Prophylaxis of pressure sores

The main direction of solving the problem is the systematic prophylaxis of bedsores in patients at risk. It should include the early activation of patients after surgery and serious illnesses, regular changes in the position of the patient's body in a stationary position, the constant replacement of soaked bed linen, the use of anti-bedsore mattresses and other devices for unloading the most affected areas, the use of massage and physiotherapy. Prophylaxis of pressure sores brings significant economic benefits.

It is widely believed that nurses should be involved in the prevention of pressure sores. Most doctors are not aware of their responsibilities towards such patients and do not have adequate training. Scientific research is mainly aimed at developing new methods of treatment for already formed pressure sores, and not for their prevention. The greatest difficulties arise when implementing effective methods and principles of prevention and care in clinical practice.

The prophylaxis of bedsores is based on adequate treatment of the underlying disease that caused the patient's general severe condition and local neurotrophic disorders. Prophylaxis of bedsores entirely depends on qualified treatment and careful care of patients. General approaches to the prevention of pressure ulcers are as follows:

• a continuous assessment of the risk of developing bedsores;
• timely start of the whole complex of preventive measures;
• adequate technique of performing simple medical care services.

Numerous multicenter clinical studies, based on the principles of evidence-based medicine, identified the main activities and procedures related to caring for a person, really allowing to reduce pressure on bone tissue and reduce the development of pressure sores. Prophylaxis of pressure sores and features of patient care are regulated. They should be performed by nursing staff after special training under the supervision of a doctor. The following are the main measures to reduce the risk of bedsores.

• Accommodation of 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 wire net or with old spring mattresses. The height of the bed should be at the midpoint of the hips of staff caring for the patient.
• A person should be on a bed with a varying height, allowing him to move independently or with the help of other improvised means from the bed.
• The choice of an anti-decubitus mattress depends on the risk of developing bedsores and body weight. At a low degree, a foam mattress of 10 cm thickness can be sufficient. With a higher degree, and also with available bedsores of different stages, special mattresses are used. When placing the patient in the armchair (wheelchair) under the buttocks and behind the back put foam rubber cushions thickness of 10 cm, and under the feet put foam pads thickness of at least 3 cm.
• Bed linen is cotton. The blanket is light.
• Under sensitive areas, rollers and foam cushions must be placed.
• Change the body position should be carried out every 2 hours, including at night, according to the schedule: the position of Fauler, Sims (on the side with special pillows placed under the arm and leg), on the abdomen (as agreed with the doctor). The position of Fowler should coincide with the time of eating. Whenever a patient moves, the risk areas should be inspected. The results of the examination should be recorded in the list of the registration of the anti-bedsore measures.
• Move the person carefully, excluding friction and shearing of tissues, lifting it above the bed or using a bed sheet.
• Do not allow a person to lie directly on the large thighbone in the "on the side" position.
• Do not expose plots to friction. Massage the entire body, including in the area of sections (within a radius of at least 5 cm from the bony protuberance), after a plentiful application of a moisturizing nourishing cream on the skin.
• Wash the skin without rubbing and lumpy soap, use a liquid soap. Thoroughly dry the skin after washing with soaking movements.
• Use special diapers and diapers that reduce excessive moisture.
• Maximize the activity of the patient: teach him self-help to reduce pressure on the fulcrum. Encourage him to change his position: turn around using the bed grips and pull himself up.
• Do not excessively moisturize or dry the skin: if moistened excessively - dry using powder without talc, dry with moisten with cream.
• Constantly maintain a comfortable state of the bed: shake the crumbs, straighten the folds.
• Educate the patient on 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 enough to maintain the ideal body weight of the patient.
• Teach relatives and others to take care of sick people.

Adequate prophylaxis of bedsores can prevent their development in patients at risk in more than 80% of cases, which leads not only to reducing the financial costs of bedsore treatment, but also to improving the quality of life.

[1], [2], [3], [4]