Pressure Injury Prevention
Purpose of this brochure
Pressure injuries are serious. Anyone who is confined to
bed, chair or wheelchair because of illness or injury can get
a pressure injury. Fortunately, most pressure injuries can be
prevented or if present, they do not have to get worse. This
brochure explains where pressure injuries form and how to tell
if you are at risk of getting a pressure injury, and what steps
you can take to minimise the risk of getting a pressure injury.
What are pressure injuries?
A pressure injury is caused by unrelieved pressure that damages
the skin and underlying tissue and can range in severity from mild
(minor skin reddening) to severe (deep craters down to muscle
Unrelieved pressure on the skin squeezes tiny blood vessels,
which supply the skin with nutrients and oxygen. When skin
is starved of nutrients and oxygen for too long, the tissue dies
and a pressure injury forms. Skin reddening that disappears
after pressure is removed is normal and not a pressure injury.
Other factors cause pressure injuries too. If a person slides
down in the bed or chair, blood vessels can stretch or bend
and cause pressure injuries. Even slight rubbing or friction on
the skin may cause minor pressure injuries.
Where pressure injuries form
Pressure injuries form where bone lies close to the skin and
tissue and squeezes them against an outside surface. In persons
who must stay in bed (or do not move around) most pressure
injuries form on the lower back below the waist, the hip bone, and
on the heels. In people in chairs or wheelchairs, the exact spot
where pressure injuries form depends on the sitting position.
Pressure injuries can also form on the knees, ankles, shoulder
blades, back of the head, ears and spine.
Nerves normally tell the body when to move to relieve
pressure on the skin. People unable to move (or where nerves
are disrupted through surgery, medication etc) may get
pressure injuries after as little as 1-2 hours. Persons who sit in
chairs and who cannot move can get pressure injuries in even
less time because the force on the skin is greater.
Confinement to bed or a chair, being unable to move, loss
of bowel or bladder control, poor nutrition, and lowered
mental awareness are all factors that can contribute to the
development of a pressure injury. Your risk results from the
number and seriousness of the risk factors that apply to you.
Fortunately, you can lower your risk. Following the steps in
this brochure can help you and your nurse reduce your risk of
developing pressure injuries.
The following steps for prevention are based on research,
professional judgement and practice. These steps can also keep
existing pressure injuries from getting worse. Some steps apply to all
prevention efforts; others apply only in specific conditions. Your nurse
or doctor will be happy to discuss which steps are right for you.
Take care of your skin
Inspect your skin at least once a day (or have someone
inspect difficult to see areas for you) - Pay special attention to
reddened areas that remain after you have changed positions
and the pressure has been relieved.
Your skin should be cleansed as soon as it is soiled. A soft cloth
or sponge should be used to reduce injury to skin. When bathing or
showering, warm (not hot) water and a mild soap should be used. Use
barrier creams or oils to prevent and protect dry skin, and avoid cold
or dry air. Minimize skin exposure to urine, stool, perspiration or wound
drainage. Use/wear pads or briefs that have a quick drying surface, or
creams and ointments to protect the skin from moisture exposure.
Protect your skin
Avoid massage of your skin over bony parts of the body. This
can damage the tissues under the skin and make you more
likely to get pressure injuries.
Limit pressure by changing positions frequently - if you are in
bed, at least every 2 hours; if in a chair, at least every hour.
Pillows or wedges can be used to keep knees or ankles from
touching each other. Avoid lying on your hip bone when lying on
your side. If possible (subject to medical condition) do not raise
the head of your bed too much. This will reduce the “sliding down”
motion which can damage skin & underlying blood vessels.
Eat a well balanced diet. Protein and calories are very
important. Drink adequate fluids. A dietician may visit you to
discuss your dietary requirements.
Increase your Activity
You may be seen by a physiotherapist or occupational therapist
to enhance your activity levels and assist your mobility.
Be Active in your Care
This brochure tells how to reduce your risk of getting pressure
injuries. Not all steps apply to every person at risk. Your nurse
and doctor will tailor a program best for YOU.
Ask questions, understand what and why things
are being done and know what is best for you.