A pressure ulcer, also known as a bedsore or decubitus ulcer, is an area of skin that breaks down when someone stays in one position for too long without shifting their weight. This often happens if they use a wheelchair, are paralyzed, or are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.
A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.
Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst):
Stage I: A reddened area on the skin that, when pressed, is “nonblanchable” (does not turn white). This indicates that a pressure ulcer is starting to develop.
Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.
Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.
The patients treated at Maryville Children’s Healthcare Center have many physical challenges, and are at very high risk for developing pressure ulcers while hospitalized. Many of our patients are admitted with pressure ulcers that occurred in their prior setting of care.
Pressure ulcers are painful, take a long time to heal, and cause other complications such as skin and bone infections. Our goal is to employ forefront strategies to improve pressure ulcers patients already have at admission and prevent new ones from developing.
Based on the Hill Rom Inpatient Pressure Ulcer Prevalence Survey, which is the nationally recognized benchmark for measuring the frequency of hospital-acquired pressure ulcers (more than 700 facilities participate in creating this database). An average of 3.3% of all acute hospital patients acquire pressure ulcers and in long term acute care hospitals, like the Center, 2.8% of patients acquire ulcers. The rate for Maryville Children’s Healthcare Center patients is only half of this average.
Complications are very serious and include:
Cellulitis – This acute infection of a patient’s skin’s connective tissue causes pain, redness and swelling, all of which can be severe. Cellulitis can also lead to life-threatening complications, including sepsis and meningitis — an infection of the membrane and fluid surrounding your brain and spinal cord.
Bone and joint infections – These develop when the infection from a bedsore burrows deep into the joints and bones. Joint infections (septic or infectious arthritis) can damage cartilage and tissue, whereas bone infections (osteomyelitis) may reduce the function of joints and limbs.
Sepsis – One of the greatest dangers of an advanced pressure sore, sepsis occurs when bacteria enters the bloodstream through the broken skin and spreads throughout the body — a rapidly progressing, life-threatening condition that can cause shock and organ failure.
Cancer – This is usually an aggressive carcinoma affecting the skin’s squamous cells. Sending your child to a place that provides care so they do not develop these ulcers is very important.
Maryville has successfully healed these sores in every child sent to the Center with a pressure ulcer.