PRESSURE SORESChosen Care Group Ltd.

OBJECTIVES• Definition

• Epidemiology

• Pathogenesis

• Risk Factors

• Stage and Risk Assessment

• Prevention

• Management

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.

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.

PATHOGENESIS• Prolonged pressure• Friction• Shearing forces• Moisture

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.

Common sites

Intrinsic risk factors

• Limited mobility

• Spinal cord Injury

• Pain

• Alzheimer's disease

• Fractures

• Post Surgical

• Coma or Sedation

• Parkinson Disease

INTRINSIC RISK FACTORS

• Poor Nutrition• Anorexia• Poor Dentition• Poverty or lack of access to food• Dietary Restriction

Intrinsic risk factors

• Dementia• Diabetes• Depression• Renal disease• Cancer

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

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.

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.

Staging classification

• Stage 3 – Full thickness skin loss. Fat may be visible but bone , tendon or muscle tissue are not ,slough may be present.

Staging classification

• Stage 4 – Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present.

preventionAims:

• Reduce pressure and shearing effects

• Reduce Moisture

• General skin care

• Nutrition

• Co Morbidities

• Involve Patient, family, care givers

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

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.

management• Based on staging and Investigation• Wound swabs and cultures shows mixed growth• Clean Barrier• Antibiotic where appropriate• Debride necrotic tissue

complications• Sepsis, Cellulitis, endocarditis, meningitis• Fistula formation• Septic arthritis• Sinus tracts

conclusion• Risk• Prevention• Identify early• Manage

The end

ANY QUESTIONS?

Thank you