Best practices for preventing pressure Ulcers – also known as GOOD SKIN CARe

I like to think of the CNA as eyes and ears for the RN. They have the most important job of all- ( I am an old nurse- we used to be able to do these things ourselves)   The CNA has the ability not only to assess a patient, but to also educate them and family members on basic skin care.

Let’s start with understanding what are pressure sores,( pressure ulcers . or AKA bed sores)

A pressure ulcer is an injury to the skin caused by unrelieved pressure to the skin. The skin gets it nutrients and oxygen from the blood supply. When there is pressure on the skin that blood supply is cut off. When this happens, the skin is starved and the tissue dies. This results in open areas on the skin.

Normally, nerves tell the body to move to relieve pressure.  In individuals that are immobile, that does not happen. A pressure ulcer can occur in as little as 1 to 2 hours in some individuals.

The most common areas that are vulnerable to pressure ulcers are the where the bony parts of the body may press against an outside surface. The heels, the sacral area ( the lower back below the waist), and the hip bone. For someone that wears oxygen- the areas of the face where the tube presses is also a vulnerable area.

People that are at the highest risk for pressure ulcers:
patients confined to bed or a wheelchair
Patients unable to move – coma, fractured hip
Patients that are incontinent of bowel or bladder
patients with poor nutritional status
Patients with a lowered mental status- may be due to anesthesia, medications or medical conditions

REMEMBER- Pressure area are totally preventable. Pro active good nursing is the key to prevention.

Best practices to prevent skin breakdown-
Inspect the skin at least once a day. Pay special attention to areas where the bones and skin may be pressed against any area for a period of time.  Pay special attention to ANY reddened areas that may remain. This is an indication of pressure and special attention should be paid to prevent further damage.  Heels, knees, buttocks, hips, face (ears), ankles etc.

Keep skin clean and dry. Clean skin as soon as it becomes soiled.

Use creams or oils on the skin to prevent dryness. Skin prep protective spray may be a product that is suitable for the skin to reduce friction on pressure prone areas.

If a person is incontinent, after cleaning, apply cream or ointment to continue to protect the skin.

limit pressure over bony parts. This means changing positions at the minimum – every 2 hours. This is so critical and the most neglected of the best practices.

Reduce friction and shearing of the skin when moving a patient- lift or roll- do not drag during repositioning. Use bed sheets, assistance from another nurse or a lifter.

Use of special mattresses, pillows and wedges to position a patient so that knees and ankles do not touch one another.

Keep the head of the bed as flat as possible- Raising the head of the bed greater than 30 degrees causes a person to slide down in bed and damage the blood vessels in the skin. OF course there are many patients with medical conditions that will need to have their head of the bed raised. In this case, it is so important to be more diligent on skin care and observation.

Proper nutrition is so important to healthy skin.  Protein, calories and proper hydration are all important components of good skin care. Encouraging your patients to eat and drink is just as important to skin care as observation.

Know what to look for- reddened areas that stay red after pressure is removed are indications there is a problem. Take action immediately to prevent further damage. Avoid any more pressure to that area. Follow the best practices that you have learned.

Remember, pressure ulcers are preventable. As the hands on care giver, you are the first line of defense. You are the most important part of the team. If you have any questions or concerns, make the other members of the health care team aware of them. You can make a difference.