Organizational approaches to prevent bedsores

Abstract

Material and methods. The work is based on the prevention of bedsores in the surgical department of Zaporozhye PU «City Clinical Hospital № 2» and literature information.

Results and discussion. Fundamental factor for the successful prevention of bedsores is to prevent compression of the skin and subcutaneous fat, which is achieved by changing the position of the patients in bed every 2 hours. Alternative ways are special plastic splint, bedsore mattresses with continuously changing pressure in individual sections, beds, cushions, pads and mattresses filled with water, air, foam, gel.

When you are sick and always in bed doctors should not lift the head of the bed more than 45 degrees in order to reduce pressure on the sacrum. Also rubber rings are used which are placed under the sacrum, heel bumps and other bony prominences to avoid contact with the ground. In some cases, the position on the patient's abdomen is indicated. The changing over time pressure and vibration are provided by specific regulatory systems.

The thesis of early activation of patients should be considered as one of the fundamental. Patient should be allowed to sit in the bed, stand up on his feet and walk around, firstly around the ward, as early as possible, consistent with the main and co-morbidities, the volume of surgery, age. The use of small laparotomic surgical approaches follows the principle of the earlier mobilization of the patient as well as possible, since it allows, for example, after cholecystectomy, to climb out of bed and walk around the ward after only 8-10 hours after surgery. Performing a small trocar access at endovideolaparascopic operation surgeons activate patients in the same terms.

Doctors prescript daily massage of the possible locations of bedsores, as well as along the spine to improve the overall and local circulation of blood and regulation of the nervous tissue.

Treatment of skin in places of possible formation of bedsores has its own features. It is axiomatic thesis - dry skin should be wet, wet - dry a little. Alcohol-containing agents such as camphor spirit and lotions are used in patients with greasy skin. In connection with the results of recent research on the adverse effect of antiseptics on the skin due to their damaging effect on the cell membrane of ion-exchange agents (chlorhexidine, povidone-iodine, etc.), which manifests itself with a violation of the permeability of cell membranes and the suppression of the cell's ability to resist bacterial invasion, the use of ion-exchange products should be excluded from practice. Skin toilet should be carried out with saline solution or drugs, which do not possess ion-exchange properties. After the toilet skin is dried and treated with agents improving local circulation.

Make sure that the patient is dressed in clean and dry clothes, change it regularly.

Good nutrition with adequate protein and vitamins promotes improvement of the skin.

There is no doubt of great importance of physical therapy, and counseling instructor will help you to choose the most appropriate set of exercises.

Conclusions. The first step is to identify a group of persons with risk of bedsores developing. The subsequent application of a set of measures designed to prevent pressure sores will reduce the proportion of their formation.