The Four Pillars of Bedsore Prevention

 

Effective prevention is a holistic approach that involves the entire care team (nurses, doctors, family, and the patient themselves). It rests on four main pillars.

Pillar 1: Frequent Repositioning and Turning

This is the single most important step. The goal is to relieve pressure on vulnerable areas and redistribute it.

• The 2-Hour Rule: Bedridden Patients should be repositioned at least every 2 hours. This includes turning from back to side, and side to back.
• Scheduled Turns: Use a turning clock or schedule posted in the room to keep track and ensure turns are not missed.
• Chair-Bound Patients: If a patient spends time in a wheelchair, they should shift their weight every 15 minutes. If they cannot do this independently, a caregiver should reposition them every hour.
• Proper Positioning:
• Use pillows or foam wedges to keep bony prominences (like ankles and knees) from pressing against each other.
• For side-lying positions, place a pillow behind the patient's back and between their legs.
• Keep the head of the bed at the lowest safe degree of elevation (preferably 30 degrees or less) to prevent shear injury from sliding down.
• Use devices like heel protectors or boots to float the heels completely off the bed.

Pillar 2: Meticulous Skin Care and Inspection

Healthy, clean, and dry skin is much more resistant to breakdown.

• Daily Skin Inspections: Check the patient's skin from head to toe at least once a day. Pay special attention to bony areas. Look for the first signs of damage: persistent redness (that doesn't fade when pressure is relieved), warmth, swelling, or areas of hardness.
• Keep it Clean and Dry:
• Cleanse the skin with a mild, pH-balanced cleanser whenever it is soiled.
• Use moisturizers to keep skin from becoming too dry and cracking.
• For incontinent patients, use barrier creams or ointments (like zinc oxide) to protect the skin from moisture.
• Change incontinence briefs and absorbent pads promptly.

Pillar 3: Optimize Nutrition and Hydration

The body needs the right building blocks to maintain skin integrity and repair minor damage.

• Adequate Protein: Protein is essential for tissue repair. Include sources like lean meat, eggs, dairy, beans, and protein supplements if recommended.
• Hydration: Encourage the patient to drink plenty of fluids (unless fluid-restricted) to keep skin cells plump and healthy.
• Vitamins and Minerals: Ensure adequate intake of vitamins C and A, as well as zinc and iron, which play a role in skin health and wound healing. A doctor or dietitian may recommend supplements.

Pillar 4: Use of Support Surfaces and Pressure-Relieving Devices

These are not a replacement for turning, but they are a powerful tool to reduce pressure between turns.

• Specialty Mattresses and Overlays: These are not standard mattresses.
• Alternating Pressure Mattresses: Have air cells that inflate and deflate in cycles, constantly changing the points of pressure.
• Low Air Loss Mattresses: Keep skin cooler and drier by circulating air.
• Static Air, Foam, or Gel Overlays: Placed on top of a standard mattress to distribute weight more evenly.
• Padding and Positioning Devices:
• Heel Protectors/Boots: Elevate the heel to completely remove pressure.
• Pillows and Foam Wedges: Essential for positioning and offloading.
• Elbow and Heel Protectors: Provide a cushioning layer.
• Lift Sheets (Draw Sheets): Use these to move or reposition a patient. Lifting prevents the dragging (shear) that damages skin.