Treatment for Bed Sores: Who, When, Why, and What’s Next?

Treatment for Pressure Ulcers

Bed sores, a type of pressure injury also known as pressure ulcers or decubitus ulcers, are painful for everyone involved: the patients who suffer from them, their loved ones who provide support, and the doctors and nurses who treat them. The statistics and reality of the condition are sobering. Each year, more than 2.5 million people in the United States develop some form of bed sore.

These wounds are painful, debilitating, significantly impact quality of life, and can also be life-threatening. The Agency for Healthcare Research and Quality (AHRQ) reports that about 60,000 patients die each year from complications due to pressure injuries. They are also costly. The U.S. spends approximately $26.8 billion annually on treating these pressure injuries, ranging from $20,900 to $151,700 per patient.

When Do Pressure Sores Form?

Pressure sores form when an area of skin receives less blood flow than normal, typically from extended contact with a bed or cushion. This combines with the friction from rubbing against the surface, and the tissue begins to atrophy, leaving an open wound, known as a pressure ulcer. They’re most commonly found on areas where extended contact with a surface like a bed is expected, like the back of the head, base of the spine and buttocks, heels of the feet, hips, and shoulder blades. Understanding which parts of the body are most vulnerable to pressure sores is crucial to prevent these injuries.

With the reality of the condition as the impetus, clinicians, researchers, and the industry at large are investing time and money in finding a better treatment for pressure sores. The commitment is needed. While the basics are well understood by professionals in the field, research into treatment strategies, innovations in technologies, and new product development continuously evolve and are paramount to winning the battle against bed sores. Knowing the current who, when, why and what’s next is crucial.

The Importance of Effective Treatment for Bed Sores

Any provider who has cared for patients in hospitals, nursing homes, or other facilities knows the telltale signs of bed sores. Redness, heat to touch at early stages, skin loss, and necrotic tissue as it worsens. Stage III and Stage IV bedsores that occur in hospitals (HAPIs) or other facilities show significant tissue loss and, in some situations, affect the underlying muscle, bone, tendon, or joint. These severe bedsores can also lead to joint infections, which may spread to underlying bones and joints, causing conditions like septic arthritis and osteomyelitis.

Caused by prolonged pressure on the skin, especially in individuals with fragile skin, bed sores often develop on bony areas of the body such as the heels, ankles, hips, and tailbone. Untreated or poorly managed bed sores, pressure injuries or pressure ulcers can lead to severe infections, prolonged hospital stays, and increased healthcare costs. It is imperative to relieve pressure and treat pressure injuries or pressure ulcers, ensuring blood flow to the wound.

Financial Implications of Sores

From a healthcare system perspective, the financial implications are substantial, with increased hospital stays resulting in higher treatment costs (which may happen regardless of the length of hospital stay), and the potential for penalties associated with hospital-acquired conditions (HACs). Per the Centers for Medicare and Medicaid Services (CMS), facilities in the lowest-performing 25% face a 1% reduction in their Medicare payments.

In addition to avoiding penalties associated with HACs, hospitals must ensure compliance with guidelines set by accreditation bodies, such as the Joint Commission. Nursing homes and skilled nursing facilities (SNF) are also heavily monitored and regulated to prevent bed sores. Plus, expanding value-based care programs also require a proactive approach to bed sore prevention, as it directly impacts outcomes, patient satisfaction, and readmission rates.

Focusing on bed sore treatments also helps providers address goals related to social drivers of health (SDOH). Ensuring all patients receive optimal care, regardless of their background or socioeconomic status, is one of the key efforts of emerging initiatives to reduce health disparities for healthcare professionals. Effective treatment to ease pressure for life threatening sores contributes to this objective by preventing complications from disproportionately affecting vulnerable populations. Sometimes this is as simple as helping the patient by changing position, or having access to nutritious options to minimize body fat, both of which can be a factor predicting an open sore. Poor nutrition greatly affects this population.

What Are the Current Options for Treatment for Life Threatening Sores?

As we’ve established, it’s imperative for hospitals and long-term care facilities to be vigilant about monitoring and preventing bed sores. But once they’ve appeared, what treatment options do exist for bed sores? As it turns out, a few avenues of care are the most common choices for wound care providers.

The first line of pressure ulcer or bed sore treatment is actually prevention of a pressure sore. Frequent changes in position are a simple way to reduce pressure and increase blood flow on a single area of the body, prevent the bed sore formation and minimizing sustained pressure. As a healthcare professional knows, pressure injuries or a pressure ulcer are less likely to form when the area is not consistently pressing against a cushion or mattress.

