While bed rest helps to overcome illness and promote healing, bed rest itself can be the cause of sores that are difficult to treat. The patient's choice of mattress, padding, and overlays can make the difference between healing or exacerbating the problem. Products exist that provide solutions to decrease pressure and increase comfort.
Identification
Bed sores or decubitus ulcers are ulcerations of the skin caused by prolonged periods of confinement to bed. These sores are prevalent on bony prominences such as elbows, heels, low back and buttocks. They occur in stages and are categorized medically on a scale from one to four, with one being a reddened area and four being an open deep ulcer. Other factors such as dehydration, weight loss, weakness with inability to easily weight shift, and skin shearing on sheets exacerbate the condition.
Choosing a Mattress
The most obvious solution to bed sores would be replacement of the patient's mattress. Internal and external mattress components impact skin integrity. In considering internal components, the patient would desire those that do not push back against her skin. Mattresses composed of memory foam, gel padding or air chambers reduce pressure on bony prominences. The mattress cover should be flexible and breathable. Plastic coatings and dense, closely woven synthetics are unforgiving toward fragile skin, increasing pressure and heat build up. Sheets should be high thread count cotton.
Mattress Overlays and Cushions
An alternative to replacing a mattress would be use of a pressure relieving overlay. These are available in all sizes with the most common being the egg-crate mattress pad. Memory foam overlays are sold with stretchy removable covers, and are available in several thicknesses. The thickest pad possible is recommended for stage three to four ulcers. Medical suppliers provide air flotation beds with alternating pressure to gently provide weight shifting for severe non-healing ulcers. These must be maintained by the supplier on a regular basis. Also sold are thin gel filled cushions with removable covers. These can be used in bed or on chairs for continuous pressure relief. Most are 18" x18."
Clothing Choices
As with the overlay and mattress fabric, the patient's clothing affects skin condition. He should wear cotton or lightweight fabrics.Thick seams, pockets, synthetics and wide zippers should be avoided. These increase pressure, heat, and shear further impacting skin integrity. The thinner the clothing between the patient and the pressure relieving surface the better for the patient's skin.
Considerations
Once the mattress, overlay, and clothing have been optimized, the patient should also be reminded or assisted with regular weight shifting. Laying in one position for more than two hours should be avoided. He should alternate between side lying and lying on his back. Care should be taken in transfers from the bed to avoid skin shearing. If possible, alternate between a slightly elevated head position and lying flat to reduce pressure on sacral, low back area. Keep skin as dry and cool as possible.
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