A bed sore (also known as: pressure sore, pressure ulcer, or decubitus ulcer) is caused by unrelieved pressure on bony prominences of the body. Over time, the unrelieved pressure restricts necessary blood circulation to the skin and tissue resulting in the death of the tissue and the surrounding muscle. What may begin as a small area of skin irritation can rapidly develop into a large wound and progress into a deadly medical condition.
In order to help identify bed sores and implement medical treatment, a ‘staging system’ has been established by the medical community to provide a standardized system of identify and treating wounds.
Stage 1 – Initially, a pressure sore appears as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.
Stage 2 – At this point, some skin loss has already occurred — either in the epidermis, the outermost layer of skin, in the dermis, the skin’s deeper layer, or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration. If treated promptly, stage II sores usually heal fairly quickly.
Stage 3 – By the time a pressure ulcer reaches this stage, it has extended through all the skin layers down to the muscle, damaging or destroying the affected tissue and creating a deep, crater-like wound.
Stage 4 – In the most serious and advanced stage, a large-scale loss of skin occurs, along with damage to muscle, bone, and even supporting structures such as tendons and joints. Stage IV wounds are extremely difficult to heal and can lead to lethal infections. For patients confined to a wheelchair, they are most likely to develop a pressure sore on: their tailbone or buttocks, shoulder blades and spine. Some wheelchair patients may develop bed sores on the backs of their arms and legs where they rest against the chair. Bed-bound patients are prone to develop pressure sores in the following additional areas: back or sides of your head, the rims of your ears, shoulders, hip bones, lower back or tailbone, backs or sides of your knees, heels, ankles and toes.
Unstageable – Unstageable bed sores are usually referred to as an extremely advanced wound where there is involvement of skin, muscle and bone.
Medical Facilities Duty To Prevent Bed Sores
As a known threat to patient health and well-being, staff in nursing homes, hospitals and other non-medical facilities such as assisted living facilities or residential care facilities for the elderly must be diligent in preventing bed sores from developing. Perhaps the most important part of bed sore prevention is to identify patients who are at high risk for developing bed sores and implementing a care plan for them.
The following conditions, put a patient at high-risk for developing bed sores:
Prevention of Bed Sores
The most widely accepted ways of preventing bed sores is to keep patients clean and dry. This means removing soiled clothing and bedding as soon as feasible and bathing patients regularly. Additionally, for patients who have limited mobility, staff must actively turn patients on a regular basis (every 2 hours) to avoid unrelieved pressure from forming on the body.
By some estimates, more than 500,000 patients develop bed sores in nursing homes and hospitals every year. In addition to the pain and embarrassment that accompanies bed sores, bed sore patients are at risk for developing a variety of medical complications.
Sepsis is an illness caused by infection in the bloodstream by bacteria that frequently enter the body through open wounds or bed sores. Sepsis must be identified and treated as early on as possible in order to provide the best chances of survival. If left undiagnosed and untreated, sepsis can be fatal. In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below 4000 cells/mm.
Gangrene is a complication that may develop due to the death of tissue in and around the bed sore. Severe bed sores may result in the reduction of blood flow in and around the wound. The reduced blood flow increases the ability of bacteria to grow. Bacteria produce toxins that the body is unable to remove. Once the toxins accumulate, deterioration of tissue ensues. Ultimately, as the tissue deteriorates the common gangrene symptoms may occur (black or green discoloration of skin and foul odors).
Osteomyelitis is an inflammation of the bones that is caused by bacteria. In adults, the most common types of osteomyelitis causing bacteria are S. Aureus, Enterobacter and Streptococcus. In cases of severe bed sores (also referred to as decubitus ulcers, pressure ulcers or pressure sores) the bacteria enters the body through the open wound and attacks the bone. Once the bone becomes infected, enzymes are released that restrict the bodies ability to heal. If left untreated osteomyelitis can spread into the bone marrow and surrounding joints, leading to further medical complications or even death.
Because people with severe bed sores literally have an open wound, they are at a higher risk for contracting the infection causing bacteria that can cause necrotizing fasciitis. The early stages of necrotizing fasciitus are characterized by severe pain and swelling in the area of the infection frequently accompanied by diarrhea and vomiting. Rather than ‘eating’ the flesh, as is commonly suggested, necrotizing fasciitis infection causes flesh to die.
