Maintaining healthy skin and pressure ulcer prevention
This page gives you information about pressure damage and moisture associated skin damage, how it develops and what can be done to prevent it.
What are pressure ulcers?
A pressure ulcer, commonly called a pressure sore or bed sore, is described as damage to the skin and/or underlying tissue caused by a lack of supply of blood and oxygen. They usually occur over an area of the body where bones are prominent; the skin may be broken or intact.
Pressure ulcers are caused by a combination of:
Pressure: Pressure is applied to an area of the skin for a period of time which prevents blood from supplying the tissues. This pressure can be caused by a person’s normal body weight or from gravity and bone pressing on the skin from the inside.
Shear: When sitting in a chair or bed it is easy to slide down. The action of sliding down causes strain on the skin and causes it to break or blister.
Friction: Friction damage happens when the skin is rubbed up against another object for example a bed or a chair. The repeated action can remove the top layer of the skin and increase the risk of developing a pressure ulcer.
Pressure ulcers can be very serious if the correct prevention and treatment is not started. They can cause pain and may require a longer stay in hospital if infection develops. Pressure ulcers can be life threatening if they become infected.
Pressure ulcers can occur anywhere on the body but there are areas where they are more common. These areas are shown in these pictures above.
See the figure within the PDF below.
What care to expect while in hospital
When you are admitted to hospital, a healthcare professional will ask if they can carry out an assessment of your skin. The assessment will highlight any areas of your skin that may be vulnerable or any damage that may already be present. This will allow staff to provide you with the most appropriate care focussing on you as a whole and not just the reason why you have been admitted to hospital.
During your stay in hospital, a healthcare professional will ask if they can inspect your skin regularly to make sure further or new damage has not occurred. They will also provide treatment if required.
Within the Gloucestershire Hospital NHS Foundation Trust there are different pieces of equipment available to help prevent pressure damage. These include pressure relieving mattresses and pressure relieving cushions. If it is assessed that you are at risk of pressure damage or have pre-existing pressure damage, equipment may be sought to help in your treatment.
If you are able, the health care professional will encourage you to change position regularly while in bed or in a chair. If you have difficulty in repositioning then they will assist you if needed. By changing your position, this relieves the pressure on different parts of the body which reduces your risk of pressure ulcer development.
Some times when the skin comes into contact with excessive amounts of moisture it will soften, swell and can become wrinkled such as the way fingers become wrinkled in the bath.
Prolonged exposure to moisture can make the skin more vulnerable to pressure damage or breakdown. Moisture damage can be caused by urine, faeces, sweat and wound leakage. Moisture on the skin can cause the skin to become red and sore. This can also increase your risk of pressure damage. To help with this, creams/films are used within the trust to provide a barrier between your skin and the moisture. The health care professional will discuss this treatment with you.
It is important to eat and drink a balanced diet as this will help you to maintain healthy skin. Within the trust we have our own team of Dieticians, a healthcare professional will refer you to the team if needed.
Hospital acquired pressure damage
While in hospital if you develop pressure damage, the hospital will complete an investigation. We will then put into practice care measures, if possible, to help reduce the risk from this happening again. If this happens a healthcare professional will discuss this with you.
Specialist departments who may be involved in your care
Within Gloucestershire Hospitals NHS Foundation Trust, we have a team who have an advanced knowledge in the prevention and treatment of pressure damage and complex wounds. They are called the Tissue Viability Team.
During your stay, a member of this team may visit you to assess any damage that you may have and to advise the most appropriate care. They will devise a care plan specifically for you. This may include having photographs taken of the pressure ulcer by a medical photographer. These photographs are taken for medical purposes only and can only be accessed by health care staff involved in your care. Please ask for a copy of leaflet GHPI0441 Medical Photography Consent for more information.
How to reduce your risk of pressure ulcers and the signs to look out for?
Regular repositioning while sat in bed or in a chair will help to reduce the risk of pressure ulcer development, as will inspection of your own skin if you are able. Some signs to look out for are:
- Broken areas of skin
- Purple/black patches over bony areas of dark skin
- Red patches over bony areas on light skin
- Swelling
- Blisters
- Shiny areas of skin
- Dry patches
- Cracks, calluses, wrinkles
- Warm areas
- Pain or burning
If you experience any of these symptoms, please discuss with your health care professional.