Pressure Ulcer

Description

• Breakdown in a localized area of skin or underlying tissue, primarily caused by prolonged pressure and/or shear
• Usually over a bony prominence where the skin is in proximity with the underlying bone (e.g., sacrum, calcaneus, ischium)
• Classified in stages according to the National Pressure Injury Advisory Panel (NPIAP):
  • Stage I: nonblanchable erythema—intact skin with nonblanchable redness; darkly pigmented skin may not have visible blanching.
  • Stage II: partial-thickness skin loss—shallow open ulcer with a viable red-pink, moist wound bed, without slough; or intact or open/ruptured serum-filled blister
  • Stage III: full-thickness skin loss—subcutaneous fat may be visible, but bone, tendon, or muscle is not exposed; slough, if present, does not obscure depth of tissue loss.
  • Stage IV: full-thickness tissue loss—exposed bone, tendon, or joint; slough or eschar may be present but does not completely obscure wound base.
  • Unstageable: depth unknown—base of the ulcer is covered by slough and/or eschar in the wound bed.
  • Suspected deep tissue injury: depth unknown—purple or maroon area of intact skin or blood-filled blister. Pain and temperature change precede skin color changes.
• Synonyms: bedsores, decubitus ulcers, pressure sores, pressure injuries, pressure wounds, pressure points, pressure damage, pressure-related skin injuries, skin breakdown, ischemic ulcers

Epidemiology

Incidence
Ranges widely depending on setting and population: 0–53.4% (1)

Prevalence
Ranges widely depending on setting and population: 0–72.5% (1)

Etiology and Pathophysiology

Complex process of risk factors interacting with external forces (pressure and/or shear, friction, and moisture)

Risk Factors

• Mobility impairment
• Malnutrition
• Reduced skin perfusion
• Sensory impairment
• Medical devices

General Prevention

• Structured risk assessment
• Skin and tissue assessment
• Preventive skin care
• Nutrition screening
• Repositioning
• Early mobilization
• Support surfaces
• Microclimate control
• Prophylactic dressings
• Electrical stimulation of the muscles

Commonly Associated Conditions

• Advanced age
• Immobility
• Trauma
• Hip fractures
• Diabetes
• Cerebrovascular and cardiovascular disease
• Incontinence