Clinical Information
for Patients and Carers
It is estimated that a staggering 1 in 5 hospital inpatients has a pressure ulcer - this represents at least 20,000 hospital patients at any one time. In addition, many more individuals with pressure ulcers are cared for at home or in residential and nursing homes. Around 400,000 people develop a new pressure ulcer annually in the UK leading to prolonged hospital treatment in serious cases. In terms of human cost, pressure ulcers seriously affect a person’s quality of life.
This section is designed to give patients or carers a basic understanding of pressure ulcers, how they develop and importantly, how they can be prevented.
What is a pressure ulcer?
A pressure ulcer is an area of skin that breaks down when a person stays in one position for too long without shifting their weight. This often happens to people who are immobile, bedridden or use a wheelchair and can occur within a relatively short period of time, for example, after surgery or an injury. The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.
A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences like the elbow, heels, hips, ankles, shoulders, back and the back of the head.
Common sites for pressure ulcers
*Reproduced by kind permission of the Tissue Viability Society
What are the causes?
There are many factors which increase the risk of a person getting pressure ulcers. They include:
- Lack of mobility i.e. being bedridden or in a wheelchair.
- Fragile skin.
- Friction and shearing caused when a patient or resident is pulled up in bed or
in the chair. These forces can make the skin irritated. They can cause the skin to
break and develop a pressure ulcer. - Having a chronic condition, such as diabetes or vascular disease, that prevents
areas of the body from receiving proper blood flow. - Inability to move certain parts of the body without assistance, such as after spinal
or brain injury or having a neuromuscular disease e.g. Multiple Sclerosis. - Malnourishment.
- Mental disability from conditions such as Alzheimer's disease -
the patient may not be able to properly prevent or treat pressure ulcers. - Older age.
- Urinary incontinence or bowel incontinence.
What are the symptoms?
Pressure ulcers are categorised by severity, from stage 1 (earliest signs) to stage 4 (worst):
- Stage 1: A reddened area on the skin that, when pressed, is "non-blanchable"
(does not turn white). This indicates that a pressure ulcer is starting to develop. - Stage 2: The skin blisters or forms an open sore. The area around the sore
may be red and irritated. - Stage 3: The skin breakdown now looks like a crater where there is damage to the
tissue below the skin. - Stage 4: The pressure ulcer has become so deep that there is damage to the
muscle
and bone, and sometimes tendons and joints.
How can pressure ulcers be prevented or helped?
Pressure ulcers lead to pain and sometimes, even death. Pressure ulcers are difficult and very costly to cure once they have formed. It is therefore vital that wheelchair users, bedridden or immobile patients are checked for pressure ulcers every day. Specialist pressure care equipment should be provided for those at risk of developing pressure ulcers. These can include dynamic or static mattresses and overlays and pressure prevention seating.
Patients should have their position changed at least every two hours to relieve pressure. They should eat healthy, well balanced meals and drink lots of fluids. Skin should be kept clean and dry and mobility should be encouraged as walking and moving about increases blood flow. Lifting devices should be used rather than dragging a person’s body along bed sheets as this can cause unnecessary friction to the skin.