Pressure Pointers: Preventing Pressure Ulcers with Care!

According to Ms Low Bee Geok’s expertise as a Community Nurse & Nurse Clinician at Changi General Hospital’s (CGH) renowned Wound Healing Centre, it is disheartening to note that approximately 180 out of every 100,000 Singaporeans fall victim to the debilitating effects caused by pressure injuries. These injuries arise due to prolonged periods without movement and have severe consequences for both the skin and underlying tissues. 

The lack of mobility often leads to the emergence of pressure injuries such as bedsores or pressure ulcers in areas where bones are more prominent. This excruciating condition can manifest on various parts of the body including sensitive regions like ears, back of head, shoulder blades, elbows, back spine hips, buttocks, ankles and heels. Moreover, individuals diagnosed with type 2 diabetes may also encounter additional struggles with diabetic foot ulcers which particularly target their feet.

When blood supply is insufficient to a specific area, arterial ulcers can develop primarily on the toes, feet, heel, or ankles. On the other hand, venous ulcers occur when valves in the veins malfunction and cause blood to accumulate mainly above the ankle. Unfortunately, successful healing is not guaranteed if a pressure injury goes untreated as it can worsen and lead to an infection. 

This can result in pain or discomfort from dead tissues and pus in the affected area, along with potential symptoms of lethargy or fever. The healing process for these pressure injuries can be lengthy, lasting months or even years, which presents a challenge for treatment as they progress. In severe cases, sepsis may develop and pose a life-threatening danger.

To effectively prevent and control pressure wounds, adhering to the R.I.C.E acronym is highly advantageous. The initial action involves ensuring adequate care for incontinence issues. Skin exposure to moisture resulting from urine or feces can lead to skin damage and an increased susceptibility to pressure ulcers. The RICE method is a recommended treatment. Resting, applying ice, compressing the affected area, and elevating it can effectively reduce swelling, alleviate pain, and accelerate the recovery process.

To impede this occurrence, maintaining proper personal hygiene habits is essential. This includes using water or pH-balanced cleansers for cleansing the skin after instances of incontinence. Moreover, it is vital to completely dry the skin and seek guidance from a wound care specialist or nurse regarding appropriate protective items.

In order to steer clear of pressure injuries, it is absolutely crucial that you regularly engage in pressure releases by briefly relieving all pressure from specific areas. It is vital that you consistently adhere to these guidelines: perform pressure releases every 15 to 20 minutes while using your wheelchair, conduct regular skin examinations twice a day with the aid of a mirror or assistance from another person, frequently change positions when lying in bed or sitting in the chair, acquire knowledge about transfer techniques to prevent skin dragging on surfaces, and exercise caution to prevent any accidental bumps or scrapes. 

To ensure the well-being of your skin, it is paramount that you keep it clean and moisturized while also avoiding exposure to urine and stool. Most importantly, make sure not to spend prolonged periods sitting on wet clothes or moist surfaces under any circumstances.

Properly caring for your cushions by consistently maintaining them and regularly checking their condition is an indispensable measure in order to prevent any complications that may arise. Maintaining a healthy weight is essential as excessive weight can have detrimental effects on your overall health. 

When making a choice about your footwear, it is strongly recommended that you opt for shoes that are one size bigger than what you previously wore before sustaining the injury. This will serve to prevent blisters and relieve any discomfort caused by pressure on your feet and toes.

It is absolutely essential to refrain from massaging areas that show signs of redness, using heat lamps, or attempting to dry them out as these actions can potentially worsen the situation instead of improving it.

If you happen to observe initial indications of a pressure injury or harbor any worries about its occurrence, it is imperative that you promptly get in touch with your health care provider and refrain from exerting any kind of force on the affected region. The treatment for pressure injuries varies from conventional methods employed for other types of injuries or skin conditions. 

Your physician will carry out a comprehensive evaluation to confirm the presence of damage and potential infection. It is likely that you will be advised to rest adequately while utilizing specialized bandages that assist in safeguarding the area during its recovery phase. In severe instances, surgical procedures, hospital admission, medication administration, and skin grafts may become necessary prerequisites.

To prevent infection, it is crucial that you follow your health care provider’s instructions on how to properly care for the sore. Make sure to clean the wound every time you change dressings to maintain its cleanliness.

Avoid touching or putting pressure on the skin around or on the ulcer, as this could worsen any existing damage. Also, it’s best to steer clear of using donut-shaped cushions or rings as they can hinder blood flow and potentially cause more sores.

When you have a stage I sore, it’s important to be careful when cleaning the area. Use mild soap and water, and if needed, follow your health care provider’s advice on using a moisture barrier to protect against bodily fluids. For stage II pressure sores, consider using a saline rinse or follow your health care provider’s recommendation for an appropriate cleanser. 

Avoid hydrogen peroxide or iodine cleansers as they can damage the skin. Properly dressing the sore is crucial for promoting healing. An effective specialized dressing has two important functions: protecting against infection and maintaining an optimal moisture level.

The protective layer acts as a gentle shield, keeping away any outside dirt or germs that could make the sore worse. It’s important to keep the wound moist for it to heal properly, and the specialized dressing helps create the perfect environment for that. 

By promoting moist wound healing, it helps new cells grow faster and prevents scabs from forming, which means you’ll recover more quickly.

In order to provide additional protection against friction and trauma, it is recommended to use a specialized dressing. This dressing acts as a gentle shield between the sore and external elements such as clothing or movement, which could potentially worsen the injury or delay the healing process.

For sacral wounds with moderate to high exudation levels, such as pressure ulcers or the excision of pilonidal cysts, consider using Mepilex Border Sacrum treatment. This dressing helps maintain moisture in the wound area, facilitating debridement. It is normal and expected to notice an initial increase in wound size during the process.

Preventing pressure ulcers requires a varied approach that includes regular positioning, proper nutrition and hydration, skin care, and appropriate support surfaces. By implementing these strategies, individuals at risk can significantly reduce the likelihood of developing pressure ulcers. It is important for health care providers and caregivers to be educated on these preventive measures and to consistently implement them in order to provide optimal care for patients.