Caring for bedridden patients requires knowing how to prevent and properly care for pressure sores PTP

Pressure sore wound (Pressure Sore Wound or Bed Sore Wound) is an injury that occurs on the skin and subcutaneous tissue due to prolonged pressure on the tissue, which reduces blood circulation in that area, causing the tissue to lack oxygen and gradually die.
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<h2>Stages of Pressure Sores</h2>
Pressure sores are divided into 4 stages according to the severity of the injury. Correct assessment of the stage of pressure sores helps provide appropriate care or treatment to prevent progression and possible complications.
<ul>
<li>Stage 1 The skin shows redness that does not fade when pressed on the wound area. The skin is not broken and may have slight pain. Detecting wounds at this stage is very important because it can prevent the wound from progressing to a more severe stage.</li>
<li>Stage 2 The skin begins to have partial damage. The wound appears as a shallow dry ulcer or blister.</li>
<li>Stage 3 The wound extends deep to the fat layer with total skin loss. Yellow necrotic tissue may be found, including possible subcutaneous cavities. Wounds at this stage are more severe and require special attention to infection and progression.</li>
<li>Stage 4 The wound is deep to the bone, tendon, or muscle with total skin loss. Yellow or black necrotic tissue may be present, with a risk of bone infection (osteomyelitis) and often subcutaneous cavities. The severity of wounds at this stage may cause severe pain and require urgent treatment.</li>
</ul>
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<h2>Who is at Risk of Pressure Sores?</h2>
Where do pressure sores usually occur and why?
High-risk areas for pressure sores are points where bones press against the skin and bear direct weight or repeated pressure. It often occurs in bedridden patients who must lie in the same position for a long time. Different lying positions affect the occurrence of pressure sores as follows:
<ul>
<li>Lying on the back causes sores on the heels, sacrum, back, posterior hips, and occiput.</li>
<li>Lying on the side causes sores on the lateral hips, sacrum, elbows, and knees.</li>
<li>Lying on the stomach causes sores on the clavicle and knees.</li>
</ul>
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<h2>How to Move the Body and Reduce Pressure to Prevent Pressure Sores in Bedridden Patients</h2>
In addition to changing positions at least every 1-2 hours to reduce pressure and stimulate blood circulation, patients should also perform exercises or move different parts of the body as follows:
<ul>
<li>Move the hands by spreading each finger apart, counting 1-20, doing both sides.</li>
<li>Move the arms by holding the patient&#8217;s elbow and wrist, then drawing the arm out to the side and rotating it over the head, holding for 20 seconds, then rotating down.</li>
<li>Move the elbows by bending the patient&#8217;s arm toward the body and holding for a count of 1-20, then releasing.</li>
<li>Move the hips and legs by holding under the knee and the patient&#8217;s heel, spreading the legs about 45 degrees, then bringing them back together.</li>
<li>Move the ankles by holding the shin and sole of the patient&#8217;s foot, pushing the sole upward toward the patient, then pushing down.</li>
<li>Move the torso by having the patient bend both knees and rotate them to touch the bed on the left and right sides, repeating about 20 times.</li>
</ul>
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<h2>How to Reduce Pressure</h2>
<ul>
<li>Use pillows for support by placing pillows under areas bearing weight such as the head, neck, back, hips, heels, and elbows.</li>
<li>Use an air mattress to distribute the patient&#8217;s weight and reduce pressure, equipped with an electric air pump system that continuously inflates and deflates the mattress. However, caution is advised for patients with thin skin as it may increase friction.</li>
<li>Use cushions such as Memory Foam or Silicone Gel to help distribute weight and reduce pressure, allowing the skin to receive more oxygen and improve ventilation.</li>
</ul>
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<h2>Proper Wound Cleaning to Reduce Infection Risk</h2>
Cleaning pressure sores is an important step to prevent infection and promote wound healing. The steps are as follows:
<ul>
<li>Wash hands thoroughly with soap or use alcohol gel.</li>
<li>If the wound is not severe, clean the wound with 0.9% saline solution from the inside outward, about 1 inch from the wound edge. For deep wounds or cavities, use a syringe to irrigate the wound cavity 2-3 times until clean.</li>
<li>Avoid using alcohol, Betadine, or hydrogen peroxide as they may damage new tissue or cause irritation.</li>
<li>Apply medication as directed by a doctor, as different stages of pressure sores require different medications.</li>
<li>Choose appropriate wound dressings based on the wound condition. For wounds with heavy exudate, use highly absorbent dressings such as Silicone Foam Dressing or Polyurethane Foam Dressing.</li>
<li>Change dressings frequently and immediately if there is pus or contamination.</li>
</ul>
In addition to the above methods, maintain skin hygiene by keeping the skin dry and clean, eat a high-protein diet with vitamins A, C, and E to aid wound healing, drink enough water, and check the patient&#8217;s skin daily, especially in high-pressure areas. If persistent redness is found, reduce pressure in that area immediately. For those with pressure sore problems, Phyathai Phaholyothin Hospital has a team of doctors and specialists ready to provide appropriate pressure sore care using modern medical technology and standardized treatment protocols, covering prevention, wound care at various stages, skin rehabilitation, and complication prevention to ensure the best care, reduce pain, and restore quality of life.
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Dr. Kamthorn Wijitkamthorn 
Surgeon, Surgery Center 
Phyathai Phaholyothin Hospital

Pressure ulcers are a common condition in bedridden patients. Understand the causes, symptoms, and stages of pressure ulcers, the areas at risk for ulcer development, and learn prevention methods, wound care, and cleaning of pressure ulcers, as well as ways to reposition the body to reduce pressure.

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Caring for bedridden patients requires knowing how to prevent and properly care for pressure ulcers.

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