Constant vigilance in monitoring the rotation of body pressure among people who are confined to beds and chairs is the most important factor in treating pressure ulcers. For the bedridden immobile, positions should generally be changed at least once every two hours. Keep the head of the bed as low as possible in order to prevent sliding, which pulls at the skin. Do not vigorously rub or massage reddened bony prominences, as this may contribute to blood vessel damage below the surface. Avoid lying directly on the hipbone or placing a pillow behind the knees. Finally, keep pillows between the patient’s knees and ankles to prevent them from rubbing against each other, and place a pillow under the calves, to keep the heels elevated.
For the immobile person confined to a chair, more frequent position changes may be helpful and for those persons able to move themselves, frequent changes and weight shifts are recommended. Lift, rather than drag the patient, as dragging can damage the surface of the skin by bending or stretching the underlying blood vessels. Finally, avoid using donut-ring cushions as they increase pressure on parts of the buttocks.
There are a variety of mattresses and support surfaces to help reduce pressure over bony prominences in the body. These include mattresses of foam, water, gel, and air that can go on top of a regular mattress of replace it entirely. Additionally full bed replacements exist that reduce pressure even further. An example is the air-fluidized bed, that circulates air throughout the mattress and creates an even distribution of body weight.
Advances in wound care management have introduced the concept of moist wound healing, to the overall treatment of wounds. Moist wound healing encompasses the use of protective coverings and gels that foster the protection of the wound, along with the maintenance of moisture in the environment. A moist wound bed promotes active healing, and allows skin cells to move across the wound bed and adhere to one another. Moist wound healing methods are effective in treating pressure ulcers.
Proper skin care is of utmost importance in preventing pressure ulcers. Inspect the skin often, and pay special attention to the bony pressure points. Notice reddened areas that remain after changing position and removing pressure. Make sure the skin stays clean and dry, and always clean the skin immediately after soiling. Use warm water, mild soap, and a gentle washcloth for bathing the skin, and apply creams or oils to over dried skin. When possible, treat incontinence, and if it cannot be prevented, use pads or briefs that absorb urine and wick moisture away from the skin. For the person who is consistently incontinent, routine use of protective ointment helps prevent maceration and irritation. Incontinence cleansers exist that help maintain the natural chemistry of the skin.
