Pressure ulcer

Pressure ulcers are a common problem in hospital inpatients and people who live in care facilities.

Older people, and all patients with limited mobility or impaired sensation, are at increased risk.

Pressure damage usually 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.

A pressure ulcer is defined as localised damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device.[1]Edsberg LE, Black JM, Goldberg M, et al. Revised National Pressure Ulcer Advisory Panel pressure injury staging system: Revised pressure injury staging system. J Wound Ostomy Continence Nurs. 2016 Nov/Dec;43(6):585-97. https://www.doi.org/10.1097/WON.0000000000000281 http://www.ncbi.nlm.nih.gov/pubmed/27749790?tool=bestpractice.com

It can present as intact skin or an open ulcer and occurs as a result of intense and/or prolonged pressure, or pressure in combination with shear.[1]Edsberg LE, Black JM, Goldberg M, et al. Revised National Pressure Ulcer Advisory Panel pressure injury staging system: Revised pressure injury staging system. J Wound Ostomy Continence Nurs. 2016 Nov/Dec;43(6):585-97. https://www.doi.org/10.1097/WON.0000000000000281 http://www.ncbi.nlm.nih.gov/pubmed/27749790?tool=bestpractice.com 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 extensive, deep wounds, covered or filled with necrotic tissue and involving fascia, muscle, and bone.

The term pressure injury is increasingly preferred to pressure ulcer in the US.[1]Edsberg LE, Black JM, Goldberg M, et al. Revised National Pressure Ulcer Advisory Panel pressure injury staging system: Revised pressure injury staging system. J Wound Ostomy Continence Nurs. 2016 Nov/Dec;43(6):585-97. https://www.doi.org/10.1097/WON.0000000000000281 http://www.ncbi.nlm.nih.gov/pubmed/27749790?tool=bestpractice.com