What Are Pressure Injuries?
Pressure injuries (also called pressure sores or bedsores) are wounds that form when too much pressure is put on the skin for too long. This happens most often over bony areas like the tailbone, heels, hips, elbows, and shoulders.
These injuries are common but can often be prevented with proper care. They can be painful and slow to heal, so preventing them is very important.
What Causes Pressure Injuries?
Pressure injuries happen when:
- A person stays in one position too long
- The skin rubs against sheets or clothing
- The skin gets too wet from sweat or incontinence
- A person can't move or feel pressure on their skin
- Poor nutrition makes the skin more fragile
People at higher risk include those who:
- Cannot move on their own
- Spend most of their time in bed or a wheelchair
- Have poor nutrition
- Have medical conditions that affect blood flow
- Cannot feel when pressure builds up
The Different Stages of Pressure Injuries
Stage 1: Skin looks red and doesn't turn white when pressed. The area may feel warm, cool, firm, or soft.
Stage 2: The top layer of skin is broken, creating a shallow sore that looks like a scrape or blister.
Stage 3: The sore goes deeper through all layers of skin. You can see fat tissue underneath.
Stage 4: The deepest and most serious stage. The sore goes all the way down to muscle, bone, or tendons.
How to Prevent and Treat Pressure Injuries
1. Change Positions Regularly
- In bed: Turn from side to side every 2 hours during the day and night
- In a wheelchair: Shift weight every 15-30 minutes if possible
- Use the "30-degree rule": When lying on your side, tilt only 30 degrees instead of lying completely on your side. Some patients may need to start with smaller angles (10-20 degrees) depending on their comfort level and gradually work up to 30 degrees
2. Check Skin Daily
- Look at all pressure points (heels, tailbone, hips, elbows, shoulders, back of head)
- Feel for areas that are warmer or cooler than surrounding skin
- Look for any redness, swelling, or changes in skin color
- Use a mirror or ask someone to help check hard-to-see areas
3. Keep Skin Healthy
- Keep clean: Wash gently with mild soap and warm water
- Keep dry: Pat skin dry, don't rub
- Moisturize: Use unscented lotion on dry skin, but not between toes
- Protect from wetness: Change wet clothing or bedding right away
- Don't massage red areas: This can cause more damage
4. Use Proper Support Surfaces
- Special mattresses: Foam, gel, or air mattresses that reduce pressure
- Lateral rotation mattresses: Automatic turning mattresses that help change positions safely
- Cushions: For wheelchairs and chairs
- Heel protectors: Pillows or special devices to keep heels off the bed
- Pillows: Place between knees and under arms for support
For patients who need extra help with positioning, specialized wound care and lateral rotation mattresses can automatically assist with safe turning and pressure relief.
5. Eat Well and Stay Hydrated
- Protein: Eat meat, fish, eggs, beans, or dairy to help skin heal
- Vitamins: Fruits and vegetables provide nutrients for healthy skin
- Water: Drink plenty of fluids unless your doctor says otherwise
- Ask about supplements: Your doctor may recommend extra protein or vitamins
Positioning Tips
In Bed:
- On your back: Place a pillow under your knees
- On your side: Use the 30-degree tilt with pillows behind your back and between your knees
- Head of bed: Keep raised no more than 30 degrees when possible
- Heels: Keep them "floating" with pillows under your calves
In a Wheelchair:
- Sit up straight with feet flat on footrests
- Use a pressure-relief cushion
- Shift weight every 15-30 minutes
- Check that clothing isn't bunched up under you
Daily Care Checklist
Every Day:
- [ ] Check all pressure points for redness or changes
- [ ] Change positions every 2 hours in bed
- [ ] Shift weight every 15-30 minutes in wheelchair
- [ ] Keep skin clean and dry
- [ ] Eat nutritious meals and drink fluids
- [ ] Use proper support surfaces
Call Your Doctor or Nurse If:
- You see any red areas that don't go away after changing position
- Any areas of skin feel warm, cool, firm, or soft compared to surrounding skin
- You notice any open sores or blisters
- Existing sores get bigger, deeper, or more painful
- You have signs of infection (fever, drainage, bad smell)
Questions and Answers
Q: How often should I change positions? A: Every 2 hours in bed and every 15-30 minutes in a wheelchair.
Q: Can I massage red areas to help them? A: No, never massage red or damaged skin. This can make it worse.
Q: What's the "Rule of 30"? A: Keep the head of the bed at 30 degrees or less, and when lying on your side, tilt only 30 degrees instead of lying completely on your side. Some patients may need to start with smaller angles (10-20 degrees) depending on their comfort level and gradually work up to 30 degrees
Q: Are pressure injuries preventable? A: Most pressure injuries can be prevented with proper care, positioning, and skin checks.
Remember: Prevention is much easier than treatment. Taking these steps every day can help keep your skin healthy and prevent pressure injuries from forming.
- European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019Â
- Lindgren, M., Unosson, M., Fredrikson, M., & Ek, A. C. (2004). Immobility--a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scandinavian journal of caring sciences, 18(1), 57–64. https://doi.org/10.1046/j.0283-9318.2003.00250.xÂ
- National Pressure Injury Advisory Panel. (2019, March 13). Pressure Injury Prevention--Repositioning Frequency. Npiap.com. https://npiap.com/store/viewproduct.aspx?id=14123202Â
- Skotte, J., & Fallentin, N. (2008). Low back injury risk during repositioning of patients in bed the influence of handling technique, patient weight and disability. Ergonomics, 51(7), 1042–1052. https://doi.org10.108000140130801915253 Â
- Budarick, A. R., Lad, U., & Fischer, S. L. (2020). Can the Use of Turn-Assist Surfaces Reduce the Physical Burden on Caregivers When Performing Patient Turning?. Human factors, 62(1), 77–92. https://doi.org/10.1177/0018720819845746 Â