Bed Sore Debridement

Older adults with limited mobility and various medical conditions may be at an increased risk of pressure ulcers. Regular monitoring and rotating bed-ridden patients are important preventive measures for pressure injuries. However, even with around-the-clock care, some residents will develop pressure sores requiring prompt treatment.

Proper, supervised wound healing is necessary to promote healing and to prevent the development of additional sores. Pressure injuries can also range in severity, but most require debridement and medical monitoring. Negligent nursing homes can be held accountable when residents develop a pressure injury.

What are Bed Sores (Pressure Ulcers)?

Bed sores, or pressure ulcers, are localized injuries to the skin caused by unrelieved pressure. They are commonly found on bony prominences, including the heels, hips, tailbone, or shoulders. Pressure sores are sometimes also referred to as decubitus ulcers.

Bed-ridden patients are most at risk of pressure ulcers, and preventative measures can help avoid them. Relieving pressure, such as rotating patients, can help prevent wounds. Additionally, the use of alternating pressure mattresses can also help avoid pressure ulcers.

When residents do develop pressure sores, they may require a treatment method of relieving pressure or surgical repair. Proper treatment of pressure ulcers is crucial to prevent further injury.

Stages of Bed Sores

Pressure ulcers can be minimal or severe and are classified using various stages. Here are the different stages of pressure sores:

• Stage 1: A stage 1 pressure ulcer is minimal damage to the skin surface. These superficial wounds may appear red, blue, or purplish on the surface. Stage 1 pressure injuries are the easiest to treat.
• Stage 2: Stage 2 pressure ulcers are open sores with visible scar tissue. The wound may appear as an abrasion or blood-filled blister with some discoloration. The ulcer may affect both surface level and subcutaneous tissue.
• Stage 3: A stage 3 pressure ulcer is much deeper and often requires wound debridement. There may be less healthy skin, and pain medication may be needed.
• Stage 4: With a stage 4 pressure ulcer, the damage also affects the bones or joints of the body. These wound characteristics usually require primary and secondary care to reduce pain and heal properly.

The need for surgical treatment of pressure ulcers will depend on the severity of the wound and how well it responds to other treatments. Risk factors that could indicate required surgical intervention include stage three or four ulcers, chronic wounds, or not healing. Some areas with more vulnerable skin, such as heel ulcers, may also heal slower.

Why Pressure Sores Are a Serious Concern

Pressure ulcers can cause infection or sepsis. Left untreated, severe pressure ulcers can lead to death. The healing process for pressure ulcers can be long and painful, significantly impacting a person’s overall quality of life.

Treating a pressure injury for a person with limited mobility can be difficult. Many debridement methods require the patient to avoid further pressure, which can make healing challenging.

What is Debridement?

Debridement is a medical procedure that treats pressure ulcers by removing the damaged or dead tissue. Removing the infected tissue helps promote healing by encouraging the underlying granulation tissue to regrow.

Healthcare professionals can determine if a pressure ulcer requires debridement during a medical evaluation with wound assessment. During this appointment, they will determine the best type of debridement based on the wound.

Types of Debridement

There are four types of debridement, each aimed at removing necrotic tissue from the wound. Here are the different types of debridement.

Surgical Debridement

A surgical debridement procedure, sometimes called sharp debridement, uses a sharp tool such as a scalpel or scissors to remove the necrotic tissue. This method is common for treating pressure ulcers because it’s fast and effective, making it a popular choice for large or deep wounds.

Mechanical Debridement

Mechanical debridement involves using mechanical forces to remove dead tissue from a pressure sore. This method has been used for longer than the others and is commonly used today prior to other methods, such as surgical debridement.

Enzymatic Debridement

Enzymatic debridement includes applying a topical enzyme to the wound to promote healing. Topical medication can also reduce inflammation and speed up the healing process. Topical treatments may be combined with other therapies, such as oral nutritional supplementation.

