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Causes of Bed Sores

Common Causes of Bedsores

Causes of Bed SoresNegligent medical staff or ineffective caregiving protocols could lead to patients developing bedsores.

When this occurs, the patient or surviving family member can hold the facility liable through a nursing home bedsore lawsuit. Below are the most common causes of pressure sores (decubitus ulcers, pressure wounds, pressure ulcers, and bedsores).

The personal injury attorneys at Nursing Home Law Center serve as legal advocates to victims of nursing home abuse and neglect and can help your family too.

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(Also referred to as Pressure Sores; Pressure Ulcers; Decubitus Ulcers)

Bedsores are damaged skin caused by a lack of proper blood flow to the skin because of pressure. Bedsores can happen in individuals at any age when bedridden, in a chair or wheelchair without the ability to reposition themselves.

The sore happens from even minimal pressure on the skin when in contact with a bed, chair, wheelchair, splint, cast, or hard object such as a poorly fitting prosthetic (artificial device). These decubitus wounds usually appear over a bony prominence like the elbows, ankles, heels, tailbone, or hip bones.

However, because of the common causes of bedsores, an ulcer can happen at any point on the body.

Bedsores can develop while hospitalized for a different medical condition, in a nursing home or an assisted living facility. Even small bedsores can lengthen the stay in a medical facility until it has been treated properly.

Bedsores are often life-threatening when left unattended, improperly managed, or when caused by an underlying condition that minimizes its potential to heal.

Common Causes of Pressure Ulcers in Patients in Medical Facilities

There are various common causes of bedsores. Some of these causes include:

  • Pressure – Any pressure from an object including a bed or chair can reduce the flow of blood to the skin, especially over bony areas. When the blood flow is restricted for even a few hours, the skin can die, starting at the outer layers (epidermis). Next, a breakdown of the dead skin can lead to an ulcer (open sore). Healthy individuals usually do not develop pressure ulcers because most of us change position to alleviate pressure without thinking, even while asleep.
  • Traction – Any type of sheer force can restrict blood flow to the individual skin. Sheer force traction tends to stretch the skin, like when individuals incline or are propped up in bed. This is because forces of gravity naturally draw down tissue and muscle under the skin. However, outer surfaces of the bed, chair, or other object hold the skin’s top layers in place, creating pressure and eventually a pressure sore.
  • Friction – Repeated friction by continuously rubbing against bedding or clothing can develop or worsen existing pressure ulcers. Over time, friction can wear off the skin’s top layers, such as when being repeatedly pulled across bed linens during repositioning.
  • Unfavorable Pressure Distribution – If a patient has an injury or illness that affects their mobility, they may have a dark or red area of skin before the development of a pressure sore. The darker discolored area means that the individual is not shifting positions and blood circulation is being restricted for longer periods of time.
  • Inactivity – It might seem obvious, but inactivity from illness or injury can be a common cause of bedsores. Typically this is because individuals are unable to reposition themselves and avoid pressure on certain areas for extended periods of time.
  • Moisture – Older individuals and healing patients can suffer bedsores caused by excessive moisture that weakens or damages the skin’s outer protective layer. As an example, any skin with extended contact with urine, feces, or perspiration can easily break down, causing a pressure ulcer.
  • Malnutrition –Dehydration, and malnutrition tend to increase the potential of developing a decubitus ulcer. In addition, the lack of proper nutrition can slow down the healing process. Individuals who are undernourished often lack sufficient body fat necessary for cushioning muscles and tissue, particularly when deficient in zinc, vitamin C and/or protein.

The healing process is stifled when the nursing staff fails to follow established protocols that run the risk of developing pressure ulcers. Not keeping the skin clean and dry, prolonged pressure on a body part, and poor nutrition are leading contributing risk factors to damage to tissue, muscle, and bone.

Living in nursing homes has become especially dangerous with the outbreak of Covid-19 (virus pandemic) where patients, nurses, doctors, and others are exposed to deadly contagions.

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Nursing Home Residents at Greatest Risk of Developing a Pressure Ulcer

According to the Centers for Disease Control and Prevention (CDC), mental confusion and/or physical limitations that prevent older adults from repositioning themselves frequently puts them at higher risk for bedsores.

