Pressure ulcers are commonly encountered in patients admitted to hospital and those in long-term care facilities.
Older people, and all patients with limited mobility or impaired sensation, are at particular risk.
Pressure damage most commonly occurs over bony prominences but can develop on any part of the body subjected to sustained localised pressure.
Pressure damage varies from small superficial lesions to extensive wounds with bony involvement that contain a mass of necrotic tissue.
Prevention is better than cure; all patients at risk of sustaining pressure damage should be assessed and provided with appropriate pressure-reducing strategies. Using support surfaces, repositioning the patient, optimising nutritional status, and moisturising sacral skin are appropriate strategies to prevent pressure ulcers.
Management of pressure ulcers is determined by the location and condition or severity of the wound. Wounds should be managed in accordance with wound care practices or policies.
Pressure ulcers have been defined by the National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel as localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or of pressure in combination with shear.
Pressure ulcers most commonly occur over bony prominences but can develop on any part of the body, including mucosal surfaces. They may be small, superficial wounds or blisters involving only epidermal elements or larger (sometimes massive) wounds, often covered or filled with necrotic tissue and involving deeper tissues, including fascia, muscle, or bone.
History and exam
- presence of risk factors
- use of non-pressure-relieving support surface
- localised skin changes on areas subjected to pressure
- shallow open wound or tissue loss on areas subjected to pressure
- full-thickness wound on areas subjected to pressure with or without undermining (tunnelling)
- full-thickness wound with involvement of major tissues on areas subjected to pressure with or without undermining (tunnelling)
- localised tenderness and warmth around area of wound
- increased exudate and/or foul odour
Professor of Health Policy and Management
Boston University School of Public Health
Director of the Center for Health Quality, Outcomes, and Economic Research
DRB declares that he has no competing interests.
Dr Dan R. Berlowitz would like to gratefully acknowledge Dr Madhuri Reddy and Dr Stephen Thomas, the previous contributors to this monograph. MR is the author of a number of references cited in this monograph. ST declares that he has no competing interests.
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA
JD declares that she has no competing interests.
Sub Dean of Innovation & Engagement
Head of Section of Wound Healing
School of Medicine
KH has worked in the area of wound healing for many years and has helped establish and sustain a section of wound healing in a university medical school. The school is entirely self-funded and receives funding from a wide range of commercial concerns in addition to the NHS and grant-giving bodies. The funding is provided to the University rather than to KH personally, and this funding is used to provide sustainability for a wide range of individuals employed within this section.
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