Top 18 Ways on How to Prevent Skin Breakdown

Written By Sandy B.

Outlined By Joshua P.

A person confined to any space where their skin rubs against cloth or other materials on a constant basis is at risk for pressure ulcers. A bed sore develops as a result of prolonged pressure on the skin. That causes a reduction in blood flow to the area, resulting in damage to the skin. Painful, highly risky breakdown of the skin develops.

This process does not take long. Once it happens, it can cause excruciating pain and a high risk of infection developing. Hard to treat, and sometimes the cause of early death in people who are not mobile, pressure sores cannot be ignored.

They can be prevented, though. With the right strategies and support, it is possible to reduce the risk of skin breaking down, leading to ulcers. This is critical.

https://www.pexels.com/photo/an-old-man-lying-down-on-a-bed-with-a-woman-standing-near-him-8088598/

Why Pressure Sores Could Be a Matter of Life and Death

Pressure sores are a type of skin lesion brought on by the constant rubbing and deterioration of the outer layers of the skin. They cause a serious infection that’s difficult to treat. Each year, more than 2.5 million people in the U.S. develop pressure ulcers like this, as noted by the Agency for Healthcare Research and Quality.

Consider that, in nursing homes, where residents are less mobile, about 159,000 people, or about 11% of the nursing home population, suffered from Stage 2 pressure ulcers, some of the most dangerous, according to data from the U.S. Centers for Disease Control and Prevention. Studies show that individuals with pressure sores, especially within a hospital setting, are at a much higher risk of mortality, contributing to about 60,000 deaths every year.

What can be done, then? How can you help your loved one avoid this devastating outcome or prevent yourself from developing them?

The Foundation of Preventing Pressure Ulcers

Before going into the 18 strategies you can apply right now to minimize risks, let’s talk about why pressure ulcers occur and where they happen.

Why do pressure ulcers happen?

Pressure ulcers, commonly called pressure sores, often occur in those who are immobile or who have limited mobility. When pressure is applied to the skin – such as when someone is sitting in a wheelchair or in a bed – the capillaries in the skin compress. This limits the oxygen- and nutrient-rich blood from entering this area, causing cell damage. The longer this occurs, the faster skin breaks down, leading to tissue death, or necrosis, and infection if bacteria are present.

Where do pressure ulcers happen?

Pressure ulcers can occur in any area of the skin that is subjected to consistent pressure. Some of the most common sites for pressure sores include:

• Tailbone or buttocks
• Lower back
• Hips
• The back of the arms or legs, where they rest against a bed or chair
• Shoulder blades and spine
• Back or sides of the head
• Hips and lower back for those confined to a bed
• Heels, ankles, and skin behind the knees

In those who develop pressure sores due to prosthetic use, pressure ulcers can also develop at points of connection where rubbing and pressure occur.

Photo by Jacob Wackerhausen courtesy of Istock Photos

Signs of a pressure sore you should not ignore

If you see any of the following symptoms of a pressure sore, immediate medical attention is necessary to clean the area and support the healing. Symptoms of serious bedsores include:

•       Swelling in the area
•     Changes to skin color or texture
•     Skin patches that seem cooler or sometimes warmer than other areas
•    Pus-like drainage from the sore
•     Sore, tender areas that are painful

If you provide the activities of daily living (ADLs) for family members or patients, there is a constant need to scan for early signs of pressure sores. The sooner you find them, such as when bathing or showering, dressing, or toileting, the easier and more likely they are to heal. 

Preventing Pressure Ulcers: Strategies That Work

Treatment for pressure sores is possible, but prevention is by far the better outcome. Preventing pressure sores takes a constant effort of monitoring and supplying the body with the support it needs to avoid risks. The following are 18 steps to take on a consistent basis to prevent the development of pressure sores.

1. Repositioning

The most effective strategy to eliminate the risk of pressure sores is to reduce the cause – the pressure. By repositioning often enough, it’s possible to minimize the risk of blood circulating to the area.

For those who are suffering from mobility loss, finding a way to reposition isn’t easy. If it is just you, trying to navigate the process, consider these strategies that can offer some support:

• 15 to 30 minutes: That’s how long you should try to find a method of pressure relief for your body. Hold it for 30 seconds before moving back.
• Move or lift: When possible, lift your body or turn to another position. That gives your skin the break it needs.
• Use a cane: If you are sitting for a long period, leverage a cane to provide support to extend the leg or lift off the chair. Use the cane as a stabilizer to stay safe while moving.
• Use a walker: If you are sitting but use a walker, use it to reduce pressure on your backside. Lean forward, resting your head on the walker for a brief skin break. Move your body after finding stability to lift off surfaces. Focus on your legs, back, and buttocks. (Looking for reliable support while walking? Check out our Walkers and Rollators and find the perfect fit for your needs). 
• In your power wheelchair: If you spend hours in a power wheelchair, use it to help shift. Some systems have built-in repositioning modes that tilt, recline, or shift the seat to offer support. If leaning forward or to the side, ensure you have help and lock the brakes.

