Pressure injuries are common and costly in the U.S., affecting an estimated 2.5 million people per year. They lead to increased morbidity, extended hospital stays, and substantial financial burdens. According to the Agency for Healthcare Research and Quality, the treatment costs for pressure injuries are astronomical, with individual patient care ranging from $20,900 to $151,700 per injury. Collectively, these injuries contribute to an estimated $27 billion in annual healthcare costs. Beyond the financial implications, pressure injuries are associated with approximately 60,000 deaths each year. These statistics underscore the importance of effective prevention and management strategies to mitigate both the human and economic impacts of pressure injuries. Pressure injuries occur most often in acute care hospitals, nursing facilities, and home care settings.
The good news is that pressure injuries can be prevented. The first step is identifying individuals who are at risk. Some people are more likely to develop pressure injuries than others.
One of the biggest risk factors is decreased or impaired mobility. Any individual who sits or lies in one position for an extended period is at risk for developing a pressure injury.
Many conditions can result in decreased or impaired mobility, such as obesity, arthritis, and heart and lung diseases. Persons with altered mental status, such as those with Alzheimer’s disease and dementia, may also have decreased or impaired mobility.
As a member of the healthcare team, you play an important role in preventing pressure injuries. It is important that you know what pressure injuries are, where they are most likely to occur, characteristics that increase pressure injury risk, and interventions that can reduce this risk.
What’s a pressure injury?
A pressure injury is a skin and underlying soft tissue damage caused by prolonged, unrelieved pressure to a specific area. This pressure reduces blood flow, leading to tissue damage and cell death.
How does injury occur?
Pressure injuries result from two primary factors: Pressure and shearing.
Pressure
Pressure is created when there is skin-to-skin contact. For example, a person who is in a side-lying position will have skin-to-skin contact between the knees. Pressure also develops when a bony prominence, such as the hips, elbows, or heels, presses against a hard surface. This compresses the skin and underlying soft tissue between the two surfaces, potentially causing tissue damage. For example, a person lying on their back in bed may experience pressure on the bony prominences of the shoulder blades, lower back, elbows, back of the head, and heels.
Medical devices in contact with the skin can also cause pressure, leading to damage known as a medical device-related pressure injury. These injuries often mimic the shape or pattern of the device, reflecting its placement on the skin. Examples include pressure injuries on the wrist from a tightly secured splint, on the bridge of the nose from a CPAP mask, or on the tops of the ears from oxygen tubing.
Shear
Shear is another factor contributing to pressure injuries. It occurs when layers of skin and underlying tissue shift against each other due to opposing forces. For example, pulling someone toward the head of the bed without lifting their shoulders or buttocks away from the mattress results in friction and tissue injury.
In many cases, pressure injuries result from a combination of both pressure and shear.
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Pressure injury sites
Pressure points are more common in areas of the body where bony prominences are most likely to put pressure on the skin when pressed against another surface. While pressure injuries are not limited to certain areas, there are common places on the body where pressure injuries form. These areas include the:
- Elbows
- Heels
- Ankles
- Inner knees
- Hips
- Buttocks
- Coccyx, commonly called the tailbone
- Lower back
- Shoulders and shoulder blades
- Back of the head
- Ears
Five principles of prevention and treatment
The T-N_T acronym, representing Turning, Nutrition, and Toileting, has been used as a mnemonic to emphasize key elements in pressure injury prevention. However, contemporary guidelines advocate for a more comprehensive approach.
The 2019 International Guideline for the Prevention and Treatment of Pressure Ulcers/Injuries, developed collaboratively by the European Pressure Ulcer Advisory Panel (EPUAP), the National Pressure Injury Advisory Panel (NPIAP), and the Pan Pacific Pressure Injury Alliance (PPPIA), offers comprehensive, evidence-based recommendations for healthcare professionals worldwide. The groups are actively collaborating on the fourth edition of the International Guideline, which is planned for release in 2025.
Risk assessment
The use of validated assessment tools is key for identifying individuals at risk of developing pressure injuries. Early identification allows providers to implement preventive measures and tailor interventions to meet each patient’s specific needs.
Skin care
Routine skin inspections and consistent maintenance practices are important for preserving skin integrity. By identifying early signs of damage and addressing them promptly, caregivers and clinicians can prevent further skin breakdown and reduce the risk of complications.
Nutrition
Adequate nutritional support plays a key role in maintaining skin health and promoting tissue repair. A well-balanced diet, including the proper amount of protein and hydration, is essential for reducing the likelihood of pressure injuries and supporting recovery for those who already have them.
Repositioning
Systematic repositioning schedules help alleviate pressure on vulnerable areas, ensure proper blood flow, and minimize prolonged stress on the skin. The frequency and method of repositioning should align with individual care plans to address specific patient needs.
Support surfaces
Specialized support surfaces, such as pressure-redistributing mattresses and cushions, effectively reduce localized pressure. These tools enhance comfort and safety, especially for patients with limited mobility.
By integrating these principles into daily care routines, healthcare teams can lower the incidence of pressure injuries and improve overall patient outcomes.
Pressure injuries are painful and can lead to complications like infection and even death. As a member of the healthcare team, you play an important role in preventing such devastation. You spend the majority of your time with the people receiving care and know them best. It is your responsibility to know what pressure injuries are, how they develop, where they are most likely to occur, what characteristics increase risk, and what interventions can reduce that risk and prevent injury.
The Impact of Wound Care Education
Chronic wounds impact 10.5 million people in the U.S. Yet only over 30,000 clinicians have been certified through the National Alliance of Wound Care and Ostomy since 2002. Knowing how to prevent, assess, and treat wounds can benefit your organization.
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