Since pressure is the main cause of pressure sores, relieving pressure on vulnerable areas of the body is a top priority, for example by: Mobilization, positioning and change of position. Other precautions to prevent pressure ulcers, such as skin care or promoting circulation, can supplement but not replace measures to relieve pressure. In parallel, other risks are eliminated as far as possible, for example incontinence or sweating.
Mobilization for pressure ulcer prevention.
The bedridden patient should be mobilized as soon as possible. Mobilization of a patient includes not only getting up, but any range-of-motion exercises (even in bed). Early on, passive range-of-motion exercises can be started, increasing through assistive exercises (the caregiver guides and assists) to active exercises. If these exercises are integrated into other care routines (whole-body washing, repositioning), they require a small amount of time compared with the benefits.
Pressure ulcer prophylaxis through positioning
The goal of positioning for pressure ulcer prophylaxis is to increase the support surface. This distributes the patient’s weight over a larger area, thus reducing the support pressure on individual parts of the body. A distinction is made between soft and super-soft positioning: In soft positioning (for example, with anti-decubitus mattresses, waterbed, gel cushion, fur), the support pressure should not exceed a certain pressure. With the help of special mattresses, the patient can be placed in a super-soft position, which should ensure unrestricted oxygen supply to all skin areas. However, soft and super-soft positioning leads to mobility restriction and inhibits spontaneous movements of the affected person. For this reason, patients who still have minimal movement are not positioned too softly.
Regular changes in position
If soft and super-soft positioning are not sufficient for pressure ulcer prevention, the patient must be repositioned at fixed intervals. Regular repositioning provides interim complete pressure relief of vulnerable skin areas. Patients should be repositioned at least every two hours, and more frequently if they have risk factors. As a rule, it is possible to alternate between left- and right-sided and supine positions; only a few patients accept the prone position. If, for example, a patient cannot be turned onto the right side because of his or her condition (such as an artificial hip joint), the patient is alternated between left-side and supine position every two hours. However, this cuts the recovery time of the vulnerable skin areas in half!
Skin care: protection from harmful influences.
Skin care is used to protect the skin from harmful influences. For example, skin care protects the skin of incontinent patients from stool or urine. It is not possible to “nourish” the skin from the outside, so creams and ointments do not replace actions that ensure skin circulation (i.e., nourishment from the inside), for example, positioning and changing positions. It is important to know that moist skin can turn into a pressure sore. Therefore, it is important to keep the skin dry.
Promoting circulation
To promote blood flow to the skin, if the patient’s condition allows, warm full baths with added carbon dioxide can be taken or the skin can be lightly massaged and then rubbed down during personal hygiene. The skin of vulnerable patients must be checked regularly (at least once or twice a day) for redness. Personal hygiene and bedtime are good places to do this. Reddening of the skin that does not disappear within about 20 minutes when pressure is relieved is the first sign of an incipient pressure ulcer. It makes little sense to wait for any expressions of pain from the patient, because those patients who do not feel anything due to sensory disturbances and then do not turn themselves (for example, diabetics with polyneuropathy) are particularly at risk.
Beware of outdated tips when caring for pressure ulcers!
Unfortunately, in some places, time-honored but demonstrably rather harmful “prophylactics” are still common. Therefore, consider the following tips:
- Ointments are of little help. For skin care, do not use grease ointments, milking grease, etc. They clog the skin pores and prevent the heat balance.
- Do not iron and blow dry the skin! This measure is not only ineffective, it even leads to increase the germ load, because with the hair dryer germs are blown onto the skin.Improper use may result in cold damage and burns.
- Do not rub the skin with rubbing alcohol or other alcohols, because alcohol degreases the skin. This causes small cracks in the skin, through which germs can easily penetrate.
- Also, the addition of essential oils (spruce needle oil) can not sustainably increase the blood flow to the skin.
- Mercurochrome used to be used in large quantities and even today it is sometimes still used. It contains toxic mercury, which is absorbed through the skin and its strong red color makes it difficult to observe the color of the skin. In addition, the stains from clothing never go out.
- Do not use skin disinfectants prophylactically: Skin germs are physiological. By prophylactic use of skin disinfectants, this natural skin flora is destroyed together with the pathogenic germs.
- Avoid rubber and plastic: They prevent the skin from determining the optimal moisture content itself. It can not be ruled out that some incontinence aids increase the risk of bedsores due to the incorporated plastic film.
A regular review of whether the planned and implemented measures are sufficient, ensures the success of pressure ulcer prophylaxis.
