3. Definition
• A Pressure sore is a localized Injury to the skin or the
underlying tissue as a result of unrelieved pressure.
• The other names are Decubitus ulcer or bed sore.
4. EPIDEMIOLOGY
• Between 1 to 3 million UK affected
• 11-18 % nursing home residents
• 9-60% hospital
• 3-18% home
• Health care expenditure 1.4 to 2.1 Billion pounds per year.
6. COMMON SITES
• Commonly occur at bony prominences, example: heels
• 95% occur in the caudal aspect of the body; 65% in the
pelvic area; 30% on the lower limbs.
11. Extrinsic risk factors
• Pressure from external Surface e.g. bed, chair
• Friction from being unable to move well
• Shear forces from involuntary movement
• Moisture – Bowel or bladder Incontinence, Perspiration,
Wound Drainage
12. Staging classification
• Stage -1: Intact skin with non blanchable redness of a
localized area, usually over a bony prominence. The area
may be painful, firm, soft, warmer or cooler than adjacent
tissue.
13. Staging classification
• Stage 2 – Partial thickness skin loss, presenting as
shallow open ulcer with a red pink wound bed without
slough(pus).May also present as an intact or open serum
filled blister.
14. Staging classification
• Stage 3 – Full thickness skin loss. Fat may be visible but
bone , tendon or muscle tissue are not ,slough may be
present.
15. Staging classification
• Stage 4 – Full thickness tissue loss with exposed bone,
tendon or muscle. Slough or eschar may be present.
16. prevention
Aims:
• Reduce pressure and shearing effects
• Reduce Moisture
• General skin care
• Nutrition
• Co Morbidities
• Involve Patient, family, care givers
17. prevention
• Daily skin inspection
• Bathing and skin cleaning frequency
• Moisturize skin; avoid hot water or harsh solutions
• Assess and treat incontinence: use tropical barriers or absorbent padding when
needed
• Proper repositioning frequently
• Avoid manipulating bony prominenses
18. Prevention cont.…
• Practice proper positioning , transferring and turning
techniques to avoid friction and shearing forces.
• Use dry lubricants or protective coverings to reduce
friction injury.
• Consider nutritional supplements .
• Use adjunct devices e.g. air mattresses, limb padding
where necessary
• Have a fixed repositioning schedule.
19.
20.
21.
22. management
• Based on staging and Investigation
• Wound swabs and cultures shows mixed growth
• Clean Barrier
• Antibiotic where appropriate
• Debride necrotic tissue
