Pressure Ulcer Management in Bedridden Patients

Diagnosis

The American College of Physicians recommends performing a thorough skin examination focusing on pressure-prone areas such as the sacrum, ischia, heels, and other bony prominences 1
Evaluate lesions for size (measure and document in cm) 1
Evaluate lesions for scaling pattern (note if slight or prominent) 2
Evaluate lesions for presence of epidermal detachment or blistering 3
Evaluate lesions for signs of infection (increased warmth, purulence, odor) 3
Rule out other causes of erythematous scaly lesions, such as erythema migrans (expanding lesion with central clearing, associated with Lyme disease) 4
Rule out other causes of erythematous scaly lesions, such as bullous dermatoses (blistering skin conditions) 5
Rule out other causes of erythematous scaly lesions, such as Stevens-Johnson syndrome/Toxic Epidermal Necrolysis (if extensive epidermal detachment) 3

The American College of Physicians recommends using air-fluidized beds for patients with large pressure ulcers (>7 cm) as moderate-quality evidence shows they reduce pressure ulcer size compared with other surfaces 1, 2
Provide protein-containing supplements as moderate-quality evidence shows they improve wound healing 1, 2
Consider electrical stimulation as an adjunctive therapy as moderate-quality evidence shows it accelerates wound healing 1, 2
For large or non-healing ulcers, consider platelet-derived growth factor (PDGF) as low-quality evidence shows it improves wound healing 1, 2
For large or non-healing ulcers, consider negative-pressure wound therapy for appropriate wounds 2
Cleanse wounds gently using warmed sterile water, saline, or diluted antimicrobial solution (e.g., chlorhexidine 1/5000) 6
Apply appropriate dressings based on wound characteristics, such as hydrocolloid dressings for non-infected wounds (low-quality evidence shows they reduce ulcer size compared to gauze) 1, 2
Apply silver-containing products for sloughy or potentially infected areas 6
Apply non-adherent dressings to denuded dermis (e.g., Mepitel™ or Telfa™) 6
Use secondary foam dressings to collect exudate 6

Take swabs for bacterial culture from lesional skin, particularly sloughy areas 6
Administer systemic antibiotics only if there are clinical signs of infection 6
Employ strict barrier nursing techniques to reduce nosocomial infections 6
Assess wounds regularly for changes in size and depth 1
Assess wounds regularly for signs of infection 3
Assess wounds regularly for healing progress 2
Patients with spinal cord injury have a higher rate of recurrent pressure ulcers after surgical intervention 2
Sacral pressure ulcers have lower recurrence rates after surgery than ischial pressure ulcers 2
For bedridden patients, maintain ambient temperature between 25°C and 28°C to promote healing 6
Consider consultation with specialists for complex or non-healing wounds 6