Key points pressure injuries

 

  • It is crucial that we as caregivers 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 old peoples home in the last phase of life these pressure injuries usually occur at home under the care of relatives or neighbours.  However, the incidence of pressure related injuries at for eksample hospital wards in Africa is expected to be high. 

 

  • Many are not aware of that warm and reddish skin over bony prominences are signs of a pressure injury. If the skin is non - blanching - that is it doesnt 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 high risk of developing into an ulcer.  

 

  • If you register a pressure injruy 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 to develop a pressure injury or already have a presure injury have the right to a special antidecubital matress - often multiple chamber air matresses are used for this. Obviously this is not an economical realistic alternative for most patients in Africa.  this should however not 

  • A nutrition plan is essential when treating pressure ulcers. Remember even if the patient is overweight he/she needs ekstra 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 a lot of 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 an 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 a increase of 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 where there is no undermining.

  • Concerning the choice of dressing:  the primary factor 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 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 very limited choice or no dressings available at all.​