Prevention of pressure sores

The main direction of solving the problem is the systematic prevention of bedsores in patients at risk. It should include early activation of patients after surgeries and serious illnesses, regular changes in the position of the patient's body in a motionless position, constant change of wet bed linen, the use of anti-bedsore mattresses and other devices to relieve the most affected areas, the use of massage and therapeutic exercise. Prevention of bedsores brings significant economic benefits.

It is widely believed that pressure ulcer prevention is the responsibility of nurses. Most physicians are unaware of their responsibilities in relation to such patients and do not have the appropriate training. Scientific research is mainly aimed at developing new methods of treating already formed pressure ulcers, rather than at their prevention. The greatest difficulties arise in the implementation of effective methods and principles of prevention and care in clinical practice.

The basis of pressure ulcer prevention is adequate treatment of the underlying disease that caused the general severe condition of the patient and local neurotrophic disorders. Pressure ulcer prevention depends entirely on qualified treatment and careful patient care. General approaches to pressure ulcer prevention are as follows:

• continuous assessment of the risk of developing pressure ulcers;
• timely commencement of the implementation of the entire range of preventive measures;
• adequate technique for performing simple medical care services.

Numerous multicenter clinical studies based on the principles of evidence-based medicine have identified the main activities and procedures related to human care that can actually reduce pressure on bone tissue and reduce the development of bedsores. Prevention of bedsores and the specifics of patient care are regulated. They should be performed by nursing staff after special training under the supervision of a physician. The main activities that can reduce the risk of bedsores are listed below.

• Placing the person on a functional bed. There should be handrails on both sides and a device for raising the head of the bed. The patient should not be placed on a bed with a shell mesh or with old spring mattresses. The height of the bed should be at the level of the middle of the thighs of the personnel caring for the patient.
• The person should be on a bed with an adjustable height, allowing him to move out of the bed independently or with the help of other available means.
• The choice of an anti-decubitus mattress depends on the degree of risk of developing bedsores and body weight. At a low degree, a 10 cm thick foam mattress may be sufficient. At a higher degree, as well as at existing bedsores of different stages, special mattresses are used. When placing the patient in a chair (wheelchair), foam pads 10 cm thick are placed under the buttocks and behind the back, and foam pads at least 3 cm thick are placed under the feet.
• Bed linen - cotton. Blanket - light.
• It is necessary to place foam cushions and pillows under vulnerable areas.
• The body position should be changed every 2 hours, including at night, according to the schedule: Fowler position, Sims position (on the side with special pillows placed under the arm and leg), on the stomach (as agreed with the doctor). Fowler position should coincide with meal time. Risk areas should be inspected with each patient movement. The results of the inspection should be recorded in the anti-bedsore measures registration sheet.
• The person should be moved carefully, avoiding friction and tissue displacement, lifting him off the bed or using a lining sheet.
• Avoid allowing a person to lie directly on the greater trochanter of the femur in the lateral position.
• Do not rub the areas. Massage the entire body, including the area of the areas (within a radius of at least 5 cm from the bony protrusion), after generously applying a moisturizing nourishing cream to the skin.
• Wash the skin without rubbing or using bar soap, use liquid soap. Dry the skin thoroughly after washing with blotting movements.
• Use special diapers and nappies that reduce excess moisture.
• Maximize the patient's activity: teach him self-help to reduce pressure on the support points. Encourage him to change position: turn around using the bed rails and pull himself up.
• Avoid excessive moisturizing or dryness of the skin: if excessively moisturized, dry it using talc-free powders; if dry, moisturize with cream.
• Always maintain a comfortable bed: shake off crumbs, straighten out folds.
• Teach the patient breathing exercises and encourage him to perform them every 2 hours.
• The diet should contain at least 120 g of protein and 500-1000 mg of ascorbic acid per day. The daily diet should be high in calories enough to maintain the patient's ideal body weight.
• Teach relatives and other people how to properly care for sick people.

Adequate prevention of bedsores allows us to prevent their development in patients at risk in more than 80% of cases, which leads not only to a reduction in financial costs for the treatment of bedsores, but also to an increase in the quality of life.

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