Preventing pressure injuries

What they are

Pressure injuries develop when sustained pressure cuts off blood supply to tissue over a bony prominence — the sacrum, the heels, the hips, the shoulder blades, the back of the head. Shear and moisture make it worse.

They can develop in hours in a susceptible person, and they can take months to heal.

Who is at risk

• Anyone who cannot reposition themselves independently.
• Anyone spending most of the day in a bed or a chair.
• People with reduced sensation — diabetes, spinal injury, neuropathy — who will not feel the warning discomfort.
• People who are malnourished or dehydrated.
• People with incontinence, because moisture damages skin and reduces its tolerance.
• People with existing or previous pressure injuries.

What actually prevents them

1. Reposition on a schedule. This is the intervention. A support surface extends the safe interval; it does not replace turning.
2. Offload the heels. Float them off the bed entirely with a pillow under the calves, or use heel offloading boots. The heel has almost no tissue over the bone.
3. Look at the skin every day. Every bony prominence. Redness that does not fade when pressed is a warning that must be acted on immediately.
4. Manage moisture. Change promptly after incontinence, clean gently, use a barrier cream.
5. Use the right support surface for the level of risk.
6. Nutrition and hydration. Skin does not repair without protein and fluid.

In a chair as well as a bed

Sitting concentrates pressure over a small area at the sitting bones, and a wheelchair user is often at higher risk than a bed-bound patient. A proper pressure-relief cushion is not an accessory, and weight shifts every fifteen to thirty minutes matter.

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