Which interventions are the most important?

Pressure ulcers usually heal very slowly, and they may come back. That's why it's so important to make sure they don't develop in the first place. People who are confined to a wheelchair or have to stay in bed for a long time are at greater risk. Then it’s critical to relieve pressure on the skin by regularly changing the position they sit or lie in. People who develop pressure ulcers often say that they can feel parts of their body becoming sore. It is important to take what they say seriously and then react accordingly.

Observing which parts of the body are most susceptible to pressure, as well as the positions that put the most pressure on them, can help you get an idea of what sort of relief might be helpful. For example, lying down puts much less pressure on your backside than sitting in a chair. So it can be helpful to use something soft like a cushion when sitting. If you use a wheelchair, you can find out what helps to reduce the pressure and then make that your routine.

It is also important to move if possible – even if you have to lie in bed or sit in a wheelchair. If you are able to sit up, leave the bed, or even walk a few steps with a bit of help, it’s a good idea to do that as often as possible.

How often is repositioning necessary?

Even though it's often recommended that people be repositioned every two hours, there's no single recommendation that works for everyone. Some people can lie in the same position for quite a long time without getting ulcers, while others need to switch much more often. Research has not yet found out how often someone should change position to get the best preventive effect.

Unnecessarily moving someone too much for no good reason can also have disadvantages. For instance, repositioning every two hours at night may wake the person each time and keep them from getting a good night’s sleep. Changing position can also be very painful for people who have wounds or joint conditions. Frequent repositioning is physically demanding for caregivers or family members too. It is therefore important to observe how often someone’s position really needs to be shifted. It can then help to make a note every time they are repositioned.

What role does diet play?

Some people who are hardly able to move don't get very hungry or thirsty. In order for them to stay in good physical condition, though, it's important to make sure they get enough to eat and drink. Eating too little or a very unbalanced diet and hardly having anything to drink may weaken their skin even more.

Dietary supplements that are high in calories and protein can be used to prevent malnutrition. These supplements are typically drinks that can be taken with meals. If it’s difficult or no longer possible to eat and drink as usual, the supplements can be given through a feeding tube. But there hasn’t been enough research on whether dietary supplements can help prevent pressure ulcers.

What role does skin care play?

It is essential to keep the skin clean. This is especially true for people who have incontinence (trouble controlling their bladder or bowels). Then it’s important to regularly change their diapers or incontinence pads.

It is important to keep the skin from getting too dry, but also to prevent it from being exposed to constant moisture – either one increases the likelihood of damage to the skin. So the right amounts creams and lotions should be applied. Be careful not to rub too hard. That could damage the skin, especially if it’s already sensitive.

Can pressure-relieving mattresses prevent pressure ulcers?

Pressure-relieving mattresses and support surfaces can lower the risk of pressure ulcers. There are many different products that can be used in hospitals, nursing homes or at home. Most of them offer especially soft surfaces or alternating pressure. The individual situation will determine what sort of products might be needed. So it makes sense to check what kind of mattress is most suitable. The following options are available:

• Pressure relief systems: These include special foam mattresses, gel-filled support surfaces and air cushions. These distribute the pressure over a larger surface area, reducing the pressure on especially vulnerable parts of the body.
• Alternating pressure mattresses: These mattresses have several chambers that are automatically filled with different amounts of air. The air pressure usually changes several times an hour to relieve pressure on different parts of the body. Alternating pressure mattresses are good for patients who have an especially high risk of developing pressure ulcers – such as patients in intensive care who are on a ventilator and can't move on their own.
• Mattresses with micro-stimulation: These kinds of mattresses react to movements by transforming them into counter-movements. This is done with the aim of reducing pressure and increasing blood circulation.

In Germany, a prescription from a doctor is needed for the statutory health insurer or long-term care insurer to cover the costs of a pressure-relieving mattress. You can give the prescription to the medical supply store that you are purchasing the mattress from.

Special mattresses known as alternating pressure mattresses are also commonly used and can help to prevent pressure ulcers. These mattresses have several chambers that are automatically filled with different amounts of air. The air pressure usually changes several times an hour to relieve pressure on different parts of the body. Alternating pressure mattresses are most often used for patients who have an especially high risk of developing pressure ulcers – such as patients in intensive care who are on a ventilator and can't move on their own.

Are wound dressings suitable for preventing pressure ulcers?

Wound dressings are typically used to treat wounds. But they can also be put on particularly vulnerable areas, like the tailbone, to prevent wounds from developing. The dressings can protect against friction, reducing the risk of a pressure ulcer forming. This use would be best suited for people who have an especially high risk of pressure ulcers, for example people have to lie in bed a lot.

What other kinds of aids are available?

Another thing that can help prevent damage to the skin is sheepskin mattress covers. Some people find sheepskin unpleasant, though, because it can make your skin very warm after a while.

Pressure ulcers often occur on people’s heels. So heels are often elevated using pillows, or special heel protectors made out of animal skin or foam are used. But there is no proof that these actually prevent pressure ulcers. Some people find the heel protectors uncomfortable and choose not to wear them. There are also concerns that they could increase the risk of falling if people get up and walk around while wearing them.

How can friends and family help?

There are some things that friends and family who provide care can do to lower the risk of pressure ulcers. They can help the person in need of care to move while in bed, to sit at a table or to walk around a few times a day. It is better to only help as much as needed. Movements that the person can do independently should also be done without assistance –so the person stays as independent as possible, helping to prevent pressure ulcers.

If someone needs to lie in bed for a long time, a nursing care plan is usually made together with nursing professionals. This may include information such as how many times a day a person needs to be repositioned. It is important for everyone to make sure that the plan is followed properly.

You should tell the nurses or doctors immediately about any red or sore areas of skin. They can then take a closer look at the affected area. It is always important to take pressure off that part of your body.

Family members can also learn various positioning techniques in caregiving courses. In Germany and other countries, health insurers or long-term care insurers cover the costs of many of the aids needed at home or may lend things like nursing beds. Many cities also have information centers for caregivers, offering help and advice concerning issues related to pressure ulcer prevention.

Sources

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