What is a pressure injury?
A pressure injury, also known as a bedsore, pressure ulcer, pressure sore or decubitus ulcer, is a skin injury that occurs when pressure is applied to the skin surface. It commonly develops over bony areas of the body, such as the hips, heels, tailbone, elbows, head and ankles. If left untreated, a pressure injury can progress to a deep wound or become infected, which can be life-threatening.
What are the stages of pressure injury?
There are four stages that describe the wound’s severity:
- Stage 1: The skin appears discoloured, with redness in lighter skin tones and blue/purple in darker. The affected area does not blanch or turn white when pressed.
- Stage 2: Superficial damage to the skin, resembling a blister or an open sore. The top layer of the skin can repair itself during this stage.
- Stage 3: A deeper wound that extends into the fatty layer of the skin. Muscles and bones are not visible at this stage.
- Stage 4: A severe wound that reaches deep into the tissues, potentially exposing bones and muscles.
What increases the risk of a pressure injury?
- Limited mobility or a total inability to move. Those in wheelchairs or bedridden need to be moved or turned regularly.
- Prosthetic or artificial limbs. If the device does not fit properly, the skin can be irritated.
- Loss of sensation. As a result of not feeling the pressure to the skin, the person may not move, worsening the damage.
- Healing wounds. Wound healing slows when nutritional needs are not met.
- The elderly. As they age, their skin naturally becomes thinner and more vulnerable to damage.
What are the causes of a pressure injury?
When a force is applied to the skin, damaging the tissue:
- Pressure: Constant pressure on the skin from remaining in the same position for a prolonged period.
- Shear damage: A dragging force can occur when the head of the bed is raised and the body slides down. The skin sticks to the sheets, but internal structures are damaged.
- Moisture: Fluids such as sweat, urine and faecal matter can cause the skin to become overly wet.
What are the symptoms of a pressure injury?
- Skin colour changes.
- Skin swelling, pain or tenderness.
- Cooler or warmer skin when compared to other body areas.
- Skin loss, exposing deeper layers of skin.
- Pus-like drainage from an open skin area.
How are pressure injuries treated?
Once the stage and severity of the wound is determined, it must be cleaned, usually with a saline solution. Keep the wound clean, moist and covered with an appropriate bandage including:
- Water-based gel (hydrogel) with a dry dressing.
- Foam dressing.
- Hydrocolloid dressing.
- Alginate dressing (made from seaweed).
Debridement is an important part of the healing process, changing the wound from long-lasting (chronic) to short-term (acute). Methods include:
- Ultrasound: Sound waves to remove the dead tissue.
- Irrigation: Fluid, often pressurised, to wash away dead tissue.
- Laser: Focused light beams to remove the dead tissue.
- Biosurgery: Maggots to eliminate bacteria from the wound.
- Surgery: Surgery to remove the dead tissue and close the wound.
- Topical: Medical-grade honey or enzyme ointments.
How can a pressure injury be prevented?
- Keep the skin clean and clear of bodily fluids.
- Move and reposition the body frequently to avoid constant pressure on bony parts of the body.
- Use foam wedges and pillows to relieve pressure on bony parts of the body when turned in bed.
- Maintain a healthy diet to avoid malnutrition and to assist in wound healing.
What are the long-term consequences of a pressure injury?
If the wound becomes infected, the infection can spread to other parts of the body and you may develop:
- Cellulitis: Skin infection.
- Osteomyelitis: Bone infection.
- Bacteraemia: Blood infection.
- Meningitis: Brain and spinal cord infection.
- Endocarditis: Heart infection.
When should I call the doctor?
If a pressure injury is suspected, consult a doctor for early diagnosis and treatment to prevent complications and infections.
What can my Care Manager do for pressure injury prevention？
Care Managers, Carers, Support Workers and the Clinical Monitoring Nurses can work together to prevent a pressure injury by:
- Educating or providing support to re-position and encourage mobilisation regularly. Aim for a minimum of one to two hourly position changes.
- Getting an Occupational Therapy assessment for pressure relieving options such as mattresses and cushions.
- Encouraging your GP to assess your pain relief medications and refer you to clinics when necessary.
- Discussing and/or coordinating the use of acupuncture, massage and hydrotherapy for pain management.
- Reducing moisture from incontinence and supporting good hygiene. Shower regularly and change soiled incontinence aids and clothing maintain. It may be necessary to provide adequate nutrition and hydration support, such as prompting a person to eat or drink, providing meals as they may need preparation assistance or helping them eat.
- Managing incontinence through appropriate pads that the person can regularly change.
Remember to regularly monitor your skin and Support Workers, GPs, nurses and podiatrists can help. Please also find additional resources on Allied Health Professionals.