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Pressure Ulcers: Diagnosis, Treatment, and Prevention
Preventing Pressure Ulcers from Occurring
As you might guess, reducing the risk of developing a pressure ulcer in the first place is the best recommendation for people in hospitals or those who must be in bed or seated for long periods of time. Reducing pressure on the skin is a major component of reducing the risk of ulcer formation.(21) It is important for hospital employees to turn patients with limited mobility over at frequent intervals. Avoiding lying on your side with your legs at a 90° (and therefore with excessive pressure on the hip) and avoiding pressure on the ulcer is traditional advice, although newer studies have provided mixed results at the effectiveness of any one ulcer risk reduction method.(22)
Other measures used by hospitals and long-term care settings to reduce extrinsic contributing factors include keeping the head of the bed elevated not more than 30° except when eating, using “pull sheets” to move patients up in bed, and keeping the heels off the bed with pillows or foam pads placed under the mid-calf to ankle. Sitting should be limited to less than two hours, with the use a foam or plastic seat cushion (and reposition at least every hour). Patients should be educated to shift their weight every 15 minutes, to perform range of motion exercises to prevent contractures, and to walk, if possible.
Using a good support surface is important, although no single support surface is effective for all situations. Foam overlays for mattresses (for patients whose activity is limited for a short time only), and air or water mattresses (for patients with or at risk for Stage I/II ulcers) are common options.
Other devices, known as adjunctive devices, such as sheepskin, heel and elbow protectors, and trapezes (to help a person shift in bed), may also be helpful in certain situations. There are many options depending on the condition of the patient, and there is little evidence that supports the use of a specific support surface over others.(23)
Reducing moisture is another good way to reduce risk: often, a thin layer of a petroleum-based product is used to avoid skin damage by urine or feces. Non-caking body powder may be used to reduce friction and shearing and to absorb moisture. It is particularly important to manage incontinence, since it can be a significant contributing factor.
Good nutrition is required for ulcers to have an adequate chance to heal completely. Patients who are evaluated for malnutrition typically need to consume a high-protein, high-calorie diet, along with nutritional supplements. Vitamin C and zinc are given to patients with deficiencies.
The keys to reducing the risk of pressure ulcers include identifying and managing risk factors, as well as regular examinations of skin. The Norton or Braden Scale is often used to assess ulcer risk.(24)