Nursing home patients with Alzheimer's disease, memory loss, or dementia – Residents with cognitive disabilities are at great risk of developing bedsores due to their inability to reposition themselves frequently.

Frail, older adults – The skin of frail seniors tends to be thinner and less elastic than younger individuals. The skin will also lose its resilience over time if not cared for properly.

Mobility challenged individuals – Any person with physical limitations due to paraplegic, quadriplegia, tetraplegia, or other medical condition are at risk for bedsores because they cannot reposition themselves efficiently.

Patients receiving intensive medical care – Patients in a deadly condition will be bedridden with limited mobility. The concern is that they will succumb to the pressure wounds before their critical illness subsides.

Surgical patients – Surgery requires patients to be in a prone position for extended periods of time, which increases the risk of developing a pressure sore.

Patient's weights – Individuals who are obese and extremely overweight carry additional weight on the body parts that come in contact with bedding or clothing, increasing their risk for pressure ulcers.

Understanding the Stages of Pressure Sores Used to Describe the Severity of a Wound

Even though many pressure ulcers cause significant itching and pain, when senses are dulled, the patient may experience no painful symptoms at all.

A bedsore is categorized by how severe the damage is to the soft tissue. In many incidences, a decubitus ulcer can progress quickly to severe stages, with the first noticeable signs appearing in stage III or IV.

  • Stage I – Pinkish or reddish unbroken skin, sometimes challenging to see on darker-skinned individuals. Oftentimes, the sore is firmer, cooler, softer, warmer, or more tender than skin in the nearby area. No ulcer is present.
  • Stage II – Noticeable shallow skin loss, which could include blisters, abrasions, or both. The pressure ulcer is typically shallow in appearance with a red to pink base.
  • Stage III – The skin of the pressure ulcer is worn away, sometimes into the deep layers of fat without exposing bones or underlying muscle.
  • Stage IV – At this stage, the skin is worn away, exposing underlying bones, tendons, and muscles.
  • Non-Stageable – When the decubitus ulcer is covered with eschar (a crusty, thick surface) or debris, it sometimes cannot be properly staged through assessment.
  • Deep Tissue Injury – Maroon or purple unbroken skin area that feels cool, warm, mushy, or firm when compared to surrounding tissue.

At stage IV, the area is so affected that the patient experiences serious pain deep in the wound, and little pain and discomfort at the surface due to necrotic (tissue).

The patient typically takes hospital care for the complications where the surgeon will perform "debridement" surgery, removing the dead tissue to alleviate symptoms and the risk of death due to infection.

Usually, individuals who do not have the ability to move around have a greater potential of developing bedsores, when restrained, sedated, very weak, comatose, or paralyzed. Without repositioning the body every two hours the affected area will experience restricted blood supply, leading to pressure ulcers.

Diagnosing Pressure Wounds on the Body

Pressure ulcers can be diagnosed through an examination of surrounding tissues, or through palpation with the doctor's hands. This requires examining the affected area for warmth, redness, fluid drainage (or presence of dead tissue), loss of skin surface, and depth within the wound bed.

The most important diagnostic sign is pain deep within the pressure ulcer, which is a manifestation of deeper tissue damage. The physician will also check for loss of sensation to light touch near the wound, to determine if the patient has nerve damage due to the presence of a deep injury.

Blood supply – When primary artery/vein supply is compromised, cutaneous perfusion (capillary refill) may not be visible or present.

To diagnose a pressure ulcer, the doctor will perform a medical history and physical examination as well as body system assessment for neurological, cardiovascular, respiratory, kidney function, and skin integrity.

In some cases, laboratory tests (such as blood count) are ordered to determine the presence of any pre-existing health conditions that could help the physician understand the source of poor circulation, nerve damage, or organ failure.

In rare cases, a bone scan may be ordered to determine if the pressure ulcer has injured underlying bones or joints. X-ray imaging is sometimes used as well.

Locating Ulcers on Specific Body Parts

It's important to know where to find decubitus ulcers on the body.

