Pressure sores need not happen. In 95 percent of cases, decubitus could be avoided if the right people did the right thing at the right time. We are those people.
Carenetic is more than a supplier of medical aids. We understand what it is really about. About people who need support. About relatives who feel overwhelmed. About professionals working under pressure. About care that does not follow a one-size-fits-all approach, but fits individually. We come to you. We look closely. We listen. We take time and stay by your side.
Decubitus prevention does not begin with a mattress – it begins with looking closely. We analyse your individual situation and the entire care environment from 360 degrees, advise you comprehensively, and ensure that the care provided is right for you.
From anti-decubitus aids and care beds to wound care: we remain by your side, adjust measures as needed, and respond quickly when something changes. Because genuine care means more than just delivering products.
Knowledge protects. In our Decubitus Guide you will find well-founded information that gives you confidence – whether you are a relative, patient, or nursing professional. We explain how decubitus develops, which warning signs you should take seriously, and which preventive measures truly help. Practical, understandable, and based on the latest scientific evidence.
As a team of qualified nursing professionals and scientific experts, we know: decubitus need not happen. Pressure sores are not inevitable. An enormous amount of suffering can be avoided when people receive the care they truly need. We make that happen – with professional expertise, determination, and compassion.
Because you want to help people. Because knowing that you have improved a life every day matters to you. With us you will find a team that thinks the same way, a specialist field that truly makes a difference – and a salary that recognises your commitment.
A decubitus, also known as a pressure sore or pressure ulcer, is a localised injury to the skin and/or underlying tissue. It usually develops at bony prominences when sustained pressure or pressure combined with shear forces is applied over time.
The most important cause is immobility. The longer a person sits or lies in the same position, the higher the risk. Normally, we unconsciously move constantly – even small movements protect the skin. Without these, a decubitus can develop.
A decubitus forms through sustained pressure on the tissue, which compresses blood vessels so that the skin and underlying tissue are no longer adequately supplied with oxygen and nutrients, causing damage.
A decubitus can develop within a very short time or over a longer period. How quickly this happens depends on several factors, such as:
Shear forces and friction also play an important role, e.g. when patients slip in bed or are moved incorrectly. The skin remains fixed to the mattress while deeper tissue shears against the bones, stretching, bending, or directly destroying blood vessels.
You can detect pressure sores early by regularly checking the skin across the whole body – ideally during daily personal care or while dressing.
Pay particular attention to:
Daily skin observation is essential. Areas most at risk are where bones lie close to the skin and pressure builds, for example:
If you notice redness, the finger test can help assess it more accurately.
Important: Do not apply to open wounds!
How to proceed:
Result:
In principle, anyone can develop a decubitus (pressure sore). However, certain groups of people are at significantly higher risk.
Particularly at risk are:
This also includes:
Important to know
The more of these risk factors that coincide, the greater the danger of pressure sores. Regular skin checks and preventive measures are therefore particularly important.
Which measures can help
To prevent and treat pressure sores, it is important to combine several measures:
In order to assess the extent of decubitus risk in a patient and to take the right preventive measures on that basis, it is important to see the patient and the care environment on site.
Never rely on blanket, simplistic statements based on a telephone assessment alone. Only after competent, individual consultation and a needs assessment on site can the right aids be selected. Every patient has an individual medical and care situation that requires different measures.
For example, it is important to determine to what extent a patient can still move independently and whether they can take and maintain a pressure-relieving lying position on their own. The need for external assistance must be established. The lying and sleeping situation is also very important and must be assessed on site.
Pay attention to the qualifications of the adviser from the medical aids provider. Only a qualified nursing professional can assess functional impairments arising from illness, the mobility and risk situation, and the care environment as part of a comprehensive analysis as the basis for selecting a product.
If you are uncertain about the quality of advice received, accept the aid only provisionally. An aid that is unsuitable for the patient can lead to side effects and consequential damage.
There is a wide range of useful aids to support decubitus prevention. They can be divided into:
Which aids are actually suitable for your relative must be determined through a professional, individual assessment of their mobility, clinical picture, decubitus risk, and care circumstances.
Manufacturers frequently claim in their advertising that their products are suitable for certain decubitus grades. These claims should, however, be viewed critically.
A universally valid, scientifically clear assignment of mattresses to specific decubitus grades is not possible based on current knowledge. The effectiveness of an aid always depends on the individual situation of the patient and cannot be established in general terms.
Factors such as body weight, mobility, skin condition, positioning situation, and accompanying conditions significantly influence how well a product works. The pressure-relieving properties of an aid can also vary greatly depending on application and patient.
Therefore: The selection of a mattress should not be based solely on a decubitus grade, but always on an individual on-site assessment.
IMPORTANT! Before submitting the cost estimate, a needs assessment by the aid provider must take place at the patient's location.
In cases of high decubitus risk or already identified skin damage, pressure-relieving aids – in particular an anti-decubitus mattress – must be put in place immediately. Due to the urgency, some health insurance funds provide their members with a pressure-reducing mattress within 24 hours of cost approval. If you have to wait several days for an anti-decubitus mattress after the prescription has been issued, or if you receive a refusal, firmly remind your health insurance fund of the medical prescription and their obligation to provide care.
It remains one of the most common misconceptions that a patient no longer needs to be repositioned when lying on an anti-decubitus mattress.
