The topic for support group meeting in the month of August 2025 was ‘Bed sores’ by Dr Manasi Joshi.
Dr Manasi Joshi (MBBS) is a General Physician at Anandi Clinic in Kothrud and at Vitalife in Bavdhan, who does home visits especially for the elderly.
What is a bed sore?
It is also known as pressure ulcer, decubitus ulcer, friction injury or pressure sore.
• A pressure sore is skin and tissue damage due to prolonged pressure applied on an area of the body especially the bony areas. Due to restricted blood supply to these areas, it leads to skin damage.
• The areas that are likely to be affected are
– Occiput (back of the head)
– Ears
– Scapula
– Elbow
– Pelvis
– Sacrococcygeal region (base of spine)
– Greater trochanter (part of the femur)
– Ischial tuberosity (underside of pelvis)
– Lateral malleolus (ankle)
– Heel
Factors causing bedsores and its prevention
The Braden Scale which is often used to evaluate the risk of developing bedsores based on the six factors. A low score indicates higher risk where as a higher score indicates a lower risk.
• Sensory Perception- Skin loses sensitivity because of diabetes or if patient is unresponsive
• Moisture – Urine leakage or sweat
• Activity – Physical activity of the patient
• Mobility- Ability to change position
• Nutrition -Food intake pattern
• Friction and shear – Skin brushing against any surface
Stages of Bedsores
There are typically four stages of bedsores.
Treatment of bedsores
The treatment will vary based on the stage of the bed sore. A strong antibiotic cream may not be necessary in case of a superficial wound. In case of severe infection of the bedsore wound which has a foul odour along with pus discharge, or even worse a septic wound, oral antibiotics will be necessary along with the dressing. Hence, using the right treatment for the right grade of bedsore is important. There are different types of dressings available and the type of dressing will depend on the stage of bedsore and patient’s condition
– Pain Management
Bedsores are painful for a patient and should not be ignored. In case of an unresponsive patient, we cannot assume that he/she does not experience pain. In patients who have chronic pain, apart from the pain centres in the brain, even the surrounding centres in the brain are affected which may lead to irritation, lack of sleep, depression or non-cooperative behaviour. Patient should be encouraged to give feedback on pain levels on a scale of 1 to 10.
Application of anaesthetic jelly during dressing and pain killer medication can be safely given to patients in pain without worrying about kidney damage. This ensures that they are comfortable and fresh and the caregiver is at peace.
Some tips for caregivers
• An air bed is easy to maintain and is light, hence convenient than a water bed. Keeping a patient in one position for 10-12 hrs is not at all advisable. With an air bed, maybe changing the position every 2 hours may not be required but still needs to be spaced at equal intervals.
• After cleaning the wound ,If there is skin loss and the layer below is exposed then the wound should be covered till the skin regenerates again.
• Even After a bedsore heals, it reappears again in some days in the same region ,ensure complete healing, and continue to use barrier cream and change positions even though the wound appears healed
• Diabetes complicates a lot of things. Sugar needs to be controlled. Underlying condition needs to be treated.
• For foul smelling wounds, along with proper cleaning and fresh change of clothes and sheets, keeping newspapers under the wound can reduce the smell because the carbon in the ink absorbs the smell. Keeping charcoal paste in the layers of the sheets also helps.
• If Banana leaves and papaya leaves should not be used for dressing because if they are not sterilized properly, then they may pose risk of further infection. Further, there is no data that can provide proof of complete healing.
The session was very informative and provided a guideline for caregivers .
