Preventing Pressure Ulcers
Because pressure ulcers are very difficult to treat once they have developed,
every measure should be taken to prevent them from occurring in the first
place.† The following interventions should be put in place:
- Wash skin with warm (not hot) water and use a mild soap to reduce irritation
- Apply moisturizer to prevent the skin from becoming too dry.
- Keep clothing and bedding dry and protect the skin from sweat and urinary
or fecal incontinence.
- Check for new pressure ulcers or other irritation every day, especially
over bony areas.
- Do not massage bony areas because this can cause pressure ulcers.
Moving and positioning
Moving and changing the patientís position is very important because it can
relieve or reduce pressure on an area and can reduce friction and shear.
- Encourage the patient to be as active as possible. Patients who are able
should move from a bed to a chair and stand and walk. Range-of-motion exercises
should be performed on a patient who is confined to the bed or a wheelchair.
- Change the position of bedbound patients as often as possible (at least
every 2 hours).
- Change the position of patients who are confined to a wheelchair each hour
and instruct them to shift their weight every 15 minutes.
- Elevate the head of the bed as little as possible so that the patient does
not Ďslideí down the bed.
- Use soft materials (e.g., pillows, special foam cushions, medically approved sheepskin) to
reduce pressure and keep bony areas from touching each other. Do NOT use
- Use proper techniques when moving, turning, or changing the patientís position.
A bed sheet or lifting device should be used to lift patients rather than
dragging them across the bed.
- If the patient doesnít want to change position, find out the reason. The
patient may not understand the importance of changing the position or may
have discomfort when moving. The doctor or nurse can help find a solution.
Appropriate pressure redistribution surfaces
Special mattresses, pads, and other support surfaces can be used to help reduce
pressure. These are available from medical supply stores and vary in cost
and in ease of use (e.g., from simple foam pads to cushions filled with
gel, fluid, or air). The doctor or nurse can help select the best surface
for the patientís needs. At the very least, a patient who is at risk of
pressure ulcers should use a foam mattress.† There are several important
things to consider when a support surface is being used:
- Mattress pads raise the height of the bed surface, so extra caution is necessary.
For example, the patient may roll over the side of bed or become wedged
between the mattress and bed.
- The height of a special bed or mattress pad may make it more difficult to
move, position, and turn the patient. If this is a problem, contact the
doctor or nurse.
- Some mattresses warm the patient. Make sure the patient is getting enough
fluids and that he or she is not getting too warm.
- Make sure to properly clean and maintain the devices because cross-infection
- Make sure the devices are being used properly (e.g., proper inflation of
some mattresses, placing the proper side of the support surface toward
the patient, minimally elevating the head and shoulders on a pillow or
foam wedge to minimize shear).
- Make sure the bedding is not wrinkled or irritating the personís skin.
- Support surfaces do not completely eliminate pressure; therefore, the patientís
position must be changed regularly.