Management of bedsores or "pressure ulcers"

The New York Times reported on several recent studies that have addressed the severe health problem presented by bedsores in hospitals and nursing homes.  If such a sore becomes infected, it can be fatal.  Even without infection, these wounds can can be so deep and sore that the patinent must be treated with narcotic pain relievers.

Experts estimate that two million Americans suffer from pressure ulcers each year, usually as a result of immobility, poor nutrition, dehydration or incontinence.  Christopher Reeve was one promient fatal victim of the problem.  The TImes reported a collaborative program undertakin by 52 nursing homes around the country and published in the Journal of American Geriatrics Society.  In this effort, ulcers were reduced by 69 percent through a multi-disciplinary approach.  The effort ranged from proper laundering and assuring properly fitting clothes, to improved nutrition in the institutional diet.  Waiting and sitting times were reduced in the cafeteria and beauty shop. 

The authors of the study reported that the number of superficial bedsores did not decline significantly, however, the number of wounds that turned in to dangerous ulcers was improved.  The staff rated individual patients for risk of ulceration and set schedules to assure that these patients were the last in to their wheelchairs for meals, and the first out.  Residents at risk because of weight loss were given yellow plates to remind staff to encourage them to eat more.  New mattresses of high-density foam were used at some sites, and pillows were used to elevate at-risk patients' feet.

Pressure ulcers are rated from 1 to 4, with 3 and 4 being the most severe.  Oddly, the severe ulcers are usually not superficial ulcers that become more severe:  they appear to develop from deep within the skin outward and appear as severe ulcers from the outset.  As with the Johns-Hopkins handwashing study in Michigan that significantly reduced infection in Intensive Care Units [discussed elsewhere in this blog], it appears that the primary method of avoiding problems in this area is, once again, a team approach with focus on the details.