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1992.05.18 :  AHCPR Study -- Bed Sores

Contact: Bob Isquith (301) 227-8370
May 18, 1992

        Painful, potentially dangerous pressure ulcers, or bed
sores 
-- which affect a significant number of patients in nursing homes
and hospitals -- could be markedly reduced by simple "low tech"
procedures, according to a private expert panel advising the
Agency for Health Care Policy and Research.
     Released today by AHCPR, the newest agency of the Public
Health Service, the guideline advises such procedures as checking
patients' skin daily and keeping incontinent patients dry. (Urine
can lead to skin break-down.)  In addition, the guideline says,
immobile patients should be regularly turned or moved and
properly supported by pillows or foam.  Mattress overlays can be
used to reduce pressure.
     Pressure ulcers occur when the skin of bed- or chair-bound
persons presses against bony body parts, such as heels or hips. 
Tissues can ulcerate as far down as muscle and bone, sometimes
causing serious infections and requiring surgery.
     Besides patients in nursing homes and hospitals, many
patients cared for at home are affected.
     "This guideline, the first developed for preventing pressure
ulcers, spells out a comprehensive approach to reverse this often
devastating problem," said AHCPR Administrator J. Jarrett 
Clinton, M.D.
        According to Dr. Clinton, without effective prevention
programs the incidence, and therefore the impact, of pressure
ulcers is likely to increase as America's population ages.
        "Fortunately, pressure ulcers are not inevitable," said
the panel's chair, Nancy Bergstrom, Ph.D., R.N., a professor of
nursing at the University of Nebraska Medical Center and a
leading expert on pressure ulcers.  "And, when prevention is
targeted specifically to those at risk, these wounds should be
less costly to prevent than treat."
        Dr. Bergstrom said the panel's recommendations for
preventing the development and worsening of ulcerations include:
     o    Aggressive assessment at the time of admission for all
          bed-and chair-bound persons;

     o    Periodic reassessment of persons determined to be at
          risk of developing pressure ulcers;

     o    Daily skin inspection and care for at-risk persons --
          including keeping skin clean and well moisturized -- to
          help skin resist injury;

     o    Use of appropriate devices (such as pillows, foam or
          air mattress overlays, or air mattresses) and
          techniques (such as frequent repositioning of bed- and
          chair-bound individuals) to help prevent pressure; and

     o    A team approach, including education programs on
          pressure ulcer prevention for physicians, nurses, nurse
          practitioners, geriatricians, physical and occupational
          therapists, dieticians, patients, families and care
          givers.

      According to the panel, bed or chair confinement is only one
risk factor in developing pressure ulcers.  Risk increases with
immobility; skin moisture from urinary or fecal incontinence,
perspiration, or wound drainage; nutritional deficiencies; and
reduced mental awareness.  High-risk patients include
hospitalized quadriplegics; elderly, hip-fracture patients; other
orthopedic patients (especially those with fractures); and
persons treated in critical care units.

     "As much as we would like to eliminate pressure ulcers   
entirely, some are probably inevitable.  But this is not an
excuse for less than diligent care," said Dr. Bergstrom.  "Some
very high-risk patients will develop these wounds despite 
diligent care.  Also, aggressive prevention may not be
appropriate for persons in the latter stages of a terminal
illness, when techniques such as frequent turning or
repositioning can interfere with relieving pain and promoting
comfort."

     The 13-member guideline panel consisted of physicians
specializing in geriatrics, dermatology and family practice;
nurses in the fields of rehabilitation, gerontology,
perioperative care, enterostomal therapy, management and
research; a bioengineer; an occupational therapist; and a
consumer representative.

     The panel conducted an extensive literature search, heard
public testimony and examined information provided by
consultants.  The draft guideline was widely circulated for
review by other pressure ulcer experts and for testing by
personnel in hospitals, nursing homes and other settings.

     AHCPR will distribute copies of the guideline to
organizations representing physicians, nurses and allied health
care professionals; hospital, nursing home and home health
associations; medical and nursing schools; and consumers.

     The guideline is the third issued by AHCPR since March 5
-- the others were for reducing acute postoperative pain and
detecting and treating urinary incontinence in adults.  Like
these and other guidelines being developed under AHCPR
sponsorship, its purpose is to provide health care practitioners
with recommendations based on expert opinion and a thorough
review of research on the guideline topic.

        Copies of "Pressure Ulcers in Adults:  Prediction and
Prevention" and an accompanying quick reference guide and patient
guide are free of charge.  Write:  AHCPR Publications
Clearinghouse, P.O. Box 8547, Silver Spring, Md. 20907; or call
1-800-358-9295.


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