Head, face, neck – Sometimes found along with decubitus wounds at pressure points along the spine (such as coccyx) or hip bones (greater trochanter). These types of bedsores are usually caused by malnutrition or dehydration due to decreased intake or difficulties swallowing.

Trunk – This area is one of the most common sites for pressure injuries. Because it is in constant contact with bedding, this area experiences increased friction and tissue breakdown when an individual cannot move to relieve pressure at night.

Hips/Buttocks/Thighs – The buttocks are especially susceptible because they are not supported by any bony prominences. They are also more likely to spend long periods of time in the "V" position (with knees raised and lower legs and feet resting on a chair, for example.)

Chest – At older ages, the upper backside along the spine can experience chronic pressure due to sitting or lying down for extended periods of time.

Lower legs – When a patient cannot move around much because of paralysis, casts, or splints.

Pressure Ulcers that Develop Secondary Infections

Once a pressure ulcer deepens into tissue layers that contain structures for bleeding and clotting (such as the dermis), it becomes an open wound with a high risk of bacterial contamination.

For individuals with impaired immune systems, delayed wound healing or poor nutrition risk infections from bacteria such as group A streptococcus and staphylococcus aureus.

Pressure Ulcers on the Buttocks/Hips

When a pressure ulcer occurs in this area, it may be related to an individual being placed in a sitting or stooping position for prolonged periods of time.

If an individual has to be transported in a seated position, use padding around the hips and buttocks. This will relieve pressure on bony prominences and help prevent damage to the skin.

Pressure Ulcers on the Back

One cause of this sort of pressure injury is if an individual has to sleep in a chair or bed with elevated side rails for long periods of time. In this situation, the head and shoulders are raised higher than the rest of the body.

To prevent damage due to pressure on bony prominences at the backside, pad around the shoulder blades and lumbar area. If an individual cannot turn or move around easily, try placing a pillow under the knees to help relieve pressure.

This area is often injured because it must remain in contact with a bedding material for long periods of time while an individual cannot change positions due to paralysis or immobility.

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How Can You Get Rid of Pressure Sores and Do They Heal Quickly?

To help prevent pressure sores from becoming serious, frequent repositioning of the individual is required. This allows the blood supply to keep the area properly nourished and prevents tissue from dying.

In many cases, a medical professional may use dressings or medications on the wound to promote healing while protecting against infection.

However, if a pressure sore becomes infected, a doctor may prescribe antibiotics for a period of time. In addition, the wound must be cleaned and treated with antiseptic to reduce the risk of infection at all stages of development.

Although pressure wounds are serious and painful, they usually heal within 30 days depending upon the severity. In many cases, they will heal more quickly for people who engage in regular movement and repositioning.

According to the Pressure Ulcer Advisory Panel, a trained wound care team can help in the healing process by educating family members and caregivers on how to provide proper care. The team is also available for support in the form of wound care, physical therapy, and nutritional consultations.

Are Decubitus Ulcers Worse Than Bedsores?

Medical science recognizes all bedsores as pressure wounds, pressure ulcers, decubitus sores, and decubitus ulcers. Doctors categorize ulcers in four stages (Stage I-Stage IV), deep tissue injuries, and unstageable bedsores where debris, dead skin, dried blood in other particles blocked the wound care specialist's view to accurately categorize the wound.

However, doctors and nurses often referred to decubitus ulcers as larger than traditional pressure wounds that have a longer duration of healing. Doctors and nurses often classified decubitus ulcers as a wound creating a greater risk of developing deep injuries in the tissues and bones.

The longer a wound remains open and untreated, the higher the risk of infection and pain increases significantly. Decubitus ulcers pressure wounds can cause permanent damage including scarring, amputation, and death.

Treating Ulcers with Therapeutic Massage

Therapeutic massage is the best way to prevent pressure ulcers in some people with chronic illnesses or complicated wounds. Using a neutral grip on lymphatic strokes allows the therapist to slowly work through muscles while avoiding unnecessary stretching of tissues that can create pain during massage sessions.

Massage therapists often used a neutral grip because the therapist holds the tissue underneath the muscles, right above bones. Applying deep pressure from mid-strokes helps to lengthen and separate tissues from other body systems that may have adhesions or restrictions that create pain during a massage session.

