Pressure Ulcers (Bed Sores)

Pressure ulcers, commonly known as bed sores, are areas of skin and underlying tissue damage caused by prolonged pressure, most often over bony areas of the body. They primarily affect people with reduced mobility, such as those who are bedbound or use a wheelchair for extended periods.

• Early stage: an area of persistent redness over a bony area (such as the heels, hips, lower back, or shoulder blades) that does not fade when pressed
• As it progresses: a break in the skin, which can deepen into an open wound
• Pain or tenderness over the affected area
• Advanced ulcers can extend into deeper tissue, muscle, or bone, and can become infected

• Results from sustained pressure on the skin, most often over bony prominences, which reduces blood flow to the area and causes tissue damage if not relieved.
• Risk is greatly increased by limited mobility (such as being bedbound or using a wheelchair), poor nutrition, incontinence with prolonged skin moisture, reduced sensation, and frail or thin skin, particularly in older adults.

• Diagnosed through regular skin inspection, particularly of bony pressure points, in anyone at risk due to reduced mobility.
• Assessment includes grading the severity of the ulcer, from early skin redness through to deep tissue damage, which guides the treatment approach.
• Assessment for infection is important for more advanced or non-healing ulcers.

Regular repositioning — turning a bedbound person at least every two hours, or more frequently if needed — is the cornerstone of both prevention and treatment, relieving pressure from vulnerable areas.

Use of pressure-relieving devices, such as special mattresses or cushions where available, helps reduce pressure on vulnerable areas.

Keeping the skin clean and dry, and managing incontinence promptly, helps protect skin integrity.

Established ulcers require appropriate wound care, including cleaning and dressing, with the specific approach depending on the ulcer's depth and condition; deeper or infected ulcers may need antibiotic treatment or specialist wound care.

Ensuring adequate nutrition, including sufficient protein intake, supports healing and helps prevent further ulcers.

• Reposition immobile individuals regularly, at least every two hours, to relieve pressure on vulnerable areas.
• Keep skin clean, dry, and well-moisturised, and manage incontinence promptly to reduce prolonged skin moisture.
• Use pressure-relieving cushions or mattresses where available for those at high risk.
• Ensure adequate nutrition and hydration, which supports skin health and healing.
• Inspect the skin of anyone with reduced mobility regularly for early signs of pressure damage, particularly over bony areas.