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How to prevent friction/shear and lift injuries

EDUCATION - TRAINING - PRODUCTS PRESSURE ULCER PREVENTION

For more information and support please visit our websites: Home Caregivers: www.bedsorerescue.com

Medical Professionals: www.jewellnursingsolutions.com

Best ways to protect the skin & existing pressure wounds

Effective incontinence moisture management

Together We Can Stop Bedsores

How to Stop Bedsores Reference Guide

Written by Gwen Jewell, Clinical Nurse II, BSN, CWS

Turning, repositioning, and support techniques that get the pressure off and keep it off

Methods, Equipment and Supplies Proven to to stop 95% of all pressure ulcers

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PRESSURE INJURY PREVENTION EDUCATION – TRAINING - PRODUCTS

Homecare: BedsoreRescue.com - Medical: JewellNursingSolutons.com

Here is the bad news It is most likely true you do not have the right information, training and tools you need to stop bedsores.

But there is good news too There are proven methods and effective tools you can use to stop 95% of bedsores. You just need the learn how.

Together We Can Do This. Trust and Believe That.

There are only 3 types of

people who can STOP BEDSORES

Care Providers

Care Providers

Care Providers

The P

roblem With BedsoresThe Dear Care Provider,

If you are caring for someone who is at risk or has bedsores, you probably already learned WHAT to do to stop them.

But if you are like most care providers, knowing what to do is not enough. You need to know HOW to stop Pressure Ulcers

You probably have been trying to make sense of all the partial and confusing information Given to you by people who don’t really understand what you need to know.

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EDUCATION – TRAINING - PRODUCTS PRESSURE INJURY PREVENTION


3 Things Bedsores Have in Common People who are most vulnerable to getting a bedsore are those with chronic health problems and/or limited mobility. But regardless of a persons health, a bedsore will only develop when one or more of the following 3 conditions exist

1. Too Much PressureFor too long, especially over bony parts of the body where skin is thin; the sacrum/tailbone and heel areas are most vulnerable. The pressure cuts off blood circulation and oxygen, and skin & tissue cells start to die. 2. Too Much MoistureUsually from soiled urine and/or stool, but also can be from perspiration, edema (swelling), or other fluids that make the skin soft and fragile.

3. Too Much Sliding and StickingSliding movements that happen when the person slumps in the bed, is boosted up or transferredfrom bed to chair or visa versa. Damage canhappen because the now fragile skin"sticks" to the surface and "tears" the skin open, causing a wound. Called Friction & ShearInjury.

Bony areas where skin is thin and more vulnerable to Injury

from pressure, moisture and/or friction/shear

~ 90% of bedsores occur over the lower back/buttocks/hips

and heels

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Universal Rules

to Stop Bedsores

2. REDUCE Pressure Position to support off pressure points


3. KEEP CLEAN & DRYChange linens and pads ASAP after soiling. Use good absorption and good cleaning products

4. PROTECT skin from environmental threats

Protect from exposure to moisture and themechanical forces of friction and shear

The Difficult Part There are literally hundreds of health conditions that can make a person susceptible to pressure injuries. And pressure wound development and treatment is complicated

The Easy Part Fortunately it does not really matter what the persons health problems are, The system to stop bedsores is always the same

1. PEEK under the covers Check every day for skin irritation

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Stage 2: The skin breaks open


What do Bedsores look like?

Bedsores start with red, irritated skin. When the pressure is not removed or the skin is not kept clean and dry, the skin gets damaged.

As the damage progresses the damage gets deeper, and a wound can develops.

If not treat ed with good;

- Pressure Reduction- Peri-care

- And Protection

a pressure wound can go all the way to the bone. These wounds are very difficult to heal and very painful.Open wounds are also vulnerable to infection. Aninfection can lead to sepsis, which canlead to death.

