What Are Bedsores?

Bedsores, also known as pressure ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure. These ulcers often occur when a person remains in the same position for an extended period, preventing blood flow to specific areas, which leads to skin breakdown and ulcer formation. While people who can move independently shift their body frequently throughout the day, many nursing home residents cannot do so on their own. This makes it the responsibility of nursing home staff to regularly reposition residents in bed or wheelchairs to prevent the development of bedsores.

Certain areas of the body are more prone to bedsores due to their proximity to bones, including the lower back, tailbone (sacrum and coccyx), heels, ankles, and hips. Nursing homes must take special care to protect these areas.

Who Is at Risk for Bedsores?

Many nursing home residents are at risk for developing bedsores, particularly those who have difficulty changing positions. Some common risk factors include:

• Immobility: Regardless of the underlying cause, immobility can lead to the development of bedsores if residents are unable to reposition themselves frequently.
• Wheelchair Use: Residents who spend extended periods in wheelchairs are at increased risk.
• Incontinence: Moisture from bladder or bowel incontinence weakens the skin, making it more vulnerable to damage.
• Lack of Sensory Perception: Conditions such as spinal cord injuries, diabetes, or neurological disorders can reduce sensation, making it difficult for residents to detect pressure or pain, which leads to the inability to move and prevent sores.
• Poor Nutrition and Hydration: Healthy skin requires adequate nutrition and hydration. Malnutrition or dehydration increases the risk of bedsores.
• Medical Conditions Affecting Blood Flow: Conditions such as diabetes or vascular disease impair blood flow, making the skin more susceptible to pressure injuries.
• Medical Devices: Casts or splints can apply continuous pressure to parts of the body, increasing the risk of bedsores if not properly managed.

How Do Bedsores Form?

Bedsores develop due to a combination of factors, the most common being:

• Pressure: Constant pressure on a particular area reduces blood flow, depriving the skin and underlying tissues of oxygen and nutrients. This commonly affects areas such as the lower back, heels, and hips.
• Friction: Friction occurs when skin rubs against surfaces like bedding or clothing, weakening the skin and making it more prone to injury.
• Shear: Shearing happens when the skin moves in one direction, while the underlying bone moves in another, causing the skin to tear. This is often seen when a bed is elevated, and the resident’s body slides down, creating shearing forces on areas like the tailbone.

Are Bedsores A Sign of Abuse and Neglect?

Bedsores are frequently a sign of neglect or abuse in nursing homes. A failure to prevent or properly treat bedsores indicates that the facility may not be providing adequate care. If a resident develops a significant bedsore, it should be investigated to determine whether the nursing home could be held liable. Other signs of neglect may include the failure to treat the wound, failure to communicate with the resident’s family, or allowing the wound to become infected.

Are Bedsores Preventable?

Most bedsores are preventable with proper care. Nursing homes are required to take reasonable steps to prevent the development of bedsores, such as repositioning residents, maintaining cleanliness, and ensuring proper nutrition. Bedsores are only considered unavoidable in rare circumstances, such as during end-of-life care when the resident's health is deteriorating rapidly. However, nursing homes may sometimes claim that bedsores are unavoidable to avoid responsibility, which is often untrue.

How Do Nursing Homes Prevent Bedsores?

To prevent bedsores, nursing homes must assess residents upon admission to determine their risk of developing pressure injuries. Based on the assessment, the nursing home should create a personalized care plan that includes the following steps:

• Reduce Pressure: Regular repositioning is the most effective way to prevent bedsores. Staff must assist residents in shifting positions and use supportive devices like foam pads or pillows to protect vulnerable areas.
• Maintain Cleanliness: Staff should regularly check and clean residents to prevent moisture buildup from incontinence, which weakens the skin.
• Ensure Dry Skin: Residents’ skin should be kept dry to avoid weakening due to sweat or moisture.
• Proper Nutrition: Nursing homes must monitor residents' nutrition and make dietary adjustments if there are signs of malnutrition or weight loss.
• Prevent Shearing and Friction: Lowering the angle of the bed and using protective devices can reduce the friction and shear forces on the skin.
• Daily Skin Inspections: Staff must inspect residents’ skin daily for early signs of bedsores. Early detection can prevent further complications.

Are Bedsores Dangerous?

Yes, bedsores can lead to severe complications, including infection. If left untreated, infections can spread, leading to necrotizing fasciitis (flesh-eating disease), sepsis, or septic shock. Nursing homes must take appropriate measures to prevent bedsores and, if they do develop, treat them promptly to avoid dangerous outcomes.

Stages of Bedsores

Bedsores are classified into stages based on their severity:

• Stage 1: The skin is intact but appears red and may feel warm. Stage 1 bedsores typically heal within a week if pressure is relieved.
• Stage 2: The skin breaks open, revealing a shallow wound with a red or pink base. Healing usually takes 1-2 weeks with proper care.
• Stage 3: The ulcer penetrates the fatty tissue beneath the skin. Treatment becomes more intensive, often requiring ointments or surgery.
• Stage 4: The wound penetrates all skin layers, exposing muscle, tendons, or bones. Extensive treatments, including surgery, are often needed, and complete healing may not occur.
• Unstageable: The wound is covered by dead tissue, making it difficult to assess the depth.
• Deep Tissue Injury: The sore is suspected to be deep beneath the skin, but it cannot be confirmed on the surface.

How Are Bedsores Treated?

Treatment for bedsores depends on their stage:

• Reduce Pressure: Repositioning and using protective devices help relieve pressure.
• Protect the Wound: Medicated dressings and gauze promote healing and protect the wound from bacteria.
• Clean the Wound: Keeping the wound clean prevents infection and promotes healing.
• Nutrition: Adequate protein, calories, and nutrients aid in the healing process.
• Debridement: Infected or dead tissue is removed to allow the wound to heal.
• Advanced Therapies: In severe cases, treatments such as skin grafts or wound vacuums may be necessary to promote healing and prevent infection.

What Are the Signs of an Infected Bedsore?

Signs of infection include fever, chills, oozing pus, foul odors, redness, warmth, and swelling around the wound. If any of these signs appear, immediate treatment is required to prevent the infection from worsening or becoming life-threatening.