Disclaimer: If you think you have a medical emergency, call 911. The health tips and information we share on this blog are for educational purposes only and should not be considered medical advice. They are not a substitute for advice from your own doctor or healthcare provider.
Wounds are a break in the skin or mucous membranes, and they carry a higher cost than most people realize, with chronic wounds costing the U.S. an estimated $30 billion annually in Medicare claims and nearly 15% of beneficiaries, about 8.2 million people, having at least one wound or wound-related infection in a single year, along with a raised risk of complications like infection, cellulitis, osteomyelitis, and sepsis. That risk is even higher for individuals with intellectual and developmental disabilities (IDD), so this guide covers the basics every caregiver should know: why IDD raises wound risk, how wounds are classified, how to prevent and manage pressure ulcers and burns, dressing selection, and when it’s time to call a doctor.
Why Wound Risk Is Higher in the IDD Population
Several factors combine to raise wound risk for people with IDD:
- Mobility & Positioning: Difficulty changing positions leads to prolonged pressure on bony prominences, raising the risk for pressure ulcers.
- Communication Deficits: Difficulty or inability to verbalize discomfort, pain, or skin irritation delays early intervention.
- Behavioral & Self-Injurious Factors: Compulsive behaviors or self-soothing actions, like scratching or picking, can cause open lesions.
- Incontinence & Moisture: Urinary or fecal incontinence increases skin breakdown, maceration, and friction risk.
Classifying and Identifying Wounds
Wounds fall into a few broad categories:
- Intentional: Created for medical purposes and usually sterile, like surgical incisions, biopsy sites, or IV sites.
- Unintentional: Accidental wounds like cuts, burns, animal bites, or skin tears.
- Open wounds: The skin is broken, and tissue is exposed, raising infection risk. This includes lacerations, abrasions, punctures, and avulsions.
- Closed wounds: The skin stays intact, but damage occurs underneath, such as contusions, hematomas, or crush injuries.
Common wound types caregivers may encounter include lacerations, which are irregular tears from blunt or sharp trauma; abrasions, painful surface scrapes; punctures, small openings that can extend into deeper tissue; incisions, planned surgical cuts; and contusions, bruising from blunt force trauma that damages vessels beneath intact skin.
Pressure Ulcers: Causes, Stages, and Prevention
A pressure ulcer, also called a bedsore or skin breakdown, is an injury to the skin or underlying tissue over a bony prominence, caused by three forces:
- Pressure: The force applied when tissue is compressed between the body and a surface.
- Friction: The resistance created when two surfaces rub against each other.
- Shearing: What happens when tissue layers move in opposite directions, with skin staying in place while deeper tissue shifts underneath.
Hips, tailbones, spines, shoulders, elbows, heels, and ankles are especially vulnerable to these forces. Early warning often looks like persistent redness or discoloration that doesn’t fade once weight is shifted, and catching it at this stage can prevent progression to a deeper wound. Blood flow to these areas can begin dropping in as little as two hours under sustained load, which is why regular repositioning matters so much.
The good news: 95% of pressure ulcers are preventable. Steps that help include:
- Proper body positioning in bed and in chairs
- Routinely checking wheelchairs, cushions, and adaptive equipment for correct fit
- Using pressure-redistributing mattresses, cushions, or overlays
- Keeping skin clean and dry
- Checking medical devices like oxygen tubing, splints, feeding tubes, and CPAP masks for pressure points
Burns: A Home Safety Issue
People with IDD face elevated burn risk from reduced awareness of hazards, impaired ability to sense heat, limited ability to communicate pain, mobility limitations, impulsivity, and dependence on caregivers for bathing, cooking, and using heating devices. A review of burn injuries among people with disabilities found that 84% occurred in the home, most often from scalding by bath water, showers, or hot liquids, which makes caregiver education around the home environment critical.
For burn first aid:
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Dressings and Cleaning: Match the Product to the Wound
The right dressing depends on how much a wound is draining:
- Hydrogel hydrates dry or minimally draining wounds and helps soften necrotic tissue. Avoid on heavily draining wounds, since it can cause maceration.
- Alginate absorbs excess drainage from moderate to heavily exudating wounds like pressure ulcers or surgical wounds. Avoid on dry wounds, since it can adhere to the wound bed.
- Foam absorbs drainage and cushions moderate to heavily exudating wounds. Avoid on dry wounds for the same reason.
- Gauze works as a secondary dressing on a wide range of wound types but can stick to dry wounds without moisture support.
- Tulle protects superficial wounds, burns, and skin grafts while maintaining moisture, but needs a secondary absorbent dressing.
- Hydrocolloid maintains a moist environment on low to moderately exudating wounds like minor burns, but shouldn’t be used on infected or heavily draining wounds.
Cleaning removes debris and bacteria rather than sterilizing the wound. Saline works for most open wounds, while hydrogen peroxide is cytotoxic and should be avoided on them. Betadine and chlorhexidine suit intact skin or pre-surgical prep, but repeated use on open wounds can harm healing tissue, so save them for infected or surgical wounds under clinical supervision. Gentle irrigation is the best overall practice.
What Affects Healing, and When to Escalate
Healing can be slowed by increased age, poor nutrition (especially protein and vitamin C intake), decreased blood flow from diabetes, obesity, or vascular disease, infection, poor blood sugar control, dehydration, limited mobility, and certain medications like steroids or immunosuppressants.
Given all of this, good documentation should track location, stage and size, undermining, tunneling, exudate, wound bed color, necrotic tissue, granulation, and treatment effectiveness. For dirty or major wounds, the CDC recommends checking tetanus vaccination status every 10 years.
Escalate care to a doctor right away if you see:
- Increasing redness
- Purulent drainage or foul odor
- Fever
- A rapidly enlarging wound
- Exposed tendon or bone
- Uncontrolled bleeding
- Signs of sepsis, like rapid heart rate, rapid breathing, or confusion
- No improvement after 2 to 4 weeks of appropriate treatment
Building It Into the Care Plan
Wound care plans should be individualized based on the person’s health status, functional abilities, quality-of-life goals, caregiver support, and prognosis. Common risk factors to track include mobility, incontinence, nutritional status, sensation changes, diabetes and vascular disease, and medications that delay healing or increase photosensitivity. From there, care plans typically address impaired skin or tissue integrity, infection risk, pain, and nutrition.
Practical steps caregivers and facilities can take:
- Keep basic wound care supplies on hand
- Understand medical coverage for compression stockings and wound care supplies
- Look into home health options for community wound care
- Complete routine environmental assessments and confirm smoke detectors are installed
- Know local wound care clinics and community resources
- Build in routine skin assessments, sunscreen use, and podiatry care for diabetics
- Escalate quickly when something looks wrong
StationMD Is Here to Help
At StationMD, our board-certified clinicians specialize in caring for individuals with IDD. Through our telemedicine services, we provide accessible, compassionate care whenever you need it.
For more resources and training materials for healthcare professionals working with individuals with I/DD, visit www.StationMD.com