A pressure injury (pressure ulcer) is damage to the skin and underlying tissue that results from pressure being applied to an area of the body. It often affects people who must spend a long time in a bed or chair because of a medical condition.
Pressure injuries usually occur:
- Over bony parts of the body, such as the tailbone, shoulders, elbows, hips, heels, spine, ankles, and back of the head.
- Under medical devices that make contact with the body, such as respiratory equipment, stockings, tubes, and splints.
Pressure injuries start as reddened areas on the skin and can lead to pain and an open wound.
What are the causes?
This condition is caused by frequent or constant pressure to an area of the body. Decreased blood flow to the skin can eventually cause the skin tissue to die and break down, causing a wound.
What increases the risk?
You are more likely to develop this condition if you:
- Are in the hospital or an extended care facility.
- Are bedridden or in a wheelchair.
- Have an injury or disease that keeps you from:
- Moving normally.
- Feeling pain or pressure.
- Have a condition that:
- Makes you sleepy or less alert.
- Causes poor blood flow.
- Need to wear a medical device.
- Have poor control of your bladder or bowel functions (incontinence).
- Have poor nutrition (malnutrition).
If you are at risk for pressure injuries, your healthcare provider may recommend certain types of mattresses, mattress covers, pillows, cushions, or boots to help prevent them. These may include products filled with air, foam, gel, or sand.
What are the signs or symptoms?
Symptoms of this condition depend on the severity of the injury. Symptoms may include:
- Red or dark areas of the skin.
- Pain, warmth, or a change of skin texture.
- Blisters
- An open wound.
How is this diagnosed?
This condition is diagnosed with a medical history and physical exam. You may also have tests, such as:
- Blood tests.
- Imaging tests.
- Blood flow tests.
Your pressure injury will be staged based on its severity. Staging is based on:
- The depth of the tissue injury, including whether there is exposure of muscle, bone, or tendon.
- The cause of the pressure injury.
How is this treated?
This condition may be treated by:
- Relieving or redistributing pressure on your skin. This includes:
- Frequently changing your position.
- Avoiding positions that caused the wound or that can make the wound worse.
- Using specific bed mattresses, chair cushions, or protective boots.
- Moving medical devices from an area of pressure, or placing padding between the skin and the device.
- Using foams, creams, or powders to prevent rubbing (friction) on the skin.
- Keeping your skin clean and dry. This may include using a skin cleanser or skin barrier as told by your healthcare provider.
- Cleaning your injury and removing any dead tissue from the wound (debridement).
- Placing a bandage (dressing) over your injury.
- Using medicines for pain or to prevent or treat infection.
Surgery may be needed if other treatments are not working or if your injury is very deep.
Preventing Pressure Injury:
Pressure ulcer can be prevented when it is identified at the early stage when the person is at risk (bedridden, limited mobility). The objective is to return good blood circulation and repair to the area before the skin breaks. One method of preventing pressure injury is by massaging gently the affected area at least twice a day using a topical moisturiser containing hyperoxygenated fatty acids (HOFA) present in the formulation to facilitate the renewal of epidermal cells and restore blood circulation.
Follow these instructions at home:
Wound care
- Follow instructions from your healthcare provider about how to take care of your wound. Make sure you:
- Wash your hands with soap and water before and after you change your bandage (dressing). If soap and water are not available, use hand sanitiser.
- Change your dressing as told by your healthcare provider.
- Check your wound every day for signs of infection. Have a caregiver do this for you if you are not able. Check for:
- Redness, swelling, or increased pain.
- More fluid or blood.
- Warmth
- Pus or a bad smell.
Skin care
- Keep your skin clean and dry. Gently pat your skin dry.
- Do not rub or massage your skin.
- You or a caregiver should check your skin every day for any changes in colour or any new blisters or sores (ulcers).
Medicines
- Take over-the-counter and prescription medicines only as told by your healthcare provider.
- If you were prescribed an antibiotic medicine, take or apply it as told by your healthcare provider. Do not stop using the antibiotic even if your condition improves.
Reducing and redistributing pressure
- Do not lie or sit in one position for a long time. Move or change position every 1–2 hours, or as told by your healthcare provider.
- Use pillows or cushions to reduce pressure. Ask your healthcare provider to recommend cushions or pads for you.
General instructions
- Eat a healthy diet that includes lots of protein.
- Drink enough fluid to keep your urine pale yellow.
- Be as active as you can every day. Ask your healthcare provider to suggest safe exercises or activities.
- Do not abuse drugs or alcohol.
- Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your healthcare provider.
- Keep all follow-up visits as told by your healthcare provider. This is important.
Contact a healthcare provider if:
- You have:
- A fever or chills.
- Pain that is not helped by medicine.
- Any changes in skin colour.
- New blisters or sores.
- Pus or a bad smell coming from your wound.
- Redness, swelling, or pain around your wound.
- More fluid or blood coming from your wound.
- Your wound does not improve after 1–2 weeks of treatment.
Summary
- A pressure injury is damage to the skin and underlying tissue that results from pressure being applied to an area of the body.
- Do not lie or sit in one position for a long time. Your health are provider may advise you to move or change position every 1–2 hours.
- Follow instructions from your healthcare provider about how to take care of your wound.
- Keep all follow-up visits as told by your healthcare provider. This is important.
This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.
References:
Braga I.A., Pirett C.C., Ribas R.M., Gontijo Filho P.P., Diogo Filho A.: Bacterial colonization of pressure ulcers: assessment of risk for bloodstream infection and impact on patient outcomes. J Hosp Infect 2013; 83: pp. 314-320.
European Pressure Ulcer Advisory Panel , National Pressure Injury Advisory Panel , Pan Pacific Pressure Injury Alliance : Prevention and treatment of pressure ulcers/injuries: clinical practice guideline.Haesler E.European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel.2019.Pan Pacific Pressure Injury Alliance
Hahnel E., et. al.: The epidemiology of skin conditions in the aged: a systematic review. J Tissue Viability 2017; 26: pp. 20-28.
Kottner J., Clark M.: Historical perspective on pressure injury classification. Adv Skin Wound Care 2019; 32: pp. 249.
Kottner J., Sigaudo-Roussel D., Cuddigan J.: From bed sores to skin failure: linguistic and conceptual confusion in the field of skin and tissue integrity. Int J Nurs Stud 2019; 92: pp. 58-59.
For more information on pressure injury, visit:
Ministry of Health Malaysia- Pressure Sores
For dry skin and pressure injury prevention products, visit:
Caregiver Asia e-store: Linovera
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