A bedsore is an area of skin and tissue that becomes injured or broken down. Generally, bedsores occur when a person is in a sitting or lying position for too long without shifting his or her weight. The constant pressure against the skin causes a decreased blood supply to that area. Without a blood supply, the area cannot survive and the affected tissue dies.
Alternative names: Decubitus Ulcers, Pressure Ulcers, Pressure Sores, Bed Sores, Bedsore, Dermal Ulcers, Pressure Wounds
Pressure ulcers are extremely difficult to heal. The resulting wound can be painful, destroy tissue, fat, muscle and can lead to death. Pressure as small as 60 mm Hg. to a body surface for 1-2 hours initiates the process of skin breakdown. Shear, friction, moisture and chemical irritants exacerbate the process.
A 2-hour time frame is a generally accepted maximum interval that the tissue can tolerate pressure without damage. A patient who cannot change position without assistance should be turned and repositioned at least every two hours, more frequently if needed, with the use of pillows as support.
Chronic wounds aren't particularly attractive, in fact they're revolting to look at and excruciatingly painful if you have one, but they affect over 270,000 elderly people in Australia today.
In a lot of cases, they are so debilitating that even administering morphine to dull the pain doesn't work. The main problem faced by sufferers is not that they can't get better, but that they can't afford to pay for treatment.
Bearing in mind that wounds usually effect the elderly who are often the poorest members of the community, in an enormous number of cases patients don't get treatment because they simply can't afford to pay for it.
To me that just doesn't seem right in a first world country like Australia in 2015.
Don't let anyone fool you, the majority of bedsores or 'decubitus ulcers' as they are called, are preventable.
Whether you have endured a pressure wound yourself, or have felt helpless watching the agony of a loved one, you have suffered. Many people have sent messages to us asking for information. A theme that runs through all of these messages is complete amazement that such a thing could happen:
- Hospitals do not advise incoming patients that a percentage of those in the hospital is suffering with bedsores.
- They do not point out that if you are in your seventies or older, your chances of developing a hospital-caused wound may be as great as one in five.
- There is no information provided concerning the devastating nature of the bedsore, the fact that the wound can quickly penetrate through skin, fat and muscle to the bone, often leading to death [sepsis can be a complication].
- No one is advised that bedsores are a common site of hospital-transmitted infections, and that often such infections are completely resistant to available antibiotics.
- And they may not advise patients that specialised support surfaces, able to avoid capillary closure that leads to bedsores, are available.
This website, and its links to resources, is aimed at correcting these omissions. Publications, posters, advertisements, and publicity are all means to carry out this goal. Our efforts at education also have the goal of convincing government leaders that denying funding for available specialised care for the elderly and frail is false economy.
Your support to this cause can be your testimony that, having experienced the suffering caused by pressure wounds, you are going to do your part to insure that your loved one (or even you), can escape this agony in the future.
Due to staffing shortages, medical funding cuts and other issues, many aged care facilities are chronically understaffed. This results in patients not being turned, cleaned and fed as often as the ideal standard of nursing would dictate.
Massive deep wounds over Stage 2 and chronic infections continue to be an unacceptable standard of care. Such wounds are generally a strong indication of negligence in more than one area.
Where do Bedsores appear?
The most common places for bedsores are over bony prominences (bones close to the skin), such as the elbow, heels, hips, ankles, shoulders, back, coccys/tailbone, and the back of the head.
Who's at risk?
Anyone who must stay in a bed, chair or wheelchair because of illness or injury, or who cannot change position without help is at high risk.
Why are seniors more vulnerable to this deadly medical condition?
In a nursing home setting, turning is costly and dependent on adequate staffing ratios - which Australia lacks. The use of restraints on residents and/or the lack of incontinence rehabilitation compound the problem.
If a nursing home has a higher than normal percentage of patients with pressure ulcers because the facility specialises in wound care, the staffing level should be commensurate with the higher level of care required.
Seniors are particularly vulnerable because their skin usually becomes thinner and more fragile with age.
How long does it take to happen?
Bedsores can develop in a matter of hours.
Most likely places to occur?
Decubitus ulcers can happen during hospitalisation, in a nursing home or in a community setting.
Stage 1: The skin is intact but shows a persistent pink or red area that does not turn white when you press it with your finger. The wound may look like a mild sunburn. The affected skin may be tender, painful or itchy. It may feel warm, spongy or firm to the touch.
The wound is superficial and heals spontaneously when pressure is relieved.
A Stage 1 pressure ulcer is an early warning of a problem and a signal to take preventive action.
Stage 2: The skin starts to breakdown and there is partial thickness skin loss. The wound looks like an abrasion, a blister (broken or unbroken) or a shallow crater.
The skin outer layer is broken, red and painful.
Surrounding tissues may show areas of pale, red or purple discoloration. Some swelling and/or oozing may be present.
The wound is no longer superficial and the ulcer is an open sore that does not extend through the full thickness of the skin.
A Stage 2 pressure ulcer can usually be treated successfully. With quick attention, the wound can heal rapidly.
Stage 3: The skin has broken down and the wound now extends through all layers of the skin. The ulcer has become a crater involving damage or necrosis of subcutaneous tissues.
The pressure ulcer has become deeper and very difficult to heal. At this stage, a large percentage of patients may require treatment of up to one year. The wound is now a primary site for a serious infection to occur.
A Stage 3 wound will progress very rapidly if left unattended. Medical care is necessary to promote healing and to treat and prevent infection.
Stage 4: There is full-thickness skin loss with extension beyond the deep fascia and involvement of muscle, underlying organs, bone, and tendon or joint space. This deep open wound may show blackened tissue called eschar.
The decubitus ulcer is now extremely deep, having gone through the muscle layers and now involving underlying organs and bone. Surgical removal of the necrotic or decayed tissue is often used on wounds of larger diameter. Surgery is the normal course of treatment.
The wound is very serious and can produce a life threatening infection, especially if not treated aggressively.
A Stage 4 wound is extremely difficult to heal and requires skilled medical wound care.