Preventing pressure injuries

Pressure injuries are also called bedsores, or pressure sores. They can form when your skin and soft tissue press against a harder surface, such as a chair or bed, for a prolonged time. This pressure reduces blood supply to that area. Lack of blood supply can cause the skin tissue in this area to become damaged or die. When this happens, a pressure injury may occur.

You have a risk of developing a pressure injury if you:

• Spend most of your day in a bed or a chair with minimal movement
• Are overweight or underweight
• Are not able to control your bowels or bladder or have leakage of urine or stool
• Have decreased feeling in an area of your body
• Spend a lot of time in one position

You will need to take steps to prevent these problems.

Self-care

You, or your caregiver, need to check your body every day from head to toe. Pay special attention to the areas where pressure injuries often occur. These areas are the:

• Heels and ankles
• Knees
• Hips
• Spine
• Tailbone area
• Elbows
• Shoulders and shoulder blades
• Back of the head
• Ears

Contact your health care provider if you see early signs of pressure injuries. These signs are:

• Skin redness (harder to detect in people with darker skin tones)
• Warm areas
• Spongy or hard skin
• Breakdown of the top layers of skin or a sore

Treat your skin gently to help prevent pressure injuries. You can do this by:

• Using a soft sponge or cloth and not scrubbing hard when washing.
• Using moisturizing cream and skin protectants on your skin as directed by your provider.
• Cleaning and drying areas underneath your breasts and in your groin.
• Not using talc powder or strong soaps.
• Trying not to take a bath or shower every day. It can dry out your skin more.

Eat enough calories and protein to stay healthy.

Drink plenty of water every day.

Make sure your clothes are not increasing your risk of developing pressure injuries by:

• Avoiding clothes that have thick seams, buttons, or zippers that press on your skin.
• Not wearing clothes that are too tight.
• Keeping your clothes from bunching up or wrinkling in areas where there is any pressure on your body.

After urinating or having a bowel movement:

• Clean the area right away.
• Dry well.

Ask your provider about creams or other medicines to help protect your skin in this area.

If You Use a Wheelchair

Make sure your wheelchair is the right size for you. Have your provider or physical therapist check the fit of your wheelchair once or twice a year, especially if you gain weight or feel pressure anywhere.

Sit on a foam or gel seat cushion that fits your wheelchair. Natural sheepskin pads are also helpful to reduce pressure on the skin. Do not sit on a donut-shaped cushions.

You or your caregiver should shift your weight (lean forward, left and right) in your wheelchair every 15 to 20 minutes. This will take pressure off certain areas and maintain blood flow.

If you transfer yourself (move to or from your wheelchair), lift your body up with your arms. Do not drag yourself. If you are having trouble transferring into your wheelchair, ask a physical therapist to teach you the proper technique.

If your caregiver transfers you, make sure they know the proper way to move you.

When You Are in Bed

Use a foam mattress or one that is filled with gel or air. Place pads under your bottom to absorb wetness to help keep your skin dry.

Use a soft pillow or a piece of soft foam between parts of your body that press against each other or against your mattress.

When you are lying on your side, put a pillow or a piece of foam between your knees and ankles.

When you are lying on your back, put a pillow or a piece of foam:

• Under your heels. Or, place a pillow under your calves to lift up your heels, as another way to relieve pressure on your heels.
• Under your tailbone area.
• Under your shoulders and shoulder blades.
• Under your elbows.

Other tips are:

• Do not put pillows under your knees. It puts pressure on your heels.
• Never drag yourself to change your position or get in or out of bed. Dragging may cause skin breakdown. Get help if you need to move in bed or get in or out of bed.
• If someone else moves you, they should lift you or use a draw sheet (a special sheet used for this purpose) to move you.
• Change your position every 1 to 2 hours to keep the pressure off any one spot.
• Sheets and clothing should be dry and smooth, with no wrinkles.
• Remove any objects such as pins, pencils or pens, or coins from your bed.
• Do not raise the head of your bed to more than a 30 degree angle. Being flatter keeps your body from sliding down. Sliding may harm your skin.
• Check your skin often for any areas of skin breakdown.

When to Call the Doctor

Contact your provider right away if:

• You notice a sore, redness, or any other change in your skin that last for more than a few days or becomes painful, warm, or begins to drain pus.
• Your wheelchair does not fit.

Talk to your provider if you have questions about pressure injuries and how to prevent them.

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