Bed Sore Treatment
Medical treatments can help improve the pain associated with the wounds and may prove to literally save the life of the patient. It goes without saying, that patients with bed sores should seek treatment from practitioners who have experience in wound care.
In order for bed sores to heal, attention must be paid to the removing dead tissue and protecting the wound from infection causing bacteria. Dressings are usually applied to help the body heal itself. The type of dressing and the frequency with which it is to be changed is ordered by a physician with the application and changes carried out by nurses.
Surgical debridement is when a surgeon uses a scalpel to remove the dead tissue, bone and fluid from the area around the bed sore. Surgical debridement of the bed sore may be accompanied by ‘flap reconstruction’. Flap reconstruction is when tissue is harvested from a healthy area of the person’s body to cover the open wound. The goal of reconstruction is to improve the hygiene and appearance of the wound and reduce the risk of infection.
When bed sores develop on the buttocks or sacrum, a physician may recommend a surgical procedure to prevent fecal material getting into the wounds. The surgical procedure is referred to as a ‘colostomy’ or ’diverting colostomy’.
A colostomy is a major surgical procedure that involves cutting the colon into a shorter piece and bringing it through the wall of the abdomen. A colostomy bag is attached to the end of the colon exiting the abdomen where fecal material is collected. The end of the colon that leads to the rectum is closed off and becomes dormant. Many colostomy procedures can be reversed, if and when they are no longer needed.
One of the most dramatic examples of how truly devastating bed sores can be is when a limb must be amputated due to severe bed sores or medical complications. In severe cases (where surgical debridement, antibiotics, and oxygen treatment are unsuccessful), amputation of the limb might be required to prevent the infection from spreading further. This is especially true in elderly people, especially those who are malnourished, because of poor blood flow.
When a bed sore (similarly referred to as: pressure sore, pressure ulcer or decubitus ulcer) develops during an admission to a medical facility, it is usually an indication that the facility was not properly caring for the patient. The underlying reasons may be varied: under-staffing, poor training or staff simply not following orders, the fact remains– medical facilities can be held responsible for the pain, decline in the quality of life and medical expenses associated with subsequent treatment.
Related Materials Discussing Bed Sores In Nursing Homes, Hospitals & Assisted Living Facilities:
We spend a bit of time here discussing how nursing homes and hospitals need to create and implement pressure sore preventative measure for their patients. But what happens when a pressure sore begins to develop on a patient?
Even assuming that facilities have taken all of the necessary precautions in implementing pressure sore preventative techniques, from a medical / legal perspective their responsibility doesn’t end there. Facilities must monitor each patients condition and implement changes in the care plan when the need arises. Simply continuing with the patients treatment plan after the patient has developed a pressure sore in not acceptable….
People with advanced bed sores (stage 3 or stage 4) are particularly susceptible to developing infection– both in the wound itself and potentially systematically. In order to minimize risk of infection, care should be taken to keep the wound clean and dry. Dressings should be changed on a regular basis as ordered by a treating physician….
Sometimes I get sick of hearing about the ‘good ol’ days’– when homes were affordable, people were friendlier, milk tasted like milk (as opposed to some whitish water)— and how life may have been a little bit better?
Certainly, I’m not one to bicker about they way things were and how tough everything is now, but I certainly have developed a respect for both traditions and learning how to do things fundamentally correctly– without the addition of all the new gizmo’s that alway’s promise to improve on the way things were done yesterday….
The first step in evaluating a bed sore case, is to determine when at what type of facility the bed sore developed. Aside from obviously knowing which facility to pursue a claim or lawsuit against, knowing how the facility is legally categorized is essential to a successful recovery.
The legal classification of the facility: nursing home, group home, hospital, residential care facilities for the elderly (RCFE’s) or assisted living facility is important for determining which laws are applicable to the case….
At some point during the processing of placing a loved one in a nursing home, families must rely on the representations made by facilities as to the type of care that they are capable of providing. Representations made in promotional materials and through staff at the facility are frequently a determining factor in facilities selecting one facility over another.
No doubt that inflated assurances are routinely made by personnel (salesmen) to close a sale of a product or service. While some of the assurances may ultimately prove to be false— and perhaps a source of frustration to the individual to which they were made—at the end of the day they really are nothing more than (expensive) annoyances— but usually the person can simply pick-up and move along.…
About Jonathan Rosenfeld
Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities. Jonathan has represented victims of nursing home abuse and neglect throughout Illinois and across the country. Jonathan’s reputation as an aggressive advocate for the …read more »
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