Tessa Quinn
Skin breakdown can range from scrapes, cuts, blisters, and burns to pressure ulcers that can destroy tissue down to the bone. Pressure ulcers, also known as bedsores, occur when skin and soft tissue press against a hard surface, such as a bed or chair, for an extended period, reducing blood supply to the affected area. Hospital patients are at risk of skin breakdown due to immobility, poor nutrition, and dehydration. To prevent skin breakdown, it is essential to maintain proper positioning and mobility, use appropriate equipment, and ensure adequate nutrition and hydration. Additionally, skin should be treated gently with mild cleansers and moisturizers, avoiding harsh products that can dry it out. Early identification of skin breakdown is crucial for prompt healing and prevention of severe complications.
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What You'll Learn
Use the right skincare products
When it comes to skincare products, there are several considerations to keep in mind to prevent skin breakdown during a hospital stay. Firstly, it is important to avoid skincare products that have a drying effect on the skin. This includes strong soaps, harsh cleansers, and antibacterial or antimicrobial products. Instead, opt for mild, gentle, and moisturising formulas. Choose quality skin cleansers, moisturisers, and barrier creams to protect your skin.
It is also essential to maintain proper skin hydration. Use moisturising cream or skin protectants daily, or as directed by your healthcare provider. If you have concerns about dryness, consult your provider about additional creams or medicines that can help. Bathe daily with mild soap and warm water, and be sure to thoroughly rinse and dry your skin. Pay special attention to keeping areas like the genital region and skin folds clean and dry.
In addition to skincare products, consider the use of protective equipment. For example, when sitting, use a foam or gel seat cushion, or a natural sheepskin pad to reduce pressure on the skin. Avoid donut-shaped cushions. If you use a wheelchair, shift your weight every 15 to 20 minutes to maintain blood flow and relieve pressure. When transferring in and out of a wheelchair, lift your body with your arms; do not drag yourself.
To protect your skin while in bed, use pillows and foam pads to keep bony areas from resting directly on the mattress. Avoid elevating the head of your bed unless directed by your doctor, as this can increase pressure on the buttocks and lower back. If you are at high risk for pressure sores, your healthcare provider may prescribe a special mattress or mattress overlay to further protect your skin.
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Ensure adequate nutrition and hydration
Adequate nutrition and hydration are essential to prevent skin breakdown in hospitals. Firstly, it is important to understand that skin breakdown can occur due to friction or sheer from sliding down in bed or a wheelchair, or from dragging oneself during transfers. This can be prevented by ensuring adequate nutrition and hydration, which helps to improve skin condition and overall health.
Secondly, patients who are bedridden or have limited mobility may not be consuming enough nutrients and fluids, which can increase the risk of skin breakdown. Therefore, it is crucial to enhance their nutritional intake and fluid consumption. A balanced diet rich in calories and protein can help maintain healthy skin and promote faster healing.
Additionally, adequate hydration is vital to maintaining skin health. Drinking plenty of water is recommended to ensure the body receives the fluids it needs. However, water intake may vary depending on individual bladder management routines, so consulting a healthcare provider for personalized advice is important.
Furthermore, certain skin products can help prevent skin breakdown. Moisturizing creams and skin protectants can be used daily to maintain skin hydration and protect against damage. It is also important to clean and dry areas prone to moisture, such as under the breasts and in the groin, to prevent skin breakdown due to excessive moisture.
By ensuring adequate nutrition and hydration, hospitals can help prevent skin breakdown and promote faster healing for patients, reducing the risk of more serious complications.
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Use appropriate equipment
Using appropriate equipment is essential to prevent skin breakdown in hospitals. This includes the use of specialised mattresses, cushions, pillows, and transfer aids. For patients at high risk of developing pressure ulcers, healthcare providers may prescribe a special mattress, mattress overlay, or bed. Foam or gel mattresses are recommended, as well as air-filled mattresses, which can significantly reduce pressure and improve blood flow.
Cushions and pillows are also important tools to relieve pressure. Wheelchair users should use a foam or gel seat cushion, and avoid donut-shaped cushions. A built-up cushion, such as a wedge, can help patients with abnormal postures, such as posterior pelvic tilt, by redistributing pressure away from bony prominences. Additionally, pillows and foam pads should be used to protect bony areas, ensuring that no two skin surfaces rest against each other.
