Decubitus, also known as pressure ulcers, is identified as a type of injury that tends to break down the skin and its underlying tissue. This mainly occurs when an area of the skin tends to be put under continuous pressure for a specific period, which results in the cessation of oxygen and nutrition supply to the skin tissues. The continuous pressure resulting in deformation or distortion damage is mostly recognized as the most precise description of Decubitus. Despite the rarely of the disease, Decubitus ulcers pose a significant threat to public health since grades 3 and 4 can have a prevalence of as high as 3 to 4% among the elderly receiving nursing care in hospitals(Mervis & Phillips, 2019). Therefore, analyzing the causes, risk factors, stages, prevention, and management of decubitus ulcers, as well as the implications for patient care and healthcare systems, provides a better understanding of the condition and how to manage it.
Causes of Decubitus
Decubitus ulcers are caused by the development of pressure injuries from complex and multiple factors, which include The constant pressure on any part of the body, which tends to limit the amount of blood flow to the skin tissues, which also limits the constant flow of nutrients and oxygen to these tissues (Roussou et al., 2023). In this case, the limited flow of oxygen and nutrients due to pressure makes the skin prone to damage, resulting in Decubitus. Friction also caused Decubitus ulcers. Rubbing the skin against bedding or clothing results in friction. This friction makes the skin fragile and increases its vulnerability to injury, particularly when moist skin causes Decubitus. Shear forces also lead to decubitus ulcers. Shear is caused when two surfaces move in conflicting directions (Mervis & Phillips, 2019). For instance, when a bed is raised at the head, an individual can slide down in bed, and as the tailbone starts to move down, the skin over the bone might stay at the same pace, pulling in the opposite path.
Risk Factors
The condition has multiple risk factors, which includeimmobility, lack of sensory perception, poor hydration and nutrition, and medical conditions impacting blood flow. Immobility might be a result of spinal cord injury or an alternative cause. Neurological disorders, spinal cord injuries, and other key situations tend to make an individual lose sensation. In this case, they cannot feel discomfort or pain and become unaware of any signs of changing position. People need proteins, fluids, vitamins, calories, and minerals to maintain healthy skin. This also stops the breakdown of skin tissues, which may cause Decubitus. Therefore, poor hydration and nutrition are significant risk factors for the condition (Getie et al., 2020). Many health conditions can affect the normal blood flow, causing damage to skin tissue and bedsores. These include vascular conditions and diabetes, among others.
Stages of Decubitus
Decubitus Ulcers progress in four stages based on tissue damage level. The stages help doctors determine the most appropriate course of treatment. Stage 1: At this stage, the skin looks pink or red but lacks an open wound. In many cases, people with dark skin may be unable to see the colour change but may feel pressure injury. Also, the skin may feel fond of the touch at this stage. Stage 2: A shallow wound with a red or pink base develops during this stage. At this stage, an individual may have blisters, loss, and abrasions. Stage 3: A visible wound is noted on the skin’s fatty layer. Stage 4: The wound on the skin penetrates deeply, exposing tendons, muscles, and bones in the individual’s musculoskeletal system (Mervis & Phillips, 2019).
Prevention
Preventive measures of pressure ulcers include adequate offloading and preservation and enhancement of tissue tolerance. The following approaches could be used in its prevention. Apply pressure-relieving mattresses and support surfaces. The pressure-relieving mattresses provide a soft surface area without friction and pressure, thereby preventing pressure ulcers. Individuals need to stay hydrated and eat well, which prevents the skin from becoming too dry (Getie et al., 2020). This also prevents the skin from being exposed to constant moisture and decreases damage to the skin. For patients in a wheelchair or on bed rest, it is recommended to reposition them every two hours. In repositioning, the caregivers of decubitus patients can also apply pressure-reducing devices. However, pain assessment should be considered during the repositioning of the patients.
Management
The management of pressure ulcers tends to be interdisciplinary, including primary care dermatologists, psychologists, social workers, podiatrists, infectious disease consultants, surgeons, dietitians, and rehabilitation professionals. The basic components of decubitus management include debriding necrotic tissue, relieving skin pressure, managing bacteria colonization and load, cleansing the wounds developing on the skin, and choosing a wound dressing (Getie et al., 2020). The wounds should be cleaned with each dressing change.
Implications
Patient Care
Decubitus or pressure ulcers are identified as a health problem that greatly impacts the patients, resulting in continuous pain and discomfort. Moreover, there is delayed healing, decreased quality of life, and reduced performance, which increases patients’ hospital stay, contributing to disability and death. All this increases the financial expenditure for the patients and their family members.
Implications to HealthCare Systems
Decubitus ulcers have huge financial implications for patients and the broader healthcare system. This is due to the high costs of treating the ulcers, including medication costs, hospitalization, treatment, special wound care, and prolonged medication. In addition, Decubitus is costly to the health systems due to its long-term management (Getie et al., 2020). Also, the staff education and need for training preventing strategies to mitigate the occurrence of these injuries add a burden to the Healthcare systems
In conclusion, Decubitus is a serious health condition that greatly impacts the patient and the broader healthcare system. Nevertheless, the condition is preventable, and its management depends on its severity. In this case, it’s important for healthcare professionals to understand the causes, various risk factors, prevention approaches, and the overall management of Decubitus for them to deliver ideal patient care.
References
Getie, A., Baylie, A., Bante, A., Geda, B., & Mesfin, F. (2020). Pressure ulcer prevention practices and associated factors among nurses in public hospitals of Harari regional state and Dire Dawa city administration, Eastern Ethiopia. PLOS ONE, 15(12), e0243875. https://doi.org/10.1371/journal.pone.0243875
Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Prevention and management. Journal of the American Academy of Dermatology, 81(4), 893–902. https://doi.org/10.1016/j.jaad.2018.12.068
Roussou, E., Fasoi, G., Stavropoulou, A., Kelesi, M., Vasilopoulos, G., Gerogianni, G., & Alikari, V. (2023). Quality of life of patients with pressure ulcers: a systematic review. Quality of Life of Patients with Pressure Ulcers: A Systematic Review, 96(2), 123–130. https://doi.org/10.15386/mpr-2531
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