Bedsores are a clear sign of abuse and neglect in the nursing home or long-term care facility and are typically categorized into one of four stages. Each stage requires specific treatment techniques. Once the correct stage is identified, the proper treatment can be administered.
Stage I bedsores are often easily treated by alleviating the pressure on the affected site. However, if the affected area is irritated or has a slight lesion, it is wise to protect the area with a semipermeable bandage and implement prevention techniques. A semipermeable bandage allows for water vapor and oxygen, elements that are helpful during the healing process, to pass through the material of the bandage, but does not permit water and bacteria to enter through the bandage.
Stage II bedsores should receive similar treatment as stage I bedsores, except stage II wounds should also be inspected regularly for any indication that an infection might be developing in the wound site. Adequate cleaning and regular debridement usually keep bacterial colonization under control at this stage.
Stage III treatment usually requires clearing the wound of any dead tissue before bandaging can occur. This can involve debridement of the dead tissue from the wound. Large wounds with considerable amounts of dead tissue may require surgical debridement, while smaller wounds can be cleared using non-surgical techniques, such as hydrotherapy or enzyme debridement. Hydrotherapy utilizes special water baths to flush out dead tissue from the wound site, and enzymatic debridement uses special enzymes to break down the dead tissue for easy removal by wet-to-dry wound dressings. Wet-to-dry dressings are bandages that are applied in a moist state to the wound site and then are permitted to dry out over a period of time, usually between 8-12 hours. The dry dressing is carefully removed from the wound, taking with it any dead tissue that has stuck to the wet-to-dry dressing. Stage III bedsores should be frequently inspected for signs of infection.
Stage IV bedsores are treated in a similar manner as stage III wounds and usually require surgical debridement, as they are often very large and/or very deep. Some stage III bedsores, and nearly all stage IV bedsores, are sufficiently deep that the wound site must be filled with a packing material to help facilitate proper healing. Packing material should fill the space in the wound bed and needs to be changed each and every day. Some stage IV bedsores are eligible for grafting procedures. A grafting procedure uses either artificial skin, or skin from a different part of the body, to cover clean bedsores and to facilitate healing. Stage IV bedsores should be monitored for signs of infection.
Regardless of the stage of bedsore, all courses of treatment should involve regular evaluation of the wound’s healing progress. Any sign of deterioration of the wound’s condition should prompt an immediate reassessment of the treatment regimen. Visible progress of healing should be noticeable within 2-4 weeks of the start of treatment.
If someone you love has sustained an ulcer while in the care of an Illinois’ nursing home, please contact our Nursing Home Abuse and Neglect Law Firm today, either online or at (800) 598-4348.
Jorge G. Ruiz, M.D., Pressure Ulcers, Division of Gerontology and Geriatric Medicine, University of Miami School of Medicine PowerPoint Presentation