Decubitus Ulcers

Decubitus Ulcers is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Epidemiology

Decubitus ulcers typically occur within the first 2 weeks of hospitalization and can develop within 2–6 hours. Once they develop, decubitus ulcers are difficult to heal and have been associated with increased mortality.1 More than 100 risk factors for the development of decubitus ulcers have been identified; the most important include immobility, malnutrition, reduced skin perfusion, and sensory loss.2

Prevention

Prevention is the key to management of decubitus ulcers. It is recognized that not all decubitus ulcers are avoidable.3 Preventative measures include the following:

  • Risk prediction using the Norton or Braden scales scores immobility, activity levels, incontinence, impaired nutritional status, impaired circulation, and altered level of consciousness to identify patients at risk for pressure injury.
  • Advanced static mattresses or overlays should be used in at-risk patients.4
  • Skin care, including daily inspection with particular attention to bony prominences including heels, minimizing exposure to moisture, and applying moisturizers to dry sacral skin.
  • Nutritional supplements may be provided to patients at risk.
  • Frequent repositioning (minimum of every 2 h, or every 1 h for wheelchair-bound patients) is suggested.
  • Multilayer foam dressings have been shown to reduce the rates of pressure injuries.5

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General Principles

Epidemiology

Decubitus ulcers typically occur within the first 2 weeks of hospitalization and can develop within 2–6 hours. Once they develop, decubitus ulcers are difficult to heal and have been associated with increased mortality.1 More than 100 risk factors for the development of decubitus ulcers have been identified; the most important include immobility, malnutrition, reduced skin perfusion, and sensory loss.2

Prevention

Prevention is the key to management of decubitus ulcers. It is recognized that not all decubitus ulcers are avoidable.3 Preventative measures include the following:

  • Risk prediction using the Norton or Braden scales scores immobility, activity levels, incontinence, impaired nutritional status, impaired circulation, and altered level of consciousness to identify patients at risk for pressure injury.
  • Advanced static mattresses or overlays should be used in at-risk patients.4
  • Skin care, including daily inspection with particular attention to bony prominences including heels, minimizing exposure to moisture, and applying moisturizers to dry sacral skin.
  • Nutritional supplements may be provided to patients at risk.
  • Frequent repositioning (minimum of every 2 h, or every 1 h for wheelchair-bound patients) is suggested.
  • Multilayer foam dressings have been shown to reduce the rates of pressure injuries.5

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