Bedsores, or pressure sores, are areas of skin that have been damaged by a lack of blood supply. Most often, bedsores occur when an elderly, paralyzed or comatose patient is left in one position for too long. At first, the skin trapped between bones and the bed or wheelchair turns red or purple. At this stage, protecting the area from pressure allows the skin to heal on its own. If left untreated, the skin breaks open and becomes infected, eventually involving the deeper tissues, bones and joints, according to the Merck Manual. Treatment depends on the severity of the damage.
Alleviating Pressure
All bedsores need to be protected from pressure to avoid further damage. Since the bony prominences--the heels, elbows, hips, tailbone, spine and the back of the head--are most vulnerable because there is little padding covering the bones, these areas should be protected with foam or other soft materials, recommends MayoClinic.com. Alternating air pressure mattresses, water-filled seat cushions and other devices designed to shift pressure from one area to another are useful for prevention, as well as for treatment. Caregivers should turn the patient in bed at least every two hours and shift his position in a wheelchair every 15 minutes to relieve pressure and prevent future skin damage.
Cleaning
Bedsores should be kept clean and dry to prevent infection and promote healing. If the skin is not broken, washing the area with soap and water is sufficient. Open sores, however, need to be cleaned with saline, or saltwater, solution to wash away dead or infected tissue, according to MayoClinic.com. If the bedsore is deep, the caregiver may need to remove dead tissue, or debridement, using a scalpel, high pressure irrigation device or chemical preparation to promote healing. The area must also be protected from contamination, so an incontinent patient may need a urinary catheter, toileting schedule or adult diapers to minimize contact with urine or feces.
Dressings
A covering is not usually necessary when the skin is unbroken, according to the Merck Manual. Dressings are appropriate for open bedsores to keep the wound moist and the surrounding skin dry, according to MayoClinic.com. The type of dressing chosen depends on the severity of the skin damage. Early wounds may need only a transparent covering, while deeper bedsores may require a hydrocolloid patch that retains oxygen and moisture to provide a healing environment. Draining, or very large, wounds may require more specialized dressings.
Antibiotics
Infection is a potentially life-threatening complication of bedsores. Organisms from an infected bedsore can spread to other parts of the body, including the bones, joints, connective tissues and the blood, according to MayoClinic.com. To prevent or treat infection, the health care provider can prescribe antibiotics to be administered by mouth or through an intravenous line. Antibiotic creams may also be applied to the pressure sore for minor infections.
Nutrition
Poor nutrition is a risk factor for developing bedsores, as well as an obstacle in the healing process. Patients with bedsores need a balanced diet rich in protein, vitamin C and zinc, according to MayoClinic.com. If the patient is not eating well, his physician may order supplements, tube feedings or total parenteral nutrition--special intravenous feedings--to boost his nutritional status.
Surgery
Sometimes conservative treatment, including dressings, antibiotics, alleviating pressure and protecting the damaged area, is not enough. In those instances, a surgeon may need to clean or debride the wound, while the patient is anesthetized, and close it surgically, according to the Merck Manual. Deep or extensive wounds may need to be covered with a tissue and skin graft from another area of the patient's body. Malnourished or very frail patients are not good candidates for surgical intervention.