2. Maintain a Good Skin Routine

The second component that causes bedsore complications is bacteria. Both moisture and bacteria work against your skin to increase the odds of complications.

Moisture-associated skin damage, or MASD, is a form of skin damage that causes inflammation and skin erosion. While it is not the same as a pressure ulcer, it can increase the risk of pressure ulcers.

Reducing the risk of pressure ulcers means minimizing moisture and eliminating bacteria. Bathing daily with a mild soap and warm water is one of the simplest prevention strategies from a bacterial point of view, but it is often challenging for a person who is immobile. However, cleansing the skin using the following steps can prevent ulcer development:

• Use only a mild soap that does not cause abrasion to the skin.
• Wash with warm water and thoroughly rinse the area.
• Pat dry and allow to air dry as much as possible before covering the area.
• Do not use powders that can trap and hold moisture on the skin.
• Avoid any type of antibacterial or alcohol-based product, as these can dry out the skin.
• Use a moisturizer approved by your health care provider that creates a barrier.

Being consistent and thorough makes a remarkable difference in these areas. If you cannot do so yourself, choose a provider that is willing to spend the extra time necessary to properly bathe.

3. Foods to Eat

https://www.pexels.com/photo/elderly-man-doing-barbecue-8523137/

Preventing pressure ulcers is also possible when you provide your body with the nutrients it needs to keep bacteria at bay and to rebuild damaged skin cells. Both fluids and protein can be beneficial.

Maintaining a healthy weight can also help reduce skin breakdown. Those who are overweight or underweight are more likely to struggle with skin damage, as noted by the Siegel Rare Neuroimmune Association.

Focus on a diet that includes the following nutrients:

• Omega-3 fatty acids: You’ll get these from fatty fish, flaxseed, and nuts.
• Vitamin A: Get this from dark green vegetables or vegetables that are a dark orange color.
• Vitamin C: This immunity-boosting nutrient is found in citrus fruits, broccoli, and strawberries.
• Protein: Healthy sources of protein include meats, eggs, soy products, and cheese.
• Zinc: Often found in eggs, meat, and seafood.

If there is skin breakdown, extra calories are necessary to fuel the body’s energy-intensive process of repairing damaged skin.

4. Therapeutic Surfaces

Therapeutic surfaces are those that alleviate some of the pressure on your body, reducing the risk of pressure sores developing. Various types of equipment are available to help with this process today. Some examples include:

• Wheelchair cushions designed specifically for pressure sore avoidance.
• Pressure-relieving mattresses or mattress pads.
• Alternative pressure beds that adjust the pressure on every area of the bed over time, creating a level of airflow between your skin and the mattress.
• If you are using orthotics, be sure they are the right size and are being used properly. This includes fastening them properly and keeping them in position when using them.
  

Explore our selection of Alternating Pressure Mattresses, each designed to help you or your loved one stay comfortable and protect your skin.

5. Sit to Stand Aids and Hoyer Lifts

The realistic situation for many people who are bedridden is that they cannot adjust themselves to create the necessary pressure relief. Caregivers have tools that can afford some significant relief, though.

Sit-to-stand lifts help a person go from a sitting position, such as in a recliner, to a standing position. They also enable a person to gain some relief in those areas of pressure by elevating their bottom for a few seconds as needed.

For those who are unable to move, Hoyer lifts are a very effective and safe way to create pressure relief when used properly. They allow caregivers to transfer a person from a bed to a chair or back without requiring any pressure being placed on the legs or reaching a standing position. 

Looking for safe and reliable lifting solutions? Check out our Patient Lifts designed to make moving easier for everyone involved.

https://www.pexels.com/photo/woman-assisting-elderly-man-7551667/

6. Monitor Skin Condition Consistently

Whether you are providing relief for yourself or trying to keep a family member or patient safe, it is always important to consistently monitor the skin for breakdown. Early treatment is critical. The Model Systems Knowledge Translation Center, an organization within the American Institutes for Research, provides an excellent graphic that demonstrates the stages of skin breakdown.

The very first signs occur before the skin breaks and include red coloring or discoloration. It may feel cool or warm to the touch and even have a hardness developing. When you press on this area, if it stays red, that could be indicative of the early stages of pressure sore development.

Teach your family to watch for these signs as well. Since many of them occur on areas of the body you cannot see, anyone providing caregiving duties can be an incredible resource to you.

7. Foams

Foams have become one of the most effective strategies for treating early signs of pressure sores. They create a layered guard against the forces that cause skin to deteriorate. One product, called Optifoam, helps to create a regulated microclimate within the treatment area while also absorbing the force and friction that causes damage. Using this at the first sign of breakdown can provide protection.

8. Take Pictures and Keep Records

If you are cleansing the skin daily and throughout the day, you may not notice early signs of breakdown. There may not be a significant difference from one moment to the next. However, subtle changes can be spotted over time.

To monitor for this, take photos of the areas at risk on a routine basis, even as often as once a day. That way, you can see differences in the skin over time. Try to use the same angle and lighting from one picture to the next.