Stage 4: Wound goes all the way to the bone

Stage 1: Red skin that says red. (Dark pigment skin may look darker, swollen and be tender) Right image is what

happens when a wet diaper is left on too long

Stages of Bedsores

Development

Stage 3: The wound goes through the skin and you can see muscle, fat, fascia

Stage Deep Tissue Injury: Skin turns deeppurple or black. Happens with excessive pressure but little movement. Damage goes all the way to the bone

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Gwen Jewell, Certified Wound Care Nurse

EDUCATION – TRAINING - PRODUCTS

PRESSURE INJURY PREVENTION

Other common spots are where the skin is thin and close to the bone, called bony prominences


People can also get pressure injuries where there is pressure from a hard surface like wheelchair bars and even hard shoes.

1. Sneak a PeekThe sooner you see signs of damage, The better your chances of stopping it.

Check for skin irritation and signs of pressure related skin damage (redness, darkened areas, broken skin) every day

Where to look Pay special atten tion to the skin

on the lower back, buttocks and heels. Also look where skin is thin, and parts that may be pressing against a hard surfacesuch as a wheelchair bar,bed rail or the bed mattress itself.

90% of bedsores occur over the lower back, tailbone, sit bones and heels.

Bony prominences are where pressure

injuries commonly occur.

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Universal Turning

Techniques



2. Get The Pressure Off Tur ning & Repositioning

When a person cannot turn himself/herself easily and spontaneously, the care provide must assist to Turn and Reposition the person to about 30 degrees to the side. This angle relieves pressure from the sacrum/tailbone but does not push the person too far onto the side of the hip and shoulders.

How to Turn & RepositionTurning a mostly immobile person is not necessarily as easy as it sounds.* The trick is to maximize your person's participation and practice good ergonomic handling techniques to maintain safety and prevent lift injury.

* This page just scratchesthe surface!If you need help withturning & Repositioninggo to our websiteor call us at650-294-8557

www.TheU-Turner.com for single caregiver turning

1. Encourage the person to doas much of the turning as

he/she can

3. Always ask the person to face, reachand bend legs toward the turn as much as

they can

The caregiver should stand on the side of turn & pull with flat palms at bent knee

and shoulder blade if possible. Pull toward care providor

Install simple handrails if needed so person can have

something to help pull themselves over

2. Start with person parallel to the bedand with plenty of room to turn

4. Use assistive equipment if your person cannot turn easily

(if more than about 30 lbs “pull” weightand/or if they cannot turn fully on his/her side

5. Two caregivers my be necessary.Or advanced lift equipment may be needed. Consult your OT,

PT or Wound RN for assistance with lift equipment choices

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Also use pillows under arms to offload elbows and for comfort


3. Keep the Pressure offWhen a person cannot move easily and spontaneously, it is up to the care provider to help him/her move off pressure points. Avoid direct contact to vulnerable areas by turning & repositioning

so that there is lift off the matress or chair.This is called offloading.

The trick to offloading isto support a position that maintains comfortable and longlasting pressurereduction. Itcan be hardto do!

Bedsore Rescue Cushions & Pillows

To Support Pressure Relieving Position

1. Turn and set support deviceso that when the person laysback onto it there will beminimal or no contact withsacrum/coccyx

How Often Should You Turn?Due to natural shifting and sinking, turning should be done frequently

To restore a pressure reduced positionStandard pillows shift and sink easily

Turn about every 2 hours if you are using standard pillows.The Bedsore Rescue Cushion is designed for better stability and lasting lift.

Turn about every 4 – 6 hours with the Bedsore Rescue Cushion

Support is a gentle 30 degree angle. Just enough to remove pressure off Sacrum/Coccyx, but not too far onto the opposite shoulder.

The Bedsore Rescue cushion provides full support under the back and pelvis for balanced lift and cradleed comfort. Your person is comfortable for a longer time

Support the legs and lift the heels perfectly with BSR Advanced

Positioning pillows

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Basic Mechanical Protection



4. Protect From Friction/ShearFragile skin is vulnerable to mechanical injury, called the forces of Friction and Shear.Friction and shear occur when a person with fragile skin slides across a surface. There is "drag" and "stick" on the skin, which can tear the skin and cause a wound. How to Protect from Friction & Shear Sliding is common when a person has limited mobility. He/she may slide down (slumping), Up (boosting), move from side to side or transfer from one surfaceto another.

The trick to preventing friction/sheer injury isto LIFT, not drag or slide.

