Pressure Ulcers: A Public Health Quandary

english3050 WAT Research March 10, 2022 | 0

The incidence of pressure ulcers varies from 1 to 3 million per year. The prevalence of pressure ulcers is estimated to range from 5% to 15% which can be higher in intensive care units and other long-term care settings (Mervis & Phillips, 2019). The diagnosis of pressure ulcers can sometimes be delayed due to inconsistencies in healthcare systems. It also has psychological effects on patients suffering from it as many are unable to communicate or indicate the pain associated with developing ulcers. Others who can communicate cannot prevent pressure ulcers from occurring due to immobility over long periods of time.

Bedsores is a term used historically to denote pressure ulcers, which was classified by British surgeon Sir James Paget as:

“The sloughing and mortification or death of a part produced by pressure. Sloughing follows these in the skin and subcutaneous tissue and fat. These later die before the skin as sloughing proceeds faster in them, so when the skin comes away, the place formerly occupied by these tissues is empty” (Bliss, 1992).

Given that this distinction was made in 1873, it is astounding that Paget’s characterization of pressure ulcers still holds true today. The terminology “bedsore” is no longer deemed accurate to the complex etiology [a term medical researchers use for the set of causes of a disease or condition] of the disease itself. Pressure ulcers can occur from exposure to pressure from other surfaces than a bed. For example, people with disabilities are sitting for long periods of time or are wheelchair-bound. Hence in 2016, the National Pressure Injury Advisory Panel (NPIAP) renamed the condition “pressure injury” to encompass various forms of pressure that can cause tissue damage. In order to understand these various forms of pressure injury, I will discuss its etiology, the population affected, and treatment.

Etiology:

As the rewording by the NPUAP suggests, pressure ulcers occur due to many forms of skin damage. The damage is relative to time and the amount of pressure applied. Intense pressure over a short period of time is just as likely as less pressure over a long period of time to develop pressure ulcers. Shear and friction are the two forces at play here. Shear occurs as the body wright exerts a downward force on the skin and subcutaneous tissue which lie between a bony stature and an external surface ( Mervis & Phillips, 2019 ). Friction is the force of two surfaces rubbing against one another. In pressure ulcers, it is the movement of the patient’s body and the external surface against one another that creates friction. The external surface can vary depending on the patient’s condition such as a bed, a wheelchair, or medical equipment. Sustained pressure leads to ischemia inhibiting blood flow and causing local tissue hypoxia. In some cases, reperfusion, which is the return of the blood to the tissues after a period of ischemia, can exacerbate tissue damage ultimately causing pressure ulcers ( Mervis & Phillips, 2019 ). A common location for pressure ulcers includes the sacrum, ischial tuberosity, greater trochanter, heel, and lateral malleolus as represented by Figure 1 ( Mervis & Phillips, 2019 ).

Figure 1 ( Mervis & Phillips, 2019 )

Classification of Pressure Ulcers:

Pressure ulcers are classified into 6 stages by the NPUAP which is determined after wound cleaning for optimal visual representation of the anatomy. Stage one is denoted by non-blanchable erythema of intact skin where the skin lesions do not fade when a person presses on them. Stage two is characterized as partial-thickness skin loss with exposed dermis whereas stage 3 is full-thickness skin loss occurs. Stage five is identified by full-thickness skin and tissue loss. Stage six is persistent non-blanchable deep red, maroon, or purple discoloration. Pressure ulcers are identified using the above staging system to determine severity and treatment.

Population Affected:

Pressure injury cases can vary from as young as infants to the elderly being more common in the latter. Individuals with compromised sensation and mobility due to spinal cord injury, neurologic impairment, prolonged hospitalization are all at risk of sustained pressure leading to skin injury (Bhattacharya & Mishra, 2015 ). Aging risk factors include poor nutrition, loss of muscle, and body mass in the elderly putting them at risk of developing pressure ulcers. While the feet have a vasculature that is adapted to withstand changing force and pressure, health conditions such as diabetes can cause ulcers of the foot. This occurs as high blood glucose levels damage the sensory, motor, and autonomic nerves. Due to this, someone living with a disability may not be able to feel or have proper circulation of the feet.

Treatment:

Treatment of pressure ulcers aims to reverse the underlying factors causing them. Causative factors such as pressure, shear, friction, when possible, need to be removed and allow for fluid movement within the body. Hygiene care is the number one method of prevention and treatment of open sores. Self-care such as cleaning and debridement is the simplest form of treatment which removes dead tissue and contamination of the skin. Wound dressings are also important and can vary depending on the healing of the area. Changing of wound dressing can vary from weekly or daily depending on the severity of the open area (Bhattacharya & Mishra, 2015). Antibiotics can be prescribed to supplement other forms of treatment by treating bacterial infections. Additionally, negative pressure wound therapy has been found to be effective for severe cases of pressure ulcers as classified by deep injury exposing the bone. Other treatments include hyperbaric oxygen therapy, skin substitutes such as bio-engineered skin, reconstructive surgery, and cell therapy using bone marrow or adipogenic stem cells ( Bhattacharya & Mishra, 2015).

Concluding Remarks:

Pressure ulcers are not specific to gender, age, or health. It can affect any one of us and that is reason enough to continue research in this field and find better methods of prevention and treatment. Wilson Adaptive Technologies (WAT) is designing practical and affordable solutions for someone living with a disability. Our affordable shower will aid in the number one method of prevention and treatment of pressure ulcers: hygiene care. We hope our ongoing research can inform business partners, the disability community, and interested parties of the need for accessible products such as showers so they too can share our vision of making our founder Ron’s dream come true: “Hygiene is a right, not a privilege.”