What is a pressure ulcer?

Pressure ulcers or bed sores as they are commonly known, is an injury that occurs when skin is subjected to pressure or friction causing lack of blood to this area. They can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle. They can also be referred to as:

  • pressure sores
  • pressure damage
  • pressure injuries
  • decubitus ulcers

How do pressure ulcers develop?

Pressure ulcers occur when a large amount of pressure is applied to an area of skin over a short period of time. They can also occur when less pressure is applied over a longer period of time. The skin has a rich blood supply that delivers oxygen to all its layers however the extra pressure disrupts the blood supply and the affected skin becomes starved of oxygen, causing body tissue to die. If the blood supply is cut off for more than two or three hours the skin dies leading to an ulcer forming. Once the skin is broken bacteria may cause an infection. Pressure ulcers tend to affect people with health conditions that make it difficult to move, especially those confined to lying in a bed or sitting for prolonged periods of time.

Where are pressure ulcers most likely to occur?

Body parts that are most at risk of developing pressure ulcers are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface, such as a bed or a wheelchair.

  • shoulders or shoulder blades
  • elbows
  • back of your head
  • rims of your ears
  • knees, ankles, heels or toes
  • spine
  • tail bone

Wheelchair users are often at risk of developing pressure ulcers on:

  • buttocks
  • backs of arms and legs
  • back of the hip bone

How can the prevention of pressure ulcers be managed?

There are three key areas in which the prevention of pressure ulcers can be managed:

  • an efficient means of assessing the vulnerability of each patient
  • a choice of appropriate methods of treatment
  • continuous monitoring of effectiveness

Rating scales can only provide a helpful guide because they may miss patients who subsequently develop sores and include some who don’t. Another problem is that patients are often only categorised on admission to hospital, although daily assessment is often necessary to ensure that a worsening risk is not overlooked. In the clinical situation, illness and pressure are the dominant factors.

Why are pressure ulcers such a big problem?

The choice of support system is vitally important. These fall broadly into two groups

STATIC – Static support provided by conventional mattress produce sustained pressure. Varying grades of foam and construction will help to distribute weight, but it will not eliminate tissue distortion and ischaemia. The disadvantage of such systems is that the patient must be mobile or repositioned regularly to avoid the development of sores

DYNAMIC – Rober’s innovative range of mattress systems are dynamic because they move. Dynamic alternating pressure systems have a generally wider application for high risk patients. The majority consist of air mattresses of numerous different designs with cells that inflate and deflate reciprocally underneath the patient thus constantly changing the weight bearing areas. This is called 2 or 3-cell technology. Probably only those with cells larger than 10cm in diameter, or a double layer of cells, provide adequate relief of pressure to prevent deep sores. Rober offers a range of mattress solutions to cater for all patient’s needs.

What types of pressure ulcers are there?

Healthcare professionals use several grading systems to describe the severity of pressure ulcers.  The higher the grade, the more severe the injury to the skin and underlying tissue. 

Grade 1

A grade one pressure ulcer is the most superficial type of ulcer. The affected area of skin appears discoloured – it is red in white people, and purple or blue in people with darker-coloured skin. Grade one pressure ulcers do not turn white when pressure is placed on them. The skin remains intact, but it may hurt or itch. It may also feel either warm and spongy, or hard.

Grade 2

In grade two pressure ulcers, some of the outer surface of the skin (the epidermis) or the deeper layer of skin (the dermis) is damaged, leading to skin loss. The ulcer looks like an open wound or a blister.

Grade 3

In grade three pressure ulcers, skin loss occurs throughout the entire thickness of the skin. The underlying tissue is also damaged, although the underlying muscle and bone are not. The ulcer appears as a deep, cavity-like wound.

Grade 4

A grade four pressure ulcer is the most severe type of pressure ulcer. The skin is severely damaged and the surrounding tissue begins to die (tissue necrosis). The underlying muscles or bone may also be damaged. People with grade four pressure ulcers have a high risk of developing a life-threatening infection.