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1994.12.21 :  Treatment of Bed Sores

Contact:  Public Health Service 
           AHCPR Public Affairs Branch  (301) 594-1364         
           Bob Isquith  ext. 173
           Bob Griffin  ext. 169
           Paula Zeller ext. 148
           Karen Carp   ext. 177
December 21, 1994

     NURSING HOMES, HOSPITALS URGED TO TREAT BED SORES 
                    FAST AND AGGRESSIVELY 
     
      Practice guidelines released today by the federal Agency
for Health Care Policy and Research urge nursing homes and
hospitals to treat bed sores, also called pressure sores, quickly
and aggressively to prevent them from deepening to muscle and
bone, and becoming dangerously infected.

     Pressure sores can form in less than two hours in bed-ridden
people and those who use wheelchairs, and afflict hundreds of
thousands of Americans, including nearly a quarter of nursing
home patients and one in 10 hospital patients.  However, prompt,
simple treatment -- keeping pressure off the wound, cleansing it
with saline solutions and ensuring that the patient is well
nourished -- can usually halt and reverse the painful progression
of the wounds, according to the guidelines.

     "These recommendations can save pain, lives and money,"
AHCPR Administrator Clifton R. Gaus, Sc.D., said in releasing the
guidelines -- which include a summary for patients and their
families. "If you have a mother, brother or other relative at
risk of developing these problems, or who already have them, the
consumer guide can help prevent serious damage and pain, and even
death."

     The guidelines were developed and tested by private
physicians, nurses and other experts under the auspices of AHCPR,
the U.S. Public Health Service agency charged with improving the
quality and effectiveness of medical care.  They are the first to
set out a research-based regimen for treating pressure sores.

     As many as 60 percent of quadriplegic patients have pressure
sores, while 65 percent of elderly persons admitted for hip
fractures are likely to develop them.

     Treatment of pressure sores cost an estimated $1.3 billion
in 1992.  Physician fees alone averaged $2,900 per patient.       
According to Dr. Gaus, savings from following AHCPR's new
guidelines will far exceed the costs of putting them in place. 

     "Following these guidelines will save more than $40 million
annually, while relieving a great deal of human suffering," said 
Dr. Gaus.


     Dr. Gaus said the new guidelines are a follow-up to earlier
ones, released by AHCPR in May 1992, that dealt with prevention
of pressure sores.  Preliminary reports show that earlier
guidelines are already cutting costs in many facilities.  

     For example, Intermountain Health Care, a Salt Lake
City-based chain of 24 hospitals plus HMOs, emergency clinics and
other health services, tested the AHCPR prevention guidelines in
one hospital and found that they saved nearly $240,000 in just
six months.  Intermountain plans to use the guidelines in all its
hospitals and possibly its home health services.

     Another example, according to Dr. Gaus, is Abbott-
Northwestern Healthcare System in Minneapolis, Minn. 
Abbott-Northwestern projected it would save $288,000 annually by
using the AHCPR pressure sore prevention guidelines and has since
expanded their use within the system.

     Dr. Gaus also said some states are using the guidelines to
monitor quality of care in nursing homes.

     AHCPR has distributed over two million copies of the
pressure sore prevention guidelines to date and expects the new
guidelines on pressure sore treatment will also trigger a large
demand. 

     The new guidelines will be disseminated widely to nursing
homes, hospitals, home health services, other organizations and
consumers.

     Nancy Bergstrom, Ph.D., R.N., chair of the 20-member
private-sector panel that developed the new guidelines, and a
professor of nursing at the University of Nebraska Medical
Center, said they call for mostly low-tech, but common sense
treatment methods such as frequent body position shifting and
proper wound cleansing and dressing.  

     Because recent studies have shown that nutritional
deficiencies can delay the healing of pressure sores, the
guidelines recommend caregivers guard against malnutrition,
especially in older patients.  The guidelines also say that
setting time frames for pressure sores to heal is critically
important.  Properly cared for sores should show signs of healing
in two to four weeks.

     If not properly treated, bacterial infections such as
gangrene and sepsis delay healing, increase treatment costs and
can cause death.

     Dr. Bergstrom said, "The fundamentals of good care are:
making sure the patient has good nutrition -- including adequate
protein, calories and supplements, when necessary -- relieving
pressure on the skin frequently, and properly cleansing and
dressing the wound."

     Shifting body position frequently relieves pressure. 
Persons using wheelchairs should shift slightly every 15 minutes.
If they cannot move themselves, they should be shifted every
hour.  Patients in bed should be repositioned at least every two
hours.

     For proper cleansing, the guidelines recommend using saline
solution and gentle rinsing of the wound; antiseptics and skin
cleaners, such as peroxide and betadine, can harm new tissue and
should never be used. 

     The guidelines also recommend:

     -- Obtaining a thorough medical history and performing a
physical examination.  Physical and mental problems that may
hinder wound healing merit close attention. 

     -- Periodically assessing at-risk patients' nutritional
status.

     -- Using mattress overlays, seat cushions or special
mattresses and beds, as needed, to keep the body off pressure
points.  Donut-shaped cushions should not be used.

     -- Reevaluating patients whose wounds do not heal.

     -- Cleansing pressure sores initially and at every dressing
change and removing dead tissue, excess fluid and other debris.
Patients may want painkillers before these procedures. 

     -- Keeping the wound continuously moist and the surrounding
skin dry.

     -- Dressings do not have to be sterile as long as they are
kept clean and dry, and precautions are taken to avoid
contaminating them.

     -- Considering surgery for severe wounds that do not respond
to treatment. 

     The guideline panel included a consumer advocate and experts
in nursing, plastic and other surgery, dermatology, family
medicine, physical medicine and rehabilitation, wound care,
nutrition, biomedical engineering, occupational therapy, health
education and pressure sore research.  The panel reviewed
approximately 1,700 studies while developing the guidelines,
which were then reviewed by more than 400 other pressure sore
experts and tested in nursing homes, visiting nurse and other
home health agencies, small rural hospitals, community hospitals
and university medical centers.

     Single copies of Pressure Ulcer Treatment: Quick Reference
Guide for Clinicians and Treating Pressure Sores: Consumer Guide,
are available free from the AHCPR Publications Clearinghouse,
P.O. Box 8547, Silver Spring, Md. 20907; tel: (800) 358-9295.
These documents are also available, seven days a week, 24 hours a
day from AHCPR InstantFAX: (301) 594-2800.
     
     The 154-page Treatment of Pressure Ulcers, Clinical Practice
Guideline No. 15, is available through the Superintendent of
Documents, U.S. Government Printing Office, Washington, D.C.
20402; tel: (202) 512-1800.  
                               ###