It’s never an elegant topic, but World Wide Pressure Ulcer Prevention Day is November 19, so elegant or not, it’s time to address this serious concern and remind ourselves how to prevent pressure ulcers.

What are pressure ulcers?

Fundamentally, a pressure ulcer is what develops when there is enough pressure on a soft tissue area of the body that rests on a bony area – consider a heel, or a hip – to clamp the capillaries there, preventing the flow of blood to the tissues. When the cells there don’t receive sufficient blood flow, they don’t receive sufficient oxygen, which means that they begin to die.

Where those cells die (that means the skin breaks down) that’s a pressure ulcer. And how easily one may expect pressure ulcers to heal depends not only on the patient’s overall health, and how he or she conducts him or herself with regard to the healing process, but also on whether the pressure ulcer itself becomes infected, which can be a game-changer in terms of the severity of the ailment.

Are pressure ulcers really such a big deal?

In a word, yes.

And for two reasons. The first is the very real health concern – if pressure ulcers get infected, and they are far too likely to do so, the healing process can be delayed and compromised.

The second is the cost to the taxpayer and the medical establishment that pressure ulcers incur.

  • People die from pressure ulcer complications – to the tune of 60,000 people every year!
  • Statistically, pressure ulcers raise the risk of death 4.5 times.
  • People sue for “pressure ulcer injury”- more than 17,000 such lawsuits are filed every year! (Note that pressure ulcer injury is one of the most common legal injury claims made, second only to “wrongful death.”)
  • Pressure ulcers cost far more to treat than to prevent. From the data, we discover that caring for pressure ulcers can cost more than $10,000 per person per day. In stark contrast, working to prevent pressure ulcers – on the physical level, I mean – costs approximately $821 per person per day. That cost differential would be comical if it weren’t so serious.

Who’s at risk?

The obvious people at risk for pressure ulcers are those who are stuck in bed while recovering from surgery – for any period of time longer than two hours (TWO HOURS!! That’s not very long!), and all the more so if any kind of paralysis is part of the equation.

By remaining sedentary, they risk the pressure on the soft tissue at the point of bone, and the subsequent deterioration. But really, anyone who sits without moving – whether that sitting is done in a wheelchair or a comfy chair – if you don’t change positions every so often (at least within each hour!), you increase your risk for pressure ulcers.

Note that the risk is present even at home – it’s not really a hospital-dependent concern. Of greater concern is ensuring that there is a knowledgeable, skilled medical assistant to help tend to the sedentary person, so that pressure ulcers are unlikely to become infected.

Others at risk include those who are subject to pressures on their bodies – for example, for those who wear medical devices like a leg brace or an oxygen mask. The risk lies at the points where the devices touch the body.

What to look for

The real risk of pressure ulcers is completely missing the fact that one has developed, and therefore not taking care of the site, causing an infection. An infected pressure ulcer is far more difficult to manage.

So – if you know someone in a risk category, and all the more so if he or she falls into a risk group, give him or her a careful once-over daily (and respectfully! And gently!) – front, and back, and side to side. Pay special attention to the following points of the body:

  • Knees
  • Heels
  • Ankles
  • Elbows
  • Shoulders
  • Shoulder blades
  • Cheekbones
  • Ears
  • Back of the head (and ears)
  • Spine (neck to tailbone)

Be sure to contact the doctor in the event that you notice any unusual changes, especially if you find a patch of red skin, or if it’s warm to the touch. You will surely be concerned – and it bears contacting the doctor – if the skin feels spongy or if underneath the skin, there’s a knob that is hard to the touch. Of course, if an area looks bruised or has formed a sore or scrape on the skin.