Key points pressure injuries.

 

  • As caregivers, it is crucial that we think about pressure injury prevention every day.

  • Most pressure injuries are preventable.

 

  • Unfortunately, the global incidence of pressure-related injuries remains alarmingly high.  Once a pressure ulcer has developed, it demands a lot of resources to get it to heal. 

  • Pressure ulcers can be fatal.

 

  • In western countries, most pressure injuries occur in health care institutions. In Africa, where most people do not move to an older people's home in the last phase of life, these pressure injuries usually occur at home under the care of relatives or neighbors.  However, the incidence of pressure-related injuries, for example, in hospital wards in Africa, is expected to be high. 

 

  • Many are unaware that warm and reddish skin over bony prominences is a sign of a pressure injury. If the skin is non-blanching - that is, it doesn't get paler when we apply pressure with a finger and release the finger after a few seconds - then this represents a serious pressure injury with a high risk of developing into an ulcer.  

 

  • If you register a pressure injury at your workplace, this should be reported and registered as an injury to the patient. It means that we have failed the patient and have not done enough to prevent this from happening. 

 

  • The most important part of the treatment is immediate offloading. You should have a written plan for how the offloading is to be carried out - i.e., how often should the patient be turned and what kind of mattress or other devices the patient should use. 

  • In many western countries, pressure who are at high risk of developing a pressure injury or already have a pressure injury have the right to a special antidecubital mattress - often, multiple chamber air mattresses are used for this. Obviously, this is not an economical realistic alternative for most patients in Africa.  If such a mattress is unavailable, you have to be extra strict about implementing a perfect turning regime for the patient. 

  • A nutrition plan is essential when treating pressure ulcers. Remember, even if the patient is overweight, they need extra proteins, calories, and vitamins to get the ulcer to heal as fast as possible. If an overweight patient has a pressure ulcer, this is not the time to start on a diet!

 

  • Almost all pressure injuries are deeper than you think. Never underestimate a pressure injury!

 

  • If you see or probe exposed bone at the bottom of the ulcer, you must have a high degree of suspicion of osteomyelitis. 

  • If a seemingly " clean" ulcer has much exudate, this is often a sign of osteomyelitis.

  • In our practice, the pressure ulcers that would not heal were either in patients who were not offloaded adequately or in patients with unrecognized osteomyelitis lurking at the bottom of the ulcer. 

 

  • Take very good care of the skin surrounding the ulcer - a breakdown of the skin will result in an increase in the ulcer. 

  • Remember that the skin can first grow over the ulcer when the ulcer has granulated to the wound surface - that is, the ulcer cavity has to first fill with granulation tissue before epithelialization can occur.

  • If there is undermining of the skin edges ( which there often is), it is a poor prognostic factor - the ulcer will take twice to heal at the least compared to an ulcer with no undermining.

  • Concerning the choice of dressing:  the primary factor in deciding which dressing to use is the amount of exudate coming from the wound. Moisture damage to the surrounding skin can cause skin breakdown in a short time! In most cases, the ulcer has a depth requiring a primary dressing to fill the ulcer - a filler. Pressure ulcers often have a heavy bacterial burden, and it is usually an advantage if the filler has some antibacterial properties. We will discuss which dressings are appropriate in the Chapter on "treatment" and include here also a discussion on what to use when you have a minimal choice or no dressings available at all.​