It is best to have the person boost or transfer him/herself, because he/she will naturallly lift the body instead of drag.

But when the person (or the caregiver) cannot lift easily, you should use a boost or transfer sheet. These sheets are slippery and prevent "sticking" during sliding

When person cannot boost him/herself, turn first to place slider (aka booster) under

person

DO NOT use sticky draw sheets or cotton chux for boosting!

No-Lift booster by AliMed.com a typical Two caregiver booster

Loop Booster (aka sliders) by Dansonsmedical.com can be

used for single caregiver boosts too

A person who can move themselves will naturally

lift instead of drag

NEVER try to boost or slide a person by the armpits!

* This page just scratchesthe surface!If you need help withturning & repositioning goto our websiteor call us at650-294-8557

DO NOT leave boost/sliders under person after boosting!

Simple MattressSurfaces



Mattress SurfacesMattress surfaces are categorized by the way they are engineered/built. The ideal mattress for people at risk of/with bedsores will support an evenly distributed body weight across the entire body surface so that there is no points of excessive weight/high pressure. Can you use a regular mattress?In many cases a regular bed with a "good" mattress is fine when the person can move themselves with minimal assistance and does not have a bedsore. Even better when you have a frame capable of elevating the head of the bed. There are thousands of brands out there, and no reliable way to determine the quality. But the ones that have been around for awhile are a better bet. Generally if the priceis too good to be true, it probably is.

If you already have the mattress but worry that it might be too firm, you can place an air overlay or high density foam overlay. If a caregiver(s) must provide assistance with movementand continence care, it is better to get a "hospital bed"(next page)

Waffle by EHOB

Air OverlaysManual or electric pump fill.

Inexpensive quick and easy to place. Allows more breathability but must be covered with sheet or blanket. Patients may complain of cold or lumpy feeling.

NEVER cover a mattress with plastic or vinyl productsUse "Waterproof terry cloth mattress cover" or blue "tent like" fabric that

covers hospital beds/gurney pads

Coil / spring mattress. Usually doesn't bend. Not recommended for at risk people. Non-metal coils are better.

Foam MattressesGenerally ok for most at risk people with less than stage 3 /

not deep tissue bedsores. May retain heat and "sweat" more. Memory high density foam from reputable companies (Temperpedic) is better. Be sure its covered with waterproof

AND BREATHABE materiel.

Sleep Number Air BedsGenerally ok for most at risk people with less than stage 3 / not deep tissue bedsores. Be sure its covered with waterproof AND

BREATHABE materiel.

Advanced Mattress Surfaces



Hospital Beds / Mattress SurfacesGenerally a "Hospital Bed" for home refers the size and type of bed frame. Hospital bed frames have adjustable height and head of bed elevation capabilities and are usually thinner and longer than a standard twin.

You can put most mattress types on a hospital bed as long they are the right size and the mattress can bend where the head of the bed is elevated. Mattresses with metal spring coils do not bend.

The patient must meet certain criteria to qualify for the most

advanced Low Air Loss and Fluid Filled models, such has

having a stage 3-4 on two or more resting

surfaces.

Your medical provider can assist with advanced hospital bed rentals

* This information just scratchesthe surface(excuse the pun) !If you need help with mattresssurface selection, consult yourcare provider or call us at650-294-8557

There are 7 types of medical mattressesThis list is in order advanced technology.

1. Foam2. Convoluted foams - variety of designs3. Static Air - Air filled bladders4. Alternating air - bladders fill up and release air

controlled by a pump5. With microclimate control - 'free air'

circulation to allow for better breathability6. Low air loss - Air bladder with tiny holes

'gives' as person shifts weight7. "Fluid" filled - a combination

of advance materials to"float" the person

Most beds are available for private pay purchase, both new and beds

Medicare and most Insurances will pay

for hospital bed rentals in most cases

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High Quality Absorption Products



Do NOT use diapers unless the person is able to and does tell you when he/she is soiled and you can clean immediately


High absorbency “maxi”pads can prevent urine from getting onto

the back and are easier to change

5. Practice Good Peri-CareKeeping the skin clean and dry is critical to prevent pressure injuries, especially over the sacrum/tailbone/buttocks area, where at least 50% of all pressure injuries occur.

