What are pressure ulcers and how do we stop them?

Did you know around 200,000 patients develop a pressure ulcer in hospital each year? Even with the appropriate level of care, preventing pressure ulcers is one of the biggest problems care providers face, especially amongst patients with mobility issues.

Currently in the UK, treating pressure ulcers costs the NHS more than £1.4 million every day. That’s an inconceivable amount of money to be losing on what some refer to as ‘the avoidable epidemic’.

To help caregivers in their fight to stop pressure ulcers, this article will look at what they are, what causes them, and how they can be treated.

1) What are pressure ulcers?

Pressure ulcers (also known as pressure sores, bed sores or pressure injuries) are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin.

They can happen to anyone, but usually affect people confined to a bed or who sit in a chair or wheelchair for long periods of time.

Usually found on bony areas of the body, they range in severity from minor skin discolouration to deep open wounds, where muscle or even bone can be visible. In extreme conditions, the complications arising from pressure ulcers can be life threatening.

Fact: Pressure ulcers, falls urinary catheters and venous thromboembolism is estimated to affect over 200,000 people each year and the estimated direct costs to the NHS is over £430 million per year.

2) What causes them?

Individuals who are wheelchair or bed bound, or those who are confined to a chair for long periods of time are most prone to developing pressure ulcers.

Blood flow declines if one area undergoes steady pressure for a long period with no movement. We feel this sensation when we’ve been sat down for too long and get a numb bum, but we shift our position to alleviate the pressure and restore blood flow.

When circulation is repressed for a while, this starves the skin of nutrients and oxygen that is usually provided by blood cells, and so it begins to die.

As the skin dies, it breaks down. The more severe the ulcer, the more susceptible it is to infection. If it’s left untreated, it becomes a wound and eventually a pressure ulcer.

How to spot pressure ulcer symptoms

Spotting a pressure ulcer early is essential to prevent complications. So, we’ve put together a quick guide to assess their severity through different stages:

Stage One	Area is reddened, inflamed, and does not become pale when pressure is applied
Stage Two	Looks like a blister or an open sore, and the surrounding area may be red or irritated
Stage Three	Skin appears crater-like, and the lower layer of fat may be exposed
Stage Four	Wound is evident and extends down to the muscle or even the bone
Unstageable:	Some ulcers cannot be classified because they are covered in slough or eschar

3) How can we prevent them?

It can be difficult to completely prevent pressure ulcers, but the best way to tackle the issue is to remove the pressure.

Of course, that’s easier said than done. When people are bedbound or have very limited mobility, you can’t simply take away the pressure of whatever they are perched on.

Luckily with the help of SSKIN, an initiative created by the NHS, there is a five step approach to prevent and treat pressure ulcers.

SSKIN Model for Pressure Ulcer Prevention

Surface — Make sure your patients have the right support using the right equipment. For example, the Arene Mk II’s tilt-in-space movement significantly removes pressure by minimising the amount of friction and shear.
Skin Inspection — Early inspection means early detection. Show patients and carers what to look for.
Keep Moving — Get your patient to move regularly during the day.
Incontinence/Moisture — Make sure your patients are clean and dry.
Nutrition/Hydration — Ensure your patients have the right diet and have plenty of fluids to keep them hydrated.

To help you remember SSKIN, Sheffield Teaching Hospital NHS Foundation Trust recorded this catchy song:

Preventing Pressure Ulcers with Care Mattresses

When it comes to surfaces (the first S in SSKIN), the right mattress will ensure patients have the right support.

For example, those at risk of getting pressure ulcers or have a minor ulcer, a specially designed static foam or dynamic mattress should be used.

If a patient has a more serious ulcer, you’ll need a more sophisticated mattress or bed system, such as a mattress connected to a pump that delivers a constant flow of air into the mattress.

We’ve been involved in the research and development of pressure care equipment for many years, creating specialist air mattresses and cushions that help to redistribute the patient’s body weight over a long period of time.

Somlent Care Mattress

Many air mattresses are hard, noisy and create a buzzing sensation, but the Somlent range has been specifically designed with the patient’s comfort in mind.

Providing excellent pressure relief, it aids prevention of pressure sores and even helps relieve and heal them!

One of our most advanced care mattresses is the Somlent Serene.

It is the world’s first 3 in 1 alternating hybrid mattress. Not only that, but the cells are filled with foam and air. This means that when the pump isn’t attached, the air can flow freely from cell to cell and contour to the shape of the patient’s body.

Enabling effective pressure redistribution, it allows blood flow to be unobstructed. Using constant low-pressure therapy, pressure is able to be redistributed through the mattress, subsequently allowing blood flow to continue to common problem areas.

Summary

Pressure ulcers may not be the biggest, most high profile obstacle, but they’re one of the most common hurdles faced in healthcare.

We have seen the huge financial burden they bring on hospitals and other care environments. That is why it’s vital that care providers adopt preventative tactics in their everyday tasks, ensuring that pressure ulcers become a thing of the past.

Through prevention and management, we can beat pressure ulcers and ensure that the individual’s quality of life is unimpeded by ‘the avoidable epidemic’.