An estimated 2.5 to three million patients are treated each year for pressure ulcers in the United States. Approximately 60,000 deaths occur each year as a result of pressure ulcers. According to the Agency for Healthcare Research and Quality, these wounds cost $9.1 billion to $11.6 billion each year in the United States with a cost of individual patient care of $20,900 to $151,700 for each pressure ulcer. It is important to note that Medicare does not reimburse for hospital-acquired pressure ulcers. After reviewing the statistics, it is not surprising that there is a great concern regarding this topic. Pressure ulcers, also referred to as bed sores or decubitus ulcers, are caused by unrelieved pressure, lying in one position for an extended period of time, and by friction over an area such as clothes rubbing against the body. They form mostly over bony prominences such as the sacrum. Their staging is related to the depth of the tissue damage from stage I to stage IV. Pressure ulcers can reduce the overall quality of life for the patient due to pain and increased hospital stay. Many patients will be on pain medications, and many will require debridement. Debridement is the removal of devitalized tissue and foreign matter from the wound. Descriptions and Stages A stage I wound is fairly mild. It has a persistent area of red skin that is intact, not broken. It could be painful. It could be warm and spongy or firm to the touch. Detection of stage I pressure ulcers is more difficult in patients with darker skin tones. The wound may appear bluish or purple. A stage II wound is a shallow, open ulcer with a pink or red wound bed. Some skin loss has occurred in the epidermis or dermis. A stage III wound is reflected by damage to the tissue below the skin. Subcutaneous fat may be visible at this time, and it may extend to but not through the fascia. The fascia is the band of fibrous tissue that lies deep below the skin or encloses muscles and various organs of the body. This wound is mostly red. Stage IV wounds are the most advanced and the most painful. They can extend into the muscle and the supporting structures such as tendons and joints. These wounds are usually accompanied by a large scale loss of skin. Deep tissue injuries are also a concern in the acute care setting. With these wounds, there is bruising or a purple area of skin or blood filled blister. The skin in still intact, so it could appear to be a stage I pressure ulcer. This error is very serious. It could easily open and progress to a stage III or IV pressure ulcer. A deep tissue injury is associated with prolonged sitting, maybe in a wheelchair. Another example for occurrence is a patient lying in one place for an extended amount of time such as in surgery, which can take several hours. The underlying soft tissue has been damaged, but the skin is still intact. Risk Factors There are
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One of the largest is age. 70% of pressure ulcers occur in the geriatric population. This population has a decreased water content of their skin, contributing to the skin being less elastic and breaking. This population is less mobile, some in wheelchairs. The decrease in activity leads to the development of pressure ulcers.
Malnutrition is another risk factor. The risk of developing a pressure ulcer is higher in those individuals who are overweight and in those who are underweight, especially if they are deficient in certain nutrients such as protein, zinc and vitamin C. Overweight individuals have more weight pushing on the boney prominences, causing a pressure ulcer to form. The underweight are at risk because they have less natural cushioning over the bones. When there is friction, between the bone and another surface, an underweight person is more likely to obtain a pressure ulcer.
Pressure ulcers are often found in patients with chronic diseases such as diabetes and other vascular diseases. Many times a wound will go unnoticed because the circulation was so week in that particular area of the body that the patient did not feel discomfort or any abnormalities. By the time the wound is noticed, it could have already progressed into a large
One of the largest is age. 70% of pressure ulcers occur in the geriatric population. This population has a decreased water content of their skin, contributing to the skin being less elastic and breaking. This population is less mobile, some in wheelchairs. The decrease in activity leads to the development of pressure ulcers.
Malnutrition is another risk factor. The risk of developing a pressure ulcer is higher in those individuals who are overweight and in those who are underweight, especially if they are deficient in certain nutrients such as protein, zinc and vitamin C. Overweight individuals have more weight pushing on the boney prominences, causing a pressure ulcer to form. The underweight are at risk because they have less natural cushioning over the bones. When there is friction, between the bone and another surface, an underweight person is more likely to obtain a pressure ulcer.
Pressure ulcers are often found in patients with chronic diseases such as diabetes and other vascular diseases. Many times a wound will go unnoticed because the circulation was so week in that particular area of the body that the patient did not feel discomfort or any abnormalities. By the time the wound is noticed, it could have already progressed into a large