Pressure Ulcers, also known as “bedsores” or Decubitus Ulcers, are the most common and well known wounds which develop in nursing homes. They are most often caused by pressure applied to soft tissue resulting in completely or partially obstructed blood flow to the soft tissue. Thus, they are often found on people who cannot freely move about such as those who are bedridden or confined to a wheelchair.
The Bedsore and Pressure Ulcer Attorneys at the Noll Law Office are experienced in all aspects of litigation related to bedsores in nursing homes abuse and neglect cases throughout the State of Illinois. If you or your loved one has been diagnosed with a bedsore, our lawyers can be contacted at (217) 414-8889 for a Free Initial Consultation.
Pressure Injury Stages
On April 8 – 9, 2016, the National Pressure Ulcer Advisory Panel (“NPUAP”) redefined the term pressure injury as well as updated the staging definitions. Below, we will summarize the definition of a pressure injury as well as the staging definitions as determined by the NPUAP.
Definition of “Pressure Injury”
A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.
Stage 1 Injury
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area differs in characteristics such as thickness and temperature as compared to adjacent tissue. Stage 1 may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk).
Stage 2 Injury
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising. This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
Stage 3 Injury
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a stage 3 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and stage 3 ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage 3 pressure ulcers. Bone/tendon is not visible or directly palpable.
Stage 4 Injury
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. The depth of a stage 4 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and these ulcers can be shallow. Stage 4 ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis likely to occur. Exposed bone/tendon is visible or directly palpable. In 2012, the NPUAP stated that pressure ulcers with exposed cartilage are also classified as a stage 4.
Causes of Bedsores
According to the British Journal of Medicine, there are four main mechanisms which contribute to pressure ulcers.
- External (interface) pressure applied over an area of the body, especially over the bony prominences can result in obstruction of the blood capillaries, which deprives tissues of oxygen and nutrients, causing ischemia(deficiency of blood in a particular area), hypoxia(inadequate amount of oxygen available to the cells), edema, inflammation, and, finally, necrosis and ulcer formation. Ulcers due to external pressure occur over the sacrum and coccyx, followed by the trochanter and the calcaneus(heel).
- Friction is damaging to the superficial blood vessels directly under the skin. It occurs when two surfaces rub against each other. The skin over the elbows and can be injured due to friction. The back can also be injured when patients are pulled or slid over bed sheets while being moved up in bed or transferred onto a stretcher.
- Shearing is a separation of the skin from underlying tissues. When a patient is partially sitting up in bed, their skin may stick to the sheet, making them susceptible to shearing in case underlying tissues move downward with the body toward the foot of the bed. This may also be possible on a patient who slides down while sitting in a chair.
- Moisture is also a common pressure ulcer culprit. Sweat, urine, feces, or excessive wound drainage can further exacerbate the damage done by pressure, friction, and shear. It can contribute to maceration of surrounding skin thus potentially expanding the deleterious effects of pressure ulcers.
Treatment of Bedsores
There are various forms of treatment depending on the staging of the wound. They range from fairly conservative treatment upto and including surgery. Below, we will outline some forms of treatment as recommended by the Mayo Clinic.
The first step in treating a bedsore is reducing the pressure and friction that caused it. Strategies include:
- Repositioning. If you have a pressure sore, turn and change your position often. How often you reposition depends on your condition and the quality of the surface you are on. Generally if you use a wheelchair, try shifting your weight every 15 minutes or so and change positions every hour. If you’re in a bed, change positions every two hours.
- Using support surfaces. Use a mattress, bed and special cushions that help you sit or lie in a way that protects vulnerable skin.
Cleaning and dressing wounds
Care for pressure ulcers depends on how deep the wound is. Generally, cleaning and dressing a wound includes the following:
- Cleaning. If the affected skin is not broken, wash it with a gentle cleanser and pat dry. Clean open sores with water or a saltwater (saline) solution each time the dressing is changed.
- Putting on a bandage. A bandage speeds healing by keeping the wound moist. This creates a barrier against infection and keeps the surrounding skin dry. Bandage choices include films, gauzes, gels, foams and treated coverings. You may need a combination of dressings.
Removing damaged tissue
To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing this tissue (debridement) is accomplished with a number of methods, such as gently flushing the wound with water or cutting out damaged tissue.
Other interventions include:
- Drugs to control pain. Nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — might reduce pain. These can be very helpful before or after repositioning and wound care. Topical pain medications also can be helpful during wound care.
- Drugs to fight infection. Infected pressure sores that aren’t responding to other interventions can be treated with topical or oral antibiotics.
- A healthy diet. Good nutrition promotes wound healing.
- Negative pressure therapy. This method, which is also called vacuum-assisted closure (VAC), uses a device to clean a wound with suction.
A large pressure sore that fails to heal might require surgery. One method of surgical repair is to use a pad of your muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).
The Personal Injury Lawyers at the Noll Law Office represent clients throughout Illinois who have developed bedsores in nursing homes. Our pressure ulcer attorneys are happy to speak to concerned family members free of cost to investigate whether the nursing home is responsible for the development of the bedsore and to pursue coverage for the injured resident to cover their medical bills, future medical bills, and pain and suffering. Most bed sores are preventable with proper care. If your loved one has been injured, our Illinois Bedsore Attorneys can be reached at (217) 414-8889.