Prevention of Bedsores
Prevention of bedsores involves an approach that blends a frequent re-positioning strategy for immobile patents with infection control, nutrition, and general health maintenance, since pressure itself is not the sole cause but a combination of pressure and host factors.
The best preventative is to have the best tissue integrity by maintenance of good health. Diabetes, peripheral vascular disease, sickle cell anemia, vasculitis, and autoimmune disease should be aggressively followed and treated to ensure the best possible tissue integrity for the individualized patient.
Exploring the Extent of Tissue Damage
Since what is observed on the surface may be masking much more severe damage below it, investigating full-thickness tissues and their underlying musculoskeletal structures will prevent treatment failure. Use of CT, MRI, and ultrasound are useful in this preventive strategy.
Patients should be positioned and repositioned at least every 2 hours to relieve constant pressure at any one site. Current bedsores can be spared altogether from pressure effects..
Vitamins and proteins are necessary for tissue integrity, and nutritional support can be established via consultation with a dietitian/nutritionist. Any anemia due to incapacitation, diet, or medical condition should be corrected since even adequate perfusion with anemic blood is simply another type of hypoperfusion.
Dressing choice is based on the stage of healing and should be adjusted for prevention of further ulceration.
Wound Care to Prevent Ulcer Progression
Wounds with necrotic tissue should have the non-vitalized tissue removed so as not to be a nidus of infection. Debridement is via irrigation (hydrostatic force) enzymes, surgery, or biologic debridement (larvae of the Australian sheep blow fly or maggots which secrete enzymes that dissolve dead tissue). Any infections are addressed immediately and tenaciously.
Altering the Physics of the Pressure Forces
Foam mattresses help diffuse the pressure, as do air- and hydrocirculating mattresses.