What To Do When Open Sores Have Already Formed

Once bed sores have formed, there are a handful of treatments providers turn to for treating pressure sores. Frequent changes in position are recommended as a treatment as well as a preventative tool. Reducing the contact to the skin can help increase blood flow and decrease the rubbing and pulling on the skin that can cause and intensify bed sores. This helps in managing the affected skin, which can become deprived of oxygen and nutrients, leading to further complications.

Depending on the stage of the pressure injury, the best course of treatment may change. If the bed sore or pressure ulcer is not an open wound, coating with a light dusting of talc powder can help reduce friction on the wound. If pressure ulcers have progressed to an open wound, debridement is likely going to be needed to remove dead tissue. Removing dead tissue is crucial for promoting healing and preventing infection in pressure sores. Some pressure injuries or pressure ulcers, like bed sores, do need surgery to heal.

Prevent Infection and Promote Healing

All bed sores should be cleaned, typically with a gentle saline solution, and the majority will need to be dressed. Pay close attention to the moisture balance when dressing the wound and tending to the pressure sore. Too much or not enough moisture can inhibit proper wound healing of pressure injuries. Additionally, a balanced diet is key to maintaining good health in general, but healthy eating has the added benefit of encouraging wound healing. Physical factors play a factor in constant flow of blood to the wound, and proper nutrition is important when seeking to prevent pressure ulcers due to broken skin, vulnerable skin, infected tissue, joint infections and other forms of skin damage.

Advanced Treatment Options: AI and Digital Wound Healing for Pressure Injuries

Today’s advanced bed sore therapies are helping providers meet the demands of treating the condition. One of the most promising advancements in bed sore treatment is artificial intelligence (AI). AI-powered digital wound care platforms are becoming more common, and typically feature imaging technologies to allow for precise 3D measurements of wounds, as well as preventing a pressure injury from occurring.

This tech provides detailed insights into bed sore size, depth, and progression. By utilizing high-resolution images and sophisticated algorithms in the platforms, clinicians can accurately assess the condition of the wound and make informed decisions about the best course of action, thereby preventing or promptly treating pressure ulcers. This accuracy is critical for developing effective treatment plans and monitoring healing.

Technology: An Asset for the Entire Care Team

AI is also very helpful when it comes to comparing wounds and thus hopefully reaching a more accurate diagnosis or treatment plan. AI’s ability to collect and analyze vast amounts of data is a crucial resource in combatting pressure sores, pressure ulcers and other types of wounds.

AI-developed algorithms can analyze data to predict which patients are at risk of developing bed sores, compare to determine the most likely stage of existing bed sores, suggest data-based avenues of treatment derived from similar wounds, and provide actionable insights to clinicians so they can develop effective care plans. They can also assist in preventing pressure ulcers, skin infection, join infections, and other threatening wounds from occurring.

Leading AI-wound care platforms can even integrate with advanced specialty electronic health records (EHRs) to provide a comprehensive view of a patient’s health status, both within a practice and between providers. This integration facilitates better decision-making by offering real-time data, ensuring providers can promptly take meaningful actions, especially when treating pressure ulcers.

Preventing Tissue Damage with Seamless Communication

Furthermore, digital platforms enable seamless communication between multidisciplinary teams, ensuring that all stakeholders are informed and can contribute to the patient’s care plan. This collaborative approach is essential for addressing complex cases and improving overall care quality. Providers are the key here—they’re experts at understanding and treating wounds like bed sores.

These tools have been developed to aid wound care practitioners in their effort to improve patient care and to make it easier to focus on the patient, rather than documentation and compliance. This helps communication around wounded parts of the body, healthy skin, history of pressure ulcers and more.

Other Promising Technologies and Practices to Remove Dead Tissue

While AI is at the forefront of innovation, other technologies are also showing promise in the treatment of bed sores and restoration of healthy skin cells. New wound care dressings, for example, have made significant strides in recent years. These advanced dressings come with antimicrobial and moisture-retentive properties and enhanced adherence, improving patient comfort and outcomes by accelerating healing, reducing infection rates, and minimizing the need for frequent dressing changes.

Telemedicine and remote monitoring are helping to enhance access to specialist care, particularly for patients in remote or underserved areas where pressure ulcers can pose an even greater risk. Remote monitoring technologies can facilitate continuous assessment and timely interventions, reducing the need for in-person visits. Leveraging telemedicine with digital technologies like smartphones and wound care apps allows healthcare providers to extend their reach and provide high-quality wound care to a broader patient population.

