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Preventing Bed Sores in a Home Health Care Setting

Whether you’re a caregiver, have a loved one with limited mobility, or are a care recipient, you can benefit from boosting your awareness of bed sores. These pressure injuries are a common source of infection, hospital bills, and stress for all parties involved. But you can prevent them from worsening by catching them early and seeking appropriate medical treatment. 

Key Takeaways

  • Bed sores are pressure injuries that typically affect people who are bedridden, use a wheelchair, or otherwise have limited mobility.
  • Incontinence, poor nutrition, and certain medical conditions increase the risk of developing a bed sore.
  • Regular hygiene, monitoring, and documentation are the best weapons against bed sore development.
  • Working with a healthcare provider to monitor and treat bed sores can help you avoid more severe health consequences.

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Understanding Bed Sores

Bed sores, also known as “pressure ulcers” or “decubitus ulcers,” are a type of skin injury resulting from prolonged pressure on a certain area. Those prone to bed sores often have medical conditions that limit their mobility. Anyone who spends most of their time in a bed or chair may develop bed sores over time.

Fortunately, most pressure ulcers heal with proper treatment. However, others may never heal completely, particularly if the pressure sores are severe.

Causes and Risk Factors

The primary cause of bed sores is prolonged pressure, but other factors that impact how quickly and severely a bed sore evolves can come into play. Some general risk factors for developing bed sores include:

  • Incontinence: Exposure to moisture from urine and stool can make the skin more vulnerable.
  • Immobility: Pressure sores are most likely to happen to those who aren’t able to move or change positions often throughout the day.
  • Medical conditions: Some health conditions cause problems with blood flow that can make ulcer formation more likely.
  • Poor nutrition: Without enough fluids and nutrients, the body can’t maintain good skin health.
  • Poor sensory perception: The inability to feel pain or discomfort, which often results from injuries and neurological disorders, makes it challenging to stay alert to warning signs of pressure sores.

Prolonged Pressure on Specific Body Areas

When pressure is applied to the skin, it limits blood flow to the area. As a result, the body delivers less oxygen and nutrients to the affected tissue. Over time, skin tissue can become damaged and may eventually die.

People with limited mobility are prone to pressure ulcers in areas not often padded by fat or muscle. In these zones, skin is usually stretched over a bone and little else, leaving it vulnerable to damage.

Areas of the body that commonly become a site of pressure ulcers include:

  • Shoulder blades
  • Spine
  • Backs of legs and arms
  • Tailbone or buttocks
  • Hips
  • Lower back
  • Back or sides of the head


When an individual’s skin rubs against their clothing or bedding, it becomes more vulnerable to injury. Invisible damage to the skin can be easy to overlook, but over time, it can leave the skin weakened enough to experience more severe bed sore symptoms more quickly.

Similarly, skin trapped between two surfaces may be pulled and strained by friction and stress. For instance, a person lying on an elevated bed may slowly slide their head down throughout the day, forcing the skin to stay in place as their bones shift down.

Moisture and Poor Hygiene

The more moisture the skin carries, the more likely it is to chafe and feel significant effects from friction. Poor hygiene may also directly impact pressure ulcers in this way, but it also generally means a lack of movement from one spot or position. 

Hygiene routines can be a natural reason to change positions during the day, and in their absence, relief from prolonged pressure may be difficult to achieve.

Stages of Bed Sores

As a bed sore worsens and cuts off blood supply to a certain area more and more, it can penetrate deeper into the skin and cause significant damage. Knowing the warning signs can help you get necessary medical attention before things become severe. 

Stage 1: Initial Signs

The skin may look red or pink in the first stage of developing a pressure sore. It often feels tender to the touch and may feel warmer or cooler than usual.

Other initial warning signs that a bed sore may be developing include:

  • Draining that looks like pus
  • Changes in skin color or texture
  • Swelling
  • Itchiness

Stage 2: Partial Thickness Skin Loss

At this stage, you’ll likely begin to notice a pink shallow wound with a red base. Skin loss can occur at this point, as can abrasions and blisters that may be itchy or painful. The sore itself typically appears fairly shallow and dry.

