Care of pressure areas

Pressure areas were always a source of concern on those wards where there were elderly or infirm patients who were bed-ridden. Invariably those patients returning from spells in the district general hospital returned with pressure areas, often open pressure sores, and it was a standard routine for many nurses in training to be regularly treating these.

There were a number of measures employed 50 years ago:

1. Frequent turning and massage to the affected areas. Main treatments included lashings of Zinc and Castor Oil cream applied vigorously and liberally. Massaging the area was reputed to increase blood flow. Ideally two nurses would work together to turn and support the patient, but often only one nurse was in attendance which would mean a certain amount of manipulation and tugging and pulling of sheets underneath the patient or the forcible dragging of the patient from one side of the bed to the other – to the detriment of the vulnerable areas on the buttocks, elbows etc. The frequency of turning was often left to the discretion of the least qualified person on duty. Massage depended primarily on time available and the disposition of the masseuse.

2. Severe open sores were packed with tape soaked in Hydrogen Peroxide. The effect of this was to bubble and fizz and turn the wound edges white. Personally, I never witnessed any real improvement in pressure sores using this method. It seemed to reduce any smell. Perhaps it was just another example of poor or limited nursing care or knowledge.

3. Cicatrin powder was used as a prophylactic or treatment and healing agent for surface wounds, minor burns, and stasis ulcers. It was not recommended for the treatment of superficial fungal infections. In the 1970s all geriatric wards were issued with small plastic puffer bottles of this medication to be use on open pressure sores, varicose ulcers etc. It was trumpeted as a revolution in wound care and we were encouraged to resort to it. As we went from patient to patient squirting this air-borne powder into wounds, it invariably diffused into the air and was inhaled by the care-giver. I can recall the smell in my nose, to who- knows -what effect. As with any antibiotic product, overgrowth by non susceptible organisms may occur. The possibility of allergies to neomycin should be borne in mind. We were never issued with gloves, masks or other protective measures. Ototoxicity and nephrotoxicity have been reported in association with large or prolonged doses of neomycin and nephrotoxicity has also been reported with inappropriate dosing with bacitracin. It was discontinued in the UK in 2007 largely as a result of the decline in use*. “Powdered/topical antibiotics may be associated with an increased risk of resistance and/or sensitivity”. I was inhaling this stuff on an almost daily basis for weeks at a time. In the end I was sick-of-trin powder.

4. Ripple beds/mattresses. Introduced as a relatively new innovation to the psychiatric ward, ripples mattresses were formed of a series of inflatable panels placed on top of the mattress under the bottom sheet. These electronically controlled panels were alternatively and in turn inflated and deflated in order to relieve pressure from one part of the resting body to another, thus allowing better blood flow to the effected areas. The problem was that not all wards had a ripple mattress. Cedar ward, the male medical, had two. On the other hand, Magnolia had to borrow from Hazel if it had a bed-bound patient with pressure areas. If there were more than one patient in bed requiring a ripple mattress then that person would have to wait until the other had recovered, or, more likely, died, before getting one. The ripple mattresses were controlled by a small cream plastic box at the foot of the bed. There were two lights on it to indicate when it was working correctly. Many times I passed a bed to notice that the light was on indicating that the mattress was not functioning properly. Nursing staff placed great faith in the suitability of these mattresses to do the job. So much so, that many neglected routine inspection or other areas of care, moving on to tasks with other patients that seemed more immediate.

*Cicatrin can still be purchased online 'for veterinary purposes'.