Pressure Injuries

Condition Basics

What are pressure injuries?

A pressure injury to the skin is caused by constant pressure over a period of time. The constant pressure blocks the blood supply to the skin. This causes skin cells to die and creates a sore. Pressure injuries are also called bedsores.

Pressure injuries usually occur over bony areas, such as the hips, lower back, elbows, heels, and shoulders. Pressure injuries can also occur in places where the skin folds over on itself, or where medical equipment presses on the skin, such as when oxygen tubes press on the ears or cheeks.

Pressure injuries can range from red areas on the surface of the skin to severe tissue damage that goes deep into muscle and bone. Severe sores are hard to treat and slow to heal. When pressure injuries do not heal properly, problems such as bone, blood, and skin infections can develop.

What causes them?

Things that cause pressure injuries include:

• Pressure on the skin and tissues. This is the most common cause.
• Sliding down in a bed or chair, which can cause the skin to fold over itself (shear force).
• Being pulled across bed sheets or other surfaces, which can cause friction burns.
• Excess moisture, such as from sweat, urine, or feces. Skin that is often wet is more likely to break down and form pressure injuries.

How are they diagnosed?

A doctor can diagnose a pressure injury by examining it.

In some cases, a doctor may want to do tests such as:

• Blood tests to check for infection or to see if you are getting enough protein in your diet.
• A skin and wound culture, to identify germs that may be infecting the skin or wound.
• A skin biopsy, if the cause of a skin problem is unknown.

How are pressure injuries treated?

Treatment focuses on preventing a sore from getting worse and on making the skin healthy again. These steps can help a pressure injury heal:

• Take pressure off the area. Change positions often. Spread body weight evenly with special mattresses, pads, or other support.
• Keep the sore clean and covered with a bandage. The doctor will tell you what type of bandage to use. You will probably be told to keep the wound a little moist and not let it dry out between bandage changes.
• Keep the healthy tissue around a pressure injury clean and dry.
• Eat a healthy diet with enough protein to help the skin heal.

To promote healing, your doctor may remove dead tissue from the wound. Bacteria can grow in dead tissue and cause infection. If you get an infection, you may need antibiotics.

Severe pressure injuries may be treated with surgery. For example, a skin graft may be done to help new skin grow at the site of a sore.

How do you help prevent them?

Relieving and spreading out pressure is the most important part of both preventing and treating pressure injuries. Putting pressure on one spot for long periods of time limits blood flow to that area. This damages or kills the cells and creates a sore. Pressure can be relieved and spread in several ways. Often a combination of these is best.

• Change position often.
  • In a bed, change position every 2 hours. Learn how to move yourself so that you avoid folding and twisting your skin.
  • In a wheelchair or other type of chair, shift your weight every 15 minutes.
  • Try not to slide or slump across sheets in a chair or bed. Recliner chairs are likely to allow slipping, so don't sleep in a recliner. Try to keep the head of a bed, a recliner chair, or a reclining wheelchair raised no more than 30 degrees.
• Take good care of your skin.
  • Bathe as often as needed to be clean and comfortable. Use gentle soap, and use warm (not hot) water. Be careful not to scrub the skin too hard.
  • If you have problems with bowel or bladder control, clean your skin right away if it gets soiled or wet. Use a protective barrier cream, lotion, or ointment to protect your skin from wetness. Use pads or briefs that absorb moisture and pull it away from your skin.
  • If you have dry skin, use moisturizing cream or lotion to keep your skin from drying out and cracking.
  • Check your skin every day for signs of pressure injuries. Pay special attention to bony areas such as the hips, elbows, knees, and heels. Also watch for pressure from sources such as:
    • Body parts or skin folds, especially if you're overweight. For example, the knees or ankles may rub together and cause sores.
    • Chair arms, parts of wheelchairs, braces, or other places where you rest your elbows or other body parts.
    • Medical equipment such as oxygen masks or oxygen tubing.
• Make healthy choices.
  • Eat healthy foods with enough protein, and get plenty of fluids. That can help damaged skin heal and help new skin grow.
  • Stay at a healthy weight. Both weight gain and weight loss can make pressure injuries more likely. Weight changes can also cause problems with support equipment that no longer fits.
  • Don't smoke. Smoking dries the skin and reduces blood supply to the skin.
• Talk to your doctor about pressure-relieving cushions and pads.
  • Use special support surfaces. There are mattresses, bed covers, and chair cushions designed to help reduce and spread pressure.
  • Ask your doctor which cushions and pads might help you. Some products, such as doughnut-type devices, may actually cause pressure injuries or make them worse.

If you or someone you care for is not able to move much, it's important to prevent sores and to check the skin every day. If you think that a pressure injury is forming, take steps to treat it. Talk to your doctor or nurse about what more you can do.

What puts you at risk?

Things that make a person more likely to get pressure injuries include:

• Not being able to move easily. This often happens because of a spinal injury, paralysis, coma, or surgery.
• Poor bladder or bowel control.
• Poor nutrition. A diet that doesn't have enough protein can lead to unhealthy skin and slow healing.
• Decreased alertness, which may be due to a health problem or taking certain medicines. People who are not alert may not take the steps to prevent pressure injuries or understand why prevention is important.
• Aging. As people age, their skin becomes thinner, drier, and less elastic, so it is more easily injured.
• Smoking. Smoking dries out the skin and reduces blood flow to the skin.
• Having a health problem that interferes with healing, such as diabetes.