Stage 3: Full Thickness Skin Loss

During the third stage of a bed sore, skin loss becomes more significant as necrosis (death) of the surrounding tissue begins. The sore grows and begins to look like a deep hole or crater in the skin. Some areas may peel back and slough away. 

Stage 4: Extensive Tissue Damage

As a bed sore worsens, the wound goes deeper into the skin’s fatty layer and causes moderate to severe tissue damage. Muscle, tendons, and bone may be exposed in areas surrounding the wound.

Unstageable and Deep Tissue Injuries

Once a pressure ulcer has penetrated all three layers of the skin, it may expose muscles, bones, and tendons, leaving them vulnerable to damage. When an injury is this severe, it can be a significant risk factor for bacterial infections, including some that may be fatal. Cellulitis, septicemia, and sepsis are common complications that lead to the death of over 20,000 people yearly.

An infected bed sore may smell foul, be swollen, and ooze pus. It might also cause fever and chills. No matter what, it’s vital to seek medical attention if a bed sore has advanced to this stage; otherwise, you may be left with irreversible damage to bodily tissue.

Preventative Measures

It’s often far easier to prevent pressure ulcers than heal them. Professional home care services make it simple to regularly monitor and care for areas of skin that need extra support. Otherwise, trying your best to stay on top of a hygiene and monitoring routine is necessary to stay ahead of any developing sores.

Frequent Repositioning and Turning

Ensuring that you or your care recipient change positions frequently may be the best way to keep pressure sores at bay. There are several ways to achieve this goal, even with mobility limitations in mind:

  • Shift weight or reposition parts of the body under lots of pressure about once every hour.
  • Raising the body off a chair or bed with the arms can help give the skin a break from the pressure.
  • Adjust the elevation of chairs and beds to prevent trapping skin in place as the rest of the body shifts during the day.

Proper Support Surfaces and Equipment

It’s wise to invest in special mattresses, cushions, pressure-reducing devices, and wheelchairs designed to feature extra padding and support in areas prone to pressure ulcers. Steer clear of donut-shaped cushions, though, as these can shift pressure to surrounding areas instead of distributing it evenly. 

Skin Care and Hygiene

It’s best to inspect and cleanse areas of skin prone to high levels of pressure daily. Try to keep the skin clean and dry to limit friction and moisture. You can use moisture barrier creams to protect the skin from sweat, urine, stool, and anything else irritating it.

It also helps to change sheets and clothing frequently to keep the area fresh. What’s most important to do daily, though, is take a close, careful look at affected areas daily for warning signs of a potential pressure ulcer.

Optimal Nutrition and Hydration

A well-rounded and balanced diet helps the body get the nutrients, vitamins, and minerals it needs to function at its best. This is especially true for the skin, which can easily become dehydrated and weak due to too little nutrients or fluid intake. 

If necessary, consult a nutritionist to create a meal plan that meets your or your care recipient’s needs without hassle.

Monitoring and Evaluation

Whether your goal is to prevent bed sores or keep an eye on pre-existing and healing ones, proper monitoring is key. Even subtle changes to the skin may warrant a check-in with a medical professional.

Regular Skin Assessments

Check areas of the skin that are prone to ulcers, including the hips, back, back of the head, and tailbone. Inspect the skin under good lighting and after gently cleansing the area for the best results.

Documenting Changes and Progress

It’s helpful to keep track of the skin’s progress and status; this helps you stay on top of any potential ulcer warning signs. It also makes it easy to determine whether a pressure sore is getting better or worse.

Collaborating with Healthcare Professionals

Whether you’re working with a professional like a home health aide or not, always consult a healthcare professional to learn what you should and shouldn’t do to care for a bed sore. If you notice changes or have questions, direct them to a professional first and foremost. You can share your concerns and progress regularly for updated advice.

Modifying Care Plan if Needed

Make alterations to your care plan to keep up with changing needs. You may find, for instance, that one area of the body seems to be improving, but other bony areas are beginning to show warning signs of a bed sore. Apply this information to an updated care model to prevent pressure ulcers over time.

Overall, the best way to prevent bed sores in a home health care setting is by inspecting the skin regularly and doing your best to keep it clean. Lessening friction, pressure, and nutritional deficits can also help. When in doubt, it’s best to check in with a medical professional to learn how to best treat bed sore symptoms. 

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