Absorb urine & stool to keep awayfrom skin- Use absorbency products that minimize

contact of urine and stool to the skin.- Avoid using diapers whenever possible!- Avoid using cotton cloth based productswhenever possible

- NEVER use plastic backed orvinyl coated products under aperson

Use breathable pads under person while in bed, recliner, couch.

Avoid plastic or vinyl backed chux !!!

Male incontinence wraps are good for men who are mostly bedbound. Easy to apply and change, but pricey. May consider maxi pad style too

Breathable pads are efficient at wicking moisture away

from the skin. Examples include; - Ultrasorb by Medline- Supersorb by Attends- Wings Breathable Plus by Convatec

- Ultimate Absorb by Poise- Supersorb by Attends- Discrete by Always

Quickchange by UI Medical

NEVER use plastic backed pads!

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About Cleaning Products



Do NOT use disinfectant or antimicrobial soaps

they are hard on skin and wounds and kill good bacteria


Use Perineal cleansers w/o lotion when skin is damaged to avoid retention of drainage

Clean frequently with soaps designed for peri-cleaning- Clean asap after soiling. Both urine andstool are acidic and can damage skin quickly.- Use Perineal Cleaners specifically designedto be gentle on skin and breakdown urine &stool molecules.- Perineal Cleaners with hydrating lotion is best when there is no skin irritation. - Cleaners without lotion is recommendedif skin is weeping and/or broken from

"diaper rash".- Use soft paper wipes or “babywipes" instead of wash cloths. - Avoid harsh soaps thatadvertise disinfection or odorreducing properties.

Use perineal cleaners w/lotion when there is no skin irritation

Pre-moistened wipes (Baby wipes) are safe to use as long as they don’t contain antimicrobials or disinfectants. But they are more expensive and don’t handle big messes as well as dry wash cloths. Dry paper wipes are soft on skin and more absorbent. DONT FLUSH DRY PADS. Clogs toilets!

Baza Cleanse by Coloplast

Dry Wipes By Attends

Aloe Vesta by Convatec

Rinse free spray by McKesson

No Rinse Spray by Coloplast

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Types of Barrier Creams


Simple barrier creams contain only dimethecone or petroleum. Less expensive

and are fine to protect healthy skin


Protect from MoistureGood absorption and cleaning are great, but you still must protect the skin from the moisture that gets on skin between cleanings.

Moisture Protection Products Moisture Barrier creams or ointments are made to stick to skin and provide a layer of protection from urine and stool. Barrier creams are not for moisturizing ,they are designed to provide a protective barrier layer of oil or silicone . Some have added additives to help irritated skin, like zinc or honey. Advanced formulas have high concentrations of zinc and are medicated to soothe and boost healing.

These are suitable to apply onto most shallow wounds too *

* If your person has wounds seek assistance from your medical provider. This booklet is NOT intended to instruct onwoundcare!

Some Barrier Creams contain added lotions, vitamins and or Zinc. Best when skin is

irritated but not broken

Use Calmoseptine When skin is damaged/broken due to moisture

Baza Clear by Coloplast

Secura Dimethicone by Smith Nephew

Critic-Aid by Coloplast

SensiCare by Convatec

Remedy with Olavamine by

Medline

Desitin is not recommended. Too sticky

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We hope you found this guide helpful

To learn more about how to stop bedsores, visit us at:

www.JewellNursingSolutions.com

C all us at 650-294-8557

Or Write us at [email protected]

EDUCATION – TRAINING - PRODUCTSJewell Nursing Solutions is a nurse owned and operated company dedicated to bringing effective pressure injury prevention products and services to the entire caregiving community. Our cushions and pillows for bedrest pressure relief are the only support devices designed by a nurse to meet best practice standards and functionality in any care environment from the ICU to the home.We offer patient and caregiver specific trainingon proven methods for pressure injury prevention for the bedbound person, especially supplies and equipment use, safe patient handling, caregiver lift safety, and turning &repositioning techniques for optimal pressure relief, stability and comfort.

www.bedsoreRescue.com

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