Transfer boards, mechanical lifting devices, and overhead track lift systems are essential equipment for patients who require assistance with transfers. These devices help to prevent sheer injuries caused by sliding or dragging during transfers. A hospital bed that can be raised and lowered is also beneficial, as it facilitates level transfers and reduces the risk of injury to both the patient and caregiver.
In addition to this equipment, patients should also be provided with appropriate skincare products. Moisturising creams and skin protectants are crucial to maintaining skin health, and healthcare providers should advise on suitable products.
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Change positions frequently
Changing positions frequently is crucial for preventing skin breakdown, particularly in individuals who spend most of their day seated or in bed. Prolonged pressure on the skin from sitting or lying down can reduce blood supply to that area, leading to skin damage and potentially serious pressure ulcers.
For those in a wheelchair, it is essential to shift your weight every 15 to 20 minutes to relieve pressure and maintain blood flow. This can be achieved by adjusting your posture or using your arms to lift and reposition yourself. If you require assistance, ensure your caregiver knows the proper technique for moving you, such as lifting or using a draw sheet. Additionally, consider using a foam or gel seat cushion, as well as natural sheepskin pads, to reduce pressure on the skin. Avoid donut-shaped cushions, as they can increase pressure on certain areas.
For individuals who are bedridden, changing positions every one to two hours is recommended. Adjusting the position of the bed can also help relieve pressure. Avoid elevating the head of the bed beyond a 30-degree angle, as it can cause your body to slide down, increasing the risk of skin breakdown. A hospital bed that can be raised and lowered is beneficial, as it allows for easier transfers and repositioning. If a hospital bed is unavailable, you can raise the height of your entire bed using blocks or bed leg adjusters to match the height of your wheelchair.
In both seated and bedridden positions, pillows, and foam pads can be used to protect bony areas and prevent skin-on-skin contact. Additionally, ensure that your clothing is properly fitted and smooth, without thick seams, buttons, or zippers that can press on your skin. By changing positions frequently and implementing these supportive measures, you can effectively reduce the risk of skin breakdown and promote healthy skin.
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Identify and correct abnormal postures
To prevent skin breakdown in hospitals, healthcare providers must identify and correct abnormal postures in patients. Abnormal postures such as posterior pelvic tilt or pelvic rotation can occur due to the frequency of being supine or seated. For instance, consider a patient who frequently slides into a posterior pelvic tilt. In this case, there is an enormous amount of pressure on their coccyx and greater trochanters, putting them at high risk for coccyx and hip wounds.
To correct abnormal postures, healthcare providers can suggest using a cushion built up in the front, similar to a wedge. This type of cushion helps position the pelvis back into the seat, redistributing pressure away from bony prominences. Additionally, hospital beds that can be raised and lowered with an elevating head and footrest can be beneficial. These beds can facilitate transfers and mobility, reducing the risk of sheer injuries.
Furthermore, healthcare providers should encourage patients to mobilise regularly during their hospital stay to minimise the risk of functional decline. However, the use of mobility aids can also increase the risk of skin damage through wheelchair injuries, falls, or transfers. Therefore, it is essential to conduct a falls risk assessment and implement prevention programs if necessary. Padding on mobility aids can also reduce the risk of injury.
Additionally, abnormal postures and skin breakdown can be prevented by addressing nutritional deficiencies. Poor nutrition can lead to a lack of essential nutrients and vitamins required for healthy skin and wound healing. Dehydration can also cause skin fragility and increase the likelihood of skin breakdown. Thus, healthcare providers should encourage adequate nutritional intake and hydration to maintain skin health.
Identifying and correcting abnormal postures is crucial in preventing skin breakdown in hospitals. By utilising appropriate equipment, encouraging mobilisation, and addressing nutritional needs, healthcare providers can help reduce the risk of skin injuries and promote healing.
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Frequently asked questions
Skin breakdown can be caused by friction or sliding down in bed or a wheelchair. Pressure ulcers can form when skin and soft tissue press against a harder surface like a bed or chair for a long time.
Hospitals can provide equipment to prevent skin breakdown, such as transfer boards, hospital beds, and cushions. Patients should also be checked for areas where pressure ulcers may form.
Use pillows and foam pads to protect bony areas. Avoid elevating the head of your bed as this can put pressure on your buttocks and lower back. Use a prescribed or recommended seat cushion for your wheelchair.
Drink plenty of water and eat a nutritious diet. Avoid products that dry out the skin. Use mild soap and moisturiser. Change positions every 1-2 hours to keep the pressure off any one spot.
If you notice sores, redness, or any other changes in your skin that last for several days, seek medical attention.
