Pressure injuries are a growing menace in every country. These injuries are also known as bedsores, ulcers, pressure sores. They are often painless and may not show up for weeks or months after contact with skin to bedding or clothing. Pressure Injury is one of the most life-threatening complications faced in a healthcare facility. Pressure injuries are caused by unrelieved pressure over bony prominences for an extended period.
At the time of writing, there is no universally agreed-upon definition for a pressure injury. However, most experts generally agree that “pressure injuries” are any wound or lesion that occurs in an area where compression or shear force has been applied to the tissue. The pressure injury is one of the most serious workplace injuries. It can take a long time to be treated, and, in the meantime, there may be a risk of permanent disability or death. This article explores how pressure injuries happen and how they are dealt with.
A Brief Explanation
What does this mean? It means anything from bedsores (also known as pressure ulcers) to decubitus ulcers and peri-wound skin breakdown, right up to amputations and endotracheal intubation tubes becoming obstructed by surrounding tissues.
Pressure injuries can occur in any area of the body, but certain areas are more commonly affected. Areas at risk include the heel (especially when a person is bed-bound or seated for long periods), ankles, hips, shoulders, and elbows.
Pressure injuries may be superficial (redness and inflammation), or they may progress to more severe levels of injury, which involve damage to the underlying tissue and/or bone. The body will attempt to heal these injuries via the formation of new tissue and the natural processes of wound-healing.
Unfortunately, there is no level of technology on this earth that can stop wounds and injuries from occurring. So it is important to prevent pressure injuries from becoming worse as early on in the development of the injury as possible.
Health care professionals need to identify patients at risk and communicate and educate the patient to help them avoid over-using their injured body part(s). As soon as a “red flag” symptom occurs, action needs to be taken immediately.
Preventive Measures
Patients can work with nurses to identify signs and symptoms of the progress of pressure injury development. Nurses can explain in detail the measures that can be taken to reduce the risk of further injury.
The most important measure is positioning. Patients must be turned, repositioned, and moved regularly to reduce pressure on the affected body part(s). The aim is to prevent local muscle spasms, pain, and immobility from developing.
Unfortunately, the effectiveness of this measure varies depending on the severity of the patient’s disability and/or pain.
Constant repositioning may be difficult for patients who cannot walk around their bed and equally frustrating for others who prefer to avoid active movement.
In these situations, a combination of repositioning and passive positioning (e.g., pillow elevation) can provide similar benefits as active repositioning without causing further injury or pain.
Another important measure is maintaining good skin hygiene. As we age, skin becomes drier and more difficult to keep clean and moist. Because of this, pressure injuries may occur on areas that are easy to access (e.g., heels).
The effects of poor hygiene are increased friction in the wound area, increasing the potential for infection. Patients with poor skin hygiene can also experience pain from irritation caused by fissures on the skin surface.
Poor hygiene can also lead to long-term damage to the skin by producing constant and repeated microtrauma, which stimulates the skin fibroblasts to produce extra collagen. In addition, it can increase the risk of pressure injury developing.
An important step in preventing pressure injuries is regular self-care and wound repair. This means that patients need to learn how to care for their own wounds and respect their body’s need for rest.
It is not possible for patients to completely avoid pressure injuries; however, it is possible to prevent injury from developing and becoming worse.
Likewise, health care professionals need to understand their patients’ needs and respect their wishes if they cannot be attended to as regularly as would be desirable.
Patient education should focus on reducing the risk of further injury by taking simple measures such as repositioning, skin hygiene, and wearing suitable support stockings when walking.
The key to preventing pressure injuries is early recognition and action.
Conclusion
Pressure injury prevention is an important aspect of patient care that simply cannot be overlooked. Unfortunately, pressure injuries are often the result of poor knowledge, lack of awareness, and poor communication between health care professionals and their patients.
Health care professionals need to take all possible steps to prevent pressure injuries from developing at all costs, including educating patients on preventing access injury, explaining practical measures such as positioning, good skin hygiene, and supporting footwear when walking. The sooner pressure injury prevention is discussed with the patient; the better protected patient and health care professional will be!
References
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Pressure_injury_prevention_and_management/
https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893
https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/bedsores.html
https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/joint-commission-online/quick_safety_issue_25_july_20161pdf.pdf?db=web&hash=A8BF4B1E486A6A67DD5210A2F36E0180
https://www.ausmed.com/cpd/articles/pressure-injuries-and-ulcerations
https://my.clevelandclinic.org/health/diseases/17823-pressure-injuries-bedsores#:~:text=A%20pressure%20injury%20(also%20called,the%20surface%20of%20the%20skin
