When a person is laying, or sitting in one position for any period, the pressure on that point causes the skin to become red, painful (due to reduced circulation) and, if not remedied by movement or skin care, the skin can eventually break down, resulting in a pressure sore.
The breakdown in skin is also affected by several other factors as shown in the table below;
| Factors | Causes |
|---|---|
| Friction | Wrinkled clothes, bedclothes; being pulled or dragged over a surface. |
| Moisture | May be due to incontinence; incorrect drying technique; perspiration; illness; dehydration. |
| Compression of tissues | Laying or sitting in same position for any length of time (1-2 hours plus) |
| Poor skin hygiene | Not washing frequently - especially after incontinence or leakage. |
| Poor general nutrition | Inadequate diet that is either deficient in vitamins or minerals or insufficient in quantity. |
| Age | Wear and tear on the skin; decreased porosity and elastin. |
| Reduced mobility or immobility | Difficulty with movement can mean a person remains in the same position for longer periods and so circulation becomes slower; the tissues do not receive as much oxygen. |
| Mental health | Confusion, disorientation or dementia-based illness may mean a person is unaware of actual or developing skin problems or they are unable to report them to others. |
Pressure sores often occur over bony prominences, such as the elbows, heels, the sacral area, ears, shoulder blades, hip bones (iliac crest), knees and sides of the feet. This is because there is less skin in these areas to cushion the full pressure and weight of the person.
Pressure-area care involves monitoring a person’s skin, ensuring that it is clean, dry and in good condition, and moving the individual regularly so that they do not develop pressure sores. Many care settings use specialist scoring tools to identify individuals who may be at risk of developing pressure sores. When an individual has developed a pressure sore, their care and the procedures for managing this should be described in detail in their care plan. You should always follow this plan and request help and further explanation if you think that the care required is beyond your level of competence.
