Wound Care for Pressure Ulcers

Wound Care is a hot topic of conversation throughout hospitals and long term care facilities. Health care professionals have recognized pressure ulcers, also known as decubitus ulcers and bed sores, as a rising problem. A pressure ulcer is defined as any lesion caused by unrelieved pressure resulting in a damage of underlying tissue. Pressure Ulcers can cause serious damage and require specialized care, creating added costs for facilities. Prevention of pressure ulcers is critical and with more and more wound care products being developed, preventing pressure ulcers is becoming more attainable. Wound care products like the Heelift Suspension Boot keep the patient's boney points, such as the heel, from absorbing all the pressure, instead spreading the pressure throughout a larger surface space. Another wound care product that helps prevent pressure ulcers is a sensation test for the foot, which determines if a patient has loss of sensation, making the foot susceptible to neuropathic ulcer development.

Pressure ulcers generally occur over bony prominences and are categorized into 4 different wound stages. The 4 stages according to the National Pressure Ulcer Advisory Panel are as follows:

Stage I: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching, though its color may differ from the surrounding area. The area may also be painful, firm, soft, warmer or cooler than the other tissue and more difficult to detect in individuals with darker skin tone.

Stage II: Partial thickness loss of dermis presenting as a shallow or open ulcer with a red-pink wound bed without slough. Presents as a shiny or dry shallow ulcer without slough or bruising. May also present as an intact or open/ruptured serum-filled blister. Note: This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.

Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include underminding and tunneling. The depth of a stage III pressure ulcer varies by anatomical location.

Stage IV:Full thickness tissues loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. The depth of a stage IV pressure ulcer varies by anatomical location. Stage IV ulcers can extend into muscle and/ or supporting structures, such as fascia, tendon or joint capsule, making osteomyelitis possible.

If a patient acquires a pressure ulcer there are specialized ways to properly treat it using a variety of wound care supplies. The first step is evaluating the wound and determining the stage. The next step is debridement. Debridement removes the moist, unhealthy tissue to promote healing. Debridement can be done at the bedside using a scalpel for smaller wounds, while extensive wounds should be debrided in a procedure room or operating room. Autolytic Debridement performed with moisture retentive dressings like hydrocolloid dressings is less damaging to the wound and is associated with more rapid healing. Those using autolytic debridement should expect to see debridement in 7 to 21 days depending on the depth of the necrotic tissue. The depth of the wound can be measured by using a wound measurement device. If you don't begin to see some debridement after the first 10 days go back and investigate what is causing the tissue to deteriorate.

After debridement it is time to clean the wound. Cleaning the wound should be done delicately with special wound care supplies like saline solution or a tissue grade water such as Bio Med Emergency Wash. Using solutions such as povidone iodine, iodophor, or hydrogen peroxide can further damage the wound and should not be used. When looking at wound care products and trying to find the appropriate dressing, it is important to remember a few things. The dressing should protect the wound from the outside environment, be biocompatible and provide hydration keeping the wound moist and preventing the dressing from sticking to the wound. Wound care supplies like Hydrocolloid dressings are ideal, because they keep the wound hydrated by interacting with the skin's moisture, providing a secure seal and easily conform to the contours of the body.

Monitoring the patient's wound over the course of the healing process is imperative. For stubborn wounds, medical personnel can use collagen based wound care supplies like collagen dressings by Cellerate. Remember with patience, attention and appropriate treatment pressure ulcers are treatable, but the most favorable option is prevention from the start.