Autolytic Debridement

Autolytic debridement refers to the body’s natural processes of treating pressure sores. This method relies on natural blood flow, which breaks down and removes damaged tissue in the wound bed. Systemic antibiotics may also be used to promote further wound cleansing.

Debridement Aftercare and Monitoring

Debridement is the first step in treating pressure ulcers. However, further debridement treatments may be necessary to remove all dead and infected tissue and promote healing. Staff should keep up with the following wound care monitoring tasks when treating pressure sores.

Wound Healing and Bandaging

The treatment of pressure ulcers includes dressing and bandaging the wound to prevent further infection and to promote healing. Wound dressing options may include hydrocolloids, alginate, foam, or transparent film. 

Hydrocolloid dressings are used for difficult-to-wrap wounds. They have a gel-forming agent that promotes healing. Alginate dressings are looser and made with a fleece seaweed material that absorbs 15-20 times its weight. 

Foam dressings are also highly absorbent, making them great wet-to-dry dressings. Transparent film is sometimes used in pressure ulcer debridement to create a moist wound environment with sufficient airflow. 

Depending on the severity of the sore, normal saline and dressings with topical treatment medications may be used. Wound care nurses choose dressings based on the type and stage of the pressure wound.

Pain Management

Pressure ulcers can be painful and often require pain management. The goals of pain management when treating a pressure ulcer are to relieve pressure and reduce burning. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to help control inflammation and topical pain medications may be used to alleviate pain.

Non-pharmacological methods can also be used to assist with impaired wound-healing processes. Repositioning can help with pressure reduction. Support surfaces can be placed near the resident to sit or lie in a position that relieves pressure.

Good nutrition is also important in promoting the growth of granulation tissue. High-calorie diets, ample fluid, and vitamins can be effective in the management of pressure ulcers. In some cases, mechanical devices can also be used to reduce capillary closing pressure, helping to promote healthy tissue.

Monitoring for Complications

Medical professionals should also closely monitor patients with pressure sores for any potential complications. Failing to remove infected skin or treat the affected bone could result in infection.

Effective pressure ulcer treatment may require multiple procedures to ensure proper wound irrigation and debridement. Regularly changing wound dressings also helps sores heal. A wound care specialist may be needed to treat severe or chronic pressure ulcers.

Nursing Home Negligence in a Pressure Ulcer Claim

Medical staff need to take certain steps to debride and properly heal the wounds when pressure ulcers occur. Negligent staff may be held liable when residents develop sores on their watch. Here are a few ways nursing home staff could be liable for pressure sores.

Failure to Provide Adequate Care

Nursing home residents have a legal right to receive proper care, including methods for preventing pressure sores. Staff are responsible for rotating bed-ridden patients and keeping track of patient medical concerns. Failing to do so could be considered negligence.

Failure to Perform Necessary Debridement

Staff are expected to perform debridement when they identify sores. Failing to debride pressure sores promptly can worsen the patient’s condition, causing them unnecessary pain and suffering. Of course, staff who aren’t properly trained in debridement methods should ensure residents with pressure sores receive the care they need.

Holding Nursing Homes Accountable

Staff who fail to prevent or treat pressure ulcers could be held liable. The Nursing Home Law Center is committed to holding negligent nursing homes accountable. Our nursing home negligence lawyers work closely with negligence victims to build a strong case and prove negligence.

We work hard to recover compensation on your behalf. Pressure sores can be painful and difficult to recover from, and no nursing home resident should have to endure that. Stage III and IV pressure ulcers should never occur in a nursing home environment.

A nursing home negligence lawsuit can help victims recover compensation for medical costs, lost wages, and pain and suffering.

Secure Expert Legal Counsel! 

The Nursing Home Law Center is here to help victims of nursing home negligence seek justice and recover compensation. You may be eligible for compensation if you developed a pressure sore while under the care of a nursing home.

Call (800) 926-7565 or fill out our online form to book a free consultation with a nursing home bedsore lawyer.