Traditional Pressure Ulcer Treatment for Life-Threatening Sores

In many cases, a doctor will prescribe traditional methods of removing debris from the ulcer and dress wounds that require special attention to promote healing. This often involves a medical professional dressing a wound three times a week with wet-to-dry gauze.

Patients must place damp gauze over the wound, cover the area with dry gauze, and then secure with tape or another dressing. Patients often need to make sure the gauze stays moist all day because the doctor does not prescribe any pain medications for these types of wounds.

Then, patients should re-dress their ulcers every 1–2 days according to the doctor's guidelines and effective treatment plan. In severe cases where the pressure wound or ulcer does not respond to traditional methods of care, a doctor may prescribe high-dose antibiotics and other medications.

In addition, the patient should continue repositioning and exercise while resting in bed. Exercise improves blood flow to the skin and muscles while reducing the risk for developing other problems such as low blood pressure, cellulitis, or blood clot formation.

Because bedsores are most commonly caused by poor circulation, sitting up in the bed and exercising with movement helps improve circulation. If a patient is unable to reposition themselves without assistance, then they should ask for help immediately. Repositioning every 2 hours prevents bedsores from developing on pressure points of the skin where blood flow is compromised.

Patients should also try to avoid constipation because straining during bowel movements can cause hemorrhoids, which increases the risk of developing pressure ulcers in the pelvic region. Laxatives help reduce the long-term risk for developing bedsores; however, if it causes diarrhea, patients must limit its use to prevent dehydration and electrolyte imbalances.

Patients and caregivers should avoid smoking and drinking alcohol because these habits prevent good circulation throughout the body. Smoking can cause or exacerbate bedsores while making it harder for a patient's circulatory system to recover after developing an ulcer on the skin.

Patients should also stay hydrated by drinking water during their daily activities to reduce the risk for dehydration and dry skin.

A combination of different treatments to improve patient's circulation, remove debris from bedsores, and prevent new ulcers from developing helps treat existing pressure wounds or sores which can cause permanent damage to a patient's body. With regular care and proper repositioning, patients should be able to reduce their risk of developing bedsores.

However, some patients require different types of care that can help them prevent further complications.

Special Mattresses & Pressure-Relieving Surfaces

For example, some medical centers offer an integrative approach to healing with regular use of special mattresses and pressure-relieving surfaces on hospital beds so nurses can keep patients comfortable during their treatment.

In addition, many medical facilities have lasers and other technologies to help penetrate the skin with heat energy in order to promote faster healing times. Many patients also require physical therapy so they can develop muscle strength and improve their circulation during a variety of activities, such as sitting up in bed or walking around the facility.

Because pressure wounds are often caused by a lack of movement and poor circulation, patients' bodies often have difficulty healing from wounds. Patients should be proactive about their care and ask for help if they do not feel comfortable repositioning themselves or moving around the facility to avoid developing pressure ulcers.

The severity of bedsores largely depends on the extent of the wound, whether it is chronic or acute, and whether a patient has any conditions which would inhibit their healing process. In some cases, nurses may need to use vacuum-assisted closure therapy with a wound pump to remove dead skin cells from the surface of the ulcer.

In addition, daily inspections of vulnerable areas on a patient's body can help prevent bedsores from developing into larger wounds, which can be life-threatening if they are left untreated.

Patients should ask for help from medical staff as soon as they notice redness or swelling around a wound to prevent it from getting worse.

Causes of Bed Sores Center Around Inferior Care. Get Help Now

With proper care and skin management, bedsores are almost always preventable. If you or a loved one has suffered from any type of pressure ulcer while under the care of a hospital, nursing home, or assisted living facility, you can likely seek financial recovery for your damages.

Call Nursing Home Law Center LLC (800) 926-7565 (toll-free phone call) or use the contact form for a free initial consultation to speak with an experienced attorney concerning your claim.

Our attorneys have helped hundreds of families from across the United States recover maximum compensation for injury caused by a pressure wound acquired at medical facilities and care centers. Let us help you.

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