Maintaining Healthy Skin: Pressure Ulcer Prevention & Management

What is a pressure ulcer?

What is the cause of pressure ulcers?

Where do you get pressure ulcers?

How do you get pressure ulcers?

• Friction: injury caused by pulling yourself across a surface instead of lifting
• Rubbing
• Shearing happens when the skin moves one way and the bone underneath it moves another way. An example of this is if you slouch when you sit.
• Moisture/dampness
• Dryness
• Heat and cold

How does a spinal cord injury increase your risk of developing pressure sores?

• Loss of movement causes prolonged periods of time lying or sitting in one position.
• Loss of muscle mass decreases cushioning over bones, which increases pressure on the skin.
• Loss of sensation deprives you of pain, pressure or discomfort signals, which would normally send a message to the brain to tell you to shift your weight.
• Poor blood circulation, which is common with spinal cord injury, will also contribute to skin and tissue damage.
• Inadequate perspiration affects the temperature regulation of the skin.

Pressure ulcer warning signs to watch for

• A well-defined red area on your skin
• Skin that stays red longer than 30 minutes
• Skin that feels warm or firm
• Edema (swelling) over a bony part of the skin
• Skin that is blistered or broken.

How do you prevent pressure ulcers?

• When lying down or sitting, change your position and shift your weight regularly.

• Keep your skin clean by washing it once a day.
• Carefully dry your skin with a soft towel.
• Use a mild, unscented soap.
• Avoid prolonged contact with urine, feces and excessive sweat/perspiration.
• Keep good foot care.

• Clothes, shoes and orthotics should fit properly, without being too tight.
• Limit your exposure to strong sunlight.
• Avoid temperature extremes (heat/cold).

• Drink plenty of water and other fluids—at least 8 glasses a day.
• Avoid alcohol.
• Eat plenty or proteins—meat, dairy products, eggs, fish, legumes, tofu.

• Inspect your skin daily.
• Check skin before getting out of bed and again before returning to bed.
• Look for pressure ulcer warning signs.

Safety precautions used to prevent injury to the skin from the following:

• Don’t use hot water bottles, heating pads, electric blankets or ice packs in bed.
• Don’t carry hot drinks on your lap to avoid spills and burns.

• Don’t rest feet/legs on hot water pipers, heaters and radiators.
• Don’t sit too closely to the fire.
• Don’t set an astray on your lap and carefully attend to cigarette ash.
• Wear warm, loose-fitting, dry clothing when going outside to the cold.

• Transfer safely, using only the techniques taught to you.
• When using a wooden transfer board, check for breaks or slivers.
• Protect your feet from hitting objects during transfers and when you are in your wheelchair.
• Watch out that you are not rubbing against parts of your wheelchair such as casters, leg rest hangers.

• Use a turn sheet when changing positions in bed.
• Keep the head of the bed under 30 degrees.
• Limit the number of times the head of the bed is adjusted up or down.
• During transfers, use talcum or place a towel on the board to avoid bare skin friction.
• Never allow anyone to pull your bare skin across a bed sheet.
• Use socks and elbow/heel protectors to reduce friction.

Vacation, travel and pressure ulcers

• Remember to shift your weight during long rides in the car, train, boat, plane, etc.
• Wear appropriate clothing that suits your destination.
• Avoid wearing wet clothes.
• Use plenty of sunscreen whenever there is strong sunlight.
• Don’t neglect your personal hygiene and inspection. Maintain your skin care routines.

What should you do if a pressure ulcer is starting?

• Keep pressure off the red area.
• Don’t massage directly on the red area.
• Don’t use a heating pad or lamp.
• Maintain good hygiene.
• Evaluate your diet.
• Look at your mattress, wheelchair cushion, transfers for possible causes.
• Notify a health care professional.

Resources