Negative pressure wound therapy (NPWT) continues to be an effective treatment for complex bed sores. This therapy applies controlled negative pressure to a wound, which helps remove exudate, reduce edema, and promote perfusion, accelerating the healing process.

An Increasingly Popular Treatment to Promote Healing

Hyperbaric oxygen therapy (HBOT) is another promising treatment option for non-healing wounds. Patients are placed in a chamber with 100% oxygen, a higher percentage than the air we breathe daily. By increasing the oxygen supply to the affected area, HBOT enhances the body’s natural healing process. This therapy can be particularly beneficial for patients with chronic, non-responsive bed sores or pressure ulcers, an advanced wound care option that offers a potential solution for wounds that have not responded to conventional treatments.

Nutritional and cognitive support for patients with bed sores are also emerging as important strategies for treatment. We now know that the right combination of nutrients plays a major role in healing. Notably, more clinicians are also recognizing the toll chronic wounds play on mental health. Many patients are socially isolated or depressed, especially if they are also dealing with long-term care or a terminal illness. The care plan should include education, counseling, and support groups.

Looking to the Future: Emerging Innovations

Future bed sore treatments read like a page from science fiction. We will see smart dressings  with built-in sensors that monitor various parameters such as pH, temperature, and moisture levels. These smart dressings can provide real-time data to clinicians, enabling timely interventions and personalized treatment plans, and in the more exciting previews, they can even deliver treatments through their contact with the wound.

Regenerative medicine will spur tissue regeneration and repair, a very promising opportunity for the field of wound care, including stem cells and bioengineered tissues. Nanotechnology will target specific cellular and molecular pathways to deliver targeted healing.  

Promoting Prevention: A Proactive Approach to Bed Sore Risk Assessment and Management

While current and future innovations hold promise, the healthcare industry must prioritize prevention to improve patient health, operational efficiency, and financial viability. Prevention is not just a cost-saving measure; it is a moral imperative. The AHRQ estimates that up to 60% of pressure ulcers are preventable through proper care and protocols​ (AHRQ)​.

Perhaps most troubling, a January 2024 article in Medscape notes that the risk of death is “4.5 times greater than that of persons with the same risk factors but without pressure injuries.”

These statistics underscore the need for a paradigm shift in the healthcare industry. The outdated belief that bed sores are an inevitable consequence for older or immobile patients must be replaced with a proactive, prevention-focused mindset.

Repositioning to Relieve Pressure

One of the most important preventive steps is repositioning. The Joint Commission has spelled out several steps, including frequent turning and repositioning of at-risk patients if not contraindicated. Clinicians are also examining the practical nature of prevention strategies. Repositioning an immobile patient can be time-consuming for already busy facility staff. It can also be difficult and potentially lead to injury for the provider. New movement guidelines emphasize using mechanical lift devices and team-based approaches to safely reposition immobile patients with bed sores, reducing the risk of injury for patients and nurses. Technology to help streamline workflow can also provide more time for much-needed hands-on patient care.

Educating those who care for patients in home settings is also crucial, including family members, home health aides, or others providing hands-on care outside of a hospital or nursing home. Wound care providers must allocate time and resources to help these caregivers understand what bed sores are, how they develop, and their role in prevention and treatment.

Effective education should ensure that no patient with a bed sore is discharged without their primary caregiver fully informed and supported. This includes providing clear instructions and resources to ensure proper wound care, preventing further complications, and promoting healing. By equipping caregivers with the necessary knowledge and skills, we can significantly improve patient outcomes and enhance the quality of home-based care.

Embracing Innovation and Information

The future of bed sore management lies in leveraging advanced technologies and innovative strategies and staying abreast of the latest products and best-practice research. Staying updated on these advancements is essential for improving patient outcomes and ensuring compliance, avoiding penalties, and optimizing reimbursement as regulations and rules evolve.

Sores heal with proper healthcare professional attention to tissue damage, turning a life threatening infection or wound on a particular area of skin into clinical dermatology success for the healthcare team. Keeping skin clean will help fight infection and keep surrounding tissue protected. Lack of movement reduces blood flow, so at times a specially designed mattresses should be considered to combat poor circulation and prevent an open sore from forming, allowing new skin cells to develop healthily.

Conclusion

By committing to a zero-tolerance policy towards bed sores and integrating continuous education and technological advancements, healthcare facilities and providers can provide the highest standard of care for vulnerable patients. The ongoing research and development in this field pave the way for more effective and efficient care solutions, ensuring a brighter future for bed sore prevention and management​.