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:

Skin hygiene
  • Wash skin with warm (not hot) water and use a mild soap to reduce irritation and dryness.
  • 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 Ďdonutí cushions.
  • 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 can occur.
  • 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.