PennLive.com - Helen Nickle went to the hospital for a hip replacement last December and left with a problem that was almost as challenging to recover from as surgery —a bedsore.
“My daughter was helping me bathe after I came home and she saw it. At first, I didn’t have any pain with it so I didn’t even know it was there,” the Upper Mifflin Twp. woman said. “I was only in the hospital for two and half days — that’s how fast it came on.”
Her doctor diagnosed her with a Stage 3 (out of 4) pressure ulcer — commonly called a bedsore — on her buttock.
Bedsores are injuries to the skin and underlying tissue caused by prolonged pressure and often occur on bony places such as the tailbone, hips, buttocks, back of the head and heels in people who are bed-bound or in a wheelchair.
Even with daily care, Nickle wasn’t fully healed from her bedsore until March.
To cope, she sat on a pressure-relieving cushion filled with air cells to keep pressure suspended. Shelly Abeln, a wound care specialist with Celtic Healthcare Inc., a home health care service provider in Carlisle, used a wound dressing made of freeze-dried collagen, which helps tissue to grow and contains silver to help fight infection.
“It became something I had to think about all the time. I was a little concerned as to what would happen if it didn’t heal up,” said Nickle, 67. “It will be on the top of my mind if I ever have to go back to a hospital again.”
Pressure ulcers are a major source of pain, frustration and expense for patients, their caregivers and the U.S. health care system.
Nationally, the annual costs associated with pressure ulcers are about $13 billion a year just in the Medicare program, due to longer lengths of stay, infection, use of specialty beds and supplies and increased nursing time, according to the Pennsylvania Pressure Ulcer Partnership.
For what is a largely preventable condition, the rise in incidence is alarming. The Agency for Healthcare Research and Quality estimates that nationwide the number of hospital stays with pressure ulcers increased nearly 80 percent from 1993 to 2006.
“Prevention is possible, but it requires constant attention, multiple times a day because these pressure ulcers can develop very quickly, and once they develop, they can be very hard to treat,” said Lisa Lewis, chief nursing officer at Holy Spirit Hospital in Camp Hill.
Lewis has a special passion for bedsore prevention, borne out of personal loss. Her 65-year-old father developed a bedsore after surgery at a hospital — not in this area — and ended up with sepsis, a systemic infection that occurs when bacteria enters the bloodstream. He died.
Lewis is proud that the rate of hospital-acquired pressure ulcers at Holy Spirit Hospital is well below 1 percent, much lower than the national rate of 7 percent. In fact, the Institute for Healthcare Improvement recognizes Holy Spirit as a mentor hospital on preventing pressure ulcers. In 2010, they had no stage 3 or 4 pressure ulcers.
“To me, that’s an indication that our nurses are doing all the right things,” said Lewis, who noted that every patient gets a skin evaluation on admission to determine risk and a protocol for prevention measures.
Other area hospitals are also better than the U.S. average, according to their representatives. In 2010, Carlisle Regional Medical Center and PinnacleHealth System also had rates below 1 percent for stage 2 or higher hospital-acquired pressure ulcers. Penn State Milton S. Hershey Medical Center’s rate was nearly 4 percent in 2010, but it has fallen so far this year.
Evidence shows that the incidence and severity of pressure ulcers can be reduced by focusing on risk for developing them, frequent skin assessment for at-risk patients, turning and repositioning, pressure reduction techniques, nutrition, skin cleansing and wound care, according to the Pennsylvania Pressure Ulcer Partnership.
The partnership, which includes the Hospital & Healthsystem Association of Pennsylvania, the Healthcare Improvement Foundation and Hospital Council of Western Pennsylvania, formed three years ago to launch its pressure ulcer reduction project, using this approach to prevention.
The results show it works: Among the 58 Pennsylvania hospitals that participated in the project, the rate of pressure ulcers that developed decreased by 23 percent and the rate of pressure ulcers that worsened decreased by 81 percent.
Bedsores can also happen at home, often because caregivers aren’t aware that they should be vigilant against them, Abeln said.
“Caregivers should do daily skin checks, particularly on the heels and butt. If the person is incontinent, caregivers should be sure to clean them up immediately,” she said. “As soon as you see a reddened area that doesn’t blanche when you push on it, call the doctor.”
Daily attention to the wound is essential, she said. “Moist wound therapy is the key to getting good tissue to grow back,” she said.
There are many gels and dressings available to aid healing, but relieving pressure is paramount, Abeln said. Caregivers should look into the many pressure-reducing products available, from special cushions to mattresses, some of which are covered under Medicare, she said.
Caregivers must also pay attention to their loved one’s nutrition. Skin breaks down if it is not properly hydrated and a protein-rich diet is needed for new tissue growth, she said.
If a bedsore simply won’t heal, patients can take advantage of the treatment available at local wound care centers, which might include hyperbaric oxygen treatment to speed wound healing.
“Prevention of pressure ulcers is expensive, yet it would be more expensive to treat them once they develop, let alone the increased risk of infection or amputation for the patient,” said Dr. Joseph Torchia, chief medical officer at Holy Spirit Hospital.
Caregiver tips to prevent bedsores at home:
•Do daily skin checks, particularly of bony areas.
•Make sure to clean up any accidents from incontinence right away.
•Reposition your loved one every two hours.
•Take advantage of pressure-relieving mattresses and cushions.
•Pay attention to nutrition. Adequate protein intake is needed to help new tissue to grow.
•Put a pillow under the calves to keep pressure off the heels.
•Keep the head of the bed below 30 degrees.
•Add physical therapy to increase mobility.
•Bathe your loved one with warm water and use lotion.
•Call the doctor at first sight of a reddened area that doesn’t turn white when pressed.
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