What is the primary treatment for a stage 1 pressure ulcer?

Primary Treatment for Stage 1 Pressure Ulcers

The primary treatment for stage 1 pressure ulcers should focus on hydrocolloid or foam dressings to reduce wound size, along with pressure redistribution and proper repositioning. 1

Understanding Stage 1 Pressure Ulcers

Stage 1 pressure ulcers are characterized by:

• Non-blanchable erythema of intact skin 2
• Localized area of tissue damage occurring over bony prominences 2
• Early warning sign that requires immediate intervention to prevent deterioration 3

Treatment Algorithm

1. Pressure Redistribution

• Use alternative foam mattresses rather than standard hospital mattresses (provides 69% relative risk reduction in pressure ulcer incidence) 1, 4
• Consider specialized support surfaces based on patient needs and risk assessment 1
• Avoid advanced support surfaces like alternating-air and low-air-loss beds unless specifically indicated, as evidence for these is limited and they add unnecessary costs 1

2. Wound Dressings

• Apply hydrocolloid or foam dressings to reduce wound size and promote healing 1
• Low-quality evidence shows hydrocolloid dressings are superior to gauze dressings for reducing wound size 1
• Moderate-quality evidence indicates hydrocolloid dressings have similar complete wound healing outcomes compared to foam dressings 1
• These dressings work by:
  • Decreasing frictional forces transmitted to the skin 5
  • Absorbing and redistributing shear forces 5
  • Reducing humidity at the skin/dressing interface 5

3. Nutritional Support

• Provide protein or amino acid supplementation to reduce wound size 1
• Particularly beneficial for patients with nutritional deficiencies 1
• Note that vitamin C supplementation alone has not shown benefit compared to placebo 1

4. Repositioning Schedule

• Implement regular repositioning to relieve pressure on affected areas 6
• Consider a 4-hourly turning schedule when using a vesico-elastic polyurethane foam mattress (low-quality evidence suggests this may be superior to more frequent turning) 4
• For patients who cannot reposition themselves, provide assistance 6

5. Adjunctive Therapies

• Consider electrical stimulation as an adjunctive therapy to accelerate wound healing (moderate-quality evidence) 1
• Be cautious when using electrical stimulation in frail elderly patients, who may be more susceptible to adverse events 1

Monitoring and Follow-up

• Monitor stage 1 pressure ulcers closely as they can deteriorate to higher stages if not properly managed 3
• In acute care settings, approximately 22.1% of stage 1 pressure ulcers deteriorate to higher stages 3
• In long-term care settings, about 8.7% deteriorate to higher stages 3

Common Pitfalls and Caveats

• Do not underestimate stage 1 pressure ulcers - they are an important warning sign 3
• Avoid using sheepskins as they may bunch up in a patient's bed and can contribute to wound infection if not properly cleaned 4
• Be aware that the relationship between reduction in wound size and eventual complete healing has not been well-defined 1
• Remember that stage 1 pressure ulcers may be reversible within hours with proper intervention, but can also reappear if interventions are not maintained 3

Special Considerations

• Women in acute care settings may have higher persistence rates of stage 1 pressure ulcers compared to men 3
• Patients with sacral pressure ulcers have lower recurrence rates after treatment compared to those with ischial pressure ulcers 1