses, foam cushions, or gel pads can help distribute body weight evenly. This reduces pressure on bony areas and prevents sores.
5. Encourage Movement: Even small movements can make a big difference. For patients who can move, simple exercises like stretching or lifting their arms and legs can improve blood circulation and reduce the risk of sores. For those who cannot move on their own, caregivers can help with gentle range-of-motion exercises.
6. Watch for Warning Signs: Bedsores often start as red or discoloured areas on the skin. These spots may feel warm or hard to the touch. If these signs are noticed, action should be taken immediately by reducing pressure on the area and consulting a healthcare professional as early as possible.
7. Involve Healthcare Professionals: Don’t hesitate to consult a doctor or nurse for advice. They can provide guidance on skin care, recommend suitable equipment, or treat early-stage bedsores.
8. Training and Education: Training and health education should be provided to patients and their caregivers regarding the techniques and measure to prevent and manage bed sore.
   How caregivers can help prevent bedsores
   Caregivers play a crucial role in preventing and managing bedsores. With proper knowledge of pressure ulcer prevention, they can help patients maintain a better quality of life. This includes regularly repositioning the patient, keeping their skin clean, ensure that patient eats well and stays hydrated, and watching for early signs of sores.
   Bedsores don’t just cause physical pain-they can also lead to emotional distress and even social stigma, as visible wounds may affect a patient’s confidence and relationships. Additionally, they can result in costly medical treatments and hospital stays. By taking simple preventive steps, caregivers can not only protect patients from these challenges but also improve their comfort and overall well-being.
   Here are some tips for caregivers:
   ” Be gentle but observant: Always handle the patient’s skin carefully and look for any signs of redness, swelling, or irritation.
   ” Use the right tools: Invest in pressure-relieving equipment like cushions, pressure-relieving mattresses, or heel protectors to make the patient more comfortable.
   Conclusion Bedsores are a preventable problem that affects many bedridden patients. With consistent care and attention, they can be avoided entirely. Preventing bedsores is a team effort involving family members, caregivers, and healthcare providers.Awareness, proactive care, and timely interventions can prevent the development of bedsores, ensuring patients remain comfortable and free from complications. Byfollowing these simple steps, we can ensure a better quality of life for our loved ones.
   (The writers Anjali Sharma, Nursing Officer, Aman Deep, Nursing Officer and Dr. Shruti Sharma, Department of Anaesthesia)