As a general rule: Yes, in cases of severely restricted mobility and the inability to change position independently, at-risk body areas must continue to be regularly relieved of pressure.
Anti-decubitus mattresses reduce pressure on the skin and contribute to pressure distribution. They can thereby significantly extend repositioning intervals and thus reduce the burden on carers. However, they cannot fully replace manual repositioning.
This means: Even with aids in place, additional measures are necessary. Relying solely on a few daily visits from a care service is generally not sufficient to ensure continuous pressure relief.
Which positioning measures are appropriate and possible in individual cases should always be agreed with the doctor and nursing staff, particularly where there are illness-related restrictions.
It is important that repositioning intervals are determined according to individual patient needs. There is no fixed schedule that applies to everyone. Intervals must be individually adapted to the patient's condition and the aids being used.
A guideline of approximately 2 hours is often cited – however, this stems from a myth. Modern anti-decubitus mattresses can allow for longer intervals. What is decisive is regular skin inspection, not the clock.
The practice of repositioning bedridden patients at fixed intervals is often attributed to Florence Nightingale. This derivation is now viewed with more nuance. The roughly two-hour interval that emerged was primarily the result of organisational processes and practical necessities – not a scientifically proven requirement.
There are situations where patients simultaneously have pressure points at the sacrum, both buttock halves, and the hips. Positioning must be individually adapted in such cases. The aim is to avoid permanently burdening any affected area.
Combinations of lateral positioning, micro-positioning, and free positioning are often appropriate. There is no standard solution – every case is different. Specialist mattresses such as automatic lateral positioning systems can provide excellent support for decubitus treatment in such situations.
If there is no improvement despite aids and wound care in place, the provision should be reviewed again.
The provider should carry out a new expert assessment of the situation on site. The individual needs, risks, and possible limitations of the patient must be reconsidered and the existing measures and aids adjusted accordingly.
In this case, ask the aid provider for a new on-site appointment – ideally together with the care service. This allows the care provision to be coordinated and reviewed holistically.
A lack of improvement can have various causes. A new, comprehensive assessment of the overall situation is therefore necessary.
Always insist that the supplier provides a written guarantee of a free exchange of the aid in the event of intolerance or the development of a decubitus.
Yes. The "Expert Standard for Decubitus Prophylaxis in Nursing Care" by the DNQP is an internationally recognised work on the subject, which in case of dispute is also cited in court as an initial expert opinion.
The skin of elderly people in need of care can no longer perform important protective functions optimally. Dry skin, cracking, and itching are common consequences. When friction and shear forces occur in this situation, skin damage is very frequent.
Particularly important are creams and lotions containing moisture-retaining amino acids, which protect the skin from drying out. Unsaturated fatty acids stimulate the metabolism and protect against inflammation. Where incontinence is present, protecting the intimate area is especially important.
When selecting body lotions, care should be taken to choose a "W/O" product (water in oil) rather than an "O/W" product (oil in water). For cleansing, re-fattening, surfactant-active substances with a neutral pH value of up to 5.5 are recommended. The skin should only be gently patted dry, not rubbed. Massaging of at-risk skin areas is strongly advised against.
Sheets on an anti-decubitus mattress are not only possible but expressly advisable. If patients lie directly on the PU cover of the mattress, this can lead to increased sweating. The skin remains moist, softens more quickly, and becomes more susceptible to damage.
It is important to use thin, breathable fitted sheets without creases, so that the pressure distribution of the mattress is maintained. Incontinence pads can also be used but should be breathable and as thin as possible. Too many layers or unsuitable, dense materials can significantly reduce the effectiveness of the mattress.
The key principle is: as much protection as necessary, but as little material as possible between the patient and the mattress.
Regular pressure relief is important, e.g. through pushing up or shifting body weight. Position changes in the wheelchair should take place as frequently as possible.
Anti-decubitus seat cushions are a central element of prevention. Which seat cushion is suitable depends, among other things, on: daily sitting duration, body weight, ability to change position independently, capacity to perceive sensory stimuli, and seating surface.
In addition, the skin should be checked regularly. Small, independent movements also play a decisive role.
The heels should be completely free of pressure so that they float freely. This can be achieved most safely and comfortably with a specialised heel-offloading shoe that provides complete relief through true free positioning.
Direct pressure on the heel should be consistently avoided. Ring cushions are unsuitable and can even increase pressure. Regular skin checks are also important.
Responsibility is distributed among several parties. Nursing staff are responsible for the professional implementation of measures. Physicians bear responsibility for medical decisions and prescriptions. Aid providers must make appropriate products available.
A decubitus does not in every case mean that an error has occurred – what is decisive is whether care was provided in accordance with guidelines. As a general principle, decubitus is considered preventable in 95% of all cases, except in palliative care situations where it is consciously accepted.
Promoting movement is the most important approach to preventing pressure sores. It improves circulation, supports the cardiovascular system, and helps maintain mobility.
Which movements are appropriate always depends on the individual situation and the patient's existing capabilities. Therefore, consult with the care service, physician, or physiotherapy to determine which movements are possible and where support is needed.
Even small, independent changes of position – in bed or while sitting – can significantly reduce the risk of pressure sores. Take care not to overburden yourself when providing support, and make use of appropriate aids.
More detailed information on promoting movement can be found in our guide.
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