Bed and Pressure Sores

The Oklahoman has reported that Oklahoma ranks as one of the worst in the country for the number of patients suffering from pressure sores: a condition that is entirely preventable, but if not treated can be deadly. The newspaper cites the Centers for Medicare and Medicaid Services' report that about 7% of all nursing home residents developed bed sores from 2007 to 2008. It should also be noted that around 60,000 people die nationally from pressure sores each year.

A pressure sore is any lesion caused by unrelieved pressure resulting in damage to the underlying tissue. It is this circumscribed area at which cutaneous tissue has been destroyed because of the restriction of blood flow. The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure ulcer as "localized injury to the skin and/or underlying tissue usually over a bony prominence."

The NPUAP describes pressure sores on six different levels, or "stages." Prior to 2005, the existing definitions of stages had too many variations to them, leading to many different analysis as to the severity of any given pressure sore. The lowest form is a suspected deep tissue injury, which is purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue. This "stage zero" can be difficult to detect on people with darker skin tones, but evolution may be rapid exposing additional layers of tissue even with optimal treatment. Very few clinical studies have been done to determine the difference between deep tissue injuries and pressure sores, however, they do most certainly exist.

The pressure soars develop through various degrees of infection and stage number, each one generally categorized by a greater loss of skin tissue and black/brown coloration of the wound. They ultimately arrive at stage six, which can be identified as full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erytherma or fluctuance) eschar on the heels serves as "the body's natural cover" and should not be removed.