Do the same if a wound occurs. This daily photo can help indicate that the wound is healing or show that it may not be healing as expected.

9. Wound Care Nursing

In situations where a pressure sore occurs, wound care nursing services become critical. These are high-risk wounds that require constant attention and careful management to minimize bacterial risk and further tissue damage. In some situations, it is best to seek out a professional with specific wound care knowledge if skin breakdown is occurring.

Advanced pressure sores require this. They may require hospitalization if they worsen or become pus-filled or painful. Do not wait to get into a medical center if this is occurring.

10. Home Health

If your loved one, or you, are developing pressure sores, the best way to prevent worsening is to get professional treatment and support. Home health care nurses and professionals can help if they have specific training and experience in areas of pressure sore relief. Seek out a professional who has worked with bed-bound individuals or those who have limited mobility and has had success in minimizing the risks of worsening.  

https://www.pexels.com/photo/caring-senior-assistance-in-cozy-home-setting-29372722/

11. Preventing Pressure Ulcers After Surgeries

If you have been in the hospital for more than a day, you could be at risk for the development of pressure sores. After surgeries, follow your doctor’s guidance on getting up and getting moving as soon as possible. This is important to alleviate pressure on the back, hips, knees, or treatment area.

This is a delicate balancing act. By working with physical therapists and with determination to move, you reduce the risk of pressure sore development.

12. Nursing Homes Strategies

If your loved one is in a nursing home or medical facility, including with a G-tube or PEG tube, it is imperative that they have an advocate working for them. That means being there, asking questions, and pushing staff members to address concerns as they happen.

Ideally, it is beneficial to become friendly and show respect to the nursing staff. Doing so encourages them to educate you but also to pay closer attention to your loved one, and that can be life-saving.

13. Routine for Strengthening

Not everyone can heal, but most people can consistently work to be as healthy as possible. That includes building the strength in muscles that you can. For example, engage in bed-specific exercises that help to support good blood circulation and movement. When your core muscles are stronger, you give yourself more ability to move.

Work with physical therapy or occupational therapy as much as possible. Even if your objective is not to heal, it can be to support movement.

Photo by Mikhail Nilov from Pexels: https://www.pexels.com/photo/an-elderly-woman-doing-a-yoga-6975760/

14. Larger Burns and Skin Area

Pay close attention to the skin’s ability to heal after a significant burn or area of skin damage. Those surface layers provide significant protection for the surfaces under, and are critical in protecting your skin’s overall well-being.

If there are areas of burns, very careful management of moisture and pressure is necessary. Work with a burn specialist to minimize the risk of further tissue damage.

15. The Mental Game and Pain Control

The reality is, pressure ulcers are another layer of complication, frustration, and pain. Your life can easily feel helpless and intimidating, and you may find it nearly impossible to maintain a healthy mindset.

• Be sure to express how you feel: Let out the frustration and pain. Talking alleviates all of that bottled-up stress that only worsens your condition.
• Focus on your improvements: Keep a journal of all the good you are doing. Celebrate those small victories.
• Document your strengths: Consistently work to address your strengths and focus on what you do well.
• Be grateful: That’s really hard to do, but focusing your mind on the good can alleviate a lot of the negative thoughts that limit you.
• Don’t be alone: Find help and create friendships.

16. Bariatric Patient Support

For those who are larger or have significant mobility limitations due to lipedema, maneuvering is more challenging, but still critical. In these situations, it’s best to focus on repositioning on a consistent basis to allow for pressure relief. Moving every 30 minutes using tools like lifts can be very important.

The investment in alternating pressure beds can also be life-saving. It allows for reduced friction on the skin, allowing for better air movement.

17. Diabetes, Immunosuppression, and Skin Protection

Those who have type 2 diabetes are at an increased risk of developing bed sores because of the risk of inflammation buildup in the body. Those taking immunosuppressants are also at a higher risk because the immune system isn’t able to fight off bacteria effectively.

Carefully monitoring for the development of skin damage is critical. As soon as you see damage, seek treatment.

18. Musculoskeletal Disorders and Paralysis

Those who are at the highest risk of developing bed sores and pressure ulcers are individuals who cannot move easily, including those with musculoskeletal disorders or full paralysis.

In these situations, family members become critical advocates for checking and ensuring skin remains clear from risk. Select nurses who are capable of providing highly specialized treatment in these areas.

Preventing Pressure Sores Is Not Something to Put Off

The most important tool you have in protecting your skin or that of your loved one is consistency. By monitoring and making changes to keep your skin or your loved ones skin healthy, you minimize the risk of the start of damage.

 

 

Sources:

https://msktc.org/sci/factsheets/preventing-pressure-sores.

/ https://www.betterhealth.vic.gov.au/health/servicesandsupport/skin-care-and-preventing-pressure-sores-in-hospital

https://www.medline.com/skin-health/pressure-injuries/optifoam/

https://bariatrictimes.com/keeping-the-bariatric-patients-skin-intact/