1.5 Identify a range of interventions that can reduce the risk of skin breakdown and pressure sores

This guide will help you answer 1.5 Identify a range of interventions that can reduce the risk of skin breakdown and pressure sores.

Skin breakdown and pressure sores, also known as pressure ulcers, occur when prolonged pressure or friction damages the skin and underlying tissue. They often develop in individuals with limited mobility or those confined to beds or wheelchairs. Pressure sores can cause pain, infection, and prolonged recovery times, so preventing them is an essential part of care work.

This guide covers a range of interventions that can minimise risk of skin breakdown and pressure sores.

Pressure Sores and Their Causes

Pressure sores develop in four stages, from redness of the skin (stage 1) to severe damage involving muscles and bones (stage 4). Key causes include:

• Prolonged pressure: This restricts blood flow, depriving tissues of oxygen and nutrients.
• Friction: Repeated rubbing can weaken the skin, making it prone to tearing.
• Shearing: When the skin moves in one direction, and the bone moves in another, it stretches and damages underlying tissues.
• Moisture: Sweat, urine, and wound exudates can weaken the skin, increasing susceptibility.

Preventing these risks involves careful planning and daily care interventions.

Regular Repositioning

Prolonged immobility is a significant factor in developing pressure sores. Changing an individual’s position regularly helps to relieve pressure on vulnerable areas.

Key points:

• For bed-bound individuals, repositioning should occur every 2 hours.
• Chair-bound individuals should be repositioned every 1 hour.
• Use a repositioning chart to track and ensure routine repositioning.
• Focus on relieving pressure from areas like the heels, sacrum (lower back), hips, and elbows.

When repositioning, avoid dragging the skin, as this can cause shearing. Use sliding sheets to move individuals gently. Always involve two carers if needed to ensure safety.

Skin Inspection and Hygiene

Frequent skin checks are vital to detect early signs of pressure damage, such as redness, discolouration, or warmth. This allows early intervention.

Steps to follow:

1. Inspect bony areas where sores are likely to form, such as the tailbone, hips, and knees.
2. Keep skin clean and dry to reduce the risk of infection. Cleansing should be done with pH-balanced products that are gentle on the skin.
3. Use barrier creams or sprays to protect against moisture damage caused by sweat, urine, or incontinence.

Hygiene routines should also include managing incontinence effectively, as prolonged exposure to urine or faeces can degrade the skin.

Pressure-Relieving Equipment

Specialist equipment reduces pressure on vulnerable body areas. These tools are especially helpful for individuals unable to move or who are at high risk of developing pressure sores.

Examples include:

• Pressure-relieving cushions: Often used for wheelchair users. These distribute weight evenly to reduce pressure on the hips and buttocks.
• Specialist mattresses: Alternating pressure mattresses use air pumps to inflate and deflate cells at intervals, ensuring no single area bears pressure for too long.
• Heel protectors: Foam or gel-based devices reduce pressure on heels.
• Bed positioning aids: Foam wedges or pillows support the body in positions that relieve pressure on vulnerable areas.

The recommendation for equipment use often comes from occupational therapists or physiotherapists following a risk assessment.

Nutrition and Hydration

Good nutrition and hydration have a direct impact on skin health. The skin needs adequate protein, vitamins, and minerals to stay strong and heal effectively.

• Protein supports skin repair and growth.
• Vitamin C aids collagen production, which strengthens skin.
• Zinc is necessary for tissue development and repair.
• Adequate water intake keeps the skin hydrated, making it more resilient to pressure.

You can encourage individuals to eat balanced meals, including lean meats, fish, dairy, fruit, and vegetables. Make hydration accessible throughout the day and monitor fluid intake where necessary.

Promoting Mobility

Encouraging individuals to move as much as safely possible relieves pressure and improves blood flow to tissues. Even small movements, like shifting weight in bed or chair, can reduce risks.

Suggestions include:

• Gentle, regular exercises for bed or chair-bound individuals, such as leg lifts or arm movements.
• Support with walking aids.
• Physiotherapy sessions for those able to engage in more intensive mobility exercises.

Provide ongoing encouragement and support. Always assess the individual’s abilities and limitations before introducing exercises or mobility practices.

Educating Staff and Individuals

Education ensures that everyone involved understands how to reduce risks. Staff training should focus on:

• Correct repositioning methods.
• Recognising early signs of pressure damage.
• Using pressure-relieving equipment properly.

For individuals or their families, education involves teaching them about skin care, hydration, nutrition, and the importance of regular movement.

Reducing Friction and Shearing

Minimising friction and shearing during care activities is crucial. This reduces the risk of skin damage that can lead to pressure sores.

Ways to achieve this:

• Use hoists or slide sheets when lifting or moving a person.
• Raise the head of the bed slightly but avoid raising it too high to prevent sliding.
• Ensure clothing and bedding are smooth and wrinkle-free to avoid rubbing.

Always handle individuals gently during transfers or care tasks.

Involving a Multidisciplinary Team

Pressure sore prevention works best when care teams collaborate. Input from professionals such as:

• Tissue viability nurses: Specialists in skin care and wound healing.
• Physiotherapists or occupational therapists: Advising on equipment and exercise plans.
• Dietitians: Recommending appropriate nutrition for skin health.

This ensures each individual receives appropriate and effective interventions.

Recognising High-Risk Individuals

Some people are more vulnerable to pressure sores, such as those who:

• Are bed or chair-bound.
• Have medical conditions affecting circulation (e.g., diabetes).
• Are malnourished or underweight.
• Are elderly, as ageing skin is thinner and less elastic.
• Have existing sores or a history of skin problems.

Regular risk assessments can identify vulnerable individuals and focus preventative efforts where they are needed most.

Communication Tips

Care workers must communicate effectively with the wider team and individuals under their care. This ensures consistent interventions and early reporting of concerns.

For example:

• Use care records to document skin inspections, repositioning routines, and changes in skin condition.
• Share information promptly with healthcare professionals if there are signs of deterioration.

Being vigilant in communication prevents pressure sores from progressing to serious levels.

Final Thoughts

Preventing skin breakdown and pressure sores is about combining multiple interventions. Repositioning, good hygiene, effective use of equipment, balanced nutrition, promoting mobility, and reducing friction all reduce risks. Equally, education and teamwork play a big role in prevention. Spotting early signs and acting swiftly can make all the difference.

Each of these interventions requires regular effort and monitoring. But they improve comfort, dignity, and quality of life for individuals, while avoiding complications associated with pressure sores.