Treat those bedsores fast!

BY Dr Dahlia McDaniel

The typical undertaker will tell you that many of his subjects present with bedsores which were obviously untreated or unsuccessfully treated. This is understandable since many people are ailing, bedridden and immobile for weeks, months, or years before their passing. In fact, bedsores themselves may cause death, but they are treatable.

The making of a bedsore

Bedsores (pressure sores or decubitus ulcers) are painful skin ulcers which develop when constant pressure on a body part shuts down blood supply to that skin area.

This happens when we sit or lie in the same position for too long. Affected skin becomes starved of oxygen and nutrients.

The skin breaks down and an ulcer (sore) is formed. Friction between skin and clothing or bedding may cause bedsore formation. Areas along the backbone, shoulder blades, heels, hips, and elbows are common ground for bedsores.

Healthy people don't usually develop bedsores since we're constantly adjusting posture and position, shifting the 'pressure' of body weight around. We tend to acquire pressure sores when we are unable to recognise or say that we are uncomfortable (e.g. in dementia, Alzheimer's or mental illness), or we are physically unable to reposition ourselves (paralysed, bedridden or wheelchair bound). Seniors are at risk.

If skin is kept excessively dry or moist (in sweat, urine, or faeces, and breeding bacteria) it is likely to break down when faced with friction or pressure. Complications leading to death can happen when bacteria enter the wound then the blood, infecting body parts including the brain.

Treatment plan

Bedsores are easier to prevent than treat. We must be vigilant, inspecting skin regularly, especially skin covering bony areas. If it is swollen, torn, shiny, discoloured (red, ashen purple), feels warm, or has pus, it is worth attention.

Caregivers should reposition clients regularly or encourage them to reposition themselves regularly where possible. Cushions (foam, gel, water-filled, air-filled) placed appropriately are helpful. Special mattresses, wedges, and pads are designed to protect 'at-risk' areas. Consult a physiotherapist for advice.

It is important to exercise good personal hygiene (mild soap and water). Manage urinary and bowel incontinence with hygiene practices, make frequent diaper changes where appropriate, and apply protective barrier creams. Protect potentially moist areas with talcum powder and protect dry areas with moisturising lotions and barrier creams.

Zinc oxide is a common ingredient in these.

More serious bedsores, which have broken skin or craters with dead flesh, require medical attention. Necrotic flesh (dead and infected) makes sores difficult to heal. Hydrocolloid adhesive dressings keep the bedsore environment moist while protecting it from contamination. Antibiotic creams control infection. Debridement is a method of removing necrotic flesh, and agents like collagenase and papain/chlorophyll are helpful. However, surgery may be necessary.

Dr Dahlia McDaniel is a pharmacist with a doctorate in public health. She is the chief executive officer of two pharmacies and a medical practice in Kingston. Email: yourhealth@gleanerjm.com.