Treating Pressure Sores, Part 2

by National Institute of Health

(Page 2 of 2)

Storing and caring for dressings

Clean (rather than sterile) dressings usually can be used, if they are kept clean and dry. There is no evidence that using sterile dressings is better than using clean dressings. However, contamination between patients can occur in hospitals and nursing homes. When clean dressings are used in institutions, procedures that prevent cross-contamination should be followed carefully.

At home, clean dressings may also be used. Carefully follow the methods given below on how to store, care for, and change dressings.

To keep dressings clean and dry:

• Store dressings in their original packages (or in other protective, closed plastic packages) in a clean, dry place.
• Wash hands with soap and water before touching clean dressings.
• Take dressings from the box only when they will be used.
• Do not touch the packaged dressing once the sore has been touched.
• Discard the entire package if any dressings become wet or dirty.

Changing dressings. Ask your doctor or nurse to show how to remove dressings and put on new ones. If possible, he or she should watch you change the dressings at least once.

Ask for written instructions if you need them. Discuss any problems or questions about changing dressings with the doctor or nurse.

Wash your hands with soap and water before and after each dressing change. Use each dressing only once. You should check to be sure the dressing stays in place when changing positions. After the used dressing is removed, it must be disposed of safely to prevent spread of germs that may be on dressings.

Using plastic bags for removal. A small plastic bag (such as a sandwich bag) can be used to lift the dressing off the pressure sore (Figure 8). Seal the bag before throwing it away. If you use gloves, throw them away after each use.

Good Nutrition

Good nutrition is the third principle of healing. Eating a balanced diet will help your pressure sore heal and prevent new sores from forming.

You and your doctor, dietitian, or nurse should review any other medical conditions you have (such as diabetes or kidney problems) before designing a special diet.

Weigh yourself weekly. If you find you cannot eat enough food to maintain your weight or if you notice a sudden increase or decrease, you may need a special diet and vitamin supplements. You may need extra calories as part of a well-balanced diet.

Tell your doctor or nurse about any weight change. An unplanned weight gain or loss of 10 pounds or more in 6 months should be looked into.

Pain and Infection

Even if you care for your pressure sore properly, problems may come up. Pain and infection are two such problems. Pain can make it hard to move or to participate in care. Infection can slow healing.

Managing Pain

You may feel pain in or near the pressure sore. Tell your doctor or nurse if you do. Covering the sore with a dressing or changing your body position may lessen the pain.

If you feel pain during cleaning of the pressure sore or during dressing changes, medicine may help. It may be over-the-counter or prescription medicine. Take medicine to relieve pain 30 to 60 minutes before these procedures to give it time to work. Tell your doctor or nurse if your pain medicine does not work.

Treating Infection

Healing may slow if the sore becomes infected. Infection from the sore can spread to surrounding tissue (cellulitis), to underlying bone (osteomyelitis), or throughout the body (sepsis). These serious complications demand immediate medical attention. If you note any of the signs of infection in Table 3, call your doctor right away.

Checking Your Progress

A health care professional should check your pressure sore regularly. How often depends on how well the sore is healing. Generally, a pressure sore should be checked weekly.

Examining the Sore

The easiest time to check pressure sores is after cleaning. Signs of healing include decreased size and depth of the sore and less drainage. You should see signs of healing in 2 to 4 weeks. Infected sores may take longer to heal. Signs to Report

Tell your doctor or nurse if:

• The pressure sore is larger or deeper.
• More fluid drains from the sore.
• The sore does not begin to heal in 2 to 4 weeks.
• You see signs of infection.

Also report if:

• You cannot eat a well-balanced diet.
• You have trouble following any part of the treatment plan.
• Your general health becomes worse.

Changing the Treatment Plan

If any of these signs exist, you and your health care professional may need to change the treatment plan. Depending on your needs, these factors may be changed:

• Support surfaces.
• How often you change how you sit or lie.
• Methods of cleaning and removing dead tissue.
• Type of dressing.
• Nutrition.
• Infection treatment.

Other Treatment Choices

If sores do not heal, your doctor may recommend electrotherapy. A very small electrical current is used to stimulate healing in this procedure. This is a fairly new treatment for pressure sores. Proper equipment and trained personnel may not always be available.

If your pressure sore is large or deep, or if it does not heal, surgery may be needed to repair damaged tissue. You and your doctor can discuss possible surgery.

Care of Healthy Skin

Having healthy skin is important to preventing future pressure sores. Healthy skin is less likely to be damaged and heals faster than skin in poor condition.

You can help prevent new pressure sores while helping to heal the ones you have. To improve your skin's health:

• Bathe when needed for cleanliness and comfort.
• Use mild soap and warm (not hot) water.
• Apply moisturizers (such as skin lotions) to keep skin from becoming too dry.

Inspect your skin at least once a day for redness or color changes or for sores. Pay special attention to pressure points where pressure sores can form (Figure 2).

Skin problems can also result from bladder or bowel leakage (urinary or fecal incontinence). If you have these problems, ask your doctor or nurse for help. If the leakage cannot be controlled completely:

• Clean your skin as soon as it becomes soiled.
• Use a protective cream or ointment on the skin to protect it from wetness.
• Use incontinence pads and/or briefs to absorb wetness away from the skin.

For more detailed information about how to prevent pressure sores, ask for a copy of Preventing Pressure Ulcers: Patient Guide.

Be Active in Your Care

If you understand the basic ideas of pressure relief, sore care, and good nutrition, you can take the steps needed to heal pressure sores and prevent new ones. Not all steps apply to every person. The best program will be based on your needs and the condition of your sores.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.