The aging of the population is an increasing problem worldwide. Caring for elderly, permanently bedridden members of the family and catering to their special needs have, therefore, become an everyday challenge. Immobility for a prolonged period of time as a consequence of an accident or surgery, however, is independent of age, making professional care and the prevention of bedsores, or decubitus, in bedridden patients an important task in all age groups.
How can you recognise the early signs of decubitus?
The development of decubitus has four distinct stages.
Redness of the skin, disappearing when the area is pressed by finger, appearing again after a short while. The skin is warm to the touch, thin and vulnerable, and the patient complains of pain. In patients with darker shades of skin, discoloured, warm, oedematous or thickened skin is considered as an early sign.
Partial erosion of the epithelium on the surface of or under the skin, or both. The skin is hot and eroded, and extremely painful. From a clinical point of view, ulcers are considered bruises or blisters. At this stage, decubitus can still be treated successfully and the development of deep ulcerous sores can be prevented. If, however, such sores are left untreated, the condition soon progresses into the third stage, which is more difficult to treat.
In stage 3, erosion involves the full depth of the epithelial layer. There is extensive skin loss, the skin is no longer visible, and the underlying tissues are damaged or destroyed. Damage may extend as deep as the muscular membrane but does not penetrate it yet. Clinically, ulcers are characterised by the formation of craters or cavities. If the ulcer becomes infected, the affected area responds by inflammation and increasing pain; the wound expands and oozing increases. Infected bedsores are usually an indication for antibiotic administration.
This stage is characterised by complete loss of skin and the damage and destruction of underlying tissues penetrating so deep that even the tendons, muscles and bones may be affected. Bone tissues become visible. Severe bedsores are open wounds – for this reason, everything must be done to prevent infection, which may not only hinder wound healing but, due to certain pathogens, can aggravate the condition.
How can you prevent bedsores?
By changing the patient’s position frequently enough, you can prevent the development of sensitive pressure points on the patient’s body. Turn the patient frequently on their left or right side, avoiding supine position for too long. Make sure that the sheets are always dry and free from wrinkles. With patients turned on their stomach, make sure their breathing is unaffected. Place small pillows under body parts like elbows, heels, sacrum and buttocks which are continuously exposed to pressure.
Take care of the patient’s skin by regular washing and bathing. Dry the skin carefully after each washing and bathing.
Maintaining blood circulation is essential. Easing pressure is the best way to achieve this, but rotation, massage, exercise in bed, as well as regular care of areas at risk can also help a lot.
The use of herbal preparations may have a complementary role in the prevention and treatment of pressure ulcers, as declared in the current Hungarian guidelines for health professionals on the risk assessment, prevention and treatment of decubitus.